Residual symptoms at remission from depression: impact on long-term outcome.

BACKGROUND Although residual symptoms after remission from depression are common and predict early relapse, little is known about the impact of residual symptoms on longer-term clinical course of depression or social functioning. METHODS Sixty severe recurrent depressives, who remitted from an index episode of depression with residual symptoms or below residual symptomatology, were followed-up at 8-10 years. Subjects underwent detailed longitudinal interviewing on course of depression, treatment and socioecomonic functioning over follow-up. RESULTS Long-term follow-up data was obtained on all living subjects and 55 (95%) were interviewed. The residual symptoms group spent more time with depressive symptoms over follow-up but not at full criteria for major depression and showed greater impairment in longitudinal and follow-up social adjustment. No significant differences were found between the two groups in percentage recurring long-term, mean number of recurrences, readmissions, chronic episodes or clinical global outcome criteria. LIMITATIONS Long-term clinical and social outcomes were assessed by a single retrospective longitudinal interview. CONCLUSIONS Patients who remit from depression with residual symptomatology continue to have more depressive symptoms and impaired social functioning long-term and may need more aggressive treatment.

[1]  E. Paykel.  The clinical interview for depression. Development, reliability and validity. , 1985, Journal of affective disorders.

[2]  M B Keller,et al.  Social functioning in depression: a review. , 2000, The Journal of clinical psychiatry.

[3]  R. Murray,et al.  The Long-Term Outcome of Maudsley Depressives , 1988, British Journal of Psychiatry.

[4]  M. Weissman,et al.  The depressed woman: A study of social relationships , 1974 .

[5]  J. Deakin,et al.  Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 1993 British Association for Psychopharmacology guidelines , 2000 .

[6]  R Ramana,et al.  Remission and relapse in major depression: a two-year prospective follow-up study , 1995, Psychological Medicine.

[7]  Jan Scott,et al.  The influence of cognitive variables on recovery in depressed inpatients. , 1997, Journal of affective disorders.

[8]  J. Teasdale,et al.  Prevention of relapse in residual depression by cognitive therapy: a controlled trial. , 1999, Archives of general psychiatry.

[9]  K. Wells,et al.  Socioeconomic burden of subsyndromal depressive symptoms and major depression in a sample of the general population. , 1996, The American journal of psychiatry.

[10]  A. B. Prasad,et al.  British National Formulary , 1994 .

[11]  E. Robins,et al.  Research diagnostic criteria: rationale and reliability. , 1978, Archives of general psychiatry.

[12]  E. Paykel,et al.  Remission and recurrence of depression in the maintenance era: long-term outcome in a Cambridge cohort , 2003, Psychological Medicine.

[13]  D. Kupfer,et al.  Five-year outcome for maintenance therapies in recurrent depression. , 1990, Archives of general psychiatry.

[14]  R Ramana,et al.  Residual symptoms after partial remission: an important outcome in depression , 1995, Psychological Medicine.

[15]  A. Simons,et al.  Cognitive therapy and pharmacotherapy for depression. Sustained improvement over one year. , 1986, Archives of general psychiatry.

[16]  J. Mintz,et al.  Treatments of depression and the functional capacity to work. , 1992, Archives of general psychiatry.

[17]  John A. Rice,et al.  Major depressive disorder: a prospective study of residual subthreshold depressive symptoms as predictor of rapid relapse. , 1998, Journal of affective disorders.

[18]  Aileen B. Sedman,et al.  A longitudinal study , 1987 .

[19]  G. Fava,et al.  Cognitive behavioral treatment of residual symptoms in primary major depressive disorder. , 1994, The American journal of psychiatry.

[20]  C. Katona,et al.  Long-term outcome of severe puerperal psychiatric illness: a 23 year follow-up study , 2000, Psychological Medicine.

[21]  D J Kupfer,et al.  Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence. , 1991, Archives of general psychiatry.

[22]  H. Brodaty,et al.  Predicting the Course of Melancholic and Nonmelancholic Depression: A Naturalistic Comparison Study , 1992, The Journal of nervous and mental disease.

[23]  W. Coryell,et al.  Recovery after 5 years of unremitting major depressive disorder. , 1996, Archives of general psychiatry.

[24]  E. Paykel,et al.  Life events, social support and marital relationships in the outcome of severe depression , 1996, Psychological Medicine.

[25]  J. Fleiss,et al.  The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. , 1976, Archives of general psychiatry.

[26]  R G Priest,et al.  Recognition and management of depression in general practice: consensus statement. , 1992, BMJ.

[27]  E. Paykel,et al.  Expressed emotion and depression , 1997, British Journal of Psychiatry.

[28]  E. Kaplan,et al.  Nonparametric Estimation from Incomplete Observations , 1958 .

[29]  Steven D. Hollon,et al.  Cognitive therapy and pharmacotherapy for depression. , 1991 .

[30]  Marija J. Norusis,et al.  SPSS for Windows Base System User''s Guide , 1992 .

[31]  P. Lavori,et al.  Time to recovery, chronicity, and levels of psychopathology in major depression. A 5-year prospective follow-up of 431 subjects. , 1992, Archives of general psychiatry.

[32]  J. Fawcett.  Antidepressants: Partial Response in Chronic Depression , 1994, British Journal of Psychiatry.

[33]  G. W. Snedecor.  Statistical Methods , 1964 .

[34]  N. Andreasen,et al.  The Longitudinal Interval Follow-up Evaluation. A comprehensive method for assessing outcome in prospective longitudinal studies. , 1987, Archives of general psychiatry.

[35]  C. Barkley,et al.  Future Imperfect: the Long-Term Outcome of Depression , 1994, British Journal of Psychiatry.

[36]  H. Akiskal.  Dysthymic disorder: psychopathology of proposed chronic depressive subtypes. , 1983, The American journal of psychiatry.

[37]  A. Rush.  Treatment of major depression , 1993 .

[38]  P. Lavori,et al.  Maintenance strategies for unipolar depression: an observational study of levels of treatment and recurrence. , 1998, Journal of affective disorders.

[39]  L. Judd,et al.  Does incomplete recovery from first lifetime major depressive episode herald a chronic course of illness? , 2000, The American journal of psychiatry.

[40]  A. Leon,et al.  Recovery, chronicity, and levels of psychopathology in major depression. , 1996, The Psychiatric clinics of North America.

[41]  C. Faravelli,et al.  Depressive relapses and incomplete recovery from index episode. , 1986, The American journal of psychiatry.

[42]  C. O. Kennedy.  A controlled trial , 1971, British Homeopathic Journal.

[43]  John P. Rice,et al.  Psychosocial disability during the long-term course of unipolar major depressive disorder. , 2000, Archives of general psychiatry.

[44]  M. Hamilton.  A RATING SCALE FOR DEPRESSION , 1960, Journal of neurology, neurosurgery, and psychiatry.

[45]  P. Lavori,et al.  Recovery in major depressive disorder: analysis with the life table and regression models. , 1982, Archives of general psychiatry.