PMID- 26580150
OWN - NLM
STAT- MEDLINE
DCOM- 20170630
LR  - 20191210
IS  - 1555-2101 (Electronic)
IS  - 0160-6689 (Linking)
VI  - 77
IP  - 8
DP  - 2016 Aug
TI  - A New Empirical Definition of Major Depressive Episode Recovery and Its Positive 
      Impact on Future Course of Illness.
PG  - 1065-73
LID - 10.4088/JCP.15m09918 [doi]
AB  - OBJECTIVE: To provide the first head-to-head test of the predictive validity of 2 
      resolution levels included in the current consensus definition of major 
      depressive episode (MDE) recovery and provide an empirically based, clinically 
      useful definition of the end of an MDE. METHOD: 322 participants entering the 
      National Institute of Mental Health Collaborative Depression Study with MDE 
      (diagnosed by Research Diagnostic Criteria) in 1978-1981, and followed thereafter 
      for up to 31 years, were divided into those with 8 consecutive weeks of 
      asymptomatic MDE recovery or residual subsyndromal depressive symptom (SSD) 
      resolution of their index MDE. These 2 levels of recovery were defined based on 
      weekly symptom status on all depressive conditions, assessed by Longitudinal 
      Interval Follow-Up Evaluation (LIFE) interviews conducted every 6 months. Primary 
      measures of validity of these 2 alternative definitions were first well interval 
      duration and long-term depressive illness burden. Groups were also compared on 
      clinical variables, antidepressant treatment, and psychosocial function. RESULTS: 
      61.2% of subjects recovered asymptomatically from their index MDE. By survival 
      analysis, they remained free of a depressive episode relapse or recurrence 4.2 
      times longer than those with SSD resolution (median = 135 vs 32 weeks; chi(2) = 
      70.65; P < .0001). This was not attributable to a difference in intensity of 
      antidepressant medication. Compared to asymptomatic recovery, SSD resolution was 
      associated with significantly longer and more severe index MDEs, with more 
      miscellaneous psychopathology as well as increased long-term psychosocial 
      dysfunction and a greater depressive illness burden during the ensuing 10 or 20 
      years. Asymptomatic MDE resolution was a stronger predictor of time well than any 
      of 18 other predictors, singly or combined. Eight consecutive weeks of 
      asymptomatic recovery had 93% overlap with a 4-week definition and conferred 
      little benefit over 4 weeks. CONCLUSIONS: Four consecutive weeks of asymptomatic 
      recovery defines the end of an MDE and the beginning of a stable well state with 
      improved psychosocial function. Residual symptom resolution is a continuation of 
      an active state of the episode, not the end of an MDE.
CI  - (c) Copyright 2016 Physicians Postgraduate Press, Inc.
FAU - Judd, Lewis L
AU  - Judd LL
AD  - Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, 
      La Jolla, CA 92093. ljudd@ucsd.edu.
AD  - Department of Psychiatry, University of California, San Diego, La Jolla.
FAU - Schettler, Pamela J
AU  - Schettler PJ
AD  - Department of Psychiatry, University of California, San Diego, La Jolla.
FAU - Rush, A John
AU  - Rush AJ
AD  - Duke-National University of Singapore.
FAU - Coryell, William H
AU  - Coryell WH
AD  - Departments of Psychiatry and Internal Medicine, Carver College of Medicine, Iowa 
      City, Iowa, USA.
FAU - Fiedorowicz, Jess G
AU  - Fiedorowicz JG
AD  - Departments of Psychiatry and Internal Medicine, Carver College of Medicine, Iowa 
      City, Iowa, USA.
AD  - Department of Epidemiology, College of Public Health, University of Iowa, Iowa 
      City.
FAU - Solomon, David A
AU  - Solomon DA
AD  - Department of Psychiatry and Human Behavior, Alpert Medical School, Brown 
      University, Providence, Rhode Island; and UpToDate, Waltham, Massachusetts, USA.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Clin Psychiatry
JT  - The Journal of clinical psychiatry
JID - 7801243
SB  - IM
CIN - J Clin Psychiatry. 2016 Aug;77(8):e1026-8. PMID: 27561150
MH  - Adult
MH  - Aged
MH  - *Consensus
MH  - Depressive Disorder, Major/*diagnosis/*therapy
MH  - Female
MH  - Humans
MH  - Longitudinal Studies
MH  - Male
MH  - Middle Aged
MH  - National Institute of Mental Health (U.S.)/*standards
MH  - Outcome Assessment, Health Care/*standards
MH  - Recurrence
MH  - Remission Induction
MH  - Reproducibility of Results
MH  - United States
EDAT- 2015/11/19 06:00
MHDA- 2017/07/01 06:00
CRDT- 2015/11/19 06:00
PHST- 2015/02/24 00:00 [received]
PHST- 2015/08/03 00:00 [accepted]
PHST- 2015/11/19 06:00 [entrez]
PHST- 2015/11/19 06:00 [pubmed]
PHST- 2017/07/01 06:00 [medline]
AID - 10.4088/JCP.15m09918 [doi]
PST - ppublish
SO  - J Clin Psychiatry. 2016 Aug;77(8):1065-73. doi: 10.4088/JCP.15m09918.