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Presence of individual (residual) symptoms during depressive episodes and periods of remission: a 3-year prospective study

Published online by Cambridge University Press:  08 October 2010

H. J. Conradi ,
J. Ormel  and
P. de Jonge
H. J. Conradi*
Affiliation:
Interdisciplinary Center for Psychiatric Epidemiology (ICPE), Department of Psychiatry, University Medical Center Groningen/University of Groningen, The Netherlands Department of Clinical Psychology, University of Amsterdam, The Netherlands
J. Ormel
Affiliation:
Interdisciplinary Center for Psychiatric Epidemiology (ICPE), Department of Psychiatry, University Medical Center Groningen/University of Groningen, The Netherlands
P. de Jonge
Affiliation:
Interdisciplinary Center for Psychiatric Epidemiology (ICPE), Department of Psychiatry, University Medical Center Groningen/University of Groningen, The Netherlands Department of Internal Medicine, University Medical Center Groningen, University of Groningen, The Netherlands Center of Research on Psychology and Somatic Disease (CORPS), Department of Medical Psychology, Tilburg University, The Netherlands
*
*Address for correspondence: H. J. Conradi, Ph.D., Department of Psychiatry, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands. (Email: h.j.conradi@med.umcg.nl)
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Abstract

Background

Residual depressive symptomatology constitutes a substantial risk for relapse in depression. Treatment until full remission is achieved is therefore implicated. However, there is a lack of knowledge about the prevalence of (1) residual symptoms in general and (2) the individual residual symptoms in particular.

Method

In a 3-year prospective study of 267 initially depressed primary care patients we established per week the presence/absence of the individual DSM-IV depressive symptoms during subsequent major depressive episodes (MDEs) and episodes of (partial) remission. This was accomplished by means of 12 assessments at 3-monthly intervals with the Composite International Diagnostic Interview (CIDI).

Results

In general, residual depressive symptomatology was substantial, with on average two symptoms present during remissions. Three individual symptoms (cognitive problems, lack of energy and sleeping problems) dominated the course of depression and were present 85–94% of the time during depressive episodes and 39–44% of the time during remissions.

Conclusions

Residual symptoms are prevalent, with some symptoms being present for almost half of the time during periods of remission. Treatment until full remission is achieved is not common practice, yet there is a clear need to do so to prevent relapse. Several treatment suggestions are made.

Keywords

Depressionprimary careprospective studyresidual depressive symptomssymptom profiles
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 6 , June 2011 , pp. 1165 - 1174
Copyright
Copyright © Cambridge University Press 2010

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References

APA (2000). Practice guideline for the treatment of patients with major depressive disorder (revision). American Psychiatric Association. American Journal of Psychiatry 157 (Suppl. 4), 1–45.Google Scholar
Babyak, MA, Blumenthal, JA, Herman, S, Khatri, P, Doraiswamy, M, Moore, KA, Craighead, WE, Baldewicz, TT, Krishnan, KR (2000). Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosomatic Medicine 62, 633–638.CrossRefGoogle ScholarPubMed
Blumenthal, JA, Babyak, MA, Moore, KA, Craighead, WE, Herman, S, Khatri, P, Waugh, R, Napolitano, MA, Forman, LM, Appelbaum, M, Doraiswamy, PM, Krishnan, KR (1999). Effects of exercise training on older patients with major depression. Archives of Internal Medicine 159, 2349–2356.CrossRefGoogle ScholarPubMed
Chen, LS, Eaton, WW, Gallo, J, Nestadt, G, Crum, RM (2000). Empirical examination of current depression categories in a population-based study: symptoms, course and risk factors. American Journal of Psychiatry 157, 573–580.CrossRefGoogle Scholar
Conradi, HJ, de Jonge, P, Kluiter, H, Smit, A, van der Meer, K, Jenner, JA, van Os, TWDP, Emmelkamp, PMG, Ormel, J (2007). Enhanced treatment for depression in primary care: long-term outcomes of a psycho-educational prevention program alone and enriched with psychiatric consultation or cognitive behavioral therapy. Psychological Medicine 37, 849–862.CrossRefGoogle ScholarPubMed
Conradi, HJ, de Jonge, P, Ormel, J (2008). Cognitive-behavioural therapy v. usual care in recurrent depression. British Journal of Psychiatry 193, 505–506.CrossRefGoogle ScholarPubMed
Dimidjian, S, Hollon, SD, Dobson, KS, Schmaling, KB, Kohlenberg, RJ, Addis, ME, Gallop, R, McGlinchey, JB, Markley, DK, Golland, JK, Atkins, DC, Dunner, DL, Jacobson, NS (2006). Randomized trial of behavioral activation, cognitive therapy and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology 74, 658–670.CrossRefGoogle ScholarPubMed
Dobson, KS, Hollon, SD, Dimidjian, S, Schmaling, KB, Kohlenberg, RJ, Gallop, R, Rizvi, SL, Gollan, JK, Dunner, DL, Jacobson, NS (2008). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. Journal of Consulting and Clinical Psychology 76, 468–477.CrossRefGoogle ScholarPubMed
Fava, GA, Rafanelli, C, Grandi, S, Conti, S, Belluardo, P (1998). Prevention of recurrent depression with cognitive behavioral therapy: preliminary findings. Archives of General Psychiatry 55, 816–820.CrossRefGoogle ScholarPubMed
Fava, GA, Ruine, C, Rafanelli, C, Finos, L, Conti, S, Grandi, S (2004). Six-year outcome of cognitive behavior therapy for prevention of recurrent depression. American Journal of Psychiatry 161, 1872–1876.Google Scholar
Gaudiano, BA, Young, D, Chelminski, I, Zimmerman, M (2008). Depressive symptom profiles and severity patterns in outpatients with psychotic vs nonpsychotic major depression. Comprehensive Psychiatry 49, 421–429.CrossRefGoogle ScholarPubMed
Gaynes, BN, Rush, A, Trivedi, M, Wisniewski, SR, Balasubramani, GK, Spencer, DC, Peterson, T, Klinkman, M, Warden, D, Nicholas, L, Fava, M (2007). Major depression symptoms in primary care and psychiatric setting: a cross-sectional analysis. Annals of Family Medicine 5, 126–134.Google Scholar
Judd, LL, Akiskal, HS, Maser, JD, Zeller, PJ, Endicott, J, Coryell, W, Paulus, MP, Kunovac, JL, Leon, AC, Mueller, TI, Rice, JA, Keller, MB (1998). Major depressive disorder: a prospective study of residual subthreshold depressive symptoms as predictor of rapid relapse. Journal of Affective Disorders 50, 97–108.CrossRefGoogle ScholarPubMed
Judd, LL, Paulus, MJ, Schettler, PJ, Akiskal, HS, Endicott, J, Leon, AC, Maser, JD, Mueller, T, Solomon, DA, Keller, MB (2000). Does incomplete recovery from first lifetime major depressive episode herald a chronic course of illness? American Journal of Psychiatry 157, 1501–1504.Google Scholar
Kessler, RC, Berglund, P, Chiu, WT, Demler, O, Heeringa, S, Hiripi, E, Jin, R, Pennell, BE, Walters, EE, Zaslavsky, A, Zheng, H (2004). The US National Comorbidity Survey Replication (NCS-R): design and field procedures. International Journal of Methods in Psychiatric Research 13, 69–92.CrossRefGoogle ScholarPubMed
Kornstein, SG, Schatzberg, AF, Thase, ME, Yonkers, KA, McCullough, JP, Keitner, GI, Gelenberg, AJ, Ryan, CE, Hess, AL, Harrison, W, Davis, SM, Keller, MB (2000). Gender differences in chronic major and double depression. Journal of Affective Disorders 60, 1–11.CrossRefGoogle ScholarPubMed
Minor, KL, Champion, JE, Gotlib, IH (2005). Stability of DSM-IV criterion symptoms for major depressive disorder. Journal of Psychiatric Research 39, 415–420.CrossRefGoogle ScholarPubMed
Nierenberg, AA, Trivedi, MH, Fava, M, Biggs, MM, Shores-Wilson, K, Wisniewski, SR, Balasubramani, GK, Rush, AJ (2007). Family history of mood disorder and characteristics of major depressive disorder: a STAR*D (sequenced treatment alternatives to relieve depression) study. Journal of Psychiatric Research 41, 214–221.Google Scholar
Ormel, J, Oldehinkel, AJ, Brilman, E, van den Brink, W (1993). Outcome of depression and anxiety in primary care: a three-wave, 3.5-year study of psychopathology and disability. Archives of General Psychiatry 50, 759–766.CrossRefGoogle Scholar
Patten, SB (2009). Accumulation of major depressive episodes over time in a prospective study indicates that retrospectively assessed lifetime prevalence estimates are too low. BMC Psychiatry 9, 19.CrossRefGoogle Scholar
Paykel, ES, Ramana, R, Cooper, Z, Hayhurst, H, Kerr, J, Barocka, A (1995). Residual symptoms after partial remission: an important outcome in depression. Psychological Medicine 25, 1171–1180.Google Scholar
Paykel, ES, Scott, J, Cornwell, PL, Abbott, R, Crane, C, Pope, M, Johnson, AL (2005). Duration of relapse prevention after cognitive therapy in residual depression: follow-up of controlled trial. Psychological Medicine 35, 59–68.CrossRefGoogle ScholarPubMed
Paykel, ES, Scott, J, Teasdale, JD, Johnson, AL, Garland, A, Moore, R, Jenaway, A, Cornwall, PL, Hayhurst, H, Abbott, R, Pope, M (1999). Prevention of relapse in residual depression by cognitive therapy: a controlled trial. Archives of General Psychiatry 56, 829–835.CrossRefGoogle ScholarPubMed
Pettit, JW, Lewinsohn, PM, Joiner, TE (2006). Propagation of major depressive disorder: relationship between first episode symptoms and recurrence. Psychiatry Research 141, 271–278.Google Scholar
Smith, DJ, Kyle, S, Forty, L, Cooper, C, Walters, J, Russel, E, Caesar, S, Farmer, A, McGuffin, P, Jones, I, Jones, L, Craddock, N (2008). Differences in depressive symptom profile between males and females. Journal of Affective Disorders 108, 279–284.CrossRefGoogle ScholarPubMed
Thase, ME, Simons, AD, McGeary, J, Cahalane, JF, Hughes, C, Harden, T, Friedman, E (1992). Relapse after cognitive behavior therapy of depression: potential implications for longer courses of treatment. American Journal of Psychiatry 149, 1046–1051.Google ScholarPubMed
Ter Smitten, MH, Smeets, RMW, van den Brink, W (1998). Composite International Diagnostic Interview (CIDI), Version 2.1, Lifetime Module [in Dutch]. World Health Organization: Amsterdam.Google Scholar
WHO (1997). The Composite International Diagnostic Interview (CIDI). World Health Organization: Geneva.Google Scholar
Wittchen, HU (1994). Reliability and validity studies of the WHO-Composite International Diagnostic Interview: a critical review. Journal of Psychiatric Research 28, 57–84.CrossRefGoogle ScholarPubMed