Skip to main content Accessibility help

Residual symptoms of depression: clinical and theoretical implications

  • Jean-Philippe Boulenger


Residual symptoms of variable intensity often persist following pharmaco/or psychotherapeutic interventions for treatment of major depression (MD). In several studies, such persistent symptoms have been clearly shown to be associated with a higher risk of relapse, chronicity and functional impairment, but their true nature is still controversial. Several authors consider that these symptoms belong to the range of depression proper and thus indicate that the current episode has been inadequately treated, a hypothesis reinforced by their frequent similarity with the symptoms preceding the full-blown picture of MD. However, in the current state of research, their connection with certain personality traits or comorbid disorders—notably anxiety disorders—cannot be completely ruled out. This article reviews the main data from the literature concerning residual symptoms and their treatment, as well as the issues related to their psychopathological meaning. In practice, once the state of a patient has been stabilized in partial remission of the depressive syndrome, the clinician should revise the current therapeutic strategy and seek to find how to return as fully as possible to the previous euthymic state.


Corresponding author

E-mail (J.-P. Boulenger).


Hide All
[1]American Psychiatric Association. Diagnostic and statistical manual for mental disorders (DSM-IV). Washington (DC): APA; 1994.
[2]Angst, JKupfer, DJRosenbaum, JF.Recovery from depression: risk or reality? Acta Psychiatr Scand 1996;93:413–9.
[3]Bakish, D.New standard of depression treatment: remission and full recovery. J Clin Psychiatry 2001;62(Suppl 26):5–9.
[4]Barlow, DHCampbell, LA.Mixed anxiety-depression and its implications for models of mood and anxiety disorders. Compr Psychiatry 2000;41(Suppl 1):55–60.
[5]Boulenger, JPLavallée, YJ.Mixed anxiety and depression: diagnostic issues. J Clin Psychiatry 1993;5(Suppl 1):3–8.
[6]Boulenger, JPFournier, MRosales, DLavallée, YJ.Mixed anxiety and depression: from theory to practice. J Clin Psychiatry 1997;58(Suppl 8):27–34.
[7]Brodaty, HHarris, LPeters, KWilhelm, KHickie, IBoyce, Pet al. Prognosis of depression in the elderly: a comparison with younger patients. Br J Psychiatry 1993;163:589–96.
[8]Cornwall, PLScott, J.Partial remission in depressive disorders. Acta Psychiatr Scand 1997;95:265–71.
[9]Escande, MFabre, S.Symptômes résiduels et rémissions incomplètes. Encéphale 1994;20:269–75.
[10]Evans, MDHollon, SDDe Rubeis, RJPiasecki, JMGrove, WMGarvey, MJet al. Differential relapse following cognitive therapy and pharmacotherapy for depression. Arch Gen Psychiatry 1992;49:802–8.
[11]Ezquiaga, EGarcia, ABravo, FPallarés, T.Factors associated with outcome in major depression: a 6-month prospective study. Soc Psy chiatry Psychiatr Epidemiol 1998;33:552–7.
[12]Faravelli, CAmbonetti, APallanti, SPazzagli, A.Depressive relapses and incomplete recovery from index episode. Am J Psychiatry 1986; 143:888–91.
[13]Fava, GA.Subclinical symptoms in mood disorders: pathophysiologi-cal and therapeutic implications. Psychol Med 1999;29:47–61.
[14]Fava, GAGrandi, SZielezny, MCanestrari, RMorphy, MA.Cognitive behavioral treatment of residual symptoms in primary major depressive disorder. Am J Psychiatry 1994;151:1295–9.
[15]Fava, GAGrandi, SZielezny, MRafanelli, CCanestrari, R.Four-year outcome for cognitive behavioral treatment of residual symptoms in major depression. Am J Psychiatry 1996;153:945–7.
[16]Fava, GARafanelli, CCazzaro, MConti, SGrandi, S.Well-being therapy. A novel psychotherapeutic approach for residual symptoms of affective disorders. Psychol Med 1998;28:475–80.
[17]Fava, GARafanelli, CGrandi, SCanestrari, RMorphy, MA.Six-year outcome for cognitive behavioral treatment of residual symptoms in major depression. Am J Psychiatry 1998;155:1443–5.
[18]Fava, GARafanelli, COttolini, FRuini, CCazzaro, MGrandi, S.Psychological well-being and residual symptoms in remitted patients with panic disorder and agoraphobia. J Affect Disord 2001;65:185–90.
[19]Ferrier, IN.Treatment of major depression: is improvement enough? J Clin Psychiatry 1999;60(Suppl 6):10–4.
[20]Frank, EPrien, REJarrett, RBKeller, MBKupfer, DJLavoir, PNet al. Conceptualisation and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse and recurrence. Arch Gen Psychiatry 1991;48:287–97.
[21]Georgotas, AMcCue, RECooper, TBHagachandran, NChang, I.How effective and safe is continuation therapy in elderly depressed patients: factors affecting relapse rate. Arch Gen Psychiatry 1988;45: 929–32.
[22]Helmchen, HLinden, M.Subthreshold disorders in psychiatry: clinical reality, methodological artefact, and the double-threshold problem. Compr Psychiatry 2000;41(Suppl 1):1–7.
[23]Johnson, JWeissman, MMKlerman, GL.Service utilization and social morbidity associated with depressive symptoms in the community. J Am Med Assoc 1992;267:1478–83.
[24]Judd, LLAskikal, HSMaser, JDZeller, PJEndicott, J CoryellW, et al. Major depressive disorder: a prospective study of residual subthresh-old depressive symptoms as predictor of rapid relapse. J Affect Disord 1998;50:97–108.
[25]Judd, LLPaulus, MJSchettler, PJAkiskal, HSEndicott, JLeon, ACet al. Does incomplete recovery from first lifetime major depressive episode herald a chronic course of illness? Am J Psychiatry 2000;157:1501–4.
[26]Kupfer, DJSpiker, DG.Refractory depression: prediction of nonre-sponse by clinical indicators. J Clin Psychiatry 1981;42:307–12.
[27]MacEwan, GWRemick, RA.Treatment resistant depression: a clinical perspective. J Clin Psychiatry 1988;33:788–92.
[28]Mintz, JMintz, LIArruda, MJHwang, SS.Treatment of depression and functional capacity to work. Arch Gen Psychiatry 1992;49:761–8.
[29]Mojtabai, R.Residual symptoms and impairment in major depression in the community. Am J Psychiatry 2001;158:1645–51.
[30]Nierenberg, AADeCecco, LM.Definitions of antidepressant treatment response, remission, nonresponse, partial response and other relevant outcomes: a focus on treatment-resistant depression. J Clin Psychiatry 2001;62(suppl 16):5–9.
[31]Paykel, ES.Remission and residual symptomatology in major depression. Psychopathology 1998;31:5–14.
[32]Paykel, ESRamana, RCooper, ZHayhurst, HKerr, JBarocka, A.Residual symptoms after partial remission: an important outcome in depression. Psychol Med 1995;25:1171–80.
[33]Paykel, ESScott, JTeasdale, JDJohnson, ALGarland, AMoore, Ret al. Prevention of relapse in residual depression by cognitive therapy. Arch Gen Psychiatry 1999;56:829–35.
[34]Ramana, RPaykel, ESCooper, ZHayhurst, HSaxty, MSurtees, PG.Remission and relapse in major depression: a two-year prospective follow-up study. Psychol Med 1995;25:1161–70.
[35]Rouillon, FMarkabi, SFebvre, NPhillips, RVaillant, J.Etude contrôlée du traitement des dépressions résiduelles par la clomipramine versus placebo. Encéphale 1994;20:139–45.
[36]Scott, JTeasdale, JDPaykel, ESJohnson, ALAbbott, RHayhurst, Het al. Effects of cognitive therapy on psychological symptoms and social functioning in residual depression. Br J Psychiatry 2000; 177:440–6.
[37]Shea, MTElkin, IImber, SDSotsky, SMWatkins, JTCollins, JFet al. Course of depressive symptoms over follow-up. Findings from the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Arch Gen Psychiatry 1992;49:782–7.
[38]Shea, MTLeon, ACMueller, TISolomon, DAWarshaw, MGKeller, MB.Does major depression result in lasting personality change? Am J Psychiatry 1996;153:1404–10.
[39]Simons, ADMurphy, GELevine, JLWetzel, RD.Cognitive therapy and pharmacotherapy of depression: sustained improvement at one year. Arch Gen Psychiatry 1986;43:43–50.
[40]Taylor, SMcLean, P.Outcome profiles in the treatment of unipolar depression. Behav Res Ther 1993;31:325–30.
[41]Teasdale, JDScott, JMoore, RGHayhurst, HPope, MPaykel, ES.How does cognitive therapy prevent relapse in residual depression? Evidence from a controlled trial. J Consult Clin Psychol 2001;69: 347–57.
[42]Thase, MESimons, ADMcGreary, JCahalane, JFHughes, CHarden, Tet al. Relapse after cognitive therapy of depression: potential implications for longer courses of treatment. Am J Psychiatry 1992;149:1046–52.
[43]Thase, MEEntsuah, ARRudolph, RL.Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors. Br J Psychiatry 2001;178:234–41.
[44]Van Londen, LMolenaar, RPGGoekoop, JGZwinderman, AHRooijmans, HGM.Three-to 5-year prospective follow-up of outcome in major depression. Psychol Med 1998;28:731–5.
[45]Wittchen, HUKessler, RCPfhister, HLieb, M.Why do people with anxiety disorders become depressed? A prospective-longitudinal community study. Acta Psychiatr Scan 2000;120(suppl 406):14–23.


Residual symptoms of depression: clinical and theoretical implications

  • Jean-Philippe Boulenger


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.

Residual symptoms of depression: clinical and theoretical implications

  • Jean-Philippe Boulenger
Submit a response


No Comments have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *