Complex Depression and Early Adverse Stress: A Domain-Based Diagnostic Approach

Complex versus noncomplex depression is a clinically meaningful distinction that should be made in clinical practice. We propose that treatment outcomes might be improved by this clinical differentiation by means of predicting clinical trajectories and, accordingly, defining at earliest opportunity individually tailored therapeutic approaches. Clinical presentation, course, family history, treatment response, and, to some extent, physical and psychiatric comorbidities have been recognized as critical dimensions in the differentiation between complex versus noncomplex depression. Herein we suggest that the addition of early adverse stress, an often-neglected dimension, should also be made, further enriching thoughtful clinical practice. In this regard, we present evidence that early adverse stress is linked to several dimensions of complex depression and that an important proportion of health-damaging and behavioral outcomes might be attributed to early adverse stress, highlighting the need for earlier detection and tailored treatment.