Psychological Medicine



Time to recurrence after recovery from major depressive episodes and its predictors


T. KANAI a1, H. TAKEUCHI a1, T. A. FURUKAWA a1c1, R. YOSHIMURA a1, T. IMAIZUMI a1, T. KITAMURA a1 and K. TAKAHASHI a1
a1 Department of Psychiatry, Nagoya City University Medical School; Department of Psychiatry, University of Occupational and Environmental Health; Kachi Hospital; Department of Neuropsychiatry, Kumamoto University Medical School; and National Center of Neurology and Psychiatry, Japan

Article author query
kanai t   [PubMed][Google Scholar] 
takeuchi h   [PubMed][Google Scholar] 
furukawa t   [PubMed][Google Scholar] 
yoshimura r   [PubMed][Google Scholar] 
imaizumi t   [PubMed][Google Scholar] 
kitamura t   [PubMed][Google Scholar] 
takahashi k   [PubMed][Google Scholar] 

Abstract

Background. Depression is a remitting but recurring disease. However, there is a paucity of prospectively recorded data on the course of depression after recovery.

Method. A multi-centre prospective serial follow-up study of an inception cohort of hitherto untreated unipolar major depression (N=95) for 6 years. We report the time to recurrence after recovery from the index depressive episode and their predictors.

Results. The cumulative probability of remaining well without subthreshold symptoms was 57% (95% CI, 46 to 68%) at 1 year, 47% (95% CI, 36 to 58%) at 2 years and 35% (95% CI, 23 to 47%) at 5 years. The same without full relapse was 79% (95% CI, 70 to 88%) at 1 year, 70% (95% CI, 60 to 80%) at 2 years and 58% (95% CI, 46 to 70%) at 5 years. The median duration of well-interval from the end of the index episode to the beginning of the subthreshold episode was 19·0 months (95% CI, 2·4 to 35·7), and that to the end of the full episode was over 6 years. Residual symptoms at time of recovery predicted earlier recurrence.

Conclusions. The median length of the well-interval was much longer than previously reported in studies employing similar definitions but dealing with a more severe spectrum of patients. However, the sobering fact remains that less than half of the patients can expect to remain virtually symptom-free for 2 years or more after recovery from the depressive episode.


Correspondence:
c1 Professor Toshi A. Furukawa, Department of Psychiatry, Nagoya City University Medical School, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.


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