Course trajectories of unipolar depressive disorders identified by latent class growth analysis

Abstract

Background. Current classification of unipolar depression reflects the idea that prognosis is essential. However, do DSM categories of major depressive disorder (MDD), dysthymic disorder (Dysth) and double depression (DD=MDD+Dysth) indeed adequately represent clinically relevant course trajectories of unipolar depression ? Our aim was to test DSM categories (MDD, Dysth and DD) in comparison with empirically derived prognostic categories, using a prospectively followed cohort of depressed patients.Method. A large sample (n=804) of out-patients with unipolar depression were derived from a prospective cohort study, the Netherlands Study of Depression and Anxiety (NESDA). Using latent class growth analysis (LCGA), empirically derived 2-year course trajectories were constructed. These were compared with DSM diagnoses and a wider set of putative predictors for class membership.Results. Five course trajectories were identified, ranging from mild severity and rapid remission to high severity and chronic course trajectory. Contrary to expectations, more than 50 % of Dysth and DD were allocated to classes with favorable course trajectories, suggesting that current DSM categories do not adequately represent course trajectories. The class with the most favorable course trajectory differed on several characteristics from other classes (younger age, more females, less childhood adversity, less somatic illnesses, lower neuroticism, higher extraversion). Older age, earlier age of onset and lower extraversion predicted poorest course trajectory.Conclusions. MDD, Dysth and DD did not adequately match empirically derived course trajectories for unipolar depression. For the future classification of unipolar depression, it may be wise to retain the larger, heterogeneous category of unipolar depression, adopting cross-cutting dimensions of severity and duration to further characterize patients.

The Four-Year Course of Major Depressive Disorder: The Role of Staging and Risk Factor Determination

“…Our study also corroborates the findings of previous studies [12,13,20] by showing that clinical factors played an important role in predicting the course of MDD. For example, MDD severity was a strong and independent risk factor for the course of nonchronic as well as chronic MDD at baseline.…”

“…For example, clinical factors, such as MDD characteristics (e.g. depression severity or an early age of onset of MDD [12]) and psychiatric comorbidity [13], are risk factors for a poor prognosis of MDD. In addition, sociodemographics (e.g.…”

Data-Driven Course Trajectories in Primary Care Patients With Major Depressive Disorder

“…[13] Notably, several studies have used mixture models in treatment trials [14][15][16][17][18][19] and cohort studies. [20] Despite the use of similar techniques, the number of identified course groups varied (2)(3)(4)(5). This could be explained by differences in numbers of follow-ups (7 [14] to 24 [20]), interval lengths (1 week [18] to 3 months [14]), and instruments.…”

Failure to Respond after Reinstatement of Antidepressant Medication: A Systematic Review

“…For depressive disorders, it is known that with an increasing number of episodes the likelihood of symptom occurrence also increases [50][51][52][53], potentially resulting in a chronic course with a more severe symptomatology [54]. Thus, the effectiveness of the antidepressants may remain unchanged, but the underlying disorder may become more severe and can no longer be effectively treated.…”

“…Although a failure to respond only seems to occur in a minority of patients restarting antidepressants (16.5%, range 3.8-42.9%), it is of clinical relevance given the high number of patients taking antidepressants [1], the occurrence of the phenomenon in all common classes of antidepressants, the high prevalence of anxiety disorders, depressive disorders, OCD, and PTSD [11], and the tendency of these disorders to run a chronic course in which the occurrence of symptoms is common [24,25,54,[59][60][61][62][63][64][65][66][67][68][69][70].…”