Diagnosing major depressive disorder IX: are patients who deny low mood a distinct subgroup?

A dysphoric mood is not required for the diagnosis of DSM-IV major depressive disorder. Individuals who deny depression, sadness, or feeling blue may nonetheless be diagnosed with major depressive disorder if they have lost interest or pleasure in all, or almost all, of their usual activities, and experienced at least four other symptoms of depression. The underlying assumption is that depressed patients without low mood are no different than depressed patients who report dysphoric mood. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we examined the validity of this assumption. We compared the demographic, family history, and clinical characteristics of patients who met the DSM-IV criteria for a current major depressive episode who did (N = 839) and did not (N = 63) report low mood. Patients without depressed mood were significantly younger, and their current episodes were briefer, less severe, and associated with less suicidality and less psychosocial impairment. The results thus do not support DSM-IV's implicit assumption of no difference between depressed patients who do and do not report low mood. The alternative ways this might be addressed in future editions of the DSM are discussed.