Depression is not a consistent syndrome: An investigation of unique symptom patterns in the STAR∗D study

Eiko I. Fried, Randolph Nesse

Research output: Contribution to journalArticlepeer-review

228 Scopus citations

Abstract

Background: The DSM-5 encompasses a wide range of symptoms for Major Depressive Disorder (MDD). Symptoms are commonly added up to sum-scores, and thresholds differentiate between healthy and depressed individuals. The underlying assumption is that all patients diagnosed with MDD have a similar condition, and that sum-scores accurately reflect the severity of this condition. To test this assumption, we examined the number of DSM-5 depression symptom patterns in the "Sequenced Treatment Alternatives to Relieve Depression" (STAR∗D) study. Methods: We investigated the number of unique symptom profiles reported by 3703 depressed outpatients at the beginning of the first treatment stage of STAR∗D. Results: Overall, we identified 1030 unique symptom profiles. Of these profiles, 864 profiles (83.9%) were endorsed by five or fewer subjects, and 501 profiles (48.6%) were endorsed by only one individual. The most common symptom profile exhibited a frequency of only 1.8%. Controlling for overall depression severity did not reduce the amount of observed heterogeneity. Limitations: Symptoms were dichotomized to construct symptom profiles. Many subjects enrolled in STAR∗D reported medical conditions for which prescribed medications may have affected symptom presentation. Conclusions: The substantial symptom variation among individuals who all qualify for one diagnosis calls into question the status of MDD as a specific consistent syndrome and offers a potential explanation for the difficulty in documenting treatment efficacy. We suggest that the analysis of individual symptoms, their patterns, and their causal associations will provide insights that could not be discovered in studies relying on only sum-scores.

Original languageEnglish (US)
Pages (from-to)96-102
Number of pages7
JournalJournal of Affective Disorders
Volume172
DOIs
StatePublished - 2015

Keywords

  • D
  • DSM
  • Depression symptoms
  • Heterogeneity
  • Major depressive disorder
  • STAR

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

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