Skip to main content Accessibility help
×
Home

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

  • R. Ramana (a1), E. S. Paykel (a1), Z. Cooper (a1), H. Hayhurst (a1), M. Saxty (a1) and P. G. Surtees (a1)...

Synopsis

This paper reports the course with respect to remission and relapse of a cohort of predominantly in-patient RDC major depressive subjects, who were followed at 3-monthly intervals to remission and for up to 15 months thereafter. Remission was comparatively rapid with 70% of subjects remitting within 6 months. Only 6% failed to do so by 15 months. However, 40% relapsed over the subsequent 15 months, with all the relapses occurring in the first 10 months. Greater severity of the depression and longer duration of the illness predicted a longer time to remission. Greater initial severity of depression also predicted relapse. Subjects with a worse outcome had not received less adequate treatment than the remainder. Our results confirm the comparatively poor outcome subsequent to remission that has been reported in recent literature, in spite of the availability of modern methods of treatment. The clustering of relapses in the first 10 months gives some support to the distinction between relapse and later recurrence.

Copyright

Corresponding author

1 Address for correspondence: Dr R. Ramana, Fulbourn Hospital, Box 351, Cambridge CB1 5EF.

References

Hide All
Akiskal, H. S., Bitar, A. H., Pazantian, V. R., Rosenthal, T. L. & Parks, W. W. (1978). The nosological status of neurotic depression. Archives of General Psychiatry 35, 757766.
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders (3rd edn. Revised). American Psychiatric Association: Washington, DC.
American Psychiatric Association (1993). Practice Guideline for Major Depressive Disorder in Adults. American Journal of Psychiatry 150 (Supplement).
Andrew, B., Hawton, K., Fagg, J. & Westbrook, D. (1993). Do psychosocial factors influence outcome in severely depressed female psychiatric outpatients? British Journal of Psychiatry 163, 747754.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. E. & Erbaugh, J. K. (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561571.
Bratfos, O. & Haug, J. O. (1968). The course of manic depressive psychosis: a follow-up investigation of 215 patients. Acta Psychiatrica Scandinavica 44, 89112.
Brodaty, H., Harris, L., Peters, K., Wilhelm, K., Hickie, I., Boyce, P., Mitchell, P., Parker, G. & Eyers, K. (1993). Prognosis of depression in the elderly: a comparison with younger patients. British Journal of Psychiatry 163, 589596.
Carney, M. W. P., Roth, M. & Garside, R. F. (1965). The diagnosis of depression syndromes and the prediction of ECT response. British Journal of Psychiatry 3, 659674.
Coryell, W., Zimmerman, M. & Pfohl, B. (1985). Short-term prognosis in primary and secondary major depression. Journal of Affective Disorders 9, 265270.
Frank, E., Prien, R. F., Jarrett, R. B., Keller, M. B., Kupfer, D. J., Lavori, P. W., Rush, A. J. & Weissman, M. M. (1991). Conceptualisation and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse and recurrence. Archives of General Psychiatry 48, 851855.
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 5662.
Hinrichsen, G. A. & Hernandez, N. A. (1993). Factors associated with recovery from and relapse into major depressive disorder in the elderly. American Journal of Psychiatry 150, 18201825.
Kaplan, E. L. & Meier, P. (1958). Non-parametric estimations from incomplete observations. Journal of the American Medical Association 53, 457481.
Kay, D. W. K., Garside, R. F., Roy, J. R. & Beamish, P. (1969). Endogenous symptoms in neurotic syndromes of depression; a 5 to 7 year follow-up. British Journal of Psychiatry 115, 389399.
Keller, M. B., Shapiro, R. W., Lavori, P. W. & Wolfe, N. (1982 a). Recovery in major depressive disorder: analysis with the life table and regression models. Archives of General Psychiatry 39, 905910.
Keller, M. B., Shapiro, R. W., Lavori, P. W. & Wolfe, N. (1982 b). Relapse in major depressive disorder: analysis with the life event table. Archives of General Psychiatry 39, 911915.
Keller, M., Lavori, P. W., Lewis, C. E. & Klerman, G. L. (1983). Predictors of relapse in major depression. Journal of the American Medical Association 250, 32993304.
Keller, M. B., Klerman, G. L., Lavori, P. W., Coryell, W., Endicott, J. & Taylor, J. (1984). Long-term outcome of episodes of major depression: clinical and public health significance. Journal of the American Medical Association 252, 788792.
Keller, M. B., Lavori, P. W., Rice, J., Coryell, W. & Hirschfeld, R. M. A. (1986 a). The persistent risk of chronicity in recurrent episodes of nonbipolar major depressive disorder: a prospective follow-up. American Journal of Psychiatry 143, 2428.
Keller, M. B., Lavori, P. W., Klerman, G. L., Andreasen, N. C., Endicott, J., Coryell, W., Fawcett, J., Rice, J. P. & Hirschfeld, R. M. a. (1986 b). Low levels and lack of predictors of somatotherapy and psychotherapy received by depressed patients. Archives of General Psychiatry 43, 548566.
Keller, M. B., Lavori, P. W., Mueller, T. I., Endicott, J., Coryell, W., Hirschfeld, R. M. A. & Shea, T. (1992). Time to recovery, chronicity, and levels of psychopathology in major depression. A 5-year prospective follow-up of 431 subjects. Archives of General Psychiatry 49, 809816.
Kiloh, L. G., Andrews, G. A. & Neilson, M. (1988). The long-term outcome of depressive illness. British Journal of Psychiatry 153, 752757.
Klerman, G. L., Endicott, J., Spitzer, R. & Hirschfeld, R. (1979). Neurotic depressions: a systematic analysis of multiple criteria and meanings. American Journal of Psychiatry 136, 5761.
Kraepelin, E. (1921). Manic Depressive Insanity and Paranoia. E. & S. Livingstone: Edinburgh.
Lee, A. S. & Murray, R. M. (1988). The long-term outcome of Maudsley depressives. British Journal of Psychiatry 153, 741751.
Lundquist, G. (1945). Prognosis and course in manic depressive psychosis. A follow-up study of 319 first admissions. Acta Psychiatrica et Neurologica 35 (suppl. 1), 196.
Parker, G., Hadzi-Pavlovic, D., Brodaty, H., Boyce, P., Mitchell, P., Wilhelm, K. & Hickie, I. (1992). Predicting the course of melancholic and nonmelancholic depression. A naturalistic comparison study. Journal of Nervous and Mental Disease 180, 673682.
Paykel, E. S. (1985). The Clinical Interview for Depression: development, reliability and validity. Journal of Affective Disorders 9, 8596.
Paykel, E. S., Klerman, G. L. & Prusoff, B. A. (1974). Prognosis of depression and the endogenous—neurotic distinction. Psychological Medicine 4, 5764.
Paykel, E. S., Hollyman, J. A., Freeling, P. & Sedgwick, P. (1988). Predictors of therapeutic benefit from amitriptyline in mild depression: a general practice placebo-controlled trial. Journal of Affective Disorders 14, 8395.
Paykel, E. S., Ramana, R., Cooper, Z., Hayhurst, H., Kerr, J. & Barocka, A. (1995). Residual symptoms after partial remission: an important outcome in depression. Psychological Medicine 25, 11711180.
Paykel, E. S., Cooper, Z., Ramana, R. & Hayhurst, H. (1996). Life events, social support and marital relationships in the outcome of severe depression. Psychological Medicine (in the press).
Poort, R. (1945). Catamnestic investigations on manic depressive psychosis with special reference to the prognosis. Acta Psychiatrica et Neurologica 20, 5974.
Prien, R. F. (1992). Maintenance treatment. In Handbook of Affective Disorders, 2nd edn. (ed. Paykel, E. S.), pp. 419435. Churchill Livingstone: Edinburgh.
Rao, A. V. & Nammalvar, N. (1977). The course and outcome of depressive illness: a follow up study of 122 cases in Madurai, India. British Journal of Psychiatry 130, 392396.
Raskin, A., Schulterbrandt, J. G., Reatig, N. & McKeon, J. J. (1970). Differential response to chlorpromazine, imipramine and placebo. A study of sub-groups of hospitalised depressed patients. Archives of General Psychiatry 43, 4350.
Sargeant, J. K., Bruce, M. L., Florio, L. P. & Weissman, M. M. (1990). Factors associated with 1-year outcome of major depression in the community. Archives of General Psychiatry 47, 519526.
Sireling, L. I., Freeling, P., Paykel, E. S. & Rao, B. M. (1985). Depression in general practice: comparison with out-patients. British Journal of Psychiatry 147, 119126.
Spitzer, R. L., Endicott, J. & Robins, E. (1978). Research Diagnostic Criteria: rationale and reliability. Archives of General Psychiatry 35, 773782.
Surtees, P. G. & Barkley, C. (1994). Future imperfect: the long-term outcome of depression. British Journal of Psychiatry 164, 327341.
Surtees, P. G., Sashidharan, S. P. & Dean, C. (1986). Affective disorder amongst women in the general population. British Journal of Psychiatry 148, 176186.
Tyrer, P. (ed.) (1988). Personality Disorders: Diagnosis, Management and Course. Wright: London.
Vaughn, C. E. (1976). The measurement of expressed emotion in the families of psychiatric patients. British Journal of Social and Clinical Psychology 15, 157165.
Watts, C. A. H. (1956). The incidence and prognosis of endogenous depression. British Medical Journal 1, 13921397.
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974). The Measurements and Classification of Psychiatric Symptoms. Cambridge University Press: Cambridge.
Winokur, G. & Morrison, J. (1973). The Iowa 500: follow-up of 225 depressives. British Journal of Psychiatry 123, 543548.
WHO (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. World Health Organization: Geneva.

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

  • R. Ramana (a1), E. S. Paykel (a1), Z. Cooper (a1), H. Hayhurst (a1), M. Saxty (a1) and P. G. Surtees (a1)...

Metrics

Altmetric attention score

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