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November 1997, Vol 54, No. 11 >
Article | November 1997

The Clinical Course of Unipolar Major Depressive Disorders

Lewis L. Judd, MD
Arch Gen Psychiatry. 1997;54(11):989-991. doi:10.1001/archpsyc.1997.01830230015002
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A FUNDAMENTAL paradigmatic shift is occurring in the understanding of unipolar major depressive disorders (MDD) among the general public, by many public health experts, and by the practicing psychiatric community. Most people in our society no longer view depression as a mysterious sickness of spirit or emotional weakness, but rather as a disease of the brain and an important health problem.1 International public health experts acknowledge the high prevalence of unipolar MDD2 combined with the pervasive human misery and impairment associated with it, and have identified this disease in 1990 as the fourth-ranked cause of disability and premature death worldwide.3 In parallel, the treatment of unipolar MDD has evolved from incarceration, exorcism, and prayer to classic psychoanalysis, and now in the modern era to treatment with empirically proven, effective antidepressant medications and depression-specific brief psychotherapies. Meta-analyses of 6 standardized treatment studies by Thase et al4 have

REFERENCES

1 +
National Mental Health Association. National Opinion Poll on Depression . Washington DC: NMHA; 1992 1992;.
2 +
Kessler RC, McGonagle KA, Zhao S, Nelson CD, Hughes M, Eshelman S, Wittchen HU, Kendler KS.  Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States . Arch Gen Psychiatry . 1994;;151:8-19.
3 +
Murray CJL, Lopez AD, eds. The Global Burden of Disease . Geneva, Switzerland: The Harvard School of Public Health on behalf of The World Health Organization and The World Bank; 1996;.
4 +
Thase ME, Greenhouse JB, Frank E, Reynolds CF, Pilkonis PA, Hurley K, Grochocinski V, Kupfer DJ.  Treatment of major depression with psychotherapy or psychotherapy-pharmacotherapy combinations . Arch Gen Psychiatry . 1997;;54:1009-1015.
5 +
Angst J, Baastrup P, Grof H, Hippius W, Poldinger W, Weiss P.  The course of monopolar depression and bipolar psychoses . Psychiatr Neurol Neurschir (Amst) . 1973;;76:489-500.
6 +
Angst J.  The course of affective disorders . Psychopathology . 1986;;19( (suppl2) ):47-52.
7 +
Katz M, Klerman GL.  Introduction: overview of clinical studies programs . Am J Psychiatry . 1979;;136:49-51.
8 +
Katz M, SecundaSK, Hirschfeld RMA, Koslow SH.  NIMH clinical research branch collaborative program on psychology of depression . Arch Gen Psychiatry . 1979;;36:765-771.
9 +
NIMH/NIH Consensus Development Panel.  Mood disorders: pharmacologic prevention of recurrences . Am J Psychiatry . 1985;;142:469-476.
10 +
Frank E, Prien RF, Jarrett RB, Keller MB, Kupfer DJ, Lavori PW, Rush AJ, Weissman MM.  Conceptualization and rationale for consensus definitions of terms in major depressive disorder: remission, recovery, relapse, and recurrence . Arch Gen Psychiatry . 1991;;48:851-855.
11 +
Lehmann HE, Fenton FR, Deutsch M, Feldman S, Englesmann F.  A 22-year follow-up study of 110 depressed patients . Acta Psychiatr Scand . 1988;;78:57-65.
12 +
Kiloh LG, Andrews G, Neilson M.  The long-term outcome of depressive illness . Br J Psychiatry . 1988;;153:752-757.
13 +
Winokur G, Tsuang MT. The natural history of mania, depression, and schizophrenia. Washington, DC: American Psychiatric Press Inc; 1996.
14 +
Winokur G.  All roads lead to depression: clinically homogenous, etiologically heterogeneous . J Affect Disord . 1997;;45:97-108.
15 +
Frank E, Kupfer DJ, Perel JM, Cornes C, Jarret JB, Mallinger AG, Thase ME, McEachran AB, Grochocinski VJ.  Three-year outcomes for maintenance therapies in recurrent depression . Arch Gen Psychiatry . 1990;;47:1093-1099.
16 +
Frank E, Kupfer DJ, Wagner EF, McEachran AB, Cornes C.  Efficacy of interpersonal psychotherapy as a maintenance treatment of recurrent depression . Arch Gen Psychiatry . 1991;;48:1053-1059.
17 +
Kupfer DM, Frank E, Perel JM, Cornes C, Mallinger AG, Thase ME, McEachran AB, Grochocinski VJ.  Five-year outcome for maintenance therapies in recurrent depression . Arch Gen Psychiatry . 1992;;49:769-773.
18 +
Dew MA, Reynolds CF, Houck PR, Hall M, Buysse DJ, Frank E, Kupfer DJ.  Temporal profiles of the course of depression during treatment: predictors of pathways toward recovery in the elderly . Arch Gen Psychiatry . 1997;;54:1016-1024.
19 +
Eaton W, Holzer C III, VonKorff M, Anthony JC, Helzer JE, George L, Burr A, Boyd JH, Kessler LG, Locke BZ.  The design of the ECA surveys: the control and measurement of error . Arch Gen Psychiatry . 1984;;41:942-948.
20 +
Broadhead WE, Blazer DG, George LK, Tse CK.  Depression, disability days, and days lost from work in a prospective epidemiologic survey . JAMA . 1990;;264:2524-2528.
21 +
Howarth E, Johnson J, Klerman GL, et al.  Depressive symptoms as relative and attributable risk factors for first-onset major depression . Arch Gen Psychiatry . 1992;;49:817-823.
22 +
Johnson J, Weissman MM, Klerman GL.  Service utilization and social morbidity associated with depressive symptoms in the community . JAMA . 1992;;267:1478-1483.
23 +
Judd LL, Rapaport MH, Paulus MP, Brown JL.  Subsyndromal symptomatic depression: a new mood disorder? J Clin Psychiatry . 1994;;55:18-28.
24 +
Judd LL, Paulus MP, Wells KB, Rapaport MH.  Socio-economic burden of subsyndromal depressive symptoms and major depression in a sample of the general population . Am J Psychiatry . 1996;;153:1411-1417.
25 +
Judd LL, Akiskal HS, Paulus MP.  The role and clinical significance of subsyndromal depressive symptoms (SSD) in unipolar major depressive disorder . J Affect Disord . 1997;;45:5-18.
26 +
Margolis JR, Gillum RF, Feinleib M, Brasch RC, Fabsitz RR.  Community surveillance for coronary heart disease: the Framingham Cardiovascular Disease Survey . Am J Epidemiol . 1974;;100:425-436.
27 +
Angst J, Preizig M.  Course of a clinical cohort of unipolar, bipolar and schizoaffective patients: results of a prospective study from 1959 to 1985 . Schweiz Archiv Neurol Psychiatr . 1995;;146:1-16.
28 +
Angst J, Preizig M.  Outcome of a clinical cohort of unipolar bipolar and schizoaffective patients: results of a prospective study from 1959 to 1985 . Schweiz Archiv Neurol Psychiatr . 1995;;146:17-23.
29 +
Angst J.  Clinical course of affective disorders . In: Helgason T, Daly RJ, eds. Depressive Illness: Prediction of Course and Outcome . Berlin, Germany: Springer-Verlag; 1988;:1-44.
30 +
Burke KC, Burke JD Jr, Regier DA, Rae DS.  Age at onset of selected mental disorders in five community populations . Arch Gen Psychiatry . 1990;;47:511-518.
31 +
Judd LL, Akiskal HS, Maser JD, Zeller PJ, Endicott J, Coryell W, Paulus MP, Kunovac JL, Leon AC, Mueller T, Rie JA, Keller MB.  A prospective 12-year study of subsyndromal and syndromal depressive symptomatology in 431 patients with uni-polar major depressive disorder . Arch Gen Psychiatry . In press.
32 +
Keller MB, Shapiro RW, Lavori PW, et al.  Relapse in major depressive disorder: analysis with the life table . Arch Gen Psychiatry . 1982;;39:911-915.
33 +
Keller MB, Lavori PW, Mueller TI, Endicott J, Coryell W, Hirshfeld RMA, Shay T.  Time to recovery, chronicity, and levels of psychopathology in major depression . Arch Gen Psychiatry . 1992;;49:809-816.
34 +
Mueller T, Keller MB, Leon AC, Solomon DA, Shea MT, Coryell W, Endicott J.  Recovery after 5 years of unremitting major depressive disorder . Arch Gen Psychiatry . 1996;;53:794-799.
35 +
Solomon DA, Keller MB, Leon AC, Mueller TI, Shea MT, Warshaw M, Maser JD, Coryell W, Endicott J.  Recovery from major depression: a 10-year prospective follow-up across multiple episodes . Arch Gen Psychiatry . 1997;;54:1001-1006.
36 +
Akiskal HS.  Dysthymic disorder: psychopathology of proposed chronic subtypes . Am J Psychiatry . 1983;;140:11-20.
37 +
Skodol AE, Schwartz S, Dorenwend BP, Levav I, Shrout PE.  Minor depressions in a cohort of young adults in Israel . Arch Gen Psychiatry . 1994;;51:542-551.
38 +
Keller MB, Lavori PW, Endicott J, et al.  Double depression: two-year follow-up . Am J Psychiatry . 1983;;140:689-694.
39 +
Keller MB, Hirschfeld RMA, Hanks DL.  Double depression: a distinctive subtype of unipolar depression . J Affect Disord . 1997;;45:65-73.
40 +
Angst J, Merikangas K, Scheidegger P, Wicki W.  Recurrent brief depression: a new subtype of affective disorder . J Affect Disord . 1990;;19:87-98.
41 +
Eaton WW, Anthony JC, Gallo J, Cai G, Tien A, Romanoski A, Lyketsos C, Chen L-S.  Natural history of Diagnostic Interview Schedule/DSM-IV major depression: the Baltimore Epidemiologic Catchment Area follow-up . Arch Gen Psychiatry . 1997;;54:993-999.
42 +
Kessler RC, Zhao SY, Blazer DG, Swartz M.  Prevalence, correlates and courses of minor depression and major depression in the National Co-morbidity Survey . J Affect Disord . 1997;;45:19-30.
43 +
Sherbourne CD, Wells KB, Hays RD, Rogers W, Burnam MA, Judd LL.  Subthreshold depression and depressive disorder: clinical characteristics of general medical and mental health specialty outpatients . Am J Psychiatry . 1994;;151:1777-1784.
44 +
Angst J, Merikangas K.  The depressive spectrum: diagnostic classification and course . J Affect Disord . 1997;;45:31-40.
45 +
Akiskal HS, Judd LL, Lemmi H, Gillin JC.  Subthreshold depressions: clinical and sleep EEG, validation of dysthymic, residual and masked forms . J Affect Disord . 1997;;45:53-63.
46 +
Judd LL.  Pleomorphic expressions of unipolar depressive disease: summary of the 1996 CINP President's Workshop . J Affect Disord . 1997;;45:109-116.
47 +
Akiskal HS, Cassano GB, eds. Dysthymia and the Spectrum of Chronic Depressions . New York, NY; Guilford Press: 1997;.

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Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
National Mental Health Association. National Opinion Poll on Depression . Washington DC: NMHA; 1992 1992;.
2 +
Kessler RC, McGonagle KA, Zhao S, Nelson CD, Hughes M, Eshelman S, Wittchen HU, Kendler KS.  Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States . Arch Gen Psychiatry . 1994;;151:8-19.
3 +
Murray CJL, Lopez AD, eds. The Global Burden of Disease . Geneva, Switzerland: The Harvard School of Public Health on behalf of The World Health Organization and The World Bank; 1996;.
4 +
Thase ME, Greenhouse JB, Frank E, Reynolds CF, Pilkonis PA, Hurley K, Grochocinski V, Kupfer DJ.  Treatment of major depression with psychotherapy or psychotherapy-pharmacotherapy combinations . Arch Gen Psychiatry . 1997;;54:1009-1015.
5 +
Angst J, Baastrup P, Grof H, Hippius W, Poldinger W, Weiss P.  The course of monopolar depression and bipolar psychoses . Psychiatr Neurol Neurschir (Amst) . 1973;;76:489-500.
6 +
Angst J.  The course of affective disorders . Psychopathology . 1986;;19( (suppl2) ):47-52.
7 +
Katz M, Klerman GL.  Introduction: overview of clinical studies programs . Am J Psychiatry . 1979;;136:49-51.
8 +
Katz M, SecundaSK, Hirschfeld RMA, Koslow SH.  NIMH clinical research branch collaborative program on psychology of depression . Arch Gen Psychiatry . 1979;;36:765-771.
9 +
NIMH/NIH Consensus Development Panel.  Mood disorders: pharmacologic prevention of recurrences . Am J Psychiatry . 1985;;142:469-476.
10 +
Frank E, Prien RF, Jarrett RB, Keller MB, Kupfer DJ, Lavori PW, Rush AJ, Weissman MM.  Conceptualization and rationale for consensus definitions of terms in major depressive disorder: remission, recovery, relapse, and recurrence . Arch Gen Psychiatry . 1991;;48:851-855.
11 +
Lehmann HE, Fenton FR, Deutsch M, Feldman S, Englesmann F.  A 22-year follow-up study of 110 depressed patients . Acta Psychiatr Scand . 1988;;78:57-65.
12 +
Kiloh LG, Andrews G, Neilson M.  The long-term outcome of depressive illness . Br J Psychiatry . 1988;;153:752-757.
13 +
Winokur G, Tsuang MT. The natural history of mania, depression, and schizophrenia. Washington, DC: American Psychiatric Press Inc; 1996.
14 +
Winokur G.  All roads lead to depression: clinically homogenous, etiologically heterogeneous . J Affect Disord . 1997;;45:97-108.
15 +
Frank E, Kupfer DJ, Perel JM, Cornes C, Jarret JB, Mallinger AG, Thase ME, McEachran AB, Grochocinski VJ.  Three-year outcomes for maintenance therapies in recurrent depression . Arch Gen Psychiatry . 1990;;47:1093-1099.
16 +
Frank E, Kupfer DJ, Wagner EF, McEachran AB, Cornes C.  Efficacy of interpersonal psychotherapy as a maintenance treatment of recurrent depression . Arch Gen Psychiatry . 1991;;48:1053-1059.
17 +
Kupfer DM, Frank E, Perel JM, Cornes C, Mallinger AG, Thase ME, McEachran AB, Grochocinski VJ.  Five-year outcome for maintenance therapies in recurrent depression . Arch Gen Psychiatry . 1992;;49:769-773.
18 +
Dew MA, Reynolds CF, Houck PR, Hall M, Buysse DJ, Frank E, Kupfer DJ.  Temporal profiles of the course of depression during treatment: predictors of pathways toward recovery in the elderly . Arch Gen Psychiatry . 1997;;54:1016-1024.
19 +
Eaton W, Holzer C III, VonKorff M, Anthony JC, Helzer JE, George L, Burr A, Boyd JH, Kessler LG, Locke BZ.  The design of the ECA surveys: the control and measurement of error . Arch Gen Psychiatry . 1984;;41:942-948.
20 +
Broadhead WE, Blazer DG, George LK, Tse CK.  Depression, disability days, and days lost from work in a prospective epidemiologic survey . JAMA . 1990;;264:2524-2528.
21 +
Howarth E, Johnson J, Klerman GL, et al.  Depressive symptoms as relative and attributable risk factors for first-onset major depression . Arch Gen Psychiatry . 1992;;49:817-823.
22 +
Johnson J, Weissman MM, Klerman GL.  Service utilization and social morbidity associated with depressive symptoms in the community . JAMA . 1992;;267:1478-1483.
23 +
Judd LL, Rapaport MH, Paulus MP, Brown JL.  Subsyndromal symptomatic depression: a new mood disorder? J Clin Psychiatry . 1994;;55:18-28.
24 +
Judd LL, Paulus MP, Wells KB, Rapaport MH.  Socio-economic burden of subsyndromal depressive symptoms and major depression in a sample of the general population . Am J Psychiatry . 1996;;153:1411-1417.
25 +
Judd LL, Akiskal HS, Paulus MP.  The role and clinical significance of subsyndromal depressive symptoms (SSD) in unipolar major depressive disorder . J Affect Disord . 1997;;45:5-18.
26 +
Margolis JR, Gillum RF, Feinleib M, Brasch RC, Fabsitz RR.  Community surveillance for coronary heart disease: the Framingham Cardiovascular Disease Survey . Am J Epidemiol . 1974;;100:425-436.
27 +
Angst J, Preizig M.  Course of a clinical cohort of unipolar, bipolar and schizoaffective patients: results of a prospective study from 1959 to 1985 . Schweiz Archiv Neurol Psychiatr . 1995;;146:1-16.
28 +
Angst J, Preizig M.  Outcome of a clinical cohort of unipolar bipolar and schizoaffective patients: results of a prospective study from 1959 to 1985 . Schweiz Archiv Neurol Psychiatr . 1995;;146:17-23.
29 +
Angst J.  Clinical course of affective disorders . In: Helgason T, Daly RJ, eds. Depressive Illness: Prediction of Course and Outcome . Berlin, Germany: Springer-Verlag; 1988;:1-44.
30 +
Burke KC, Burke JD Jr, Regier DA, Rae DS.  Age at onset of selected mental disorders in five community populations . Arch Gen Psychiatry . 1990;;47:511-518.
31 +
Judd LL, Akiskal HS, Maser JD, Zeller PJ, Endicott J, Coryell W, Paulus MP, Kunovac JL, Leon AC, Mueller T, Rie JA, Keller MB.  A prospective 12-year study of subsyndromal and syndromal depressive symptomatology in 431 patients with uni-polar major depressive disorder . Arch Gen Psychiatry . In press.
32 +
Keller MB, Shapiro RW, Lavori PW, et al.  Relapse in major depressive disorder: analysis with the life table . Arch Gen Psychiatry . 1982;;39:911-915.
33 +
Keller MB, Lavori PW, Mueller TI, Endicott J, Coryell W, Hirshfeld RMA, Shay T.  Time to recovery, chronicity, and levels of psychopathology in major depression . Arch Gen Psychiatry . 1992;;49:809-816.
34 +
Mueller T, Keller MB, Leon AC, Solomon DA, Shea MT, Coryell W, Endicott J.  Recovery after 5 years of unremitting major depressive disorder . Arch Gen Psychiatry . 1996;;53:794-799.
35 +
Solomon DA, Keller MB, Leon AC, Mueller TI, Shea MT, Warshaw M, Maser JD, Coryell W, Endicott J.  Recovery from major depression: a 10-year prospective follow-up across multiple episodes . Arch Gen Psychiatry . 1997;;54:1001-1006.
36 +
Akiskal HS.  Dysthymic disorder: psychopathology of proposed chronic subtypes . Am J Psychiatry . 1983;;140:11-20.
37 +
Skodol AE, Schwartz S, Dorenwend BP, Levav I, Shrout PE.  Minor depressions in a cohort of young adults in Israel . Arch Gen Psychiatry . 1994;;51:542-551.
38 +
Keller MB, Lavori PW, Endicott J, et al.  Double depression: two-year follow-up . Am J Psychiatry . 1983;;140:689-694.
39 +
Keller MB, Hirschfeld RMA, Hanks DL.  Double depression: a distinctive subtype of unipolar depression . J Affect Disord . 1997;;45:65-73.
40 +
Angst J, Merikangas K, Scheidegger P, Wicki W.  Recurrent brief depression: a new subtype of affective disorder . J Affect Disord . 1990;;19:87-98.
41 +
Eaton WW, Anthony JC, Gallo J, Cai G, Tien A, Romanoski A, Lyketsos C, Chen L-S.  Natural history of Diagnostic Interview Schedule/DSM-IV major depression: the Baltimore Epidemiologic Catchment Area follow-up . Arch Gen Psychiatry . 1997;;54:993-999.
42 +
Kessler RC, Zhao SY, Blazer DG, Swartz M.  Prevalence, correlates and courses of minor depression and major depression in the National Co-morbidity Survey . J Affect Disord . 1997;;45:19-30.
43 +
Sherbourne CD, Wells KB, Hays RD, Rogers W, Burnam MA, Judd LL.  Subthreshold depression and depressive disorder: clinical characteristics of general medical and mental health specialty outpatients . Am J Psychiatry . 1994;;151:1777-1784.
44 +
Angst J, Merikangas K.  The depressive spectrum: diagnostic classification and course . J Affect Disord . 1997;;45:31-40.
45 +
Akiskal HS, Judd LL, Lemmi H, Gillin JC.  Subthreshold depressions: clinical and sleep EEG, validation of dysthymic, residual and masked forms . J Affect Disord . 1997;;45:53-63.
46 +
Judd LL.  Pleomorphic expressions of unipolar depressive disease: summary of the 1996 CINP President's Workshop . J Affect Disord . 1997;;45:109-116.
47 +
Akiskal HS, Cassano GB, eds. Dysthymia and the Spectrum of Chronic Depressions . New York, NY; Guilford Press: 1997;.

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