The impact of residual symptoms on outcome of major depression
Unipolar depression should be viewed as a chronic illness with multiple phases rather than as a relapsing-remitting disorder. Incomplete remission from depression is common, with approximately one third of patients continuing to have residual depression at remission. Patients who have had a depressive episode spend more time with residual depressive symptoms than with major depression long term. The presence of residual symptomatology after an episode of depression is associated with an increased risk of short-term relapse, a long-term chronic course, higher risk of suicide attempts, poor social functioning, and poor outcome of comorbid medical illnesses.
Unable to display preview. Download preview PDF.
References and Recommended Reading
- 1.Lee AS, Murray RM: The long-term outcome of Maudsley depressives. Br J Psychiatry 1988, 153:741–751. In this seminal long-term study of outcomes of depression using actuarial methods, 89 consecutive admissions with depression in a tertiary referral center were followed up after 18 years. Less than 20% had remained well, one third had suffered an unnatural death or severe chronic disability and a high proportion suffered an unnatural death.PubMedCrossRefGoogle Scholar
- 5.Judd LL, Akiskal HS, Maser JD, et al.: A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders. Arch Gen Psychiatry 1998, 55:694–700. The weekly symptom level of 431 patients with major depression at five centers was rated prospectively over a period of 12 years. The amount of time spent at each level was rated. Patients spent 43% of time at combined minor depressive or subsyndromal symptom level, three times more than at a major depression level. Symptom levels changed on average twice per year.PubMedCrossRefGoogle Scholar
- 6.Paykel ES, Ramana R, Cooper Z, et al.: Residual symptoms after partial remission: an important outcome in depression. Psychol Med 1995, 25:1171–1180. Seventy patients with major depressive episodes were followed-up longitudinally after remission and interviewed every 3 months over 2 years. Residual symptoms were present in 32% of the subjects. The nature of these symptoms is described, as is the proportion relapsing.PubMedGoogle Scholar
- 8.Frank E, Prien RF, Jarrett RB, et al.: Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence. Arch Gen Psychiatry 1991, 48:851–855. This paper defined important points in the natural history of depressive illness, including remission, partial remission and relapse.PubMedGoogle Scholar
- 9.American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Association; 1994.Google Scholar
- 10.World Health Organization: International Statistical Classification of Diseases and Related Health Problems, 10th Revision. Geneva: World Health Organization; 1992.Google Scholar
- 27.Kennedy N, Abbott R, Paykel ES: Remission and recurrence of depression in the maintenance era: long-term outcome in a Cambridge cohort. Psychol Med 2003, 33:791–802. This paper describes a poor long-term outcome of depression in a more recent cohort despite high levels of pharmacological and psychologic treatments over follow-up. Social functioning also was poor but seemed to have improved compared with earlier studies.CrossRefGoogle Scholar
- 33.Kennedy N, Foy K, Sherazi R, McDonough M, McKeon P: Longterm social functioning after severe depression: a review. Bipol Disord, In press.Google Scholar