Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-22T06:01:38.923Z Has data issue: false hasContentIssue false

Residual symptoms of depression: clinical and theoretical implications

Published online by Cambridge University Press:  16 April 2020

Get access

Abstract

Residual symptoms of variable intensity often persist following pharmaco/or psychotherapeutic interventions for treatment of major depression (MD). In several studies, such persistent symptoms have been clearly shown to be associated with a higher risk of relapse, chronicity and functional impairment, but their true nature is still controversial. Several authors consider that these symptoms belong to the range of depression proper and thus indicate that the current episode has been inadequately treated, a hypothesis reinforced by their frequent similarity with the symptoms preceding the full-blown picture of MD. However, in the current state of research, their connection with certain personality traits or comorbid disorders—notably anxiety disorders—cannot be completely ruled out. This article reviews the main data from the literature concerning residual symptoms and their treatment, as well as the issues related to their psychopathological meaning. In practice, once the state of a patient has been stabilized in partial remission of the depressive syndrome, the clinician should revise the current therapeutic strategy and seek to find how to return as fully as possible to the previous euthymic state.

Type
Review
Copyright
Copyright © European Psychiatric Association 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association. Diagnostic and statistical manual for mental disorders (DSM-IV). Washington (DC): APA; 1994.Google Scholar
Angst, JKupfer, DJRosenbaum, JF.Recovery from depression: risk or reality? Acta Psychiatr Scand 1996;93:413–9.Google ScholarPubMed
Bakish, D.New standard of depression treatment: remission and full recovery. J Clin Psychiatry 2001;62(Suppl 26):5–9.Google ScholarPubMed
Barlow, DHCampbell, LA.Mixed anxiety-depression and its implications for models of mood and anxiety disorders. Compr Psychiatry 2000;41(Suppl 1):55–60.Google ScholarPubMed
Boulenger, JPLavallée, YJ.Mixed anxiety and depression: diagnostic issues. J Clin Psychiatry 1993;5(Suppl 1):3–8.Google Scholar
Boulenger, JPFournier, MRosales, DLavallée, YJ.Mixed anxiety and depression: from theory to practice. J Clin Psychiatry 1997;58(Suppl 8):27–34.Google ScholarPubMed
Brodaty, HHarris, LPeters, KWilhelm, KHickie, IBoyce, Pet al. Prognosis of depression in the elderly: a comparison with younger patients. Br J Psychiatry 1993;163:589–96.CrossRefGoogle ScholarPubMed
Cornwall, PLScott, J.Partial remission in depressive disorders. Acta Psychiatr Scand 1997;95:265–71.CrossRefGoogle ScholarPubMed
Escande, MFabre, S.Symptômes résiduels et rémissions incomplètes. Encéphale 1994;20:269–75.Google Scholar
Evans, MDHollon, SDDe Rubeis, RJPiasecki, JMGrove, WMGarvey, MJet al. Differential relapse following cognitive therapy and pharmacotherapy for depression. Arch Gen Psychiatry 1992;49:802–8.CrossRefGoogle ScholarPubMed
Ezquiaga, EGarcia, ABravo, FPallarés, T.Factors associated with outcome in major depression: a 6-month prospective study. Soc Psy chiatry Psychiatr Epidemiol 1998;33:552–7.CrossRefGoogle ScholarPubMed
Faravelli, CAmbonetti, APallanti, SPazzagli, A.Depressive relapses and incomplete recovery from index episode. Am J Psychiatry 1986; 143:888–91.Google ScholarPubMed
Fava, GA.Subclinical symptoms in mood disorders: pathophysiologi-cal and therapeutic implications. Psychol Med 1999;29:47–61.CrossRefGoogle Scholar
Fava, GAGrandi, SZielezny, MCanestrari, RMorphy, MA.Cognitive behavioral treatment of residual symptoms in primary major depressive disorder. Am J Psychiatry 1994;151:1295–9.Google ScholarPubMed
Fava, GAGrandi, SZielezny, MRafanelli, CCanestrari, R.Four-year outcome for cognitive behavioral treatment of residual symptoms in major depression. Am J Psychiatry 1996;153:945–7.Google ScholarPubMed
Fava, GARafanelli, CCazzaro, MConti, SGrandi, S.Well-being therapy. A novel psychotherapeutic approach for residual symptoms of affective disorders. Psychol Med 1998;28:475–80.Google ScholarPubMed
Fava, GARafanelli, CGrandi, SCanestrari, RMorphy, MA.Six-year outcome for cognitive behavioral treatment of residual symptoms in major depression. Am J Psychiatry 1998;155:1443–5.Google ScholarPubMed
Fava, GARafanelli, COttolini, FRuini, CCazzaro, MGrandi, S.Psychological well-being and residual symptoms in remitted patients with panic disorder and agoraphobia. J Affect Disord 2001;65:185–90.CrossRefGoogle ScholarPubMed
Ferrier, IN.Treatment of major depression: is improvement enough? J Clin Psychiatry 1999;60(Suppl 6):10–4.Google Scholar
Frank, EPrien, REJarrett, RBKeller, MBKupfer, DJLavoir, PNet al. Conceptualisation and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse and recurrence. Arch Gen Psychiatry 1991;48:287–97.CrossRefGoogle Scholar
Georgotas, AMcCue, RECooper, TBHagachandran, NChang, I.How effective and safe is continuation therapy in elderly depressed patients: factors affecting relapse rate. Arch Gen Psychiatry 1988;45: 929–32.CrossRefGoogle ScholarPubMed
Helmchen, HLinden, M.Subthreshold disorders in psychiatry: clinical reality, methodological artefact, and the double-threshold problem. Compr Psychiatry 2000;41(Suppl 1):1–7.Google Scholar
Johnson, JWeissman, MMKlerman, GL.Service utilization and social morbidity associated with depressive symptoms in the community. J Am Med Assoc 1992;267:1478–83.CrossRefGoogle Scholar
Judd, LLAskikal, HSMaser, JDZeller, PJEndicott, J CoryellW, et al. Major depressive disorder: a prospective study of residual subthresh-old depressive symptoms as predictor of rapid relapse. J Affect Disord 1998;50:97–108.CrossRefGoogle ScholarPubMed
Judd, LLPaulus, MJSchettler, PJAkiskal, HSEndicott, JLeon, ACet al. Does incomplete recovery from first lifetime major depressive episode herald a chronic course of illness? Am J Psychiatry 2000;157:1501–4.CrossRefGoogle Scholar
Kupfer, DJSpiker, DG.Refractory depression: prediction of nonre-sponse by clinical indicators. J Clin Psychiatry 1981;42:307–12.Google Scholar
MacEwan, GWRemick, RA.Treatment resistant depression: a clinical perspective. J Clin Psychiatry 1988;33:788–92.Google ScholarPubMed
Mintz, JMintz, LIArruda, MJHwang, SS.Treatment of depression and functional capacity to work. Arch Gen Psychiatry 1992;49:761–8.CrossRefGoogle ScholarPubMed
Mojtabai, R.Residual symptoms and impairment in major depression in the community. Am J Psychiatry 2001;158:1645–51.CrossRefGoogle Scholar
Nierenberg, AADeCecco, LM.Definitions of antidepressant treatment response, remission, nonresponse, partial response and other relevant outcomes: a focus on treatment-resistant depression. J Clin Psychiatry 2001;62(suppl 16):5–9.Google ScholarPubMed
Paykel, ES.Remission and residual symptomatology in major depression. Psychopathology 1998;31:5–14.CrossRefGoogle ScholarPubMed
Paykel, ESRamana, RCooper, ZHayhurst, HKerr, JBarocka, A.Residual symptoms after partial remission: an important outcome in depression. Psychol Med 1995;25:1171–80.CrossRefGoogle ScholarPubMed
Paykel, ESScott, JTeasdale, JDJohnson, ALGarland, AMoore, Ret al. Prevention of relapse in residual depression by cognitive therapy. Arch Gen Psychiatry 1999;56:829–35.CrossRefGoogle ScholarPubMed
Ramana, RPaykel, ESCooper, ZHayhurst, HSaxty, MSurtees, PG.Remission and relapse in major depression: a two-year prospective follow-up study. Psychol Med 1995;25:1161–70.Google ScholarPubMed
Rouillon, FMarkabi, SFebvre, NPhillips, RVaillant, J.Etude contrôlée du traitement des dépressions résiduelles par la clomipramine versus placebo. Encéphale 1994;20:139–45.Google Scholar
Scott, JTeasdale, JDPaykel, ESJohnson, ALAbbott, RHayhurst, Het al. Effects of cognitive therapy on psychological symptoms and social functioning in residual depression. Br J Psychiatry 2000; 177:440–6.Google ScholarPubMed
Shea, MTElkin, IImber, SDSotsky, SMWatkins, JTCollins, JFet al. Course of depressive symptoms over follow-up. Findings from the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Arch Gen Psychiatry 1992;49:782–7.CrossRefGoogle ScholarPubMed
Shea, MTLeon, ACMueller, TISolomon, DAWarshaw, MGKeller, MB.Does major depression result in lasting personality change? Am J Psychiatry 1996;153:1404–10.Google ScholarPubMed
Simons, ADMurphy, GELevine, JLWetzel, RD.Cognitive therapy and pharmacotherapy of depression: sustained improvement at one year. Arch Gen Psychiatry 1986;43:43–50.Google Scholar
Taylor, SMcLean, P.Outcome profiles in the treatment of unipolar depression. Behav Res Ther 1993;31:325–30.Google ScholarPubMed
Teasdale, JDScott, JMoore, RGHayhurst, HPope, MPaykel, ES.How does cognitive therapy prevent relapse in residual depression? Evidence from a controlled trial. J Consult Clin Psychol 2001;69: 347–57.CrossRefGoogle ScholarPubMed
Thase, MESimons, ADMcGreary, JCahalane, JFHughes, CHarden, Tet al. Relapse after cognitive therapy of depression: potential implications for longer courses of treatment. Am J Psychiatry 1992;149:1046–52.Google ScholarPubMed
Thase, MEEntsuah, ARRudolph, RL.Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors. Br J Psychiatry 2001;178:234–41.CrossRefGoogle ScholarPubMed
Van Londen, LMolenaar, RPGGoekoop, JGZwinderman, AHRooijmans, HGM.Three-to 5-year prospective follow-up of outcome in major depression. Psychol Med 1998;28:731–5.CrossRefGoogle ScholarPubMed
Wittchen, HUKessler, RCPfhister, HLieb, M.Why do people with anxiety disorders become depressed? A prospective-longitudinal community study. Acta Psychiatr Scan 2000;120(suppl 406):14–23.CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.