Is Minor Depression Minor?

Someone is dogged by a bad mood that they just can’t shake for a month or two.

Is it a big deal?

Isn’t some suffering expected in this universe? If someone is distressed and impaired by low grade depressive symptoms, how seriously should we take their complaints? Scholars like Jerome Wakefield and Allan Horwitz are concerned that our diagnostic system has transformed normal sorrow into a psychiatric disorder. By taking minor depression seriously, are we paying homage to the worried well?

So far the fields of psychology and psychiatry have largely overlooked minor depression. The amount we know about it is dwarfed by what we know about major depression.

Here are four reasons why you should care about minor depression.

1. Minor depression is persistent. In 2001, Mark Hegel and his colleagues studied patients in New Hampshire who went to their primary care doctor. On the doctor’s visit, they filled out a depression screener – a standardized questionnaire about common symptoms of depression. Many patients reported on the screener that they just weren’t feeling up to snuff—complaints of a low mood, vague aches and pain, problems concentrating. Some of these patients had minor depression, which involves persistent problems with a sustained low mood without the full complement of major depression symptoms. In primary care settings, such patients are encountered more often than are patients with major depression. Historically, such less affected patients often receive a period of “watchful waiting.” Watchful waiting simply means that they would be watched carefully by their physician for a time, with the optimistic assumption that most would likely get better over a period of weeks, but if they got worse, a traditional treatment for depression, like antidepressants, could be initiated. Hegel wondered if this assumption was warranted. What would happen if a group of these patients were simply followed over one month of watchful waiting? Would most get better on their own?

Much to Hegel’s surprise, only about 1 in 10 of these patients with minor depression got better in a month’s time. Nearly everyone else remained stuck in their low mood.

Epidemiological studies take Hegel’s finding one step further. Judd and his colleagues in a representative sample of the US population found that when you reevaluate people who are bumping along with a minor depression a year later, nearly 3 in 4, or 72%, will be bothered by one or more symptoms of depression.

2. Minor depression is prevalent. The persistence of minor depression helps explain why low grade depression symptoms are so prevalent in the population. More than one fifth of the population, 22 percent, suffers from at least one bothersome symptom of depression. In fact, people who have shallow depression(forms of depression that fall short of the criteria for major depression) outnumber people with deep depression 7 to 1.

3. Minor depression causes major problems. There is growing evidence that the term minor depression is something of a misnomer; it is not minor in its consequences. Individuals with minor depression may use outpatient services and miss work almost as frequently as individuals with major depression. Overall, the economic impact of minor depression is comparable to that of major depression, in part because so many more people are affected by minor depression.

4. Minor depression often escalates to major depression. The final reason you should care about minor depression is that it oftentimes does not stay minor. Minor depression has been estimated to quintuple the future risk for developing a deep major depression. Indeed, if you wonder why we have a growing epidemic of major depression, look no further than the immense pool of people with shallow and persistent low-grade depression. Thus, figuring out how and when to intervene when a person can’t shake a low grade depression is not about cosseting the worried well, it’s about denying the next wave of recruits to the army of major depression.

By Jonathan Rottenberg, Ph.D.