Long-Term Outcome of Major Depressive Disorder in Psychiatric Patients Is Variable
J Clin Psychiatry 2008;69(2):196-205
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Objective: The prevailing view of outcome of major depressive
disorder (MDD), based on mostly inpatient cohorts sampled from tertiary
centers, emphasizes chronicity and frequent recurrences. We investigated
the long-term outcome of a regionally representative psychiatric MDD cohort
comprising mainly outpatients.
Method: The Vantaa Depression Study included 163
patients with DSM-IV MDD (71.5% of those eligible) diagnosed using structured
and semistructured interviews and followed up at 6 months, 18 months, and 5
years with a life chart between February 1, 1997, and April 30, 2004. The
effects of comorbid disorders and other predictors on outcome were
Results: Over the 5-year follow-up, 98.8% of patients achieved
a symptom state below major depressive episode (MDE) criteria, and 88.4%
reached full remission, with the median time to full remission being 11.0
months. Nearly one third (29.3%) had no recurrences, whereas 30.0% experienced
1, 12.9% experienced 2, and 27.9% experienced 3 or more recurrences. Preceding
dysthymic disorder (p = .028), cluster C personality disorder (p = .041), and
longer MDE duration prior to entry (p = .011) were the most significant
predictors of longer time in achieving full remission. Severity of MDD and
comorbidity, especially social phobia, predicted probability of, shorter time
to, and number of recurrences.
Conclusion: Previous literature on mostly inpatient MDD may
have, by generalizing from patients with the most severe psychopathology,
overemphasized chronicity of MDD. The long-term outcome of MDD in psychiatric
care is variable, with about one tenth of patients having poor, one third
having intermediate, and one half having favorable outcomes. In addition to
known predictors, cluster C personality disorders and social phobia warrant
further attention as predictors of MDD outcome among outpatients.