The course of nonbipolar, primary major depression. A prospective 16-month study of ambulatory patients.

Abstract

This paper reports the 16-month clinical course of 96 ambulatory patients who met the Research Diagnostic Criteria for nonbipolar, nonpsychotic, primary major depressive disorder. In the first 4 months, the patients participated in a clinical trial comparing the efficacy of short term interpersonal psychotherapy with amitriptyline alone and in combination as treatments of depression. Seventy-two of the patients were re-evaluated 12 months after they completed study treatment. Over the 16-month period, none of the patients developed episodes of mania, hypomania, schizophrenia, or any other disorder which would have necessitated reclassification of the initial diagnosis. For most patients, the course of depressive symptoms and social functioning was one of improvement both during the 4-month study treatment period and during the subsequent 12 months. However, despite 4 months of study treatment, 14 per cent of the patients had not experienced a symptomatic recovery. At the follow-up evaluation 12 months after the study, 12 per cent were still depressed and 14 per cent had, during the poststudy period, experienced a relapse from which they had recovered. Although 3 per cent of the patients had made suicide attempts during the poststudy period, there were no completed suicides. The majority of patients sought additional outpatient psychotherapy, pharmacotherapy, or a combination of both treatments during the 12-month poststudy period, although the duration of any treatment they received was usually less than (i months. During this period also, 7 per cent of the patients were hospitalized. Evaluation of the treatment received by relapsers and chronically depressed patients revealed that most of the patients who relapsed during the poststudy period and sought treatment had recovered. The nine (13 per cent) patients who were depressed at the 12- month poststudy evaluation consisted of five (7 per cent) who had been inadequately treated during the poststudy period and four (6 per cent) treatment-resistant depressives who remained symptomatic despite adequate treatment. The findings suggest a) the stability of the Research Diagnostic Criteria diagnosis of nonbipolar primary major depression; and b) the need for the continuing availability and accessibility of follow-up psychiatric care for patients who have received brief outpatient interventions as treatment for a major depressive episode.