Pattern of recurrence of illness after recovery of an episode of major depression: A prospective study
Department of Psychiatry, First Medical School, University of Naples, Italy. American Journal of Psychiatry
(Impact Factor: 12.3).
This study assessed prospectively the pattern of recurrence of illness after recovery from an episode of major depression.
Seventy-two patients who had recovered from an episode of primary, nonbipolar, nonpsychotic major depression were evaluated bimonthly with the Comprehensive Psychopathological Rating Scale for a period ranging from 20 to 108 months (median = 66 months). New ("prospective") episodes were ascertained with a structured diagnostic interview. The probabilities of remaining well after the index episode and after the first prospective episode were assessed by the life-table method. The severity and duration of prospective episodes and the index episode were compared by linear regression analysis.
The probability of remaining well after recovery from the index episode was 76% at 6 months, 63% at 1 year, and 25% at 5 years. The risk of recurrence was lower among patients receiving prophylactic treatment with antidepressants and/or lithium and among those with histories of fewer than three previous episodes. The probability of remaining well was significantly lower 2 years after the first prospective episode than 2 years after the index episode. A pattern of increasing severity from the index episode to the first, second, and third prospective episodes was observed and was not affected by treatment.
Major depression has a high rate of recurrence, even when bipolar and psychotic cases are excluded. The highest rate is observed during the first months after recovery from an episode. Prophylactic drug treatment reduces the risk of recurrence but apparently does not affect the trend toward increasing severity of subsequent episodes.
Available from: Arne Hofmann
- "Elle estime qu'elle affecte 340 millions de personnes à travers le monde (Greden, 2001 ; Murray & Lopez, 1996). Bien qu'un nombre important de patients affectés par la dépression ne connaissent qu'un seul épisode dépressif, une grande partie du poids morbide de la dépression est associée avec la reconnaissance croissante de la nature chronique et récurrente de ce trouble : il a été estimé que 75 % à 90 % des patients ayant traversé un épisode dépressif, selon la longueur de la période d'observation, connaîtront plus d'un épisode dépressif (Angst, 1992 ; Keller, 2002; Kupfer, 1991 ; Maj et coll., 1992). Fait intéressant , un des facteurs de risque majeurs pour la récurrence du trouble réside dans le fait que la rémission du premier épisode soit incomplète (Nierenberg, Petersen & Alpert, 2003). "
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ABSTRACT: La dépression est un trouble mental grave qui constitue un défi pour les systèmes de santé mentale du monde entier. Environ 30 % des patients n'obtiennent pas de rémission complète après le traitement, et plus de 75 % des patients souffrent d'épisodes dépressifs récurrents. Si la psychothérapie et la médication améliorent les taux de rémission, les taux de réussite des traitements actuels sont limités. Dans cette étude exploratoire contrôlée non randomisée, 21 patients souffrant de dépression unipolaire primaire ont été traités avec une moyenne de 44,5 séances de thérapie cognitive comportementale (TCC), avec en moyenne 6,9 séances supplémentaires de désensibilisation et de retraitement par les mouvements oculaires (EMDR). Un groupe contrôle (n = 21) a été traité avec une moyenne de 47,1 séances de TCC sans séance EMDR supplémentaire. Le principal moyen de mesure des résultats a été le Questionnaire de Dépression de Beck (BDI-II). Les scores BDI-II des deux groupes étaient identiques avant traitement et les deux traitements ont produit une amélioration significative. Les patients traités avec les séances d'EMDR d'appoint (p = 0,029) ont cependant obtenu des améliorations plus importantes. Le nombre de rémissions post-traitement, indiqué par un niveau symptomatique inférieur à 12 sur l'échelle BDI-II, était aussi significativement plus élevé dans le groupe ayant bénéficié de séances d'EMDR d'appoint : ce groupe a présenté davantage de rémissions (n = 18) que le groupe de contrôle (n = 8 ; p < 0,001). Cet effet potentiel de l'EMDR chez les patients souffrant de dépression primaire doit faire l'objet d'études contrôlées randomisées plus larges.
Available from: Cristina Colombo
- "Some authors have stressed the concept of seasonality, as many patients show critical months of the year when they tend to have a new recurrence independent of polarity . The recurrence pattern is also affected by external factors, such as exposition to light which appears to have an antidepressant effect both on its own and when associated to acute pharmacological treatments, which shorten the subsequent cycle of illness  and maintenance treatments, which are expected to decrease the episode rates. Mood stabilizers, the first choice of treatment for bipolar disorder, can successfully sustain the effect of chronotherapeutics and can help to manage the low risk of manic switches . "
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ABSTRACT: Background. Research on mood disorders has progressively focused on the study of seasons and on the mood in association with them during depressive or manic episodes yet few studies have focused on the seasonal fluctuation that characterizes the patient's clinical course both during an illness episode and during euthymic periods. Methods. 113 euthymic outpatients 46 affected by major recurrent depression and 67 affected by bipolar disorder were recruited. We evaluated the impact of clinical "rhythmical" factors: seasonality, sleep disturbance, and chronotype. Patients completed the SPAQ+ questionnaire, the MEQ questionnaire, and the medical outcomes study (MOS) sleep scale. We used t-test analyses to compare differences of clinical "rhythmical" and sociodemographic variables and of differences in the assessment scales among the diagnostic groups. Results. Patients reporting a family history for mood disorders have higher fluctuations throughout seasons. Sleep disturbance is more problematic in unipolars when compared to bipolars. Conclusions. Sleep, light, and seasonality seem to be three interconnected features that lie at the basis of chronobiology that, when altered, have an important effect both on the psychopathology and on the treatment of mood disorders.
Available from: Claudi L H Bockting
- "It is less clear what these models predict with respect to the duration of subsequent depressive episodes. In several studies, it was found that recurrent episodes may be shorter than first-ever episodes, such as in the NEMESIS study (Spijker et al., 2002), the STAR*D trial (Hollon et al., 2006) and the Baltimore ECA study (Eaton et al., 1997), while Solomon et al. (1997) found that the duration of recurrent depressive episodes was relatively uniform and Maj et al. (1992) reported no significant pattern in duration of subsequent episodes. However, data from these studies may be insufficient to address this question as they may produce biased estimates of the duration subsequent episodes, due to memory bias in retrospective and cross-sectional studies and selective censoring of data in prospective studies within a fixed follow-up period. "
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ABSTRACT: Little is known about the duration of subsequent depressive episodes and periods of recovery, and much is based on potentially biased retrospective data. We therefore prospectively assessed whether duration of depressive episodes and recoveries is correlated within subjects and across episodes, and whether duration of subsequent depressive episodes and recoveries increases or decreases over time.
From a sample of 267 depressed primary care patients enrolled in a RCT, we identified 279 depressive episodes and 455 recovery periods during a 3-year follow-up. We correlated durations of depressive episodes and of recovery within subjects, and compared within subjects the duration of first depressive episodes after index depression with second and third episodes, and similarly with recovery periods.
No significant correlations were found between duration of depressive episodes or between recovery periods within subjects (Rs ranging from -0.17 to 0.08; all Ps >0.05). Median duration of first and second depressive episodes was 11 (IQR 6-19) and 9 weeks (IQR 5-14). Median duration of first and second recovery periods was 16.5 (IQR 7-31) and 17.5 weeks (IQR 9-32). No significant increase or decrease was observed in duration of consecutive depressive episodes, nor in recovery periods across episodes (all Ps >0.05).
In this prospective study, we found no correlation between duration of depressive episodes or between recovery periods within subjects. Moreover, we found no support for an increase or decrease in subsequent duration of depressive episodes or a decrease in recovery periods across episodes. These findings do not support the notion that experiencing multiple depressive episodes results in a growing vulnerability.
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