Fortnightly review: A regular review of the long term follow up of depression

Introduction

Depression is a common and disabling psychiatric disorder with a lifetime prevalence in the community estimated at 17%.1 Outcome studies show that depressive disorders often recur and may become chronic in up to 25% of patients. For these patients the issue is whether they can reasonably expect to recover completely, while the challenge for clinicians is to recognise the course of the disorder and to manage it appropriately. I have reviewed data from long term outcome studies to clarify the issues surrounding recovery from depression and to help identify appropriate management. Studies were selected from a literature search of the full Medline database (1966 to date) and my own collection of publications.

Depression and disability

The medical outcomes study collated data from 11 242 outpatients in the United States.2 3 It showed that depressive symptoms, with or without major depressive disorder (Diagnostic and Statistical Manual of Mental Disorders, third edition, revised, DSM-III-R), impaired functional ability and wellbeing as much as the most common chronic medical conditions such as diabetes, chronic lung disease, hypertension, and heart disease. After two years' follow up approximately 40% of patients with major depression were still affected and functionally impaired, while those with chronic minor depression (dysthymia) had the worst outcome—54% had had a major depressive episode during this period.3 Partial recovery of functional capacity was the rule.3

The World Health Organisation collaborative study, a cross national study of over 5000 outpatients, examined the relationship between psychiatric status …