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Rates and predictors of remission, recurrence and conversion to bipolar disorder after the first lifetime episode of depression – a prospective 5-year follow-up study

Published online by Cambridge University Press:  08 January 2016

J. D. Bukh ,
P. K. Andersen  and
L. V. Kessing
J. D. Bukh*
Affiliation:
Psychiatric Centre Copenhagen, Research Unit for Affective Disorders, Department O, Rigshospitalet, Copenhagen, Denmark
P. K. Andersen
Affiliation:
Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
L. V. Kessing
Affiliation:
Psychiatric Centre Copenhagen, Research Unit for Affective Disorders, Department O, Rigshospitalet, Copenhagen, Denmark
*
*Address for correspondence: J. D. Bukh, Ph.D., Psychiatric Centre Copenhagen, Rigshospitalet, Research Unit for Affective Disorders, Department 6233, Blegdamsvej 9, DK-2100 København Ø, Denmark. (Email: jens.bukh@regionh.dk)
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Abstract

Background

In depression, non-remission, recurrence of depressive episodes after remission and conversion to bipolar disorder are crucial determinants of poor outcome. The present study aimed to determine the cumulative incidences and clinical predictors of these long-term outcomes after the first lifetime episode of depression.

Method

A total of 301 in- or out-patients aged 18–70 years with a validated diagnosis of a single depressive episode were assessed from 2005 to 2007. At 5 years of follow-up, 262 patients were reassessed by means of the life chart method and diagnostic interviews from 2011 to 2013. Cumulative incidences and the influence of clinical variables on the rates of remission, recurrence and conversion to bipolar disorder, respectively, were estimated by survival analysis techniques.

Results

Within 5 years, 83.3% obtained remission, 31.5% experienced recurrence of depression and 8.6% converted to bipolar disorder (6.3% within the first 2 years). Non-remission increased with younger age, co-morbid anxiety and suicidal ideations. Recurrence increased with severity and treatment resistance of the first depression, and conversion to bipolar disorder with treatment resistance, a family history of affective disorder and co-morbid alcohol or drug abuse.

Conclusions

The identified clinical characteristics of the first lifetime episode of depression should guide patients and clinicians for long-term individualized tailored treatment.

Keywords

Conversion to bipolar disordercourse of illnessdepressionrecurrenceremission
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 6 , April 2016 , pp. 1151 - 1161
Copyright
Copyright © Cambridge University Press 2016 

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