Individuals who’ve experienced one incident of major depression are very likely to go on to have recurrent depression. Recently, researchers have discovered that the risk for having a recurrent depressive episode for individuals who have experienced recovery from major depression is significantly lower than for those who have had only a partial resolution of their depressive symptoms.
These findings make clear that there needs to be a clinical redefinition of the criteria for when a major depressive episode ends. It also indicates that there needs to be changes in how the treatment of depression is managed.
Currently, the clinical consensus for defining when an episode of major depression has ended is eight weeks in a row with the patient having “no more than minimal” lingering symptoms. Currently, there are two separate levels of the resolution of depressive symptoms: “residual symptom resolution” when there are still some lingering mild symptoms of major depression and “asymptomatic recovery” when there are no or few symptoms of depression at all (successful recovery from major depression). This study was designed to compare the two different levels with regard to the time it takes for another depressive episode to occur and other important clinical outcomes.
Data taken from 322 patients with a major depressive episode that took part in the Collaborative Depression Study done by the National Institute of Mental from 1978 to 1981 and who continued to be followed up with for 31 years. Of those participants, 61.2% recovered from their major depression and had minimal symptoms. These patients went without relapsing with a recurrent depressive episode 4.2 times longer than the patients who continued to have residual symptoms, specifically 135 weeks vs. 32 weeks when comparing median times.
Continuing to have residual symptoms was linked with an almost 3 times higher risk of going back to a full-blown episode of depression within 1 year (74% vs. 26%). The group experiencing residual symptoms also experienced a stronger depressive illness burden throughout the next 10 to 20 years, along with more difficulty long term functioning at work, managing a household and in personal relationships.
Successful recovery from major depression should certainly continue until most or nearly all depressive symptoms are resolved. If a patient experiencing a major depression episode is treated until they have no or few symptoms remaining, they have experienced a recovery from depression, allowing them to avoid recurrent depression for a period of months and possibly years. Treatment should never end just because there has been improvement. If there are any residual symptoms at all, the patient is still considered ill and they are at an increased risk of suffering recurrent depression. Hence, when patients step down from one level of care to another, it is imperative that they remain in treatment until their symptoms are minimal.
The researchers also discovered that the huge difference in how long the two groups remained well was not because of the different levels of antidepressants they received. Furthermore, the level of relief from symptoms proved more crucial than any of the 18 other predictors, which have been suggested in the clinical literature, with regard to how long the participants were able to avoid a recurrent depressive episode.
These findings offer the first assessment (based on research) of how recovery from major depression should be defined, in terms of necessary duration as well as symptom state. Regarding the length of time the patient needs to be asymptomatic before it is determined they’ve recovered from an episode of major depression, the researchers discovered that 4 weeks in a row without symptoms was as strong an indicator of a stable recovery as 8 weeks and this reduced their risk of recurrent depression.
Based on the findings in this study, it was concluded that 4 weeks of being completely free of all depressive symptoms should be how recovery from major depression should now defined and the objective of treatment.
If you or a loved one is showing signs of major depression or anxiety, they should be assessed by a trained mental health professional who can help design a treatment plan for depression that can result in recovery. Treatment for depression and anxiety can be highly successful and people who have completed our program have resulted in our treatment program receiving very highly consumer satisfaction scores and reviews. Call us at 901-682-6136 to schedule an appointment.