OBJECTIVE: Most efforts to describe the prognostic significance of
psychotic features in depression have been limited to single assessments 1
year or less after the initial evaluation. However, the various biological
and treatment response differences between patients with psychotic and
nonpsychotic depression suggest that prognostic differences may be very
long-term. METHOD: The 787 patients described here entered the study as
they sought treatment at one of five academic medical centers; they had
either RDC major depressive disorder or schizo-affective depression (other
than the mainly schizophrenic subtype) and completed at least 6 months of
follow-up. Of these, 144 (18.3%) had psychotic depression as defined here.
Patients provided follow-up interviews at 6-month intervals for 5 years and
annually thereafter; 98 of those with psychotic depression and 434 of those
with non-psychotic depression were followed for 10 years. RESULTS: Those
who began follow-up with psychotic depression had fewer weeks with minimal
symptoms in each of the 10 years of follow-up and reported more
psychosocial impairment at both 5 and 10 years. Both the index episode and
the first recurrence of psychotic depression lasted longer than
nonpsychotic episodes, but nonpsychotic episodes among previously psychotic
individuals were relatively brief. Intervals between episodes were
significantly shorter for patients who had ever been psychotic.
CONCLUSIONS: Together with evidence that psychotic features are highly
recurrent, these data show 1) that psychotic features denote a lifetime
illness of greater severity and 2) that within individuals, psychotic
features may emerge in only the more severe episodes.