Recovery from major depression. A 10-year prospective follow-up across multiple episodes

Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA.
Archives of General Psychiatry (Impact Factor: 14.48). 12/1997; 54(11):1001-6.
Source: PubMed

ABSTRACT Major depressive disorder is often marked by repeated episodes of depression. We describe recovery from major depression across multiple mood episodes in patients with unipolar major depression at intake and examine the association of sociodemographic and clinical variables with duration of illness.
A cohort of 258 subjects treated for unipolar major depressive disorder was followed up prospectively for 10 years as part of the Collaborative Depression Study, a multicenter naturalistic study of the mood disorders. Diagnoses were made according to the Research Diagnostic Criteria, and the course of illness was assessed with the Longitudinal Interval Follow-up Evaluation. Survival analyses were used to calculate the duration of illness for the first 5 recurrent mood episodes after recovery from the index episode.
Diagnosis remained unipolar major depressive disorder for 235 subjects (91%). The median duration of illness was 22 weeks for the first recurrent mood episode, 20 weeks for the second, 21 weeks for the third, and 19 weeks for the fourth and fifth recurrent mood episodes; the 95% confidence intervals were highly consistent. From one episode to the next, the proportion of subjects who recovered by any one time point was similar. For subjects with 2 or more recoveries, the consistency of duration of illness from one recovery to the next was low to moderate. None of the sociodemographic or clinical variables consistently predicted duration of illness.
In this sample of patients treated at tertiary care centers for major depressive disorder, the duration of recurrent mood episodes was relatively uniform and averaged approximately 20 weeks.

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    • "The cumulative duration of depressive episodes, as well as their repetition, has a detrimental effect on depression recurrence rates (Solomon et al., 1997), the chances of antidepressant response (Keller et al., 1992), time to obtain remission (Kanai et al., 2003), and the presence of social recovery (Sarapas et al., 2013). Memory impairment (Burt et al., 1995), atrophy of the hippocampus (Sheline et al., 1999), and higher risk for dementia (Kessing, 2012) have also been observed, raising the possibility that depressive episodes could be neurotoxic (Gorwood et al., 2008). "
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    ABSTRACT: The cumulative duration of depressive episodes, and their repetition, has a detrimental effect on depression recurrence rates and the chances of antidepressant response, and even increases the risk of dementia, raising the possibility that depressive episodes could be neurotoxic. Psychomotor retardation could constitute a marker of this negative burden of past depressive episodes, with conflicting findings according to the use of clinical versus cognitive assessments. We assessed the role of the Retardation Depressive Scale (filled in by the clinician) and the time required to perform the neurocognitive d2 attention test and the Trail Making Test (performed by patients) in a sample of 2048 depressed outpatients, before and after 6 to 8 weeks of treatment with agomelatine. From this sample, 1140 patients performed the TMT-A and –B, and 508 performed the d2 test, at baseline and after treatment. At baseline, we found that with more past depressive episodes patients had more severe clinical level of psychomotor retardation, and that they needed more time to perform both d2 and TMT. When the analyses were performed again after treatment, and especially when the analyses were restricted to patients with clinical remission, the cognitive tests were the only ones correlated with past depressive episodes. Psychomotor retardation tested at a cognitive level was therefore systematically revealing the burden of past depressive episodes, with an increased weight for patients with less remaining symptoms. If prospectively confirmed, interventions such as cognitive remediation therapy could benefit from a more specific focus on neurocognitive retardation.
    European Neuropsychopharmacology 10/2014; 24(10). DOI:10.1016/j.euroneuro.2014.07.013 · 4.37 Impact Factor
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    • "Other barriers to receiving care for depressive symptoms can be imputed to negative life events, with a trend among health care professionals towards attributing affective problems to these events, and not treating them as a clinical problem (Kraaij et al., 2002). Some reports have analysed the differences in presentation, and clinical outcomes among depressed elderly patients (Cole, 2002; Murphy, 1983; Solomon et al., 1997). However, more knowledge about how these symptoms change over time among community dwelling elderly people is needed. "
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    ABSTRACT: BACKGROUND: Depression is a well-recognised problem in the elderly. The aim of this study was to determine the factors associated with predictors of change in depressive symptoms, both in subjects with and without baseline significant depressive symptoms. METHODS: Longitudinal study of community-dwelling elderly people (>60 years or older), baseline evaluations, and two additional evaluations were reported. Depressive symptoms were measured using a 30-item geriatric depression scale, and a score of 11 was used as cut-off point for significant depressive symptoms in order to stratify the analyses in two groups: with significant depressive symptoms and without significant depressive symptoms. Sociodemographic data, social support, anxiety, cognition, positive affect, control locus, activities of daily living, recent traumatic life events, physical activity, comorbidities, and quality of life were evaluated. Multi-level generalised estimating equation model was used to assess the impact on the trajectory of depressive symptoms. RESULTS: A number of 7882 subjects were assessed, with 29.42% attrition. At baseline assessment, mean age was 70.96 years, 61.15% were women. Trajectories of depressive symptoms had a decreasing trend. Stronger associations in those with significant depressive symptoms, were social support (OR.971, p<.001), chronic pain (OR 2.277, p<.001) and higher locus of control (OR.581, p<.001). In contrast for those without baseline significant depressive symptoms anxiety and a higher locus of control were the strongest associations. CONCLUSIONS: New insights into late-life depression are provided, with special emphasis in differentiated factors influencing the trajectory when stratifying regarding basal status of significant depressive symptoms. LIMITATIONS: The study has not included clinical evaluations and nutritional assessments.
    Journal of Affective Disorders 05/2013; 150(3). DOI:10.1016/j.jad.2013.05.007 · 3.38 Impact Factor
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    • "The MacArthur Foundation task force proposed 3 different sets of operational criteria for recovery, based on different assessment scales and using different durations [i.e., Schedule for Affective Disorders and Schizophrenia (Spitzer et al., 1978) 2 symptoms for at least 8 weeks, 17-item Hamilton Rating Scale for Depression (HAM-D 17 ; Hamilton, 1960) 7 for at least 6 months, and Beck Depression Inventory (Beck et al., 1961) 8 for at least 4 months] (Frank et al., 1991). The definition used in the National Institute of Mental Health Collaborative Depression Study specified the presence of no symptoms or 1e2 symptoms to a mild degree for a minimum of 8 consecutive weeks (Keller et al., 1983; Solomon et al., 1997). The Diagnostic and Statistical Manual of Mental of Mental Disorders (Fourth Edition, Text Revision) (DSM-IV-TR) defines the end of a depressive episode as a period of at least 2 months during which full criteria for a major depressive episode are not met, although this relatively weak definition allows for significant ongoing symptomatology (American Psychiatric Association, 1994). "
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    ABSTRACT: In contrast to "remission" from an episode of major depressive disorder (MDD), for which there is general agreement in the literature, the optimal definition of "recovery" from MDD is uncertain. Previous definitions of recovery have used inconsistent thresholds for symptom severity and duration of wellness. To address the effects of duration and degree of recovery from an episode of MDD on recurrence risk, and the impact of maintenance antidepressant treatment on recurrence, we analyzed 258 patients from a randomized, double-blind study of outpatients with recurrent MDD. All patients had responded to 8½ months of venlafaxine extended release and were subsequently randomized to receive venlafaxine ER or placebo during 2 consecutive 12-month maintenance phases. Four definitions of recovery were used to evaluate recovery rates and time to recurrence: (1) 17-item Hamilton Depression Rating Scale (HAM-D(17)) total score ≤3 with duration ≥120 days; (2) HAM-D(17) ≤3 with duration ≥56 days; (3) HAM-D(17) ≤7 with duration ≥120 days; and (4) HAM-D(17) ≤7 with duration ≥56 days. Recovery definitions using lower symptom severity and longer duration thresholds produced lower rates of recurrence. Patients on placebo were more likely to have a recurrence than patients on venlafaxine ER, with hazard ratio (HR) ranging from 2.5 among patients who recovered by the most relaxed criteria (definition 4), to 5.3 among patients who recovered by the most stringent criteria (definition 1). We conclude that protection against recurrence derives from the degree and duration of recovery, particularly for patients maintained on antidepressant medication.
    Journal of Psychiatric Research 04/2012; 46(6):708-15. DOI:10.1016/j.jpsychires.2012.03.002 · 3.96 Impact Factor
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