Remission and risk for depression relapse

[David Baxter PhD]

Remission type influences depression relapse risk

Not achieving complete remission appears to be a strong risk factor for relapse in patients with depression, study findings show.

Luis Pintor and colleagues from the Hospital Clínico Provincial de Barcelona in Spain studied the rate of relapse and predictive relapse factors over a 4-year period in 139 Spanish outpatients with unipolar major depressive episode.

All the patients received standard antidepressant medication, resulting in 80 patients achieving complete remission, according to the DSM-IV definition of 8 consecutive weeks without significant mood disturbance, with a Hamilton Depression Rating Scale (HDRS) score of between 8 and 13. An additional 58 patients achieved partial remission, with HDRS scores of less then 8 in the 8 consecutive weeks without mood disturbance.

Despite this, however, depression relapsed in 94 patients, with the risk significantly greater in the patients who reached partial remission than in those who achieved complete remission, at 91.4% and 51.3%, respectively.

Further analysis indicated that there were four variables that predicted the risk of relapse: partial remission versus complete remission, the intensity of clinical symptoms, age, and the number of previous depressive episodes.

Of these, partial remission was the most powerful predictor of relapse, with patients in this group having almost eight times the risk of relapse, compared with those in the complete remission group.

"Complete remission continues to be more beneficial for the vital prognosis of the patient than the partial one," Pinto et al comment in the Journal of Affective Disorders.

They conclude that, although partial remission was the most powerful predictor associated with relapses, "it cannot be considered as isolated from other clinical characteristics."

J Affect Disord 2004; 82: 291-296

 

[Cybil2U]

Depression and relapses

Hi Dr. Baxter and everyone else !

I hope it's ok to reply to your post and that I'm going about this in the correct manner (if not my apologies, erase me and let me know the proper format).

In reading the post regarding patients relapsing into depression, and how complete remission is better than partial .......am I missing something, or doesn't that just stand to reason ......I must be missing something huh ?

 

[David Baxter PhD]

It's perfectly fine for you to reply to any post on this forum, Cybil.

You're right, of course, when you look at the terms in their true meaning. However, when it comes to depression, the terms "partial remission" and "full/complete remission" mean something a little different to many people: The issue is that often people will discontinue or be inclined to discontinue their medication and/or psychotherapy when they start to feel better, but often this is not at a time when they have in fact fully recovered. As an example, on average people taking an SSRI will start to feel better in 6 months or less. However, it typically takes several months more to be completely symptom free, and if one considers full recovery to be the point where the balance of one's neurochemistry has been restored AND the body is now able to maintain that balance without medication, this usually takes several additional months. That is one of the reasons why doctors will usually tell you to expect to remain on an SSRI for 9 months to a year. It's also why research indicates that people who remain on the SSRI for 1.5 to 2 years are significantly less likely to experience a relapse than those who discontinue the SSRI after a year.