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

Ramana, Rajini; Paykel, Eugene S.; Cooper, Zafra; Hayhurst, Hazel; Saxty, M; Surtees, Paul G.

doi:10.1017/s0033291700033134

Cited by 214 publications

(164 citation statements)

References 41 publications

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“…Several researchers have found that an increased Hamilton score, reflecting the presence of a large number of symptoms and/or several severe symptoms, predicts recurrent episodes in adult inpatient samples (e.g., Belsher & Costello, 1988;O'Leary et al, 2000;Ramana et al, 1995). However, there have been a few exceptions, including two studies of children and adolescents which found that severity of depression, as indicated by an extracted Hamilton score, does not predict later recurrent episodes (Birmaher et al, 2004;Rao et al, 1995).…”

Section: Severity Of First/index Episodementioning

confidence: 99%

“…Scores are derived by summing the responses to each of the 21 items, with scores of 14-19 generally indicating mild depression, 20-28 suggesting moderate depression, and 29-63 indicating severe depression. The Hamilton Rating Scale is a similar measure of severity of seventeen depressive symptoms (Hamilton, 1960;Ramana et al, 1995), and, despite the different reporting method, scores on this scale correlate quite highly with those on other depression inventories such as the BDI (Dozois, 2003).Another issue in defining "depression" regards whether other forms of psychopathology are excluded. This is clearly important regarding bipolar disorder.…”

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confidence: 99%

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Risk for recurrence in depression

Burcusa

Iacono

2007

Clinical Psychology Review

862

683

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Depression is a highly recurrent disorder with significant personal and public health consequences. Prevention of recurrence would be extremely desirable, and thus researchers have begun to identify risk factors that are specific to recurrence, which may be different from risk factors for first-onset of depression. Methodological issues in this area of research are briefly reviewed (e.g., the various definitions of "recurrence" and "depression"), followed by a review of studies on specific risk factors, including demographic variables (gender, socio-economic status, marital status), clinical variables (age at first onset, number of prior episodes, severity of first/index episode, comorbid psychopathology), family history of psychopathology, and psychosocial and psychological variables (level of psychosocial functioning, cognitions, personality, social support, and stressful life events). In addition, scar theories are evaluated for their potential to explain how these variables and recurrent depression are linked. Our review suggests that recurrent depression reflects an underlying vulnerability that is largely genetic in nature and that may predispose those high in the vulnerability not only to recurrent depressive episodes, but also to the significant psychosocial risk factors that often accompany recurrent depression.Major depressive disorder is one of the most common forms of psychopathology, one that will affect approximately one in six men and one in four women in their lifetimes . It is also usually highly recurrent, with at least 50% of those who recover from a first episode of depression having one or more additional episodes in their lifetime, and approximately 80% of those with a history of two episodes having another recurrence (American Psychiatric Association, 2000;Kupfer, Frank, & Wamhoff, 1996;Post, 1992). Once a first episode has occurred, recurrent episodes will usually begin within five years of the initial episode (Belsher & Costello, 1988;Lewinsohn, Clarke, Seeley, & Rohde, 1994), and, on average, individuals with a history of depression will have five (Kessler & Walters, 1998) to nine (Kessler, Zhao, Blazer, & Swartz, 1997) separate depressive episodes in their lifetime.Due to the fact that depression can be so recurrent, it can have significant personal and public health consequences. For example, one meta-analysis found that the suicide rate among those with depression is approximately twenty times higher than the rate for the general population (Harris & Barraclough, 1997). In addition, a study of over 3000 adolescents and young adults found that 90% of those with recurrent depression reported "very much" impairment, limiting work productivity and social interactions, and 40% sought professional help as a result (Wittchen, Nelson, & Lachner, 1998). Depression can also have a significant economic impact due to decreased productivity in affected individuals (Klerman & Weissman, 1992); in 1996 the annual direct (e.g., visits to doctors, pharmaceutical costs) and indirect (e.g., time...

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Section: Severity Of First/index Episodementioning

confidence: 99%

mentioning

confidence: 99%

Risk for recurrence in depression

Burcusa

Iacono

2007

Clinical Psychology Review

862

683

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“…Moreover, the high rate of recurrence of major depressive disorder may stem from undertreatment of the illness, as reflected by the persistence of residual symptoms. 20,[205][206][207] It is similarly possible that those treatments which permit residual dysthymic features to persist (eg, inadequate antidepressant dosage or insufficient duration of treatment) may also favor recurrence of this illness. It is certainly conceivable that by virtue of its effects on the secondary features of dysthymia, CBT may act to limit illness recurrence.…”

Section: Psychosocial Factors and Stressors In Major Depressive Disormentioning

confidence: 99%

Dysthymia: a review of pharmacological and behavioral factors

et al. 2000

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Although dysthymia, a chronic, low-grade form of depression, has a morbidity rate as high as that of major depression, and increases the risk for major depressive disorder, limited information is available concerning the etiology of this illness. In the present report we review literature concerning the biological and characterological features of dysthymia, the effectiveness of antidepressant treatments, the influence of stressors in the precipitation and maintenance of the disorder, and both quality of life and psychosocial correlates of the illness. We also provisionally suggest that dysthymia may stem from disturbances of neuroendocrine and neurotransmitter functioning (eg, corticotropin releasing hormone and arginine vasopressin within the hypothalamus, or alternatively monoamine variations within several extrahypothalamic sites), and may also involve cytokine activation. The central disturbances may reflect phenotypic variations of neuroendocrine processes or sensitization of such mechanisms. It is suggested that chronic stressor experiences or stressors encountered early in life lead to the phenotypic neurochemical alterations, which then favor the development of the dysthymic state. Owing to the persistence of the neurochemical disturbances, vulnerability to double depression is increased, and in this instance treatment with antidepressants may attenuate the symptoms of major depression but not those of the basal dysthymic state. Moreover, the residual features of depression following treatment may be indicative of underlying neurochemical disturbances, and may also serve to increase the probability of illness recurrence or relapse. Molecular Psychiatry (2000) 5, 242-261.

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“…In longitudinal studies in mixed-age samples, the presence of these residual symptoms consistently predicts increased risk of recurrence (Judd et al, 1998;Kanai et al, 2003;Karp et al, 2004;Paykel et al, 1995;Ramana et al, 1995;Van Londen et al, 1998). However, little is known about which particular residual symptoms impact long-term outcmes in late-life depression.…”

Section: Introductionmentioning

confidence: 99%