ArticleJournal of affective disorders2015
Depression is not a consistent syndrome: An investigation of unique symptom patterns in the STAR*D study.
Article in Journal of affective disorders, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 416 papers, 3 of them syntheses that pooled it.
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Who cites it
416 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Interventions to improve mental help-seeking behaviours in individuals with depressive symptoms: a systematic review and meta-analysis.BMC psychiatry · 2025Pooled it
- Machine learning approaches in the therapeutic outcome prediction in major depressive disorder: a systematic review.Frontiers in psychiatry · 2025Pooled it
- Structural and functional features of treatment-resistant depression: A systematic review and exploratory coordinate-based meta-analysis of neuroimaging studies.Psychiatry and clinical neurosciences · 2023Pooled it
- A comparison between rTMS and antidepressant medication on depressive symptom clusters in treatment-resistant depression.European archives of psychiatry and clinical neuroscience · 2025Trial
- Effects of home-use transcranial direct current stimulation on clusters of depressive symptoms: an ancillary analysis of the PSYLECT study.Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999) · 2025Trial
- An Explainable Self-Supervised Temporal Transformer for Participant-Level Classification of Depressive Symptoms From Resting-State EEG.International journal of methods in psychiatric research · 2026Article
- Interpretable machine learning for depression symptom classification in NHANES: Performance in a curated high-confidence corpus and the full survey population.IBRO neuroscience reports · 2026Article
- Breaking the norm: population-scale deviations of brain structure in depression and anxiety.Molecular psychiatry · 2026Article
- Neuropathophysiological changes associated with mirtazapine treatment response in major depressive disorder: insights into bottom-up dopaminergic pathways and prefrontal control networks.European archives of psychiatry and clinical neuroscience · 2026Article
- Mendelianization: Concentrating Polygenic Signal Into a Single Causal Locus.Genetic epidemiology · 2026Article
- The dynamics of loneliness: Longitudinal associations of anhedonia and dampening in a clinical sample of depressed individuals.Journal of affective disorders · 2026Article
- Multiscale Heterogeneity of White Matter Morphometry in Psychiatric Disorders.Biological psychiatry. Cognitive neuroscience and neuroimaging · 2026Article
- Dissecting pleiotropy between major depressive disorder and physical disease comorbidities.Nature genetics · 2026Article
- Neurophysiological Correlates of Neuroanatomical Dimensions in Major Depressive Disorder: Electroencephalographic Markers of Brain Function and Treatment Outcome.Biological psychiatry global open science · 2026Article
- The cross-site reproducibility of MRI morphometric phenotypes in psychiatric disorders.Nature neuroscience · 2026Article
- Validating an aphasia-accessible ecological momentary assessment for daily depressive affect: A preliminary investigation.Journal of affective disorders · 2026Article
- Arthritis/Rheumatism and Depressive Symptoms in Middle-Aged and Older Chinese Adults: Regression and Symptom Network Evidence from CHARLS 2018.Healthcare (Basel, Switzerland) · 2026Article
- The transdiagnostic network of childhood trauma, anxiety, and depression in college students: centrality of emotional neglect and the bridging function of emotional abuse.BMC psychiatry · 2026Article
- Symptom co-fluctuations with suicidal ideation over time: a dynamic time warp analysis.BMJ mental health · 2026Article
- Gamma and beta power and the 1/f slope vary across a spectrum of depression severity.Translational psychiatry · 2026Article
356 more citing papers are in PubMed but not listed here.
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Authors and funding
2 authors.
Funding
Abstract
backgroundThe 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.
methodsWe investigated the number of unique symptom profiles reported by 3703 depressed outpatients at the beginning of the first treatment stage of STAR*D.
resultsOverall, 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.
conclusionsThe 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.
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