Course Of Major Depression Research Articles

Psychosocial factors and the long-term course of major depression

Fifty-nine subjects participated in a telephone follow-up interview 6 years after being hospitalized with a severe major depressive episode and 5 years after completing a 12 month follow-up study. Patient information was used to provide a rating of symptom-free ( n=19), episodic ( n=30), or chronic ( n=10) that described each patient's long-term course of illness. Few variables from the acute stage were related to long-term course of illness; however, early patterns of global and family functioning, number of life events, and rapid reduction in depressive symptomatology were found to be of prognostic significance. For patients whose depression is severe enough to warrant hospitalization, the pattern of functioning in the first few months after discharge from hospital is a strong indicator of the future long-term course.

The course of major depression in diabetes

The course of depression in patients with comorbid medical illness is poorly understood. We report a 5-year follow-up study of 25 diabetic patients who had participated in an 8-week depression treatment trial. When a patient completed the trial, primary physicians were informed of patient outcomes and advised to monitor for relapse and treat those with ongoing depression. At the 5-year reevaluation, depression was assessed using DSM-III-R criteria, and a depression severity scale was formed that reflected the presence, severity, frequency, and duration of depression episodes as well as a global assessment of functioning. Recurrence or persistence of depression occurred in 23 (92%) of the patients with an average of 4.8 depression episodes over the 5-year follow-up period. The duration of the longest episode averaged 16 ± 4 months. Teversion to major depression occurred frequently and rapidly also in the subset that remitted during the treatment trial: 58.3% were depressed again within the first year. At the time of the follow-up interview, major depression was evident in 16 (64%) of the subjects, and glycemic control was significantly worse in this group compared with those without depression (gHb: 13.3% ± 2.6% vs 11.1% ± 1.9%, p = 0.03). Severity of depression over follow-up was related to the presence of neuropathy at entry and to incomplete remission during the initial treatment trial. Nineteen patients (82.6% of those who relapsed) received additional courses of antidepressant therapy, but none was treated continuously for depression prophylaxis. In this diabetic sample, depression was a recurrent condition in the vast majority of cases, and initial treatment response did not confer lasting euthymia. Whether maintenance antidepressant medication would be useful in preventing depression recurrence and promoting better glycemic control in diabetes remains to be studied.

Five-year course of major depression: Effects of comorbid alcoholism

Some patients enter psychiatric treatment with clear cases of both major depression and alcoholism. While assumptions are often made about the relationships of these two conditions, little empirical evidence exists on the effects of sustained remissions in alcoholism on sustained remissions in depression. 127 patients with both disorders at treatment entry were studied over a 5-year period. Survival analyses with time-dependent covariates indicating alcoholism status were used to investigate remissions and relapses in major depression. Remission in alcoholism strongly and significantly increased the chances of remission in depression and were also related to reduced chances of depression relapse, although at a weaker level.

RELIABILITY OF DIAGNOSIS IN MOOD DISORDERS

The reliability of diagnosing mood disorders is reviewed for previous and current versions of the American Psychiatric Association's DMS. Reliability is shown to improve with the increasing specificity of diagnostic criteria. The new specifiers for the course of major depression in relation to dysthymia also are shown to be reliable.

Predicting the One-Year Course of Adolescent Major Depression

To identify specific clinical and social functioning variables that predict persistence of major depression over a 1-year period of follow-up. The sample consisted of 67 adolescents with major depression, drawn from consecutive referrals to psychiatric clinics in a defined, geographic catchment area. Clinical interviews and questionnaires measuring behaviors, symptoms, and social functioning were administered to both the adolescent and a parent at inception and at follow-up. Discriminant function analyses were used to identify inception variables that predicted clinical course independent of severity of depressive symptoms and global functioning. At 1-year follow-up, major depression remitted in 66% of subjects. Persisters were characterized at inception as older, more likely to have substance use or anxiety disorders, less involved with fathers, and less responsive to mother's discipline compared with remitters. The effect of these prognostic factors was independent of symptom severity and global functioning. These variables appear to reflect perpetuating and ameliorating factors influencing the short-term course of major depression. The findings suggest that treatments for adolescent depression that aim to enhance parent-adolescent relationships, and that specifically target coexisting disorders, should be evaluated for effectiveness.

Borderline hypothyroidism and depression.

This review defines subclinical hypothyroidism and examines its influence on the occurrence and course of major depression. Recommendations are presented for the identification and treatment of patients with coexisting mood disorders and borderline thyroid failure.

Treatment of depression in late life

Depression is a common, but treatable, source of suffering, excess disability, and caregiver strain in late life. It is important to take a long-term view of the treatment of late-life depression because of the high risk for relapse, recurrence, and chronic illness. Elderly patients with medical and neurological illness or bereavement-related depressions also merit greater attention. Recent data highlight several important caveats: (a) the role of medical and psychosocial factors in the course of major depression; (b) variability in etiology, clinical presentation, and treatment response; (c) need for additional studies of syndromal and subsyndromal depression in primary and long-term care facilities, particularly in patients >75 years of age; and (d) importance of continuation and maintenance treatment to maintain quality of life and to lower the risk for chronic illness. Nortriptyline, desipramine, and the newer selective serotonin reuptake inhibitors (SSRIs), paroxetine and sertraline, are preferred pharmacotherapy for short-erm and long-term treatment. The newer SSRIs should be further studied in controlled trials of elderly depressed patients, including those >75 years and those with medical or neurological illness. Psychotherapy also appears to be of major importance in successful outcome but, as does pharmacotherapy, merits further controlled investigation in both short- and long-term clinical trials.

Cigarette smoking: implications for psychiatric illness

Psychiatry has been essentially uninterested in cigarette smoking and nicotine. However, it is the view of this author that both cigarette smoking and smoking cessation are highly relevant to the clinical psychiatrist in the care of patients and that they are potentially a source of important insights into psychopathology. To support that view, the author reviews the evidence that both major depression and depressive symptoms are associated with a high rate of cigarette smoking and that lifetime history of major depression has an adverse impact on smoking cessation. He also reviews the data available on the influence of cigarette smoking cessation on the course of major depression, the relationship between cigarette smoking and other psychiatric diagnoses, particularly schizophrenia, and the neuropharmacology that might underlie these associations. Finally, the implications of these relationships for psychiatry are discussed.

Personality Functioning: Change and Stability in Relationship to Symptoms and Psychopathology

Traditional concepts of personality emphasize the relatively stable and enduring aspects of an individual's functioning. In the present article we draw attention to the clinically important fluctuations and changes in personality in many psychiatric patients, particularly those with affective and anxiety disorders, which we term personality functioning. We delineate our concept of personality functioning in relation to personality in general and to symptoms, and outline areas in which fluctuations and changes in personality traits may occur. With this concept in mind we then reevaluate studies on the stability or instability of personality traits in affective disorders, on the symptom course in major depression treated with antidepressants or psychological means, and on personality in anxiety disorders. The findings lend support to our concept. Finally, we discuss the possible clinical and theoretical implications and make suggestions for further research.

Family functioning and major depression: an overview

The authors review the evidence supporting the idea that the family plays a major role in the development and course of major depression. They find that the family pathology evident during an acute depressive episode continues after the patient's remission; that the course of depressive illness, relapse rates, and suicidal behavior are all affected by family functioning; and that children of depressed parents are at high risk for psychopathology. The authors explore unresolved issues regarding our understanding of the factors mediating the interaction between major depression and family functioning, concluding that there is evidence to support family and marital interventions, particularly in the treatment of depressed women.

DST abnormality as a predictor of course in major depression

Seventy-six inpatients with major depression received a 1-mg dexamethasone suppression test (DST) and began a semi-annual follow-up lasting 5 years. The 20 subjects with abnormal baseline DST results were significantly more likely to make psychologically serious suicide attempts during follow-up though baseline suppressors were as likely as non-suppressors to make non-serious attempts. Patients who were non-suppressors at the beginning of follow-up were also more likely to develop mania or hypomania, whether or not they had a bipolar diagnosis at intake.

A Two Year Longitudinal Study of Poststroke Mood Disorders: Prognostic Factors Related to One and Two Year Outcome

In a prospective study of mood disorders in 103 stroke patients, we examined the predictive value of affective, cognitive, social and neurologic variables obtained in-hospital and at six months poststroke in terms of outcome as determined by the same measures at one and two years follow-up. The following factors were found to have prognostic significance: 1) Lesion Location: proximity of the lesion on CT scan to the frontal pole in patients with left anterior infarcts showed a strong positive relationship with severity of depression at one year but not at two years poststroke. 2) Affective Status: depression (in-hospital and at 6 months) strongly predicted depression at one year but not at two years poststroke. Additionally, in-hospital depression significantly correlated with physical impairment at two years, while depression at six months bore a moderate relationship to physical impairment at one year. 3) Physical Impairment: impairment in activities of daily living in-hospital bore a modest relationship to depression at one year while such impairment at six months correlated strongly with depression at both one and two years. These findings may reflect the natural course of major depression which remits between one and two years poststroke. Although stroke lesion location is the strongest predictor of subsequent depression, there appears to be a reciprocal relationship between physical impairment and depression (i.e., depression predicts impairment and impairment predicts depression). Since poststroke depressions are amenable to therapeutic intervention, these prognostic factors may have implications for the treatment and rehabilitation of stroke patients.

Course of major depression in non-referred adolescents: a retrospective study

This article reports on a naturalistic study of the course of illness of 38 children diagnosed as having a current or past episode of major depression out of a sample of 275 children who were selected by a method not related to their psychopathology or treatment-seeking behavior. Assessments of the presence of depression and the course of this disorder were made using structured clinical interviews (DICA and DICA-P) and a criterion-based diagnostic system (DSM-III). Longitudinal methods of data analysis included the use of life tables. The proportion of children depressed for 2 years closely resembles the results found in investigations of children who sought treatment for a psychiatric disorder. The probability of remaining depressed in these children was 21% at 1 year after onset, and10% at the 2-year point. This parallels the rate of chronicity and the decline in rates of recovery which occur over time in adult depression.

The influence of medication on the course of major depression: a 3-year-follow-up with polydiagnostic measures.

The influence of medication on the course of major depression: a 3-year-follow-up with polydiagnostic measures.

Prediction of course in major depression. Does psychopathology predict future drug intake or relapse?

Prediction of course in major depression. Does psychopathology predict future drug intake or relapse?

The prognostic relevance of delusions in depression: a follow-up study.

To determine whether delusional depression has a different clinical course from other types of depression, the authors followed up 31 unipolar delusional depressed patients, 28 unipolar nonpsychotic depressed patients, and 51 schizophrenic patients 14 months after hospital discharge. Patients were assessed on 1) overall outcome, 2) psychotic, anxiety-neurotic, and depressive symptoms, 3) social and work functioning, and 4) rehospitalization. The delusional depressed patients showed significantly more mood-incongruent delusions at follow-up. Surprisingly, the nonpsychotic depressed patients exhibited more depressed mood and significantly more anxiety at follow-up. The findings suggest that the diagnostic distinction between delusional and nonpsychotic depression is relevant to the clinical course of major depression.

Two-year longitudinal study of post-stroke mood disorders: dynamic changes in correlates of depression at one and two years.

As part of a prospective study of 103 stroke patients, we have analyzed the relation between depression and associated variables at 3 months, 6 months, 1 year, and 2 years after stroke. At all intervals up to and including 1 year poststroke, patients with left hemisphere strokes showed a strong relation between severity of depression and distance of the lesion on computed tomography scan from the frontal pole. At 2 years poststroke, this relation was no longer significant. The correlation between depression and impairment in activities of daily living peaked at 6 months and thereafter fell but remained significant at 1 and 2 years poststroke. The correlation between depression and cognitive impairment and between depression and social functioning fluctuated--with most correlations at 1 and 2 years follow-up nonsignificant. Although the conclusions that can be drawn from this study are limited by the fact that less than half of the original patients were followed up at each time, these declining correlations between depression and associated variables at 1 and 2 years follow-up may reflect the natural course of major depression which spontaneously remits between 1 and 2 years after stroke. The persisting significant association of impairment in activities of daily living with depression may reflect the effect of severe depression in sustaining and possibly retarding recovery from physical impairment.

Family functioning and the course of major depression

Thirty-eight psychiatric inpatients with major depression and their families were assessed during the acute phase of the depressive disorder and at remission or 12-month follow-up. They were matched to 28 nonclinical control families. Depressed families reported worse family functioning than control families, both during the acute episode and at remission. The depressive episode was significantly shorter (4.1 months) in those families that improved in family functioning during follow-up than in those that did not (8.1 months) improve. The family's perception of its functioning during the acute episode was not a good predictor of the length of depression for its family member.

Screening for depression in geriatric medical patients.

Depression, a common and treatable psychiatric disorder in later life, is often overlooked in geriatric medical patients. The authors evaluated the validity of two self-rating depression scales, the Zung Self-Rating Depression Scale and the Popoff Index of Depression, for 55 elderly patients. They compared these ratings with the diagnosis assigned by a psychiatrist who was blind to scale results and who interviewed these patients using DSM-III criteria. The two scales correctly classified 80% and 69% of the subjects, respectively. The authors identify six items from the two scales that may serve as a simple screening instrument for the detection of depression in geriatric medical patients.