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Am J Psychiatry 1992; 149:795-800
Copyright © 1992 by American Psychiatric Association
Pattern of recurrence of illness after recovery from an episode of major depression: a prospective study
M Maj, F Veltro, R Pirozzi, S Lobrace and L Magliano
Department of Psychiatry, First Medical School, University of Naples, Italy.
OBJECTIVE: This study assessed prospectively the pattern of recurrence of
illness after recovery from an episode of major depression. METHOD:
Seventy-two patients who had recovered from an episode of primary,
nonbipolar, nonpsychotic major depression were evaluated bimonthly with the
Comprehensive Psychopathological Rating Scale for a period ranging from 20
to 108 months (median = 66 months). New ("prospective") episodes were
ascertained with a structured diagnostic interview. The probabilities of
remaining well after the index episode and after the first prospective
episode were assessed by the life-table method. The severity and duration
of prospective episodes and the index episode were compared by linear
regression analysis. RESULTS: The probability of remaining well after
recovery from the index episode was 76% at 6 months, 63% at 1 year, and 25%
at 5 years. The risk of recurrence was lower among patients receiving
prophylactic treatment with antidepressants and/or lithium and among those
with histories of fewer than three previous episodes. The probability of
remaining well was significantly lower 2 years after the first prospective
episode than 2 years after the index episode. A pattern of increasing
severity from the index episode to the first, second, and third prospective
episodes was observed and was not affected by treatment. CONCLUSIONS: Major
depression has a high rate of recurrence, even when bipolar and psychotic
cases are excluded. The highest rate is observed during the first months
after recovery from an episode. Prophylactic drug treatment reduces the
risk of recurrence but apparently does not affect the trend toward
increasing severity of subsequent episodes.
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