This Article  • 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 ISI (299)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Depression  • Alert me on articles by topic  Social Bookmarking   What's this?

Lewis L. Judd, MD; Hagop S. Akiskal, MD; Jack D. Maser, PhD; Pamela J. Zeller, PhD; Jean Endicott, PhD; William Coryell, MD; Martin P. Paulus, MD; Jelena L. Kunovac, MD; Andrew C. Leon, PhD; Timothy I. Mueller, MD; John A. Rice, PhD; Martin B. Keller, MD

Arch Gen Psychiatry. 1998;55:694-700.

Background  Investigations of unipolar major depressive disorder (MDD) have focused primarily on major depressive episode remission/recovery and relapse/recurrence. This is the first prospective, naturalistic, long-term study of the weekly symptomatic course of MDD.

Methods  The weekly depressive symptoms of 431 patients with MDD seeking treatment at 5 academic centers were divided into 4 levels of severity: (1) depressive symptoms at the threshold for MDD; (2) depressive symptoms at the threshold for minor depressive or dysthymic disorder (MinD); (3) subsyndromal or subthreshold depressive symptoms (SSDs), below the thresholds for MinD and MDD; and (4) no depressive symptoms. The percentage of weeks at each level, number of changes in symptom level, and medication status were analyzed overall and for 3 subgroups defined by mood disorder history.

Results  Patients were symptomatically ill in 59% of weeks. Symptom levels changed frequently (1.8/y), and 9 of 10 patients spent weeks at 3 or 4 different levels during follow-up. The MinD (27%) and SSD (17%) symptom levels were more common than the MDD (15%) symptom level. Patients with double depression and recurrent depression had more chronic symptoms than patients with their first lifetime major depressive episode (72% and 65%, respectively, vs 46% of follow-up weeks).

Conclusion  The long-term weekly course of unipolar MDD is dominated by prolonged symptomatic chronicity. Combined MinD and SSD level symptoms were about 3 times more common (43%) than MDD level symptoms (15%). The symptomatic course is dynamic and changeable, and MDD, MinD, and SSD symptom levels commonly alternate over time in the same patients as a symptomatic continuum of illness activity of a single clinical disease.

From the Department of Psychiatry, University of California, San Diego (Drs Judd, Akiskal, Zeller, Paulus, and Kunovac); the Psychiatry Service, San Diego Veterans Affairs Medical Center (Drs Akiskal and Paulus); and the National Institute of Mental Health Collaborative Program on the Psychobiology of Depression, Clinical Studies, conducted with the participation of the following investigators: Dr Akiskal (San Diego), Dr Maser (Behavioral and Integrative Neuroscience Research Program, National Institute of Mental Health, Washington, DC), Drs Endicott (Department of Research Assessment and Training, Columbia University, New York, NY), Dr Leon (Department of Psychiatry, Cornell University, New York, NY), Dr Coryell (Department of Psychiatry, University of Iowa, Iowa City), Drs Mueller and Keller (chairperson) (Department of Psychiatry, Brown University, Providence, RI), and Dr Rice (Department of Psychiatry, Washington University, St Louis, Mo).

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

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Major depression: revisiting the concept and diagnosis
Jacob
Adv. Psychiatr. Treat. 2009;15:279-285.
ABSTRACT | FULL TEXT  

From Descartes to Desipramine: Psychopharmacology and the Self
Gold and Olin
Transcultural Psychiatry 2009;46:38-59.
ABSTRACT  

Agomelatine Treatment of Major Depressive Disorder
Dolder et al.
The Annals of Pharmacotherapy 2008;42:1822-1831.
ABSTRACT | FULL TEXT  

Psychiatric outcomes 10 years after treatment with antidepressants or anxiolytics
Colman et al.
Br. J. Psychiatry 2008;193:327-331.
ABSTRACT | FULL TEXT  

Desvenlafaxine: Another "Me Too" Drug?
Sopko et al.
The Annals of Pharmacotherapy 2008;42:1439-1446.
ABSTRACT | FULL TEXT  

Addressing circadian rhythm disturbances in depressed patients
Lam
J Psychopharmacol 2008;22:13-18.
ABSTRACT  

Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2000 British Association for Psychopharmacology guidelines
Anderson et al.
J Psychopharmacol 2008;22:343-396.
ABSTRACT  

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  

A Cohort Study of People With Diabetes and Their First Foot Ulcer: The role of depression on mortality
Ismail et al.
Diabetes Care 2007;30:1473-1479.
ABSTRACT | FULL TEXT  

Short-Term Stability of Diagnoses of Major and Minor Depression in Older Medical Inpatients
Cole et al.
Psychosomatics 2007;48:38-45.
ABSTRACT | FULL TEXT  

Patient Management Exercise FOR BIPOLAR DISORDER
Levine and Albucher
Focus 2007;5:20-32.
ABSTRACT | FULL TEXT  

Are Mood Disorders a Stroke Risk Factor?
Carod-Artal
Stroke 2007;38:1-3.
FULL TEXT  

Familial Aggregation of Illness Chronicity in Recurrent, Early-Onset Major Depression Pedigrees
Mondimore et al.
Am. J. Psychiatry 2006;163:1554-1560.
ABSTRACT | FULL TEXT  

Prevalence and Effects of Mood Disorders on Work Performance in a Nationally Representative Sample of U.S. Workers
Kessler et al.
Am. J. Psychiatry 2006;163:1561-1568.
ABSTRACT | FULL TEXT  

Depression: epidemic or pseudo-epidemic?
Hafizi
JRSM 2006;99:436-436.
FULL TEXT  

Early discontinuation of antidepressant treatment in adults is very common in the USA.
Andersson
Evid. Based Ment. Health 2006;9:65-65.
FULL TEXT  

Sub-syndromal and syndromal symptoms in the longitudinal course of bipolar disorder
Paykel et al.
Br. J. Psychiatry 2006;189:118-123.
ABSTRACT | FULL TEXT  

Depressive Symptoms in Coronary Artery Disease Patients After Hypertension Treatment
Ried et al.
The Annals of Pharmacotherapy 2006;40:597-604.
ABSTRACT | FULL TEXT  

Service innovations: developing a specialised (tertiary) service for the treatment of affective disorders
Ker and Anderson
Psychiatr. Bull. 2006;30:103-105.
FULL TEXT  

Early Affiliation and Social Engagement With Peers: Prospective Risk and Protective Factors for Childhood Depressive Behaviors
Schrepferman et al.
Journal of Emotional and Behavioral Disorders 2006;14:50-61.
ABSTRACT  

Psychosocial Disability in the Course of Bipolar I and II Disorders: A Prospective, Comparative, Longitudinal Study
Judd et al.
Arch Gen Psychiatry 2005;62:1322-1330.
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  

The medical management of depression.
Mann
NEJM 2005;353:1819-1834.
FULL TEXT  

Quality Improvement for Depression in Primary Care: Do Patients With Subthreshold Depression Benefit in the Long Run?
Wells et al.
Am. J. Psychiatry 2005;162:1149-1157.
ABSTRACT | FULL TEXT  

Chronic Depression: Medication (Nefazodone) or Psychotherapy (CBASP) Is Effective When the Other Is Not
Schatzberg et al.
Arch Gen Psychiatry 2005;62:513-520.
ABSTRACT | FULL TEXT  

Definitions and Distinctions Among Depressive Syndromes and Symptoms: Implications for a Better Understanding of the Depression-Cardiovascular Disease Association
Davidson et al.
Psychosom. Med. 2005;67:S6-S9.
ABSTRACT | FULL TEXT  

Neuropsychological Differences Between Late-Onset and Recurrent Geriatric Major Depression
Rapp et al.
Am. J. Psychiatry 2005;162:691-698.
ABSTRACT | FULL TEXT  

Women's and doctors' accounts of their experiences of depression in primary care: the influence of social and moral reasoning on patients' and doctors' decisions
Maxwell
Chronic Illness 2005;1:61-71.
ABSTRACT  

Depression: An Update for the Clinician
Nierenberg et al.
Focus 2005;3:3-12.
FULL TEXT  

A Descriptive Analysis of Minor Depression
Rapaport et al.
Focus 2005;3:98-105.
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  

The Burden of Major Depression Avoidable by Longer-term Treatment Strategies
Vos et al.
Arch Gen Psychiatry 2004;61:1097-1103.
ABSTRACT | FULL TEXT  

Randomized, Placebo-Controlled Trial of Fluoxetine for Acute Treatment of Minor Depressive Disorder
Judd et al.
Am. J. Psychiatry 2004;161:1864-1871.
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  

Clinical Results for Patients With Major Depressive Disorder in the Texas Medication Algorithm Project
Trivedi et al.
Arch Gen Psychiatry 2004;61:669-680.
ABSTRACT | FULL TEXT  

Longitudinal syndromal and sub-syndromal symptoms after severe depression: 10-year follow-up study
KENNEDY et al.
Br. J. Psychiatry 2004;184:330-336.
ABSTRACT | FULL TEXT  

Maintenance Treatment of Insomnia: What Can We Learn From the Depression Literature?
Jindal et al.
Am. J. Psychiatry 2004;161:19-24.
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  

Depression and Other Psychological Risks Following Myocardial Infarction
Frasure-Smith and Lesperance
Arch Gen Psychiatry 2003;60:627-636.
ABSTRACT | FULL TEXT  

Will the Genomics Revolution Revolutionize Psychiatry?
Merikangas and Risch
Am. J. Psychiatry 2003;160:625-635.
FULL TEXT  

A Prospective Investigation of the Natural History of the Long-term Weekly Symptomatic Status of Bipolar II Disorder
Judd et al.
Arch Gen Psychiatry 2003;60:261-269.
ABSTRACT | FULL TEXT  

A Three-Component Model for Reengineering Systems for the Treatment of Depression in Primary Care
Oxman et al.
Psychosomatics 2002;43:441-450.
ABSTRACT | FULL TEXT  

Managing depression as a chronic disease: a randomised trial of ongoing treatment in primary care
Rost et al.
BMJ 2002;325:934-934.
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  

The Natural History of Late-Life Depression: A 6-Year Prospective Study in the Community
Beekman et al.
Arch Gen Psychiatry 2002;59:605-611.
ABSTRACT | FULL TEXT  

Smoking and Depression: An Examination of Mechanisms of Comorbidity
Dierker et al.
Am. J. Psychiatry 2002;159:947-953.
ABSTRACT | FULL TEXT  

The Long-term Natural History of the Weekly Symptomatic Status of Bipolar I Disorder
Judd et al.
Arch Gen Psychiatry 2002;59:530-537.
ABSTRACT | FULL TEXT  

A Descriptive Analysis of Minor Depression
Rapaport et al.
Am. J. Psychiatry 2002;159:637-643.
ABSTRACT | FULL TEXT  

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

Recurrence of depression in those with prepubertal onset was associated with higher rates of depression in relatives
Dierker
Evid. Based Ment. Health 2001;4:94-94.
FULL TEXT  

Should depression be managed as a chronic disease?
Andrews
BMJ 2001;322:419-421.
FULL TEXT  

The Relationship Between Quality and Outcomes in Routine Depression Care
Fortney et al.
Psychiatr. Serv. 2001;52:56-62.
ABSTRACT | FULL TEXT  

Treatment of the Depressions of Bereavement
ZISOOK and SHUCHTER
American Behavioral Scientist 2001;44:782-797.
ABSTRACT  

Managing Depression in Medical Outpatients
Whooley and Simon
NEJM 2000;343:1942-1950.
FULL TEXT  

Cerebral White Matter Lesions and Depressive Symptoms in Elderly Adults
de Groot et al.
Arch Gen Psychiatry 2000;57:1071-1076.
ABSTRACT | FULL TEXT  

Adverse Outcome of Subsyndromal and Syndromal Levels of Depressive Symptom Severity
Judd
Psychosom. Med. 2000;62:472-473.
FULL TEXT  

Depression and 1-Year Prognosis in Unstable Angina
Lesperance et al.
Arch Intern Med 2000;160:1354-1360.
ABSTRACT | FULL TEXT  

Psychosocial Disability During the Long-term Course of Unipolar Major Depressive Disorder
Judd et al.
Arch Gen Psychiatry 2000;57:375-380.
ABSTRACT | FULL TEXT  

A Comparison of Diagnostic Interviews for Depression in the Stirling County Study: Challenges for Psychiatric Epidemiology
Murphy et al.
Arch Gen Psychiatry 2000;57:230-236.
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  

Persistence of Depressive Symptoms and Cardiovascular Death Among Patients With Affective Disorder
Coryell et al.
Psychosom. Med. 1999;61:755-761.
ABSTRACT | FULL TEXT  

Other Articles Noted
Evid. Based Nurs. 1999;2:105-112.
FULL TEXT  

The Role of Residual Subthreshold Depressive Symptoms in Early Episode Relapse in Unipolar Major Depressive Disorder
Judd et al.
Arch Gen Psychiatry 1999;56:764-765.
FULL TEXT  

Most patients with a first episode of major depressive disorder experienced multiple levels of depressive symptoms over time
Persons
Evid. Based Ment. Health 1999;2:23-23.
FULL TEXT  

Five-Year Risk of Cardiac Mortality in Relation to Initial Severity and One-Year Changes in Depression Symptoms After Myocardial Infarction
Lesperance et al.
Circulation 2002;105:1049-1053.
ABSTRACT | FULL TEXT