Reconsidering the prognosis of major depressive disorder across diagnostic boundaries: full recovery is the exception rather than the rule

BMC Medicine

Research Article

Yuri Milaneschi¹  Brenda W. J. H. Penninx¹  Josine E. Verhoeven¹  Judith Verduijn¹  Aartjan T. F. Beekman¹  Albert M. van Hemert²  Robert A. Schoevers³ 

[1] Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, PO Box 74077, 1070 BB, Amsterdam, The Netherlands;Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands;Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;

关键词: Major depressive disorder;    Affective disorder;    Anxiety disorder;    Course;    Prognosis;    Longitudinal;    Comorbidity;   

DOI  :  10.1186/s12916-017-0972-8

 received in 2017-03-31, accepted in 2017-11-08,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundMajor depressive disorder (MDD) is often handled as an episodic and isolated disorder, resulting in an optimistic view about its prognosis. Herein, we test the idea that the prognosis of MDD changes if we vary the perspective in terms of (1) a longer time frame and (2) a broader diagnostic conceptualisation including dysthymia, (hypo)mania and anxiety disorders as relevant outcomes.MethodsPatients with current MDD at baseline (n = 903) and available 2-, 4-, and/or 6-year follow-up assessments were selected from the Netherlands Study of Depression and Anxiety, a psychiatric cohort study. Combining psychiatric DSM-IV-based diagnoses and life-chart data, patient course trajectories were classified as (1) recovered (no diagnoses at 2-year follow-up or thereafter), (2) recurrent without chronic episodes, (3) recurrent with chronic episodes or (4) consistently chronic since baseline. A chronic episode was defined as having a current diagnosis at the follow-up assessment and consistent symptoms over 2 years. Proportions of course trajectories were provided moving from a short, narrow perspective (2-year follow-up, considering only MDD diagnosis) to a long, broad perspective (6-year follow-up, including MDD, dysthymia, (hypo)mania and anxiety diagnoses).ResultsWith the short, narrow perspective, the recovery rate was 58% and 21% had a chronic episode. However, in the long, broad perspective the recovery rate was reduced to 17%, while 55% of the patients experienced chronic episodes.ConclusionsResults from a long and rigorous follow-up in a large cohort suggests that most MDD patients have an unfavourable prognosis. Longer follow-up and broader diagnostic conceptualisation show that the majority of patients have a disabling and chronic disorder. Conceptualising and handling MDD as a narrowly defined and episodic disorder may underestimate the prognosis of the majority of depressed patients and, consequently, the type of care that is appropriate.

【 授权许可】

CC BY   
© The Author(s). 2017