This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (834)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Remission, Recovery, Relapse, and Recurrence

Ellen Frank, PhD; Robert F. Prien, PhD; Robin B. Jarrett, PhD; Martin B. Keller, MD; David J. Kupfer, MD; Philip W. Lavori, PhD; A. John Rush, MD; Myrna M. Weissman, PhD
From the Department of Psychiatry, University of Pittsburgh (Pa) School of Medicine, Western Psychiatric Institute and Clinic (Drs Frank and Kupfer); Division of Clinical Research, National Institute of Mental Health, Rockville, Md (Dr Prien); Department of Psychiatry and Human Behavior, Brown University, Butler Hospital, Providence, RI (Drs Keller and Lavori); Department of Psychiatry, University of Texas Health Science Center, Dallas (Drs Jarrett and Rush); and Division of Clinical-Genetic Epidemiology, College of Physicians and Surgeons, Columbia Univesity, New York, NY (Dr Weissman).

Arch Gen Psychiatry. 1991;48(9):851-855.

Abstract
• In 1988, the MacArthur Foundation Research Network on the Psychobiology of Depression convened a task force to examine the ways in which change points in the course of depressive illness had been described and the extent to which inconsistency in these descriptions might be impeding research on this disorder. We found considerable inconsistency across and even within research reports and concluded that research on depressive illness would be well served by greater consistency in the definition change points in the course of illness. We propose an internally consistent, empirically defined conceptual scheme for the terms remission, recovery, relapse, and recurrence. In addition, we propose tentative operational criteria for each term. Finally, we discuss ways to assess the usefulness of such operational criteria through reanalysis of existing data and the design and conduct of new experiments.

Footnotes
Accepted for publication September 20, 1990.

Reprint requests to Western Psychiatric Institute and Clinic, 3811 O'Hara St, Pittsburgh, PA 15213 (Dr Frank).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Cognitive Behavioral Analysis System of Psychotherapy and Brief Supportive Psychotherapy for Augmentation of Antidepressant Nonresponse in Chronic Depression: The REVAMP Trial
Kocsis et al.
Arch Gen Psychiatry 2009;66:1178-1188.
ABSTRACT | FULL TEXT  

Testing Definitions of Symptom Remission in First-Episode Psychosis for Prediction of Functional Outcome at 2 Years
Cassidy et al.
Schizophr Bull 2009;0:sbp007v1-sbp007.
ABSTRACT | FULL TEXT  

Clinical Recovery in First-Episode Psychosis
Wunderink et al.
Schizophr Bull 2009;35:362-369.
ABSTRACT | FULL TEXT  

Toward a Terminology for Functional Recovery in Schizophrenia: Is Functional Remission a Viable Concept?
Harvey and Bellack
Schizophr Bull 2009;35:300-306.
ABSTRACT | FULL TEXT  

Periods of Recovery in Deficit Syndrome Schizophrenia: A 20-Year Multi-follow-up Longitudinal Study
Strauss et al.
Schizophr Bull 2008;0:sbn167v1-sbn167.
ABSTRACT | FULL TEXT  

Sleep Disturbance and Depression Recurrence in Community-Dwelling Older Adults: A Prospective Study
Cho et al.
Am. J. Psychiatry 2008;165:1543-1550.
ABSTRACT | FULL TEXT  

Exercise in the Prevention and Treatment of Adolescent Depression: A Promising but Little Researched Intervention
Dunn and Weintraub
AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2008;2:507-518.
ABSTRACT  

Child Bipolar I Disorder: Prospective Continuity With Adult Bipolar I Disorder; Characteristics of Second and Third Episodes; Predictors of 8-Year Outcome
Geller et al.
Arch Gen Psychiatry 2008;65:1125-1133.
ABSTRACT | FULL TEXT  

Sildenafil Treatment of Women With Antidepressant-Associated Sexual Dysfunction: A Randomized Controlled Trial
Nurnberg et al.
JAMA 2008;300:395-404.
ABSTRACT | FULL TEXT  

Fluoxetine Versus Placebo in Preventing Relapse of Major Depression in Children and Adolescents
Emslie et al.
Focus 2008;6:348-357.
ABSTRACT | FULL TEXT  

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Depressive Disorders
Focus 2008;6:379-400.
ABSTRACT | FULL TEXT  

Hippocampal volume and 2-year outcome in depression
Kronmuller et al.
Br. J. Psychiatry 2008;192:472-473.
ABSTRACT | FULL TEXT  

Population-Based Study of First Onset and Chronicity in Major Depressive Disorder
Eaton et al.
Arch Gen Psychiatry 2008;65:513-520.
ABSTRACT | FULL TEXT  

Fluoxetine Versus Placebo in Preventing Relapse of Major Depression in Children and Adolescents
Emslie et al.
Am. J. Psychiatry 2008;165:459-467.
ABSTRACT | FULL TEXT  

Achievement and Maintenance of Sustained Response During the Treatment for Adolescents With Depression Study Continuation and Maintenance Therapy
Rohde et al.
Arch Gen Psychiatry 2008;65:447-455.
ABSTRACT | FULL TEXT  

Deep Brain Stimulation for Treatment-Resistant Depression
Mayberg et al.
Focus 2008;6:143-154.
ABSTRACT | FULL TEXT  

5-HTT Binding in Recovered Depressed Patients and Healthy Volunteers: A Positron Emission Tomography Study With [11C]DASB
Bhagwagar et al.
Am. J. Psychiatry 2007;164:1858-1865.
ABSTRACT | FULL TEXT  

Recognition of Depression in Medical Patients With Heart Failure
Koenig
Psychosomatics 2007;48:338-347.
ABSTRACT | FULL TEXT  

An Intensive Treatment Program of Interpersonal Psychotherapy Plus Pharmacotherapy for Depressed Inpatients: Acute and Long-Term Results
Schramm et al.
Am. J. Psychiatry 2007;164:768-777.
ABSTRACT | FULL TEXT  

Care Management of Poststroke Depression: A Randomized, Controlled Trial
Williams et al.
Stroke 2007;38:998-1003.
ABSTRACT | FULL TEXT  

Effects of Citalopram and Interpersonal Psychotherapy on Depression in Patients With Coronary Artery Disease: The Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) Trial
Lesperance et al.
JAMA 2007;297:367-379.
ABSTRACT | FULL TEXT  

Raising the bar for treatment expectations in schizophrenia: achieving remission as a routine goal of antipsychotic pharmacotherapy
Nasrallah and Dursun
J Psychopharmacol 2006;20:3-5.
 

Improving patient outcomes in schizophrenia: achieving remission
Nasrallah and Lasser
J Psychopharmacol 2006;20:57-61.
ABSTRACT  

Increased 5-HT2A Receptor Binding in Euthymic, Medication-Free Patients Recovered From Depression: A Positron Emission Study With [11C]MDL 100,907
Bhagwagar et al.
Am. J. Psychiatry 2006;163:1580-1587.
ABSTRACT | FULL TEXT  

Differential Effects of 5-HTTLPR Genotypes on the Behavioral and Neural Responses to Tryptophan Depletion in Patients With Major Depression and Controls.
Neumeister et al.
Arch Gen Psychiatry 2006;63:978-986.
ABSTRACT | FULL TEXT  

A Randomized Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Major Depression.
Zarate et al.
Arch Gen Psychiatry 2006;63:856-864.
ABSTRACT | FULL TEXT  

Cognitive Reactivity to Sad Mood Provocation and the Prediction of Depressive Relapse.
Segal et al.
Arch Gen Psychiatry 2006;63:749-755.
ABSTRACT | FULL TEXT  

A Cognitive-Behavioral Treatment Package for Depression in Parkinson's Disease
DeFronzo Dobkin et al.
Psychosomatics 2006;47:259-263.
FULL TEXT  

Depression outcome in inpatients with congestive heart failure.
Koenig
Arch Intern Med 2006;166:991-996.
ABSTRACT | FULL TEXT  

Remission in depression: definition and initial treatment approaches
Israel
J Psychopharmacol 2006;20:5-10.
ABSTRACT  

Pharmacological approaches to the treatment of residual symptoms
Fava
J Psychopharmacol 2006;20:29-34.
ABSTRACT  

Clinical Course of Children and Adolescents With Bipolar Spectrum Disorders
Birmaher et al.
Arch Gen Psychiatry 2006;63:175-183.
ABSTRACT | FULL TEXT  

How Should Remission From Depression Be Defined? The Depressed Patient's Perspective
Zimmerman et al.
Am. J. Psychiatry 2006;163:148-150.
ABSTRACT | FULL TEXT  

Social Inequalities in Response to Antidepressant Treatment in Older Adults
Cohen et al.
Arch Gen Psychiatry 2006;63:50-56.
ABSTRACT | FULL TEXT  

Postremission Predictors of Relapse in Women With Eating Disorders
Keel et al.
Am. J. Psychiatry 2005;162:2263-2268.
ABSTRACT | FULL TEXT  

Measuring the severity of depression and remission in primary care: validation of the HAMD-7 scale
McIntyre et al.
CMAJ 2005;173:1327-1334.
ABSTRACT | FULL TEXT  

Do Patients with Schizophrenia Ever Show Periods of Recovery? A 15-Year Multi-Follow-up Study
Harrow et al.
Schizophr Bull 2005;31:723-734.
ABSTRACT | FULL TEXT  

Recovery From Schizophrenia: A Concept in Search of Research
Liberman and Kopelowicz
Psychiatr. Serv. 2005;56:735-742.
FULL TEXT  

Is depression a chronic illness? For the motion
Gask
Chronic Illness 2005;1:101-106.
 

Outcome in severe irritable bowel syndrome with and without accompanying depressive, panic and neurasthenic disorders
CREED et al.
Br. J. Psychiatry 2005;186:507-515.
ABSTRACT | FULL TEXT  

The effects of high-dose and low-dose tryptophan depletion on mood and cognitive functions of remitted depressed patients
Booij et al.
J Psychopharmacol 2005;19:267-275.
ABSTRACT  

A preliminary report on a skills-based telephone-administered peer support programme for patients with multiple sclerosis
Mohr et al.
Mult Scler 2005;11:222-226.
ABSTRACT  

Cognitive Therapy vs Medications in the Treatment of Moderate to Severe Depression
DeRubeis et al.
Arch Gen Psychiatry 2005;62:409-416.
ABSTRACT | FULL TEXT  

Prevention of Relapse Following Cognitive Therapy vs Medications in Moderate to Severe Depression
Hollon et al.
Arch Gen Psychiatry 2005;62:417-422.
ABSTRACT | FULL TEXT  

Remission in Schizophrenia: Proposed Criteria and Rationale for Consensus
Andreasen et al.
Am. J. Psychiatry 2005;162:441-449.
ABSTRACT | FULL TEXT  

Effects of Cognitive Therapy on Psychological Symptoms and Social Functioning in Residual Depression
Scott et al.
Focus 2005;3:122-130.
ABSTRACT | FULL TEXT  

Relationship of Variability in Residual Symptoms With Recurrence of Major Depressive Disorder During Maintenance Treatment
Karp et al.
Focus 2005;3:161-169.
ABSTRACT | FULL TEXT  

Comorbid Medical Illness and Relapse of Major Depressive Disorder in the Continuation Phase of Treatment
Iosifescu et al.
Psychosomatics 2004;45:419-425.
ABSTRACT | FULL TEXT  

Six-Year Outcome of Cognitive Behavior Therapy for Prevention of Recurrent Depression
Fava et al.
Am. J. Psychiatry 2004;161:1872-1876.
ABSTRACT | FULL TEXT  

Relationship of Variability in Residual Symptoms With Recurrence of Major Depressive Disorder During Maintenance Treatment
Karp et al.
Am. J. Psychiatry 2004;161:1877-1884.
ABSTRACT | FULL TEXT  

Neural and Behavioral Responses to Tryptophan Depletion in Unmedicated Patients With Remitted Major Depressive Disorder and Controls
Neumeister et al.
Arch Gen Psychiatry 2004;61:765-773.
ABSTRACT | FULL TEXT  

Effect of Medical Comorbidity on Response to Fluoxetine Augmentation or Dose Increase in Outpatients With Treatment-Resistant Depression
Perlis et al.
Psychosomatics 2004;45:224-229.
ABSTRACT | FULL TEXT  

A Randomized, Placebo-Controlled Trial of Sertraline for Prophylactic Treatment of Highly Recurrent Major Depressive Disorder
Lepine et al.
Am. J. Psychiatry 2004;161:836-842.
ABSTRACT | FULL TEXT  

Four-Year Prospective Outcome and Natural History of Mania in Children With a Prepubertal and Early Adolescent Bipolar Disorder Phenotype
Geller et al.
Arch Gen Psychiatry 2004;61:459-467.
ABSTRACT | FULL TEXT  

Reducing Suicidal Ideation and Depressive Symptoms in Depressed Older Primary Care Patients: A Randomized Controlled Trial
Bruce et al.
JAMA 2004;291:1081-1091.
ABSTRACT | FULL TEXT  

What Is a "Mood Stabilizer"? An Evidence-Based Response
Bauer and Mitchner
Am. J. Psychiatry 2004;161:3-18.
ABSTRACT | FULL TEXT  

Modulation of Cortical-Limbic Pathways in Major Depression: Treatment-Specific Effects of Cognitive Behavior Therapy
Goldapple et al.
Arch Gen Psychiatry 2004;61:34-41.
ABSTRACT | FULL TEXT  

Death and Dependence: Current Controversies over the Selective Serotonin Reuptake Inhibitors
Nutt
J Psychopharmacol 2003;17:355-364.
ABSTRACT  

A 12-Week, Double-blind Comparison of Olanzapine vs Haloperidol in the Treatment of Acute Mania
Tohen et al.
Arch Gen Psychiatry 2003;60:1218-1226.
ABSTRACT | FULL TEXT  

Increase in Concentration of Waking Salivary Cortisol in Recovered Patients With Depression
Bhagwagar et al.
Am. J. Psychiatry 2003;160:1890-1891.
ABSTRACT | FULL TEXT  

Olanzapine Versus Divalproex Sodium for the Treatment of Acute Mania and Maintenance of Remission: A 47-Week Study
Tohen et al.
Am. J. Psychiatry 2003;160:1263-1271.
ABSTRACT | FULL TEXT  

Cost of Lost Productive Work Time Among US Workers With Depression
Stewart et al.
JAMA 2003;289:3135-3144.
ABSTRACT | FULL TEXT  

Past, Present, and Future Directions for Defining Optimal Treatment Outcome in Depression: Remission and Beyond
Keller
JAMA 2003;289:3152-3160.
ABSTRACT | FULL TEXT  

12-Month Outcome of Patients With Bipolar Disorder Following Hospitalization for a Manic or Mixed Episode
Keck et al.
Focus 2003;1:44-52.
ABSTRACT | FULL TEXT  

Practice Guideline for the Treatment of Patients With Bipolar Disorder (Revision)
Hirschfeld et al.
Focus 2003;1:64-110.
FULL TEXT  

Treatment of Antidepressant-Associated Sexual Dysfunction With Sildenafil: A Randomized Controlled Trial
Nurnberg et al.
JAMA 2003;289:56-64.
ABSTRACT | FULL TEXT  

Duration of major depressive episodes in the general population: results from The Netherlands Mental Health Survey and Incidence Study (NEMESIS)
SPIJKER et al.
Br. J. Psychiatry 2002;181:208-213.
ABSTRACT | FULL TEXT  

Remission in Major Depressive Disorder: A Comparison of Pharmacotherapy, Psychotherapy, and Control Conditions
Casacalenda et al.
Am. J. Psychiatry 2002;159:1354-1360.
ABSTRACT | FULL TEXT  

Two-Year Prospective Follow-Up of Children With a Prepubertal and Early Adolescent Bipolar Disorder Phenotype
Geller et al.
Am. J. Psychiatry 2002;159:927-933.
ABSTRACT | FULL TEXT  

Using Elicitation Techniques to Estimate the Value of Ambulatory Treatments for Major Depression
Normand et al.
Med Decis Making 2002;22:245-261.
ABSTRACT  

State and trait abnormalities in serotonin function in major depression
BHAGWAGAR et al.
Br. J. Psychiatry 2002;180:24-28.
ABSTRACT | FULL TEXT  

Defining Response and Attaining Therapeutic Goals for Depression
House and Sommi
Journal of Pharmacy Practice 2001;14:453-457.
ABSTRACT  

Can Recovery From Depression Be Achieved?
Shelton and Tomarken
Psychiatr. Serv. 2001;52:1469-1478.
ABSTRACT | FULL TEXT  

Residual Symptoms and Impairment in Major Depression in the Community
Mojtabai
Am. J. Psychiatry 2001;158:1645-1651.
ABSTRACT | FULL TEXT  

Suicide Risk in Placebo-Controlled Studies of Major Depression
Storosum et al.
Am. J. Psychiatry 2001;158:1271-1275.
ABSTRACT | FULL TEXT  

A randomized, double-blind controlled comparison of nefazodone and paroxetine in the treatment of depression: safety, tolerability and efficacy in continuation phase treatment
Baldwin et al.
J Psychopharmacol 2001;15:161-165.
ABSTRACT  

Interpersonal Psychotherapy Adapted for the Group Setting in the Treatment of Postpartum Depression
Klier et al.
J. Psychother. Pract. Res. 2001;10:124-131.
ABSTRACT | FULL TEXT  

Preventing Recurrent Depression Using Cognitive Therapy With and Without a Continuation Phase: A Randomized Clinical Trial
Jarrett et al.
Arch Gen Psychiatry 2001;58:381-388.
ABSTRACT | FULL TEXT  

Prophylactic effect of citalopram in unipolar, recurrent depression: Placebo-controlled study of maintenance therapy
HOCHSTRASSER et al.
Br. J. Psychiatry 2001;178:304-310.
ABSTRACT | FULL TEXT  

Continuation and maintenance therapy in depression
Paykel
Br Med Bull 2001;57:145-159.
ABSTRACT | FULL TEXT  

Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors
THASE et al.
Br. J. Psychiatry 2001;178:234-241.
ABSTRACT | FULL TEXT  

A 25-Year-Old Woman With Bipolar Disorder
Sachs
JAMA 2001;285:454-462.
FULL TEXT  

Effects of cognitive therapy on psychological symptoms and social functioning in residual depression
SCOTT et al.
Br. J. Psychiatry 2000;177:440-446.
ABSTRACT | FULL TEXT  

Treatment of Dysthymia and Minor Depression in Primary Care: A Randomized Controlled Trial in Older Adults
Williams et al.
JAMA 2000;284:1519-1526.
ABSTRACT | FULL TEXT  

Double-Blind, Placebo-Controlled Trial of the Use of Lithium to Augment Antidepressant Medication in Continuation Treatment of Unipolar Major Depression
Bauer et al.
Am. J. Psychiatry 2000;157:1429-1435.
ABSTRACT | FULL TEXT  

Does Incomplete Recovery From First Lifetime Major Depressive Episode Herald a Chronic Course of Illness?
Judd et al.
Am. J. Psychiatry 2000;157:1501-1504.
ABSTRACT | FULL TEXT  

Exercise Treatment for Major Depression: Maintenance of Therapeutic Benefit at 10 Months
Babyak et al.
Psychosom. Med. 2000;62:633-638.
ABSTRACT | FULL TEXT  

Outcome of hospital-treated depression
Ridley-Siegert
Br. J. Psychiatry 2000;177 :86-87.
FULL TEXT  

Meta-analysis of randomised controlled trials of fluoxetine v. placebo and tricyclic antidepressants in the short-term treatment of major depression
BECH et al.
Br. J. Psychiatry 2000;176:421-428.
ABSTRACT | FULL TEXT  

Two-Year Syndromal and Functional Recovery in 219 Cases of First-Episode Major Affective Disorder With Psychotic Features
Tohen et al.
Am. J. Psychiatry 2000;157:220-228.
ABSTRACT | FULL TEXT  

Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 1993 British Association for Psychopharmacology guidelines
Anderson et al.
J Psychopharmacol 2000;14:3-20.
ABSTRACT  

Randomised controlled trial of problem solving treatment, antidepressant medication, and combined treatment for major depression in primary care
Mynors-Wallis et al.
BMJ 2000;320:26-30.
ABSTRACT | FULL TEXT  

Clinical Outcome After Short-term Psychotherapy for Adolescents With Major Depressive Disorder
Birmaher et al.
Arch Gen Psychiatry 2000;57:29-36.
ABSTRACT | FULL TEXT  

Long-term Maintenance and Discontinuation of Imipramine Therapy in Panic Disorder With Agoraphobia
Mavissakalian and Perel
Arch Gen Psychiatry 1999;56:821-827.
ABSTRACT | FULL TEXT  

Prevention of Relapse in Residual Depression by Cognitive Therapy: A Controlled Trial
Paykel et al.
Arch Gen Psychiatry 1999;56:829-835.
ABSTRACT | FULL TEXT  

Personality and Clinical Predictors of Recurrence of Depression
Berlanga et al.
Psychiatr. Serv. 1999;50:376-380.
ABSTRACT | FULL TEXT