Background. A Dutch cohort of predominantly out-patient
DSM-III-R
major depressive patients
was followed for 3 to 5 years after start of treatment in a
psycho-neuro-endocrinological prediction
study. The study design permitted description of the course of
remissions, relapses and recurrences.
Methods. Pharmacological treatment was standardized, psychotherapy
was tailored to the needs of
the patient, follow-ups were done monthly until 3 years or more after the
initial recruitment.
Results. After 9 months 49% of the patients had reached full
remission and 45% were in partial
remission. During the following 3 to 5 years 82% of the patients had reached
a period of full
remission. Sixteen per cent of the patients needed 2 years or more
before full remission. A relapse
or recurrence rate of 41% within 5 years was found. Patients with residual
symptoms relapsed
particularly in the first 4 months after remission, while patients
without residual symptoms recurred
mainly after 12 months after remission. Previous depressive episodes and
psychoticism predicted
relapse. Psychomotor retardation at inception predicted a longer time to
partial remission.
Conclusion. In most cases, major depression is a seriously
impairing episodic disease. This is also
true for a sample of predominantly out-patients treated at a university
clinic.