Key Takeaways
- SSD is real depression, even without a full diagnosis. Subsyndromal symptomatic depression (SSD) involves two to four depressive symptoms that fall just short of a major depressive disorder diagnosis — but it can still significantly disrupt daily life, work, and relationships.
- You don’t need five symptoms to suffer. The DSM-5 requires five or more symptoms for a major depression diagnosis, but people with just two or three symptoms can experience just as much disruption to their quality of life and daily functioning.
- SSD can progress if left untreated. Without intervention, SSD symptoms can worsen over time and develop into full major depressive disorder, making early treatment critical for long-term mental health outcomes.
- Certain groups are at higher risk. Older adults and people with bipolar I or bipolar II disorder are most likely to experience SSD — and the number of people living with it is actually greater than those with a formal clinical depression diagnosis.
- Effective treatments are available. SSD responds well to cognitive behavioral therapy (CBT), and in some cases medication or TMS (transcranial magnetic stimulation) — a non-invasive, proven treatment offered at Pulse TMS for those whose symptoms don’t respond to therapy alone.
Depression is an extremely common mental health condition, affecting up to 300 million people in the world. The term depression encompasses a variety of different subsets of the disorder, and each person can manifest different symptoms of the illness. Left untreated, the symptoms of depression can significantly impair a person’s ability to function, and can even worsen or trigger physical health problems as well. Studies have found that depression that goes untreated for a long time can lower a person’s immune system, and make them far more susceptible to infections and other diseases.
For a patient to receive an official diagnosis of depression, they must manifest depression symptoms for at least two weeks, and the symptoms must impair a person’s ability to function, or otherwise disrupt their day to day living. While a significant number of people who seek out treatment for depression will come away with an official diagnosis of the disease, many patients will have distressing symptoms, but they won’t fully meet the diagnostic criteria for major depressive disorder. These patients have what’s called subsyndromal symptomatic depression.
What is subsyndromal symptomatic depression (SSD)?
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) stipulates the criteria that a person must meet in order to be diagnosed with major depressive disorder, which is what most people are probably referring to when they talk about depression. That being said, some people experience symptoms associated with depression without meeting full diagnostic criteria. For instance, the DSM-5 requires five or more symptoms of depression for a diagnosis, but some people may have only two or three symptoms that still interfere with life. In this case, a person is experiencing subsyndromal symptomatic depression (SSD).
Experts have described SSD as involving two or more symptoms but fewer than five symptoms of major depressive disorder, lasting for two or more weeks. According to these experts, common symptoms of SSD include increased sleeping, feelings of fatigue, slowed thinking, elevated appetite, and problems concentrating. Unlike major depressive disorder, SSD excludes the symptoms of depressed mood and loss of pleasure, but otherwise appears similar. Some experts in the mental health field have described SSD as being a precursor to major depression. What is important to keep in mind about SSD is that even if a person does not meet full diagnostic criteria for major depression, they will still experience difficulty with daily functioning. For instance, they may have trouble socializing with others or completing daily tasks at work because of SSD symptoms.
What are the symptoms of SSD?
The following depressive symptoms must be present every day or almost every day for at least two weeks for a diagnosis of either SSD or major depression:
- Changes in appetite, either eating too much or too little
- Weight loss or gain
- Experiencing a significant decline in enjoyment of usual activities
- Pervasive feelings of sadness, hopelessness, guilt, and self-loathing
- Changes in sleep patterns, either insomnia or hypersomnia
- Fatigue and lethargy
- Inability to concentrate or make decisions
- Thoughts of death and suicidal rumination
- Restlessness, anxiety, and agitation
If a person has at least five or more symptoms, they will get an official diagnosis of major depressive disorder. If a person has two to four symptoms, they have SSD and should be treated and monitored for worsening symptoms. In most cases of SSD, patients rarely manifest symptoms of anhedonia or depressed mood. Most of the impairment with SSD patients impacted their social life.
SSD is often difficult for clinicians to diagnose. It is easier for clinicians to rule out depression than to accurately diagnose the disorder. The thresholds for getting an official diagnosis of depression in the DSM V are high, and it can be challenging for doctors, and therapists to accurately assess how much a patient’s SSD symptoms are impacting their lives. New developments in the treatment and diagnosis of depression and related disorders suggest that SSD should be separately classified and treated similarly to major depressive disorder.
Who is most likely to develop SSD?
The elderly, and people with bipolar I and bipolar II disorder are the most likely to experience subsyndromal depression symptoms. Research has found that the numbers of people with subsyndromal depression are much higher than those with an official diagnosis of any clinical depression subtype.
Why is it important for people with SSD symptoms to seek treatment?
Even if a person doesn’t meet the diagnostic criteria for major depressive disorder, SSD symptoms can still severely disrupt their ability to function and enjoy life. Studies indicate that SSD can have as much of an impact on a person’s quality of life as major depressive disorder. If a patient with SSD is experiencing suicidal thoughts or self-harming, they need outside intervention before symptoms worsen.
Overall, SSD can have the same, negative impact on a person’s life as major depressive episodes can. All depressive episodes and subtypes, regardless of the severity or duration of their symptoms, impact a person’s life in negative and sometimes irreversible ways.
Early intervention is the key to success and adequate management of symptoms for a variety of mental health disorders and conditions, and SSD is no different. The earlier a patient’s symptoms are noted, the sooner experienced doctors and therapists can intervene and get the person the help they need.
Furthermore, if SSD symptoms are untreated, a person’s condition may worsen and progress to a diagnosis of major depressive disorder, which involves additional symptoms and may be more difficult to treat.
What about dysthymia?
Closely related to SSD, dysthymia is another form of depression listed in the DSM-5. Now referred to clinically as persistent depressive disorder (PDD), dysthymia may be confused with SSD because it is also a milder form of major depression. According to diagnostic criteria, a person with PDD experiences a depressed mood for most days for two or more years. Furthermore, to meet diagnostic criteria for PDD, a person must experience at least two of these symptoms:
- Low appetite or increased appetite
- Changes in sleep patterns, either in the form of insomnia or hypersomnia
- Feelings of fatigue or low energy
- Low self-esteem
- Difficulty concentrating or making decisions
- Feeling hopeless
PDD appears similar to SSD, because it only requires two symptoms for diagnosis, making it seem milder than major depression. The difference, however, is that PDD often involves a depressed mood, whereas SSD does not. In addition, PDD is chronic, whereas symptoms of SSD only need to be present for two weeks. Despite their differences, both conditions require treatment and intervention to reduce the dysfunction they produce in a person’s life.
How is SSD treated?
In most cases, talk therapy alone is enough to manage and alleviate the symptoms of SSD. Cognitive behavioral therapy, or CBT, is most often recommended for patients with these symptoms. Some patients may benefit from CBT in combination with medicine, especially if symptoms start to worsen or the person’s ability to function is significantly impacted. Also, persistent symptoms that do not respond to talk therapy, medication, or a combination of the two may respond to transcranial magnetic stimulation (TMS).
In TMS treatment, a strong, magnetic coil is placed over the patient’s head, and a powerful magnetic pulse is used to target areas of the brain thought to play a role in depression. The procedure is non-invasive, and patients often find relief from symptoms within the first couple of sessions. TMS is also highly effective for treating a variety of mental health issues, including major depression, postpartum depression, OCD, and bipolar depression. When it comes to treating SSD and other chronic mental health disorders, treatment is most effective when it is tailored to the patient’s specific needs and circumstances.
Are you living with disruptive and painful depression symptoms? No one has to live with the pain of untreated depression. Please contact the caring mental health professionals at Pulse TMS today. Representatives are standing by to answer your questions about how TMS treatment can alleviate your depression symptoms.
Pulse TMS is located in Los Angeles, and we provide TMS treatment for both depression and obsessive-compulsive disorder. If you are suffering from mental health symptoms that aren’t getting better with other treatments, TMS may be suitable for you. We are proud to accept multiple insurances to make treatment affordable, and our staff is here to help you discuss payment options.
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Frequently Asked Questions
What is the difference between SSD and major depressive disorder?
Major depressive disorder requires five or more depressive symptoms lasting at least two weeks, while SSD involves two to four symptoms over the same period. Both conditions can impair daily functioning, but SSD does not typically include depressed mood or loss of pleasure as symptoms.
Can SSD go away on its own?
While some symptoms may fluctuate, SSD is not something to simply wait out. Without treatment, symptoms can persist and potentially worsen into major depressive disorder. Early intervention with therapy or other treatments significantly improves outcomes.
How is SSD different from dysthymia (persistent depressive disorder)?
Both conditions share overlapping symptoms, but the key differences are duration and mood. Dysthymia (now called persistent depressive disorder, or PDD) requires a persistently depressed mood lasting two or more years, while SSD only requires symptoms for two weeks and typically does not include depressed mood.
Does insurance cover treatment for SSD?
Coverage depends on your specific insurance plan and diagnosis. Pulse TMS accepts multiple insurance plans and our team can help you understand your benefits and payment options for therapy, medication management, or TMS treatment.
When should someone with SSD consider TMS therapy?
TMS is typically considered when SSD symptoms persist despite talk therapy and medication, or when a patient is unable to tolerate medication side effects. It is a non-invasive, FDA-cleared treatment with sessions as short as 20 minutes, and many patients notice improvement within the first few sessions.
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