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Unipolar depression in adults: Clinical features

Author
Jeffrey M Lyness, MD
Section Editor
Peter P Roy-Byrne, MD
Deputy Editor
David Solomon, MD

INTRODUCTION

Depression occurs along a continuum of severity, and depressive syndromes such as unipolar major depression are heterogeneous [1]. The multiple presentations of major depression stem in part from the several subtypes that have been identified and the many comorbid disorders that frequently occur.

This topic reviews the clinical features of depression in adults. The assessment, diagnosis, epidemiology, neurobiology, treatment, and prognosis of depression in adults are discussed separately, as are the clinical features and diagnosis of depression in pediatric and older adult patients:

(See "Unipolar depression in adults: Assessment and diagnosis".)

(See "Unipolar depression in adults: Epidemiology, pathogenesis, and neurobiology".)

(See "Unipolar major depression in adults: Choosing initial treatment".)

                       

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Literature review current through: Nov 2016. | This topic last updated: Wed Dec 30 00:00:00 GMT+00:00 2015.
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References
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  1. Thase ME. The multifactorial presentation of depression in acute care. J Clin Psychiatry 2013; 74 Suppl 2:3.
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
  3. Judd LL, Schettler PJ, Coryell W, et al. Overt irritability/anger in unipolar major depressive episodes: past and current characteristics and implications for long-term course. JAMA Psychiatry 2013; 70:1171.
  4. Perlis RH, Fava M, Trivedi MH, et al. Irritability is associated with anxiety and greater severity, but not bipolar spectrum features, in major depressive disorder. Acta Psychiatr Scand 2009; 119:282.
  5. Fava M, Hwang I, Rush AJ, et al. The importance of irritability as a symptom of major depressive disorder: results from the National Comorbidity Survey Replication. Mol Psychiatry 2010; 15:856.
  6. Papakostas GI. Cognitive symptoms in patients with major depressive disorder and their implications for clinical practice. J Clin Psychiatry 2014; 75:8.
  7. Trivedi MH, Greer TL. Cognitive dysfunction in unipolar depression: implications for treatment. J Affect Disord 2014; 152-154:19.
  8. Rock PL, Roiser JP, Riedel WJ, Blackwell AD. Cognitive impairment in depression: a systematic review and meta-analysis. Psychol Med 2014; 44:2029.
  9. Bora E, Harrison BJ, Yücel M, Pantelis C. Cognitive impairment in euthymic major depressive disorder: a meta-analysis. Psychol Med 2013; 43:2017.
  10. Rakofsky JJ, Schettler PJ, Kinkead BL, et al. The prevalence and severity of depressive symptoms along the spectrum of unipolar depressive disorders: a post hoc analysis. J Clin Psychiatry 2013; 74:1084.
  11. Klonsky ED, May AM, Glenn CR. The relationship between nonsuicidal self-injury and attempted suicide: converging evidence from four samples. J Abnorm Psychol 2013; 122:231.
  12. Wide J, Mok H, McKenna M, Ogrodniczuk JS. Effect of gender socialization on the presentation of depression among men: A pilot study. Can Fam Physician 2011; 57:e74.
  13. Rutz W. Improvement of care for people suffering from depression: the need for comprehensive education. Int Clin Psychopharmacol 1999; 14 Suppl 3:S27.
  14. Möller-Leimkühler AM. Barriers to help-seeking by men: a review of sociocultural and clinical literature with particular reference to depression. J Affect Disord 2002; 71:1.
  15. Dekker J, Koelen JA, Peen J, et al. Gender differences in clinical features of depressed outpatients: preliminary evidence for subtyping of depression? Women Health 2007; 46:19.
  16. Martin LA, Neighbors HW, Griffith DM. The experience of symptoms of depression in men vs women: analysis of the National Comorbidity Survey Replication. JAMA Psychiatry 2013; 70:1100.
  17. Marcus SM, Kerber KB, Rush AJ, et al. Sex differences in depression symptoms in treatment-seeking adults: confirmatory analyses from the Sequenced Treatment Alternatives to Relieve Depression study. Compr Psychiatry 2008; 49:238.
  18. Fried EI, Nesse RM. Depression is not a consistent syndrome: An investigation of unique symptom patterns in the STAR*D study. J Affect Disord 2015; 172:96.
  19. Ayuso-Mateos JL, Nuevo R, Verdes E, et al. From depressive symptoms to depressive disorders: the relevance of thresholds. Br J Psychiatry 2010; 196:365.
  20. Kessler RC, Zhao S, Blazer DG, Swartz M. Prevalence, correlates, and course of minor depression and major depression in the National Comorbidity Survey. J Affect Disord 1997; 45:19.
  21. Lewinsohn PM, Klein DN, Durbin EC, et al. Family study of subthreshold depressive symptoms: risk factor for MDD? J Affect Disord 2003; 77:149.
  22. Harald B, Gordon P. Meta-review of depressive subtyping models. J Affect Disord 2012; 139:126.
  23. Arnow BA, Blasey C, Williams LM, et al. Depression Subtypes in Predicting Antidepressant Response: A Report From the iSPOT-D Trial. Am J Psychiatry 2015; 172:743.
  24. Ionescu DF, Niciu MJ, Henter ID, Zarate CA. Defining anxious depression: a review of the literature. CNS Spectr 2013; 18:252.
  25. Fava M, Rush AJ, Alpert JE, et al. Difference in treatment outcome in outpatients with anxious versus nonanxious depression: a STAR*D report. Am J Psychiatry 2008; 165:342.
  26. Köhler S, Unger T, Hoffmann S, et al. Acute and long-term treatment outcome in depressed inpatients with vs. without anxious features: results of a one-year follow-up study. J Affect Disord 2013; 150:1055.
  27. Tuohy A, McVey C. Subscales measuring symptoms of non-specific depression, anhedonia, and anxiety in the Edinburgh Postnatal Depression Scale. Br J Clin Psychol 2008; 47:153.
  28. Uher R, Dernovsek MZ, Mors O, et al. Melancholic, atypical and anxious depression subtypes and outcome of treatment with escitalopram and nortriptyline. J Affect Disord 2011; 132:112.
  29. Ionescu DF, Niciu MJ, Mathews DC, et al. Neurobiology of anxious depression: a review. Depress Anxiety 2013; 30:374.
  30. Schosser A, Butler AW, Uher R, et al. Genome-wide association study of co-occurring anxiety in major depression. World J Biol Psychiatry 2013; 14:611.
  31. Papakostas GI, Clain A, Ameral VE, et al. Fluoxetine-clonazepam cotherapy for anxious depression: an exploratory, post-hoc analysis of a randomized, double blind study. Int Clin Psychopharmacol 2010; 25:17.
  32. Dew MA, Whyte EM, Lenze EJ, et al. Recovery from major depression in older adults receiving augmentation of antidepressant pharmacotherapy. Am J Psychiatry 2007; 164:892.
  33. Kim JM, Kim SW, Stewart R, et al. Predictors of 12-week remission in a nationwide cohort of people with depressive disorders: the CRESCEND study. Hum Psychopharmacol 2011; 26:41.
  34. Londborg PD, Smith WT, Glaudin V, Painter JR. Short-term cotherapy with clonazepam and fluoxetine: anxiety, sleep disturbance and core symptoms of depression. J Affect Disord 2000; 61:73.
  35. Blanco C, Vesga-López O, Stewart JW, et al. Epidemiology of major depression with atypical features: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). J Clin Psychiatry 2012; 73:224.
  36. Stewart JW, McGrath PJ, Fava M, et al. Do atypical features affect outcome in depressed outpatients treated with citalopram? Int J Neuropsychopharmacol 2010; 13:15.
  37. Gili M, Roca M, Armengol S, et al. Clinical patterns and treatment outcome in patients with melancholic, atypical and non-melancholic depressions. PLoS One 2012; 7:e48200.
  38. Withers AC, Tarasoff JM, Stewart JW. Is depression with atypical features associated with trauma history? J Clin Psychiatry 2013; 74:500.
  39. Lasserre AM, Glaus J, Vandeleur CL, et al. Depression with atypical features and increase in obesity, body mass index, waist circumference, and fat mass: a prospective, population-based study. JAMA Psychiatry 2014; 71:880.
  40. Parker G, Fink M, Shorter E, et al. Issues for DSM-5: whither melancholia? The case for its classification as a distinct mood disorder. Am J Psychiatry 2010; 167:745.
  41. Bobo WV, Chen H, Trivedi MH, et al. Randomized comparison of selective serotonin reuptake inhibitor (escitalopram) monotherapy and antidepressant combination pharmacotherapy for major depressive disorder with melancholic features: a CO-MED report. J Affect Disord 2011; 133:467.
  42. McGrath PJ, Khan AY, Trivedi MH, et al. Response to a selective serotonin reuptake inhibitor (citalopram) in major depressive disorder with melancholic features: a STAR*D report. J Clin Psychiatry 2008; 69:1847.
  43. Yang SJ, Stewart R, Kang HJ, et al. Response to antidepressants in major depressive disorder with melancholic features: the CRESCEND study. J Affect Disord 2013; 144:42.
  44. Zimmermann P, Brückl T, Nocon A, et al. Heterogeneity of DSM-IV major depressive disorder as a consequence of subthreshold bipolarity. Arch Gen Psychiatry 2009; 66:1341.
  45. Koukopoulos A, Sani G. DSM-5 criteria for depression with mixed features: a farewell to mixed depression. Acta Psychiatr Scand 2014; 129:4.
  46. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, American Psychiatric Association, Washington DC 2000.
  47. Angst J, Cui L, Swendsen J, et al. Major depressive disorder with subthreshold bipolarity in the National Comorbidity Survey Replication. Am J Psychiatry 2010; 167:1194.
  48. Vieta E, Valentí M. Mixed states in DSM-5: implications for clinical care, education, and research. J Affect Disord 2013; 148:28.
  49. McIntyre RS, Soczynska JK, Cha DS, et al. The prevalence and illness characteristics of DSM-5-defined "mixed feature specifier" in adults with major depressive disorder and bipolar disorder: Results from the International Mood Disorders Collaborative Project. J Affect Disord 2015; 172:259.
  50. Zimmerman M, McGlinchey JB, Chelminski I, Young D. Diagnostic co-morbidity in 2300 psychiatric out-patients presenting for treatment evaluated with a semi-structured diagnostic interview. Psychol Med 2008; 38:199.
  51. Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62:617.
  52. Lamers F, van Oppen P, Comijs HC, et al. Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA). J Clin Psychiatry 2011; 72:341.
  53. Kessler RC, Birnbaum HG, Shahly V, et al. Age differences in the prevalence and co-morbidity of DSM-IV major depressive episodes: results from the WHO World Mental Health Survey Initiative. Depress Anxiety 2010; 27:351.
  54. Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 2003; 289:3095.
  55. Swindle RW Jr, Cronkite RC, Moos RH. Risk factors for sustained nonremission of depressive symptoms: a 4-year follow-up. J Nerv Ment Dis 1998; 186:462.
  56. Michels R. Personality disorders in the depressed: seeing clearly through blue lenses. Am J Psychiatry 2010; 167:487.
  57. Friborg O, Martinsen EW, Martinussen M, et al. Comorbidity of personality disorders in mood disorders: a meta-analytic review of 122 studies from 1988 to 2010. J Affect Disord 2014; 152-154:1.
  58. Morey LC, Shea MT, Markowitz JC, et al. State effects of major depression on the assessment of personality and personality disorder. Am J Psychiatry 2010; 167:528.
  59. Smith DJ, Court H, McLean G, et al. Depression and multimorbidity: a cross-sectional study of 1,751,841 patients in primary care. J Clin Psychiatry 2014; 75:1202.
  60. Luppino FS, de Wit LM, Bouvy PF, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry 2010; 67:220.
  61. Kravitz RL, Ford DE. Introduction: chronic medical conditions and depression--the view from primary care. Am J Med 2008; 121:S1.
  62. Campayo A, de Jonge P, Roy JF, et al. Depressive disorder and incident diabetes mellitus: the effect of characteristics of depression. Am J Psychiatry 2010; 167:580.
  63. Vancampfort D, Correll CU, Wampers M, et al. Metabolic syndrome and metabolic abnormalities in patients with major depressive disorder: a meta-analysis of prevalences and moderating variables. Psychol Med 2014; 44:2017.
  64. Robinson RG. Poststroke depression: prevalence, diagnosis, treatment, and disease progression. Biol Psychiatry 2003; 54:376.
  65. McDonald WM, Richard IH, DeLong MR. Prevalence, etiology, and treatment of depression in Parkinson's disease. Biol Psychiatry 2003; 54:363.
  66. Jorge RE, Robinson RG, Moser D, et al. Major depression following traumatic brain injury. Arch Gen Psychiatry 2004; 61:42.
  67. Shen CC, Tsai SJ, Perng CL, et al. Risk of Parkinson disease after depression: a nationwide population-based study. Neurology 2013; 81:1538.
  68. Huffman JC, Smith FA, Blais MA, et al. Recognition and treatment of depression and anxiety in patients with acute myocardial infarction. Am J Cardiol 2006; 98:319.
  69. Whooley MA. Depression and cardiovascular disease: healing the broken-hearted. JAMA 2006; 295:2874.
  70. Reiche EM, Nunes SO, Morimoto HK. Stress, depression, the immune system, and cancer. Lancet Oncol 2004; 5:617.
  71. Hanly JG, Fisk JD, McCurdy G, et al. Neuropsychiatric syndromes in patients with systemic lupus erythematosus and rheumatoid arthritis. J Rheumatol 2005; 32:1459.
  72. Katon W, Fan MY, Unützer J, et al. Depression and diabetes: a potentially lethal combination. J Gen Intern Med 2008; 23:1571.
  73. Kronish IM, Rieckmann N, Halm EA, et al. Persistent depression affects adherence to secondary prevention behaviors after acute coronary syndromes. J Gen Intern Med 2006; 21:1178.
  74. Musselman DL, Evans DL, Nemeroff CB. The relationship of depression to cardiovascular disease: epidemiology, biology, and treatment. Arch Gen Psychiatry 1998; 55:580.
  75. Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380:2197.
  76. Donohue JM, Pincus HA. Reducing the societal burden of depression: a review of economic costs, quality of care and effects of treatment. Pharmacoeconomics 2007; 25:7.
  77. Sobocki P, Jönsson B, Angst J, Rehnberg C. Cost of depression in Europe. J Ment Health Policy Econ 2006; 9:87.
  78. Whiteford HA, Degenhardt L, Rehm J, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet 2013; 382:1575.
  79. Ferrari AJ, Charlson FJ, Norman RE, et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med 2013; 10:e1001547.
  80. Murray CJ, Atkinson C, Bhalla K, et al. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA 2013; 310:591.
  81. Fergusson DM, McLeod GF, Horwood LJ, et al. Life satisfaction and mental health problems (18 to 35 years). Psychol Med 2015; 45:2427.
  82. Fazel S, Wolf A, Chang Z, et al. Depression and violence: a Swedish population study. Lancet Psychiatry 2015; 2:224.