What Is Depression Not Otherwise Specified (NOS)?

Depression is a common mental health disorder. The World Health Organization estimates that almost 300 million people live with depression worldwide. The condition is categorized by a broad range of symptoms that may significantly impact the lives of those who experience it. 

You may be experiencing some common depressive symptoms, including sadness, lack of energy, loss of interest in activities you once enjoyed, or changes in your sleep and eating habits. You might wonder whether that means you're living with depression. While your symptoms could mean you're experiencing a depressive disorder like major depression, they may also indicate the presence of a disorder that doesn't fit into an existing category.

The term not otherwise specified (NOS) was previously used to refer to symptoms that applied to a category of mental health conditions but did not fit the criteria of any one diagnosis. Thus, depression NOS was a term for symptoms of depression that didn't fit a specific depressive disorder diagnosis but belonged to that family. As of 2022, there are new terms for this type of diagnosis, so that depression NOS is no longer in usage.

How depression is diagnosed

You may want to know what to expect when you visit a medical or mental health provider regarding depression or other mental health concerns. Your physician or provider may perform a medical examination, discuss your symptoms with you, perform any necessary tests, and use their expertise to develop a treatment plan for the depression you are experiencing.  

For a formal diagnosis of depression, one must have a depressive episode for at least two weeks and be a marked change from one's previous state of functioning. Within this understanding, there are many types of depressive disorders, including seasonal depression and persistent depressive disorder (formerly called dysthymic disorder), in which one experiences symptoms of depression for most of the time. There are also associated conditions that present similar symptoms. 

At times, an individual may not have all the requisite symptoms of a condition, or their provider may need more information to provide a diagnosis and treatment plan. In that case, they may be diagnosed using a broader term, such as the ones listed below.  

Changes from DSM-IV to DSM-V

The DSM IV, Fourth Edition (DSM-IV), lists various diagnostic criteria of depressive disorders, including depression not otherwise specified (NOS). However, the term "not otherwise specified" is no longer used when diagnosing mental health conditions like depression. In the most recent version of the DSM-5, it depressive disorder NOS was replaced with two different terms to help with diagnosis: 

• Other specified 
• Unspecified

A physician may use the terms "other specified" or "unspecified" when an individual's symptoms fit within the category of depressive disorders but do not align with the criteria for any particular one. 

According to the most recent update of the DSM-V, these designations of criteria apply to "presentations in which symptoms characteristic of a depressive disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the depressive disorders diagnostic class."

With "other specified depressive disorder," for example, an individual may display all but one diagnostic criterion for major depressive disorder or exhibit some symptoms of premenstrual dysphoric disorder and some symptoms of persistent depressive disorder, but do not the full criteria of either depressive disorder.

Some mental disorders are not easily categorizable, making their diagnoses more complex. In such cases, doctors may address their patients' symptoms and mental state as a whole to diagnose disorders such as other specified depressive disorder. 

When diagnosing an individual with other specified depressive disorder, the provider might identify the reason the symptoms don't meet the criteria for a regular diagnosis.

Physicians may provide an "unspecified depressive disorder" diagnosis when they don't have enough information to make a complete diagnosis or choose not to specify why the symptoms don't mean a depressive disorder diagnosis, such as in emergency situations.

What does this mean for patients?

From a patient's perspective, these designations might feel confusing, and you may wonder why diagnosis categorization exists. Categorizations like "other specified" and "unspecified" may help doctors be as specific as possible about your condition and symptoms to provide you with the best care. While one may not fit a specific diagnosis of a depressive disorder, doctors can evaluate symptoms to provide patients a treatment plan that is suitable for their mood disorder. 

If your doctor determines you live with unspecified depressive disorder or other specified depressive disorder, these diagnoses do not mean you can't seek treatment. Depression is a treatable condition, and your plan may be personalized to ensure you receive the care you need based on your symptoms.

Treatments for unspecified depressive disorders

There are many forms of treatment for depression. Medication, therapy, or a combination of both, in addition to specific lifestyle changes, are often standard methods for addressing depression symptoms. 

Some treatments for those living with what used to be called depression NOS (now called other specified and unspecified depression) may be similar to treatments for those experiencing major depression or other depressive disorders. However, because every condition can be different, your medical professional might create a unique plan based on your symptoms.

Medication

After evaluating your medical history and symptoms, your doctor may decide that antidepressant medications are appropriate. Common antidepressants include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, and monoamine oxidase inhibitors (MAOIs). 

Medication can be a crucial part of treating depression for many people. However, consult your doctor or primary care physician before starting or stopping a medication.

Therapy

Studies show that therapeutic interventions, such as cognitive-behavioral therapy (CBT), can effectively treat symptoms of depression. In a wide-ranging meta-analysis of over 100 studies, researchers concluded that CBT was a valuable form of care, particularly when combined with medication. 

Cognitive-behavioral therapy can work by helping individuals living with depression identify and replace intrusive thoughts that may lead to feelings of sadness or discontent. Therapy might be pursued face-to-face or through an online mental health platform.

Lifestyle changes

Lifestyle changes such as exercise, healthy eating habits, or establishing a solid support system can make it easier to cope with depression symptoms. Studies show that journaling and spending time in nature are two ways to improve mental health overall. 

Exercise regularly

Physical activity is a natural way of releasing mood-boosting endorphins in the body. Consider going for regular walks outside, joining a gym, or creating an at-home workout program.

Maintain a balanced diet

Making specific changes to your diet may also improve your mood. Research shows that diet is closely tied to our emotional well-being. 

According to one study, a diet "characterized by a high intake of fruit, vegetables, whole grain, fish, olive oil, low-fat dairy and antioxidants and low intakes of animal foods was associated with a decreased risk of depression."

Avoid alcohol

Limiting alcohol consumption might promote emotional stability. Because alcohol is a depressant, it can exacerbate symptoms and make a depressive disorder more difficult to cope with. Consider restricting alcohol consumption or abstaining completely.

Develop a support system

Another standard lifestyle change includes surrounding yourself with a supportive network. Depression can make you feel isolated or disconnected from other people. The social support of family and friends can play a significant role in combating depression symptoms.

If you do not have close family or friends to confide in, consider a support group where you can interact with others living with depression. Support groups have the added benefit of building a sense of community or belonging and have been shown to treat symptoms of different depressive disorders effectively. For example, one study found that peer support resulted in "greater improvement in depression symptoms than usual care."

Navigating depression with a counselor 

Therapy can be a practical choice for those with a depressive diagnosis, even if it's unspecified. For those with depression, leaving home or organizing appointments may feel challenging. If you relate, you might appreciate the availability of online counseling. 

Recent research suggests that online therapy can be more effective than traditional methods. One study found that mindfulness-based cognitive-behavioral therapy (CBT) was highly effective in treating anxiety and depression. Another found that 71% of individuals participating in a clinical trial found online therapy preferable to traditional in-person treatment. 

If you'd like to understand more about your depression symptoms or a depression diagnosis, help is available. Consider reaching out through an online platform such as BetterHelp. You can talk to your therapist through video, voice, or in-app messaging.