Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Medicine
Published in: BMC Medicine 1/2015

Open Access 01-12-2015 | Review

Depression sum-scores don’t add up: why analyzing specific depression symptoms is essential

Authors: Eiko I Fried, Randolph M Nesse

Published in: BMC Medicine | Issue 1/2015

Login to get access

Abstract

Most measures of depression severity are based on the number of reported symptoms, and threshold scores are often used to classify individuals as healthy or depressed. This method – and research results based on it – are valid if depression is a single condition, and all symptoms are equally good severity indicators. Here, we review a host of studies documenting that specific depressive symptoms like sad mood, insomnia, concentration problems, and suicidal ideation are distinct phenomena that differ from each other in important dimensions such as underlying biology, impact on impairment, and risk factors. Furthermore, specific life events predict increases in particular depression symptoms, and there is evidence for direct causal links among symptoms. We suggest that the pervasive use of sum-scores to estimate depression severity has obfuscated crucial insights and contributed to the lack of progress in key research areas such as identifying biomarkers and more efficacious antidepressants. The analysis of individual symptoms and their causal associations offers a way forward. We offer specific suggestions with practical implications for future research.
Literature
1.
2.
Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289:3095–105.PubMed
3.
Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. Global burden of disease and risk factors. Washington, DC: World Bank; 2006.
4.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: APA; 2013.
5.
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;172:96–102.PubMed
6.
Zimmerman M, Ellison W, Young D, Chelminski I, Dalrymple K. How many different ways do patients meet the diagnostic criteria for major depressive disorder? Compr Psych. 2015;56:29–34.
7.
Olbert CM, Gala GJ, Tupler LA. Quantifying heterogeneity attributable to polythetic diagnostic criteria: theoretical framework and empirical application. J Abnorm Psychol. 2014;123:452–62.PubMed
8.
Beck A, Steer RA, Garbin MG. Psychometric properties of the Beck Depression Inventory: 25 years of evaluation. Clin Psychol Rev. 1988;8:77–100.
9.
10.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington, DC: APA; 1980.
11.
American Psychiatric Association. The diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: APA; 1994.
12.
Kapur S, Phillips AG, Insel TR. Why has it taken so long for biological psychiatry to develop clinical tests and what to do about it? Mol Psychiatry. 2012;17:1174–9.PubMed
13.
Hek K, Demirkan A, Lahti J, Terracciano A. A genome-wide association study of depressive symptoms. Biol Psychiatry. 2013;73:667–78.PubMed
14.
Lewis CM, Ng MY, Butler AW, Cohen-Woods S, Uher R, Pirlo K, et al. Genome-wide association study of major recurrent depression in the UK population. Am J Psychiatry. 2010;167:949–57.PubMed
15.
Wray NR, Pergadia ML, Blackwood DHR, Penninx BWJH, Gordon SD, Nyholt DR, et al. Genome-wide association study of major depressive disorder: new results, meta-analysis, and lessons learned. Mol Psychiatry. 2012;17:36–48.PubMed
16.
Shi J, Potash JB, Knowles JA, Weissman MM, Coryell W, Scheftner WA, et al. Genome-wide association study of recurrent early-onset major depressive disorder. Mol Psychiatry. 2011;16:193–201.PubMed
17.
Daly J, Ripke S, Lewis CM, Lin D, Wray NR, Neale B, et al. A mega-analysis of genome-wide association studies for major depressive disorder. Mol Psychiatry. 2013;18:497–511.PubMed
18.
Tansey KE, Guipponi M, Perroud N, Bondolfi G, Domenici E, Evans D, et al. Genetic predictors of response to serotonergic and noradrenergic antidepressants in major depressive disorder: a genome-wide analysis of individual-level data and a meta-analysis. PLoS Med. 2012;9:e1001326.PubMedPubMedCentral
19.
Jang KL, Livesley WJ, Taylor S, Stein MB, Moon EC. Heritability of individual depressive symptoms. J Affect Disord. 2004;80:125–33.PubMed
20.
Myung W, Song J, Lim S-W, Won H-H, Kim S, Lee Y, et al. Genetic association study of individual symptoms in depression. Psychiatry Res. 2012;198:400–6.PubMed
21.
Kendler KS, Aggen SH, Neale MC. Evidence for multiple genetic factors underlying DSM-IV criteria for major depression. Am J Psychiatry. 2013;70:599–607.
22.
Guintivano J, Brown T. Identification and replication of a combined epigenetic and genetic biomarker predicting suicide and suicidal behaviors. Am J Psychiatry. 2014;171:1287–96.PubMed
23.
Valkanova V, Ebmeier KP, Allan CL. CRP, IL-6 and depression: a systematic review and meta-analysis of longitudinal studies. J Affect Disord. 2013;150:736–44.PubMed
24.
Wium-Andersen MK, Orsted DD, Nielsen SF, Nordestgaard BG. Elevated C-reactive protein levels, psychological distress, and depression in 73,131 individuals. JAMA Psychiatry. 2013;70:176–84.PubMed
25.
26.
Young JJ, Bruno D, Pomara N. A review of the relationship between proinflammatory cytokines and major depressive disorder. J Affect Disord. 2014;169C:15–20.
27.
Lamers F, Vogelzangs N, Merikangas KR, de Jonge P, Beekman ATF, Penninx BWJH. Evidence for a differential role of HPA-axis function, inflammation and metabolic syndrome in melancholic versus atypical depression. Mol Psychiatry. 2013;18:692–9.PubMed
28.
Duivis HE, Vogelzangs N, Kupper N, de Jonge P, Penninx BWJH. Differential association of somatic and cognitive symptoms of depression and anxiety with inflammation: findings from the Netherlands Study of Depression and Anxiety (NESDA). Psychoneuroendocrinology. 2013;38:1573–85.PubMed
29.
Motivala SJ, Sarfatti A, Olmos L, Irwin MR. Inflammatory markers and sleep disturbance in major depression. Psychosom Med. 2005;67:187–94.PubMed
30.
Zuk O, Hechter E, Sunyaev SR, Lander ES. The mystery of missing heritability: genetic interactions create phantom heritability. Proc Natl Acad Sci U S A. 2012;109:1193–8.PubMedPubMedCentral
31.
Stefanis N. Genes do not read DSM-IV: implications for psychosis classification. Ann Gen Psychiatry. 2008;7:S68.
32.
Pigott HE, Leventhal AM, Alter GS, Boren JJ. Efficacy and effectiveness of antidepressants: current status of research. Psychother Psychosom. 2010;79:267–79.PubMed
33.
Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson BT. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med. 2008;5:e45.PubMedPubMedCentral
34.
Khan A, Khan S, Brown WA. Are placebo controls necessary to test new antidepressants and anxiolytics? Int J Neuropsychopharmacol. 2002;5:193–7.PubMed
35.
36.
Trindade E, Menon D, Topfer L, Coloma C. Adverse effects associated with selective serotonin reuptake inhibitors and tricyclic antidepressants: a meta-analysis. Can Med Assoc J. 1998;159:1245–52.
37.
Bet PM, Hugtenburg JG, Penninx BWJH, Hoogendijk WJG. Side effects of antidepressants during long-term use in a naturalistic setting. Eur Neuropsychopharmacol. 2013;23:1443–51.PubMed
38.
Baldwin DS. Essential considerations when choosing a modern antidepressant. Int J Psychiatry Clin Pract. 2003;7:3–8.PubMed
39.
40.
Serretti A, Chiesa A. Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis. J Clin Psychopharmacol. 2009;29:259–66.PubMed
41.
Blumenthal SR, Castro VM, Clements CC, Rosenfield HR, Murphy SN, Fava M, et al. An electronic health records study of long-term weight gain following antidepressant use. JAMA Psychiatry. 2014;71:889–96.PubMed
42.
Snaith P. What do depression rating scales measure? Br J Psychiatry. 1993;163:293–8.PubMed
43.
Dew MA, Reynolds CF, Houck PR, Hall M, Buysse DJ, Frank E, et al. Temporal profiles of the course of depression during treatment. Predictors of pathways toward recovery in the elderly. Arch Gen Psychiatry. 1997;54:1016–24.PubMed
44.
Pigeon WR, Hegel M, Unützer J, Fan M-Y, Sateia MJ, Lyness JM, et al. Is insomnia a perpetuating factor for late-life depression in the IMPACT cohort? Sleep. 2008;31:481–8.PubMedPubMedCentral
45.
Thase MME, Rush AJ, Manber R, Kornstein SG, Klein DN, Markowitz JC, et al. Differential effects of nefazodone and cognitive behavioral analysis system of psychotherapy on insomnia associated with chronic forms of major depression. J Clin Psychiatry. 2002;63:493–500.PubMed
46.
Fava M, Rush AJ, Alpert JE, Balasubramani GK, Wisniewski SR, Carmin CN, et al. Difference in treatment outcome in outpatients with anxious versus nonanxious depression: a STAR*D report. Am J Psychiatry. 2008;165:342–51.PubMed
47.
Shippee ND, Rosen BH, Angstman KB, Fuentes ME, DeJesus RS, Bruce SM, et al. Baseline screening tools as indicators for symptom outcomes and health services utilization in a collaborative care model for depression in primary care: a practice-based observational study. Gen Hosp Psychiatry. 2014;36:563–9.PubMed
48.
Wu Z, Chen J, Yuan C, Hong W, Peng D, Zhang C, et al. Difference in remission in a Chinese population with anxious versus nonanxious treatment-resistant depression: a report of OPERATION study. J Affect Disord. 2013;150:834–9.PubMed
49.
Uher R, Perlis RH, Henigsberg N, Zobel A, Rietschel M, Mors O, et al. Depression symptom dimensions as predictors of antidepressant treatment outcome: replicable evidence for interest-activity symptoms. Psychol Med. 2012;42:967–80.PubMed
50.
Colman I, Naicker K, Zeng Y, Ataullahjan A, Senthilselvan A, Patten SB. Predictors of long-term prognosis of depression. Can Med Assoc J. 2011;183:1955–6.
51.
Piccinelli M. Gender differences in depression: critical review. Br J Psychiatry. 2000;177:486–92.PubMed
52.
Kendler KS, Myers J, Prescott CA. Sex differences in the relationship between social support and risk for major depression: a longitudinal study of opposite-sex twin pairs. Am J Psychiatry. 2005;162:250–6.PubMed
53.
Kendler KS, Kuhn J, Prescott CA. The interrelationship of neuroticism, sex, and stressful life events in the prediction of episodes of major depression. Am J Psychiatry. 2004;161:631–6.PubMed
54.
Lux V, Kendler KS. Deconstructing major depression: a validation study of the DSM-IV symptomatic criteria. Psychol Med. 2010;40:1679–90.PubMedPubMedCentral
55.
Fried EI, Nesse RM, Zivin K, Guille C, Sen S. Depression is more than the sum score of its parts: individual DSM symptoms have different risk factors. Psychol Med. 2014;44:2067–76.PubMed
56.
Hammen C. Stress and depression. Annu Rev Clin Psychol. 2005;1:293–319.PubMed
57.
Keller MC, Nesse RM. Is low mood an adaptation? Evidence for subtypes with symptoms that match precipitants. J Affect Disord. 2005;86:27–35.PubMed
58.
Keller MC, Nesse RM. The evolutionary significance of depressive symptoms: different adverse situations lead to different depressive symptom patterns. J Pers Soc Psychol. 2006;91:316–30.PubMed
59.
Keller MC, Neale MC, Kendler KS. Association of different adverse life events with distinct patterns of depressive symptoms. Am J Psychiatry. 2007;164:1521–9.PubMed
60.
Cramer AOJ, Borsboom D, Aggen SH, Kendler KS. The pathoplasticity of dysphoric episodes: differential impact of stressful life events on the pattern of depressive symptom inter-correlations. Psychol Med. 2013;42:957–65.
61.
Fried EI, Nesse RM, Guille C, Sen S. The differential influence of life stress on individual symptoms of depression. Acta Psychiatr Scand. 2015. Ahead of print.
62.
Hirschfeld RM, Dunner DL, Keitner G, Klein DN, Koran LM, Kornstein SG, et al. Does psychosocial functioning improve independent of depressive symptoms? A comparison of nefazodone, psychotherapy, and their combination. Biol Psychiatry. 2002;51:123–33.PubMed
63.
64.
Murray CJL, Lopez A. Global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge, MA: Harvard School of Public Health; 1996.
65.
Fried EI, Nesse RM. The impact of individual depressive symptoms on impairment of psychosocial functioning. PLoS One. 2014;9:e90311.PubMedPubMedCentral
66.
Tweed DL. Depression-related impairment: estimating concurrent and lingering effects. Psychol Med. 1993;23:373–86.PubMed
67.
Fairclough SH, Graham R. Impairment of driving performance caused by sleep deprivation or alcohol: a comparative study. Hum Factors. 1999;41:118–28.PubMed
68.
Durmer J, Dinges D. Neurocognitive consequences of sleep deprivation. Semin Neurol. 2005;25:117–29.PubMed
69.
Ferentinos P, Kontaxakis V, Havaki-Kontaxaki B, Paparrigopoulos T, Dikeos D, Ktonas P, et al. Sleep disturbances in relation to fatigue in major depression. J Psychosom Res. 2009;66:37–42.PubMed
70.
De Wild-Hartmann JA, Wichers MC, van Bemmel AL, Derom C, Thiery E, Jacobs N, et al. Day-to-day associations between subjective sleep and affect in regard to future depression in a female population-based sample. Br J Psychiatry. 2013;202:407–12.PubMed
71.
Fawcett J, Scheftner WA, Fogg L, Clark DC, Young MA, Hedeker D, et al. Time-related predictors of suicide in major affective disorder. Am J Psychiatry. 1990;147:1189–94.PubMed
72.
Pilcher JJ, Huffcutt AI. Effects of sleep deprivation on performance: a meta-analysis. Sleep. 1996;19:318–26.PubMed
73.
Malik S, Kanwar A, Sim LA, Prokop LJ, Wang Z, Benkhadra K, et al. The association between sleep disturbances and suicidal behaviors in patients with psychiatric diagnoses: a systematic review and meta-analysis. Syst Rev. 2014;3:18.PubMedPubMedCentral
74.
Abramson LY, Metalsky GI, Alloy LB. Hopelessness depression: a theory-based subtype of depression. Psychol Rev. 1989;96:358–72.
75.
Beck A, Rush AJ, Shaw FS, Emery G. Cognitive therapy of depression. New York: Guilford Press; 1979.
76.
McGlinchey JB, Zimmerman M, Young D, Chelminski I. Diagnosing major depressive disorder VIII: are some symptoms better than others? J Nerv Ment Dis. 2006;194:785–90.PubMed
77.
Kuo W-H, Gallo JJ, Eaton WW. Hopelessness, depression, substance disorder, and suicidality – a 13-year community-based study. Soc Psychiatry Psychiatr Epidemiol. 2004;39:497–501.PubMed
78.
Brown GK, Beck A, Steer RA, Grisham JR. Risk factors for suicide in psychiatric outpatients: a 20-year prospective study. J Consult Clin Psychol. 2000;68:371–7.PubMed
79.
Klonsky ED, Kotov R, Bakst S, Rabinowitz J, Bromet EJ. Hopelessness as a predictor of attempted suicide among first admission patients with psychosis: a 10-year cohort study. Suicide Life Threat Behav. 2012;42:1–10.PubMedCentral
80.
Beck A, Brown G, Berchick R. Relationship between hopelessness and ultimate suicide: a replication with psychiatric outpatients. Am J Psychiatry. 1990;147:190–5.PubMed
81.
Smith JM, Alloy LB, Abramson LY. Cognitive vulnerability to depression, rumination, hopelessness, and suicidal ideation: multiple pathways to self-injurious thinking. Suicide Life Threat Behav. 2006;36:443–54.PubMed
82.
Abela JRZ, Brozina K, Haigh EP. An examination of the response styles theory of depression in third- and seventh-grade children: a short-term longitudinal study. J Abnorm Child Psychol. 2002;30:515–27.PubMed
83.
Nolen-Hoeksema S, Stice E, Wade E, Bohon C. Reciprocal relations between rumination and bulimic, substance abuse, and depressive symptoms in female adolescents. J Abnorm Psychol. 2007;116:198–207.PubMed
84.
Frewen PA, Allen SL, Lanius RA, Neufeld RWJ. Perceived causal relations: novel methodology for assessing client attributions about causal associations between variables including symptoms and functional impairment. Assessment. 2012;19:480–93.PubMed
85.
Frewen PA, Schmittmann VD, Bringmann LF, Borsboom D. Perceived causal relations between anxiety, posttraumatic stress and depression: extension to moderation, mediation, and network analysis. Eur J Psychotraumatol. 2013;4:20656.
86.
Wichers MC. The dynamic nature of depression: a new micro-level perspective of mental disorder that meets current challenges. Psychol Med. 2013;616:1–12.
87.
Bringmann LF, Vissers N, Wichers MC, Geschwind N, Kuppens P, Peeters F, et al. A network approach to psychopathology: new insights into clinical longitudinal data. PLoS One. 2013;8:e60188.PubMedPubMedCentral
88.
Rosmalen JGM, Wenting AMG, Roest AM, de Jonge P, Bos EH. Revealing causal heterogeneity using time series analysis of ambulatory assessments: application to the association between depression and physical activity after myocardial infarction. Psychosom Med. 2012;74:377–86.PubMed
89.
90.
Molenaar P. A manifesto on psychology as idiographic science: bringing the person back into scientific psychology, this time forever. Measurement. 2004;2014:37–41.
91.
Hamaker EL. Why researchers should think “within-person”: a paradigmatic rationale. In: Mehl M, Conner T, editors. Handbook of methods for studying daily life. New York, NY: Guilford Publications; 2012. p. 43–61.
92.
Peterson MJ, Benca RM. Sleep in mood disorders. Sleep Med Clin. 2008;3:231–49.
93.
Ma SH, Teasdale JD. Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. J Consult Clin Psychol. 2004;72:31–40.PubMed
94.
Kim NS, Ahn W. Clinical psychologists’ theory-based representations of mental disorders predict their diagnostic reasoning and memory. J Exp Psychol Gen. 2002;131:451–76.PubMed
95.
Van Loo HM, de Jonge P, Romeijn J-W, Kessler RC, Schoevers RA. Data-driven subtypes of major depressive disorder: a systematic review. BMC Med. 2012;10:156.PubMedPubMedCentral
96.
Baumeister H, Hutter N, Bengel J, Härter M. Quality of life in medically ill persons with comorbid mental disorders: a systematic review and meta-analysis. Psychother Psychosom. 2011;80:275–86.PubMed
97.
Lichtenberg P, Belmaker RH. Subtyping major depressive disorder. Psychother Psychosom. 2010;79:131–5.PubMed
98.
Bech P. Struggle for subtypes in primary and secondary depression and their mode-specific treatment or healing. Psychother Psychosom. 2010;79:331–8.PubMed
99.
Melartin T, Leskelä U, Rytsälä H, Sokero P, Lestelä-Mielonen P, Isometsä E. Co-morbidity and stability of melancholic features in DSM-IV major depressive disorder. Psychol Med. 2004;34:1443.PubMed
100.
Pae CU, Tharwani H, Marks DM, Masand PS, Patkar AA. Atypical depression: a comprehensive review. CNS Drugs. 2009;23:1023–37.PubMed
101.
Davidson JRT. A history of the concept of atypical depression. J Clin Psychiatry. 2007;68:10–5.PubMed
102.
Young MA, Keller MB, Lavori PW, Scheftner WA, Fawcett JA, Endicott J, et al. Lack of stability of the RDC endogenous subtype in consecutive episodes of major depression. J Affect Disord. 1987;12:139–43.PubMed
103.
Shafer AB. Meta-analysis of the factor structures of four depression questionnaires: Beck, CES-D, Hamilton, and Zung. J Clin Psychol. 2006;62:123–46.PubMed
104.
Gullion CM, Rush AJ. Toward a generalizable model of symptoms in major depressive disorder. Biol Psychiatry. 1998;44:959–72.PubMed
105.
Bagby RM, Ryder AG, Schuller DR, Marshall MB. Reviews and overviews – the Hamilton Depression Rating Scale: has the gold standard become a lead weight? Am J Psyc. 2004;161:2163–77.
106.
Cramer AOJ, Waldorp LJ, van der Maas HLJ, Borsboom D. Comorbidity: a network perspective. Behav Brain Sci. 2010;33:137–50. Discussion 150–93.PubMed
107.
Uher R, Farmer A, Maier W, Rietschel M, Hauser J, Marusic A, et al. Measuring depression: comparison and integration of three scales in the GENDEP study. Psychol Med. 2008;38:289–300.PubMed
108.
Faravelli C. Assessment of psychopathology. Psychother Psychosom. 2004;73:139–41.PubMed
109.
Schmittmann VD, Cramer AOJ, Waldorp LJ, Epskamp S, Kievit RA, Borsboom D. Deconstructing the construct: a network perspective on psychological phenomena. New Ideas Psychol. 2013;31:43–53.
110.
Borsboom D, Cramer AOJ. Network analysis: an integrative approach to the structure of psychopathology. Annu Rev Clin Psychol. 2013;9:91–121.PubMed
111.
Braeken J. Modeling residual dependencies in latent variable models with copulas. KU Leuven: Leuven; 2008.
112.
Lilienfeld SO. DSM-5: centripetal scientific and centrifugal. Clin Psychol Sci Pract. 2014;21:269–79.
113.
114.
Costello C. The advantages of the symptom approach to depression. In: Costello C, editor. Symptoms of depression. New York: John Wiley and Sons; 1993. p. 1–21.
115.
Hasler G, Drevets WC, Manji HK, Charney DS. Discovering endophenotypes for major depression. Neuropsychopharmacology. 2004;29:1765–81.PubMed
116.
Persons JB. The advantages of studying psychological phenomena rather than psychiatric diagnoses. Am Psychol. 1986;41:1252–60.PubMed
117.
Musselman D, Lawson D, Gumnick J, Manatunga A, Penna S, Goodkin R, et al. Paroxetine for the prevention of depression induced by high-dose interferon alfa. New Eng J Med. 2001;344:961–6.PubMed
118.
Cassidy WL, Planagan NB, Spellman M, Cohen ME. Clinical observations in manic-depressive disease; a quantitative study of one hundred manic-depressive patients and fifty medically sick controls. J Am Med Assoc. 1957;164:1535–46.PubMed
119.
Feighner JP, Robins E, Guze SB, Woodruff RA, Winokur G, Munoz R. Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatry. 1972;26:57–63.PubMed
120.
Andrews G, Slade T, Sunderland M, Anderson T. Issues for DSM-V: simplifying DSM-IV to enhance utility: the case of major depressive disorder. Am J Psychiatry. 2007;164:1784–5.PubMed
121.
Judd LL, Schettler PJ, Coryell W, Akiskal HS, Fiedorowicz JG. Overt irritability/anger in unipolar major depressive episodes: past and current characteristics and implications for long-term course. JAMA Psychiatry. 2013;70:1171–80.PubMed
122.
Gollan JK, Fava M, Kurian B, Wisniewski SR, Rush AJ, Daly E, et al. What are the clinical implications of new onset or worsening anxiety during the first two weeks of SSRI treatment for depression? Depress Anxiety. 2012;29:94–101.PubMed
123.
Van Loo HM, Cai T, Gruber MJ, Li J, de Jonge P, Petukhova M, et al. Major depressive disorder subtypes to predict long-term course. Depress Anxiety. 2014;13:1–13.
124.
Pedrelli P, Blais MA, Alpert JE, Shelton RC, Walker RSW, Fava M. Reliability and validity of the Symptoms of Depression Questionnaire (SDQ). CNS Spectr. 2014;19:535–46.PubMedPubMedCentral
125.
Sjöström N, Waern M, Hetta J. Nightmares and sleep disturbances in relation to suicidality in suicide attempters. Sleep. 2007;30:91–5.PubMed
126.
Brickenkamp R, Zillmer E. The d2 Test of Attention. Seattle: Hogrefe & Huber Publishers; 1998.
127.
Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:617–27.PubMedPubMedCentral
128.
Zimmerman M, Chelminski I, McGlinchey JB, Young D. Diagnosing major depressive disorder X: can the utility of the DSM-IV symptom criteria be improved? J Nerv Ment Dis. 2006;194:893–7.PubMed
129.
Watson D, O’Hara MW, Simms LJ, Kotov R, Chmielewski M, McDade-Montez EA, et al. Development and validation of the Inventory of Depression and Anxiety Symptoms (IDAS). Psychol Assess. 2007;19:253–68.PubMed
130.
Zimmerman M, Martinez JH, Friedman M, Boerescu D, Attiullah N, Toba C. How can we use depression severity to guide treatment selection when measures of depression categorize patients differently? J Clin Psychiatry. 2012;73:1287–91.PubMed
131.
Santor DA, Gregus M, Welch A. Eight decades of measurement in depression. Measurement. 2009;4:135–55.
132.
Uher R, Tansey KE, Dew T, Maier W, Mors O, Hauser J, et al. An inflammatory biomarker as a differential predictor of outcome of depression treatment with escitalopram and nortriptyline. Am J Psychiatry. 2014;1:1–9.
133.
Vogelzangs N, Duivis HE, Beekman ATF, Kluft C, Neuteboom J, Hoogendijk W, et al. Association of depressive disorders, depression characteristics and antidepressant medication with inflammation. Transl Psychiatry. 2012;2:e79.PubMedPubMedCentral
134.
Tukey JW. Analyzing data: sanctification or detective work? Am Psychol. 1969;24:83–91.
Metadata
Title
Depression sum-scores don’t add up: why analyzing specific depression symptoms is essential
Authors
Eiko I Fried
Randolph M Nesse
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2015
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-015-0325-4

Other articles of this Issue 1/2015

BMC Medicine 1/2015 Go to the issue

Commentary

Cardiovascular risk perception in women: true unawareness or risk miscalculation?

Research article

Major dietary patterns and risk of frailty in older adults: a prospective cohort study

Research article

Characterization of Plasmodium vivax-associated admissions to reference hospitals in Brazil and India

Guideline

Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD Statement

Opinion

Does reduced smoking if you can’t stop make any difference?

Review

New players in the preventive treatment of migraine