Are antidepressants useful in the treatment of minor depression

Abstract

In minor depression, the number, severity or duration of symptoms are insufficient to diagnose a major depression or dysthymia. Nevertheless, minor depression is a prevalent disorder associated with functional disability, impairment of quality of life, and intense healthcare use. The aim of this article is to discuss the evidence for the effectiveness of antidepressants in patients with minor depression taking into account a recent meta-analysis and further clinical trials as well as methodological problems associated with the common approach to deducing the clinical significance of therapeutic effects of antidepressants from placebo-verum differences in randomized clinical trials (RCTs). A recent meta-analysis, comprising six RCTs, and two newer studies do not provide evidence for the efficacy of antidepressants in patients with minor depression, but do not have the power and the methodological quality to exclude efficacy. Possible risks of underestimating the clinical significance of antidepressants based on RCT data are discussed. For minor depression, unspecific support like active monitoring, unspecific group counselling or internet-based guided self-help activities are reasonable treatment options. Antidepressants can be considered in special cases with, for example, suicidality, previous suicide attempts, family history of affective disorders or previous major depressive episodes.