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What Factors Affect Recovery from a Major Depressive Episode

written by: GiangNguyen • edited by: Paul Arnold • updated: 7/22/2010

Half of all episodes of major depression last more than three months, and over fifteen percent last more than five years. Here we review the factors that determine the duration of a depressive episode and what factors affect treatments.

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    Data on Duration of a Major Depression Episode

    Depression is one of the major causes of disease burden in Disability-Adjusted Life Years (DALY) in both men and women. There is a strong need to prioritize the ever-expanding options of treatment and management of depression. It is important to compare the cost-effectiveness of different treatment options, both long term and short term. In this article, we review data on the recovery period of major depression and how different health care interventions affecting the length of the recovery period.

    According to Szádóczky (2004) the factors influencing the outcome of major depressive episodes include:

    · demographic characteristics (age, gender, education, employment),

    · illness-related variables (severity, age at onset, number and duration of previous episodes)

    · personality characteristics (DSM-IV personality disorders, trait anxiety, coping style)

    · life context factors (life events before and during the depressive episode, social support, social adjustment),

    · biological markers (dexamethasone suppression test, thyroid stimulating hormone levels)

    The Netherlands Mental Health Survey and Incidence Study (NEMESIS) reported that physical illness, lack of social support, severity of depression and a prior long episode were all associated with increased duration of a major depressive episode. In general, roughly 50% of major depressive episodes are resolved with 3 months. The rate of recovery declines over time.

    Analysis of data from the Canadian Community Health Survey, Mental Health and Well-being (CCHS 1.2) study indicates that 13.7% of the subjects reported that their first episode lasted 5 years or longer (Pattern et al., 2007). The median duration of first episodes is about 4 months. Furthermore, an episode that has only lasted a few weeks is likely to be associated with a high rate of recovery in the following few weeks, whereas an episode that has lasted for many weeks has a low probability of recovery in the next few weeks.

    The above information is particularly important with respect management of depression, as treatment options should be decided upon not only age, personality traits, social support, but also the time of presentation. Another implication of this information is early detection by screening for depression may lead to much better prognosis and improve the chance of recovery.

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    Effects of Treatment

    Treatment options of major depressive disorder include:

    · antidepressant(AD)drugs

    · psychological therapy (such as cognitive behavioral therapy(CBT)and interpersonal therapy)

    · a combination of the above

    Antidepressants have been shown to reduce the severity of symptoms of depression as well as the length of a depressive episode. Trindade E, Menon DA (1997) performed a meta-analysis of 48 trials and estimated that use of selective serotonin reuptake inhibitors reduce the severity of symptoms by 45%.

    William (2004) conducted a meta-analysis of 315 trials testing medications used for treating depression. The primary outcomes were symptomaticresponse rate (defined as a 50% or greater improvementin symptoms as assessed by a depression symptoms rating scale), total discontinuation rates (dropouts), and ratesof discontinuation because of adverse events. Overall, antidepressants lower the rate of adverse events by 60%. Interestingly, the study showed that all antidepressants perform similarly in term of symptomaticresponse rate. The medications were more effective among older adults andprimary care patients.

    Vos (2004) estimated that optimal episodic treatment with cognitive behavioral therapy could avert 28% of this disease burden, and 24% with drugs.

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    Summary

    Data collected in primary care settings and clinical trials can be used to help doctors develop better treatment options. Data appears to suggest that antidepressants are cost-effective at short term while psychotherapy is effective at long term.

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    References

    Patten SB. 2006. A major depression prognosis calculator based on episode duration. Clin Pract Epidemiol Mental Hlth 2:13

    Patten SB. 2007. An Animated Depiction of Major Depression Epidemiology. BMC Psychiatry 7:23

    Trindade E, Menon D. Selective Serotonin Reuptake Inhibitors (SSRIs) for MajorDepression, Part I: Evaluation of the Clinical Literature. Ontario, Canada: Canadian Coordinating Office for Health Technology Assessment; 1997.

    William John, Mulrow Cynthia, Chiquette Elaine, Noel Hitchcock, Aguilar Christine, and Cornell John. 2000. A Systematic Review of Newer Pharmacotherapies for Depression in Adults: Evidence Report Summary. Annals of Internal Medicine 132(9): 743-756

    Vos Theo. 2004. The Burden of Major Depression Avoidable by Longer-Term Treatment Strategies. Arch Gen Psychiatry 61:1097-1103.