Is full recovery from depression possible?

57 Pages·1998·0.9 MB·English

by  M Briley

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Is full recovery from depression possible?
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Is full recovery from
depression possible?
Edited by:
Mike Briley
Institut de Recherhe
Pierre Fabre
Parc Industriel de la Chartreuse
Castres, France
MARTIN DUNITZ
CRC Press
Taylor & Francis Group
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Boca Raton, FL 33487-2742
© 1999 by Taylor & Francis Group, LLC
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No claim to original U.S. Government works
Version Date: 20130515
International Standard Book Number-13: 978-1-4822-1092-7 (eBook - General)
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Acknowledgements
This publication is the result of a Workshop on the
subject, held under the chairmanship of Stuart Mont-
gomery and Mike Briley. Martin Dunitz Ltd would like to
acknowledge the contribution of the following individuals:
This book was prepared with the aid of an unrestricted edu-
cational grant from Pierre Fabre Médicament and the
scientific support of an Advisory Board composed of:
M. Ansseas (Psychiatric unit, CHU du Sart Tilman –
Belgium), G.B. Cassano (University of Pisa, Institute of
Psychiatry – Italy), J.F. Deakin (University of Manchester,
Department of Psychiatry – United Kingdom), L. Figueira
(Faculty of Medicine, Department of Medical Psychology –
Portugal), E. Holsboer-Traschler (University of Basel,
Department of Psychiatry – Switzerland), S. Kasper (Uni-
versity of Vienna, Department of Psychiatry – Austria),
L. von Knorring (University Hospital, Department of Psy-
chiatry – Sweden), Y. Lecrubier (INSERM, Unité 3 –
France), B. Leonard (University College, Pharmacology
Department – Ireland), J. Lopez-Ibor (San Carlos Univer-
sity Hospital – Spain), H.J. Möller (University of Munich,
Department of Psychiatry – Germany), H. van Praag
(Maastricht University, Department of Psychiatry – Nether-
lands), D.Sechter(CHU du Sart).
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Contents
Introduction 1
What constitutes ‘recovery’ from
depression? 4
The time-course of depression treatment 5
How common is poor outcome in
depression? 6
The NIMH Collaborative Depression
Study 6
The Zurich Study 8
Other studies 9
The problem of under-diagnosis and
under-treatment 10
Factors affecting outcome of
depression 13
Demographic characteristics 14
Illness variables 14
Number of previous episodes 14
Unipolar depression 15
Bipolar depression 16
Residual symptoms 17
Family history of depression 18
Comorbidity 19
Treatment variables 19
Choice of drug 20
Dose 20
Duration of treatment 21
Biological correlates 22
Sleep disturbances 22
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Hypothalamus-pituitary-adrenal axis
function 23
Long-term treatment of depression 25
Tricyclic antidepressants 25
Serotonin selective reuptake inhibitors 27
Other agents 29
Lithium 30
Compliance during long-term treatment 31
Psychotherapy 33
The economic impact of recurrent
depression 34
Conclusions 37
References 39
Index 47
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Introduction
The treatment of depression has been facilitated
during the past two decades by the development of
new antidepressant drugs with high efficacy and
improved tolerability compared with the earlier tricyclic
agents (Montgomery, 1996, 1997a). Typically, modern
antidepressants produce response rates of 70–80%
during acute treatment, compared with 20–30% for
placebo (Regier et al., 1988). Despite these
favourable responses to acute treatment, however,
the long-term outcome of depression remains poor in
many patients. Between 15 and 20% of depressed
patients experience a chronic illness and recurrent
depression has been observed in 80–90% of cases
over a 10-year follow-up period (Angst, 1992; Keller et
al., 1992; Surtess and Barkley, 1994). Delayed remis-
sion, residual symptoms, relapse and recurrence are
common, even when symptoms appear to have
responded to acute treatment (Paykel, 1994; Angst et
al., 1996; Montgomery, 1996, 1997a; Solomon et al.,
1997). A long-term approach to the treatment is,
therefore, essential (Angst et al., 1996; Montgomery,
1996, 1997a).
1
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Table 1
Definitions of outcomes in major unipolar depression (Frank et al., 1991;
Montgomery and Dunbar, 1993; Bland, 1997; Montgomery, 1997a)
Episode A period lasting longer than a specified
number of days, during which the patient
is consistently within the full symptomatic
range on a sufficient number of
symptoms to meet syndromal criteria for
the disorder
Response The point at which partial remission
begins
Partial remission A period during which improvement is
such that the patient no longer meets the
syndromal criteria for the disorder, but
continues with more than minimal
symptoms
Full remission A period when improvement is such that
the patient no longer meets syndromal
criteria and has no more than residual
symptoms (asymptomatic)
Recovery A remission lasting longer than a
specified period, can last indefinitely
(this term usually designates recovery
from the episode, rather than the illness)
Relapse A return of full symptom criteria during a
period of full or partial remission, but
before recovery has occurred
Recurrence The appearance of a new episode of
illness; recurrence can only occur during
a recovery
2