Time to recurrence after recovery from major depressive episodes and its predictors

Background. Depression is a remitting but recurring disease. However, there is a paucity of prospectively recorded data on the course of depression after recovery. Method. A multi-centre prospective serial follow-up study of an inception cohort of hitherto untreated unipolar major depression (N=95) for 6 years. We report the time to recurrence after recovery from the index depressive episode and their predictors. Results. The cumulative probability of remaining well without subthreshold symptoms was 57% (95 % CI, 46 to 68 %) at 1 year, 47 % (95 % CI, 36 to 58 %) at 2 years and 35 % (95 % CI, 23 to 47 %) at 5 years. The same without full relapse was 79 % (95 % CI, 70 to 88 %) at I year, 70 % (95 % CI, 60 to 80 %) at 2 years and 58 % (95 % CI, 46 to 70 %) at 5 years. The median duration of well-interval from the end of the index episode to the beginning of the subthreshold episode was 19.0 months (95 % CI, 2.4 to 35.7), and that to the end of the full episode was over 6 years. Residual symptoms at time of recovery predicted earlier recurrence. Conclusions. The median length of the well-interval was much longer than previously reported in studies employing similar definitions but dealing with a more severe spectrum of patients. However, the sobering fact remains that less than half of the patients can expect to remain virtually symptom-free for 2 years or more after recovery from the depressive episode.