Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-19T05:55:49.505Z Has data issue: false hasContentIssue false
  • English
  • Français

Remission and relapse in major depression: a two-year prospective follow-up study

Published online by Cambridge University Press:  09 July 2009

R. Ramana ,
E. S. Paykel ,
Z. Cooper ,
H. Hayhurst ,
M. Saxty  and
P. G. Surtees
R. Ramana*
Affiliation:
Department of Psychiatry, University of Cambridge
E. S. Paykel
Affiliation:
Department of Psychiatry, University of Cambridge
Z. Cooper
Affiliation:
Department of Psychiatry, University of Cambridge
H. Hayhurst
Affiliation:
Department of Psychiatry, University of Cambridge
M. Saxty
Affiliation:
Department of Psychiatry, University of Cambridge
P. G. Surtees
Affiliation:
Department of Psychiatry, University of Cambridge
*
1 Address for correspondence: Dr R. Ramana, Fulbourn Hospital, Box 351, Cambridge CB1 5EF.
Get access Rights & Permissions [Opens in a new window]

Synopsis

This paper reports the course with respect to remission and relapse of a cohort of predominantly in-patient RDC major depressive subjects, who were followed at 3-monthly intervals to remission and for up to 15 months thereafter. Remission was comparatively rapid with 70% of subjects remitting within 6 months. Only 6% failed to do so by 15 months. However, 40% relapsed over the subsequent 15 months, with all the relapses occurring in the first 10 months. Greater severity of the depression and longer duration of the illness predicted a longer time to remission. Greater initial severity of depression also predicted relapse. Subjects with a worse outcome had not received less adequate treatment than the remainder. Our results confirm the comparatively poor outcome subsequent to remission that has been reported in recent literature, in spite of the availability of modern methods of treatment. The clustering of relapses in the first 10 months gives some support to the distinction between relapse and later recurrence.

Type
Original Articles
Information
Psychological Medicine , Volume 25 , Issue 6 , November 1995 , pp. 1161 - 1170
Copyright
Copyright © Cambridge University Press 1995

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

REFERENCES

Akiskal, H. S., Bitar, A. H., Pazantian, V. R., Rosenthal, T. L. & Parks, W. W. (1978). The nosological status of neurotic depression. Archives of General Psychiatry 35, 757–766.CrossRefGoogle ScholarPubMed
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders (3rd edn. Revised). American Psychiatric Association: Washington, DC.Google Scholar
American Psychiatric Association (1993). Practice Guideline for Major Depressive Disorder in Adults. American Journal of Psychiatry 150 (Supplement).Google Scholar
Andrew, B., Hawton, K., Fagg, J. & Westbrook, D. (1993). Do psychosocial factors influence outcome in severely depressed female psychiatric outpatients? British Journal of Psychiatry 163, 747–754.CrossRefGoogle Scholar
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. E. & Erbaugh, J. K. (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561–571.CrossRefGoogle ScholarPubMed
Bratfos, O. & Haug, J. O. (1968). The course of manic depressive psychosis: a follow-up investigation of 215 patients. Acta Psychiatrica Scandinavica 44, 89–112.CrossRefGoogle ScholarPubMed
Brodaty, H., Harris, L., Peters, K., Wilhelm, K., Hickie, I., Boyce, P., Mitchell, P., Parker, G. & Eyers, K. (1993). Prognosis of depression in the elderly: a comparison with younger patients. British Journal of Psychiatry 163, 589–596.CrossRefGoogle ScholarPubMed
Carney, M. W. P., Roth, M. & Garside, R. F. (1965). The diagnosis of depression syndromes and the prediction of ECT response. British Journal of Psychiatry 3, 659–674.CrossRefGoogle Scholar
Coryell, W., Zimmerman, M. & Pfohl, B. (1985). Short-term prognosis in primary and secondary major depression. Journal of Affective Disorders 9, 265–270.CrossRefGoogle ScholarPubMed
Frank, E., Prien, R. F., Jarrett, R. B., Keller, M. B., Kupfer, D. J., Lavori, P. W., Rush, A. J. & Weissman, M. M. (1991). Conceptualisation and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse and recurrence. Archives of General Psychiatry 48, 851–855.CrossRefGoogle ScholarPubMed
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 56–62.CrossRefGoogle ScholarPubMed
Hinrichsen, G. A. & Hernandez, N. A. (1993). Factors associated with recovery from and relapse into major depressive disorder in the elderly. American Journal of Psychiatry 150, 1820–1825.Google ScholarPubMed
Kaplan, E. L. & Meier, P. (1958). Non-parametric estimations from incomplete observations. Journal of the American Medical Association 53, 457–481.Google Scholar
Kay, D. W. K., Garside, R. F., Roy, J. R. & Beamish, P. (1969). Endogenous symptoms in neurotic syndromes of depression; a 5 to 7 year follow-up. British Journal of Psychiatry 115, 389–399.CrossRefGoogle Scholar
Keller, M. B., Shapiro, R. W., Lavori, P. W. & Wolfe, N. (1982 a). Recovery in major depressive disorder: analysis with the life table and regression models. Archives of General Psychiatry 39, 905–910.CrossRefGoogle ScholarPubMed
Keller, M. B., Shapiro, R. W., Lavori, P. W. & Wolfe, N. (1982 b). Relapse in major depressive disorder: analysis with the life event table. Archives of General Psychiatry 39, 911–915.CrossRefGoogle Scholar
Keller, M., Lavori, P. W., Lewis, C. E. & Klerman, G. L. (1983). Predictors of relapse in major depression. Journal of the American Medical Association 250, 3299–3304.CrossRefGoogle Scholar
Keller, M. B., Klerman, G. L., Lavori, P. W., Coryell, W., Endicott, J. & Taylor, J. (1984). Long-term outcome of episodes of major depression: clinical and public health significance. Journal of the American Medical Association 252, 788–792.CrossRefGoogle ScholarPubMed
Keller, M. B., Lavori, P. W., Rice, J., Coryell, W. & Hirschfeld, R. M. A. (1986 a). The persistent risk of chronicity in recurrent episodes of nonbipolar major depressive disorder: a prospective follow-up. American Journal of Psychiatry 143, 24–28.Google ScholarPubMed
Keller, M. B., Lavori, P. W., Klerman, G. L., Andreasen, N. C., Endicott, J., Coryell, W., Fawcett, J., Rice, J. P. & Hirschfeld, R. M. a. (1986 b). Low levels and lack of predictors of somatotherapy and psychotherapy received by depressed patients. Archives of General Psychiatry 43, 548–566.CrossRefGoogle ScholarPubMed
Keller, M. B., Lavori, P. W., Mueller, T. I., Endicott, J., Coryell, W., Hirschfeld, R. M. A. & Shea, T. (1992). Time to recovery, chronicity, and levels of psychopathology in major depression. A 5-year prospective follow-up of 431 subjects. Archives of General Psychiatry 49, 809–816.CrossRefGoogle ScholarPubMed
Kiloh, L. G., Andrews, G. A. & Neilson, M. (1988). The long-term outcome of depressive illness. British Journal of Psychiatry 153, 752–757.CrossRefGoogle ScholarPubMed
Klerman, G. L., Endicott, J., Spitzer, R. & Hirschfeld, R. (1979). Neurotic depressions: a systematic analysis of multiple criteria and meanings. American Journal of Psychiatry 136, 57–61.Google ScholarPubMed
Kraepelin, E. (1921). Manic Depressive Insanity and Paranoia. E. & S. Livingstone: Edinburgh.CrossRefGoogle Scholar
Lee, A. S. & Murray, R. M. (1988). The long-term outcome of Maudsley depressives. British Journal of Psychiatry 153, 741–751.CrossRefGoogle ScholarPubMed
Lundquist, G. (1945). Prognosis and course in manic depressive psychosis. A follow-up study of 319 first admissions. Acta Psychiatrica et Neurologica 35 (suppl. 1), 1–96.Google Scholar
Parker, G., Hadzi-Pavlovic, D., Brodaty, H., Boyce, P., Mitchell, P., Wilhelm, K. & Hickie, I. (1992). Predicting the course of melancholic and nonmelancholic depression. A naturalistic comparison study. Journal of Nervous and Mental Disease 180, 673–682.CrossRefGoogle ScholarPubMed
Paykel, E. S. (1985). The Clinical Interview for Depression: development, reliability and validity. Journal of Affective Disorders 9, 85–96.CrossRefGoogle ScholarPubMed
Paykel, E. S., Klerman, G. L. & Prusoff, B. A. (1974). Prognosis of depression and the endogenous—neurotic distinction. Psychological Medicine 4, 57–64.CrossRefGoogle ScholarPubMed
Paykel, E. S., Hollyman, J. A., Freeling, P. & Sedgwick, P. (1988). Predictors of therapeutic benefit from amitriptyline in mild depression: a general practice placebo-controlled trial. Journal of Affective Disorders 14, 83–95.CrossRefGoogle ScholarPubMed
Paykel, E. S., Ramana, R., Cooper, Z., Hayhurst, H., Kerr, J. & Barocka, A. (1995). Residual symptoms after partial remission: an important outcome in depression. Psychological Medicine 25, 1171–1180.CrossRefGoogle ScholarPubMed
Paykel, E. S., Cooper, Z., Ramana, R. & Hayhurst, H. (1996). Life events, social support and marital relationships in the outcome of severe depression. Psychological Medicine (in the press).CrossRefGoogle Scholar
Poort, R. (1945). Catamnestic investigations on manic depressive psychosis with special reference to the prognosis. Acta Psychiatrica et Neurologica 20, 59–74.CrossRefGoogle Scholar
Prien, R. F. (1992). Maintenance treatment. In Handbook of Affective Disorders, 2nd edn. (ed. Paykel, E. S.), pp. 419–435. Churchill Livingstone: Edinburgh.Google Scholar
Rao, A. V. & Nammalvar, N. (1977). The course and outcome of depressive illness: a follow up study of 122 cases in Madurai, India. British Journal of Psychiatry 130, 392–396.CrossRefGoogle ScholarPubMed
Raskin, A., Schulterbrandt, J. G., Reatig, N. & McKeon, J. J. (1970). Differential response to chlorpromazine, imipramine and placebo. A study of sub-groups of hospitalised depressed patients. Archives of General Psychiatry 43, 43–50.Google Scholar
Sargeant, J. K., Bruce, M. L., Florio, L. P. & Weissman, M. M. (1990). Factors associated with 1-year outcome of major depression in the community. Archives of General Psychiatry 47, 519–526.CrossRefGoogle ScholarPubMed
Sireling, L. I., Freeling, P., Paykel, E. S. & Rao, B. M. (1985). Depression in general practice: comparison with out-patients. British Journal of Psychiatry 147, 119–126.CrossRefGoogle ScholarPubMed
Spitzer, R. L., Endicott, J. & Robins, E. (1978). Research Diagnostic Criteria: rationale and reliability. Archives of General Psychiatry 35, 773–782.CrossRefGoogle ScholarPubMed
Surtees, P. G. & Barkley, C. (1994). Future imperfect: the long-term outcome of depression. British Journal of Psychiatry 164, 327–341.CrossRefGoogle ScholarPubMed
Surtees, P. G., Sashidharan, S. P. & Dean, C. (1986). Affective disorder amongst women in the general population. British Journal of Psychiatry 148, 176–186.CrossRefGoogle ScholarPubMed
Tyrer, P. (ed.) (1988). Personality Disorders: Diagnosis, Management and Course. Wright: London.Google Scholar
Vaughn, C. E. (1976). The measurement of expressed emotion in the families of psychiatric patients. British Journal of Social and Clinical Psychology 15, 157–165.CrossRefGoogle ScholarPubMed
Watts, C. A. H. (1956). The incidence and prognosis of endogenous depression. British Medical Journal 1, 1392–1397.CrossRefGoogle ScholarPubMed
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974). The Measurements and Classification of Psychiatric Symptoms. Cambridge University Press: Cambridge.Google Scholar
Winokur, G. & Morrison, J. (1973). The Iowa 500: follow-up of 225 depressives. British Journal of Psychiatry 123, 543–548.CrossRefGoogle ScholarPubMed
WHO (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. World Health Organization: Geneva.Google Scholar