May duration of untreated illness influence the long-term course of major depressive disorder?

AbstractThe aim of this naturalistic study was to investigate the possible influence of the duration of untreated illness (DUI) on the long-term course of Major Depressive Disorder (MDD). One hundred and thirteen patients with recurrent MDD, according to DSM-IV-TR criteria, followed up for 5 years, were selected, interviewed and their clinical charts were reviewed. The DUI was defined as the interval between the onset of the first depressive episode and the first adequate antidepressant treatment. The sample was divided into two groups according to the DUI: one group with a DUI ≤ 12 months (n = 75), and the other with a DUI > 12 months (n = 38). The main demographic and clinical course variables were compared between the two groups using Student's t-tests or chi-square tests. Patients with a longer DUI showed an earlier age at onset (t = 2.82, p = 0.006) and a longer duration of illness (t = 3.20, p = 0.002) compared to patients with a shorter DUI. In addition, the total number of depressive episodes occurring before the first antidepressant treatment was higher in the group with a longer DUI (t = −2.223, p < 0.03). Even though limited by the retrospective nature of the study, these preliminary findings would suggest that a longer DUI may negatively influence the course of MDD. Larger prospective studies are warranted to further investigate the role of the DUI within MDD.

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Clinical differences between bipolar and unipolar depression

The British Journal of Psychiatry ◽

10.1192/bjp.bp.107.045294 ◽

2008 ◽

Vol 192 (5) ◽

pp. 388-389 ◽

Cited By ~ 78

Author(s):

Liz Forty ◽

Daniel Smith ◽

Lisa Jones ◽

Ian Jones ◽

Sian Caesar ◽

...

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Clinical Course ◽

Bipolar Depression ◽

Unipolar Depression ◽

Major Depressive ◽

Symptom Profiles ◽

Clinical Presentations ◽

Course Variables ◽

Depressive Episodes

SummaryIt is commonly – but wrongly – assumed that there are no important differences between the clinical presentations of major depressive disorder and bipolar depression. Here we compare clinical course variables and depressive symptom profiles in a large sample of individuals with major depressive disorder (n=593) and bipolar disorder (n=443). Clinical characteristics associated with a bipolar course included the presence of psychosis, diurnal mood variation and hypersomnia during depressive episodes, and a greater number of shorter depressive episodes. Such features should alert a clinician to a possible bipolar course. This is important because optimal management is not the same for bipolar and unipolar depression.

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Recent advances in predicting responses to antidepressant treatment

F1000Research ◽

10.12688/f1000research.10300.1 ◽

2017 ◽

Vol 6 ◽

pp. 619 ◽

Cited By ~ 8

Author(s):

Thomas Frodl

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Targeted Therapies ◽

Antidepressant Treatment ◽

Inflammation Markers ◽

Major Depressive ◽

The Past ◽

Recent Advances ◽

The World ◽

Depressive Episodes

Major depressive disorder is one of the leading causes of disability in the world since depression is highly frequent and causes a strong burden. In order to reduce the duration of depressive episodes, clinicians would need to choose the most effective therapy for each individual right away. A prerequisite for this would be to have biomarkers at hand that would predict which individual would benefit from which kind of therapy (for example, pharmacotherapy or psychotherapy) or even from which kind of antidepressant class. In the past, neuroimaging, electroencephalogram, genetic, proteomic, and inflammation markers have been under investigation for their utility to predict targeted therapies. The present overview demonstrates recent advances in all of these different methodological areas and concludes that these approaches are promising but also that the aim to have such a marker available has not yet been reached. For example, the integration of markers from different systems needs to be achieved. With ongoing advances in the accuracy of sensing techniques and improvement of modelling approaches, this challenge might be achievable.

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Major Depressive Disorder: Recurrence Risk Factors

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1974 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S139-S139

Author(s):

R. Ben Soussia ◽

S. Khouadja ◽

I. Marrag ◽

S. Younes ◽

M. Nasr

Keyword(s):

Risk Factors ◽

Major Depressive Disorder ◽

Depressive Disorder ◽

Age At Onset ◽

Recurrence Risk ◽

University Hospital ◽

Major Depressive ◽

Residual Symptoms ◽

Time To Recurrence ◽

Depressive Episodes

IntroductionIn spite of the frequency and the gravity of the depressive episodes, the major depressive disorder (MDD) is diagnosed and treated today insufficiently and the risk factors of its recurrence are little approached.Aims of the studyDescribe the socio–demographic, clinical and therapeutic characteristics of patients with MDD and identify the factors involved in the recurrence risk.MethodologyThis is a retrospective study carried out in the university hospital of Mahdia, Tunisia during two years. We have included patients with a follow up for at least two years and diagnosed with MDD, isolated episode or MDD, recurrent episode according to the DSM-IV-TR criteria. Data collection was performed using two pre-established questionnaires respectively with 51 and 92 items. We have estimated the time to recurrence with the Kaplan-Meier estimator.ResultsWe have collected 150 patients. The time to recurrence was 109 months. Five factors were associated with recurrence: early age at onset of the disorder, family history of mood disorders, severity of the index major depressive episode, persistent residual symptoms and ceasing treatment.ConclusionDepression is a very common mental illness that is highly recurrent in individuals. There is great interest in the development of strategies that might reduce the recurrence of depression.

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P-474 - Duration of untreated illness and long-term outcome in major depressive disorder

European Psychiatry ◽

10.1016/s0924-9338(12)74641-2 ◽

2012 ◽

Vol 27 ◽

pp. 1

Author(s):

D. Primavera ◽

F. Cosso ◽

L. Sanna ◽

C. Bandecchi ◽

T. Lepori ◽

...

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Major Depressive ◽

Term Outcome ◽

Long Term Outcome ◽

Duration Of Untreated Illness

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Impact of Drug Tolerability on the Selection of Antidepressant Treatment in Patients With Major Depressive Disorder

CNS Spectrums ◽

10.1017/s1092852900026353 ◽

2009 ◽

Vol 14 (S12) ◽

pp. 8-14 ◽

Cited By ~ 10

Author(s):

Lawrence D. Ginsberg

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Antidepressant Treatment ◽

Tolerability Profile ◽

Major Depressive ◽

Treatment Side Effects ◽

Drug Tolerability ◽

Short And Long Term ◽

Selection Of

AbstractDespite significant progress in the development of antidepressant therapies, tolerability remains an important factor associated with the selection of appropriate antidepressant treatment. Side effects commonly reported by depressed patients taking antidepressants include weight gain, sexual dysfunction, and gastrointestinal effects. Tolerability issues associated with antidepressants can negatively impact treatment outcomes for patients with major depressive disorder. In addition, a drug's tolerability profile substantially influences a physician's choice of specific antidepressant therapy. Despite the availability of many antidepressants, empirical clinical evidence to guide physicians in making the best choice is limited and not always clear. Thus, it is key for clinicians to understand the short- and long-term outcomes and side effect profiles of the available antidepressants.

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Factors Impacting the Selection of Antidepressant Treatment in Patients With Major Depressive Disorder at Risk for Nonadherence

CNS Spectrums ◽

10.1017/s1092852900026365 ◽

2009 ◽

Vol 14 (S12) ◽

pp. 15-19 ◽

Cited By ~ 5

Author(s):

Charles Shelton

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Treatment Guidelines ◽

Patient Adherence ◽

Antidepressant Treatment ◽

Major Depressive ◽

Patient Nonadherence ◽

Subsequent Relapse ◽

Selection Of

AbstractTreatment with the newer generation antidepressants is considered generally effective for most patients with major depressive disorder when taken in accordance with treatment guidelines. However, multiple clinical studies have demonstrated that rates of patient adherence to antidepressants are inadequate, specifically with regard to long-term maintenance treatment. Tolerability issues associated with antidepressants can increase the risk for patient nonadherence and result in subsequent relapse of depressive symptoms. Comorbid symptoms of anxiety also influence psychiatrists' choice of antidepressants for patients with depression. Physicians can improve long-term patient outcomes for patients with major depressive disorder by considering the possibility of drug-drug interactions before prescribing a specific antidepressant.

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Maintenance Pharmacotherapy for Recurrent Major Depressive Disorder in Primary Care: A 5-year Follow-up Study

European Psychiatry ◽

10.1016/j.eurpsy.2016.10.010 ◽

2017 ◽

Vol 41 (1) ◽

pp. 111-114 ◽

Cited By ~ 3

Author(s):

K. Riihimäki ◽

M. Vuorilehto ◽

E. Isometsä

Keyword(s):

Primary Care ◽

Major Depressive Disorder ◽

Depressive Disorder ◽

Maintenance Treatment ◽

Antidepressant Treatment ◽

Major Depressive ◽

Recurrent Major Depressive Disorder ◽

Major Depressive Episodes ◽

Depressive Episodes

AbstractBackgroundMost practice guidelines recommend maintenance antidepressant treatment for recurrent major depressive disorder. However, the degree to which such guidance is actually followed in primary health care has remained obscure. We investigated the provision of maintenance antidepressant treatment within a representative primary care five-year cohort study.MethodsIn the Vantaa Primary Care Depression Study, a stratified random sample of 1119 adult patients was screened for depression using the Prime-MD. Depressive and comorbid psychiatric disorders were diagnosed using SCID-I/P and SCID-II interviews. Of the 137 patients with depressive disorders, 82% completed the prospective five-year follow-up. A graphic life chart enabling evaluation of the longitudinal course of episodes plus duration of pharmacotherapies was used. In accordance with national guidelines, an indication for maintenance treatment was defined to exist after three or more lifetime major depressive episodes (MDEs); maintenance treatment was to commence four months after onset of full remission.ResultsOf the cohort patients, 34% (46/137) had three or more lifetime MDEs, thus indicating the requirement for maintenance pharmacotherapy. Of these, half (54%, 25/46) received maintenance treatment, for only 29% (489/1670) of the months indicated.ConclusionsIn this cohort of depressed primary care patients, half of patients with indications for maintenance treatment actually received it, and only for a fraction of the time indicated. Antidepressant maintenance treatment for the prevention of recurrences is unlikely to be subject to large-scale actualization as recommended, which may significantly undermine the potential public health benefits of treatment.

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