Major Depressive Disorder: Recurrence and Relapse

Relapse and recurrence following successful treatment of major depression is common and often carries massive social cost. According to the current treatment guidelines, treatment of major depressive disorder contains 3 phases:

• Acute: six to twelve weeks.

• Continuation: four to nine months.

• Maintenance: months to years.

The continuation and maintenance phases are designed to prevent relapse (defined as the return of depressive symptoms during the current depressive episode) and recurrence (defined as a new, distinct episode).

Judd (1997) estimated that the risk for repeated episodes exceeds 80% and patients will experience an average of 4 lifetime major depressive episodes of 20 weeks duration each.

In the Baltimore cohort of the National Institute of Mental Health Epidemiologic Catchment Area (ECA) study, about 50% of patients had a recurrence during a 12-14 year follow-up. The National Collaborative Depression Study found 85% of patients having recurrence in a 15 year period. 50% of subjects who do not have recurrence in five years after recovery had a relapse within the next 10 years. The rates of recurrence decline over time.

Effects of gender vary between different studies. The Baltimore ECA study found no influence of gender. On the other hand, the National Collaborative Depression Study found a higher rate of recurrence in women. Women were 43% more likely to experience a recurrence. Those who never married are 55% more likely to experience a recurrence than married and divorced, separated or widowed.

Another major risk factor for recurrence is the length of depressive episode. Each additional year increases the likelihood of recurrence by 11%. Each additional episode of major depression before intake was associated with an 18% increase in the risk of recurrence.

Lewinsohn et al. (2000) concluded that formerly depressed adolescents with the risk factors identified in this study are associated with high risk for recurrence of major depressive disorder during young adulthood. Thus, it is important to maintain treatment and to catch early symptoms of major depressive disorder in these high-risk individuals.

In summary, prevention of relapse and recurrence is extremely important within the grand scheme of management of major depressive disorder. Electronic medical records can be used to identify people at high risk for relapse and subject them to preventive measures.

References

<strong>Recurrence</strong> After Recovery From <strong>Major Depressive Disorder</strong> During 15 Years of Observational Follow-Up - TI Mueller, AC Leon, MB Keller, DA Solomon, J … - American Journal of Psychiatry, 1999 - Am Psychiatric Assoc

Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review . The Lancet , Volume 361 , Issue 9358 , Pages 653 - 661 J . Geddes , S . Carney , C . Davies , T . Furukawa , D . Kupfer , E . Frank , G . Goodwin

Course of Adolescent <strong>Major Depressive Disorder</strong> in a Community Sample: Predictors of <strong>Recurrence</strong> in … PM Lewinsohn, P Rohde, JR Seeley, DN Klein, IH … - American Journal of Psychiatry, 2000 - Am Psychiatric Assoc