IMPORTANCE OF PSYCHOTIC FEATURES TO LONG-TERM COURSE IN MAJOR DEPRESSIVE DISORDER

Objective: Most efforts to describe the prognostic significance of psy chotic features in depression have been limited to single assessments 1 year or less after the initial evaluation. However, the various biol ogical and treatment response differences between patients with psycho tic and nonpsychotic depression suggest that prognostic differences ma y be very long-term. Method: The 787 patients described here entered t he study as they sought treatment at one of five academic medical cent ers; they had either RDC major depressive disorder or schizoaffective depression (other than the mainly schizophrenic subtype) and completed at least 6 months of follow-up. Of these, 144 (18.3%) had psychotic d epression as defined here. Patients provided follow-up interviews at 6 -month intervals for 5 years and annually thereafter; 98 of those with psychotic depression and 434 of those with nonpsychotic depression we re followed for 10 years. Results: Those who began follow-up with psyc hotic depression had fewer weeks with minimal symptoms in each of the 10 years of follow-up and reported more psychosocial impairment at bot h 5 and 10 years. Both the index episode and the first recurrence of p sychotic depression lasted longer than nonpsychotic episodes, but nonp sychotic episodes among previously psychotic individuals were relative ly brief. Intervals between episodes were significantly shorter for pa tients who had ever been psychotic. Conclusions: Together with evidenc e that psychotic features are highly recurrent, these data show 1) tha t psychotic features denote a lifetime illness of greater severity and 2) that within individuals, psychotic features may emerge in only the more severe episodes.