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Residual symptoms after partial remission: an important outcome in depression

  • E. S. Paykel (a1), R. Ramana (a1), Z. Cooper (a1), H. Hayhurst (a1), J. Kerr (a1) and A. Barocka (a1)...
Synopsis

This paper draws attention to an important adverse outcome in depression, the occurrence of residual symptoms after partial remission. Among patients with definite major depression followed every 3 months to remission and thereafter, residual symptoms reaching 8 or more on the Hamilton Depression Scale 17-item total were present in 32% (19) of the 60 who remitted below major depression by 15 months. The pattern was of mild but typical depressive symptoms. Residual symptoms were more common in subjects with more severe initial illness, but were not related to any other predictors, including longer prior illness, dysthymia, or lower dose of drug treatment during the illness episode. There were weak associations with personality that might have been consequences of symptom presence. Residual symptoms were very strong predictors of subsequent early relapse, which occurred in 76% (13/17) of those with residual symptoms and 25% (10/40) of those without.

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1Address for correspondence: Professor E. S. Paykel, Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 2QQ.
References
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Akiskal, H. S., King, D., Rosenthal, T. & Scott-Strauss, A. (1981). Chronic depressions. Part 1. Clinical and familial characteristics in 137 probands. Journal of Affective Disorders 3, 297315.
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised). American Psychiatric Association: Washington, DC.
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.
Berti Ceroni, G. B., Neri, C. & Pezzoli, A. (1984). Chronicity in major depression—a naturalistic prospective study. Journal of Affective Disorders 7, 123132.
Bridges, P. K. (1983). Points of view ‘…and a small dose of an antidepressant might help’. British Journal of Psychiatry 142, 676678.
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.
Coryell, W., Endicott, J. & Keller, M. (1990). Outcome of patients with chronic affective disorder: a five-year follow up. American Journal of Psychiatry 147, 16271633.
Evans, M. D., Hollon, S. D., De Rubeis, R. J., Piasecki, J. M., Gove, W. M., Garvey, M. J. & Tuason, V. B. (1992). Differential relapse following cognitive therapy and pharmacotherapy for depression. Archives of General Psychiatry 49, 802808.
Faravelli, C., Ambonetti, A., Palanti, S. & Pazzagli, A. (1986). Depressive relapses and incomplete recovery from index episode. American Journal of Psychiatry 49, 888891.
Fawcett, J. (1994). Antidepressants: partial response in chronic depression. British Journal of Psychiatry 165, 3741.
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.
Georgotas, A., McCue, R. E., Cooper, T. B., Hagachandran, N. & Chang, I. (1988). How effective and safe is continuation therapy in elderly depressed patients: factors affecting relapse rate. Archives of General Psychiatry 45, 929932.
Hamilton, M. (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology 6, 278296.
Hirschfeld, R. M. A., Klerman, G. L., Andreasen, N. C., Clayton, P. J. & Keller, M. B. (1986). Psycho-social predictors of chronicity in depressed patients. British Journal of Psychiatry 148, 648654.
Johnson, D. A. W. (1974). A study of the use of antidepressant medication in general practice. British Journal of Psychiatry 125, 186192.
Kaplan, E. L. & Meier, P. (1958). Nonparametric estimation from incomplete observations. Journal of the American Medical Association 53, 457481.
Keller, M. B., Shapiro, R. W., Lavori, P. W. & Wolfe, N. (1982). Recovery in major depressive disorder: analysis with the life table and regression models. Archives of General Psychiatry 39, 911915.
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). 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., Kane, J. M., Gelenberg, A. J., Rosenbaum, J. F., Walzer, E. A. & Baker, L. A. (1992). Subsyndromal symptoms in bipolar disorder. A comparison of standard and low serum levels of lithium. Archives of General Psychiatry 49, 371376.
Klein, D. N., Taylor, E. B., Dickstein, S. & Harding, K. (1988). The early—late onset distinction in DSM-III-R dysthymia. Journal of Affective Disorders 14, 2533.
Kotin, J., Post, R. M. & Goodwin, F. K. (1973). Drug treatment of depressed patients referred for hospitalisation. American Journal of Psychiatry 130, 11291141.
Kupfer, D. J. & Spiker, D. G. (1981). Refractory depression: prediction of non-response by clinical indicators. Journal of Clinical Psychiatry 42, 307312.
Lehmann, H. E. (1974). Therapy-resistant depression: a clinical classification. Pharmacopsychiatrica 7, 156163.
Mindham, R. H., Howland, C. & Shepherd, M. (1973). An evaluation of continuation therapy with tricyclic antidepressants in depressive illness. Psychological Medicine 3, 517.
Ormel, J., Oldenhiknel, T., Brilman, E. & van den Brink, W. (1993). Outcome of depression and anxiety in primary care: a three wave 3½ year study of psychopathology and disability. Archives of General Psychiatry 50, 759766.
Paykel, E. S. (1985). The Clinical Interview for Depression: development, reliability and validity. Journal of Affective Disorders 9, 8596.
Paykel, E. S. (1994). Epidemiology of refractory depression. In Refractory Depression: Current Strategies and Future Directions (ed. Nolen, W. A., Zohar, J., Roose, S. P. & Amsterdam, J. D.), pp. 317. John Wiley & Sons Ltd: London.
Paykel, E. S. & Griffiths, J. H. (1983). Community Psychiatric Nursing for Neurotic Patients: The Springfield Controlled Trials. Research Monographs in Nursing Series. Royal College of Nursing: London.
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., Cooper, Z., Ramana, R. & Hayhurst, H. (1996). Psychosocial stress and the outcome of severe depression. Psychological Medicine (in the press).
Philipp, M. & Fickinger, M. P. (1993). The definition of remission and its impact on the length of a depressive episode. Archives of General Psychiatry 50, 407408.
Prien, R. F. (1992). Maintenance treatment. In Handbook of Affective Disorders, 2nd edn. (ed. Paykel, E. S.), pp. 419435. Churchill Livingstone: Edinburgh.
Prien, R. F. & Kupfer, D. J. (1986). Continuous drug therapy for major depressive episodes: how long should it be maintained? American Journal of Psychiatry 143, 1823.
Quitkin, F. M. (1985). The importance of dosage in prescribed antidepressants. British Journal of Psychiatry 147, 593597.
Ramana, R., Paykel, E. S., Cooper, Z., Hayhurst, H., Saxty, M. & Surtees, P. G. (1995). Remission and relapse in major depression: a two-year prospective follow-up study. Psychological Medicine 25, 11611170.
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 23, 164173.
Rounsaville, B. J., Sholomaskas, D. & Prusoff, B. A. (1980). Chronic mood disorders in depressed outpatients: diagnosis and response to pharmacotherapy. Journal of Affective Disorders 2, 7388.
Schatzberg, A. F., Cole, J. O., Cohen, B. M., Altesman, R. I. & Sniffin, C. M. (1983). Survey of depressed patients who have failed to respond to treatment. In The Affective Disorders (ed. Davis, J. M. & Maas, J. W.), pp. 7385. American Psychiatric Press Inc.: Washington, DC.
Scott, J. (1988). Chronic depression. British Journal of Psychiatry 153, 287297.
Simons, A. D., Murphy, G. E., Levine, J. L. & Wetzel, R. D. (1986). Cognitive therapy and pharmacotherapy of depression: sustained improvement over one year. Archives of General Psychiatry 43, 4350.
Sireling, L. I., Paykel, E. S., Freeling, P., Rao, B. M. & Patel, S. P. (1985). Depression in general practice: case thresholds and diagnosis. British Journal of Psychiatry 147, 113119.
Spitzer, R. L., Endicott, J. & Robins, E. (1978). Research Diagnostic Criteria: rationale and reliability. Archives of General Psychiatry 35, 773782.
Teasdale, J. D. (1988). Cognitive vulnerability to persistent depression. Cognition and Emotion 2, 247274.
Thase, M. E., Simons, A. D., McGeary, J., Cahalane, J. F., Hughes, C., Harden, T. & Friedman, E. (1992). Relapse after cognitive behaviour therapy of depression: potential implications for longer courses of treatment. American Journal of Psychiatry 149, 10461052.
Tyrer, P. (ed.) (1988) Personality Disorders: Diagnosis, Management and Course. Wright: London.
Weissman, M. M., Prusoff, B. A. & Klerman, G. L. (1978). Personality in the prediction of long term outcome of depression. American Journal of Psychiatry 135, 797800.
WHO (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. World Health Organization: Geneva.
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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
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