RECOVERY AFTER 5 YEARS OF UNREMITTING MAJOR DEPRESSIVE DISORDER

Background: The long-term course of depression in patients who present for treatment carries prognostic and therapeutic implications. This s tudy presents prospective data on the time to recovery from an episode of major depressive disorder of 5 years' duration among patients foll owed up since 1978 in the National Institutes of Mental Health Collabo rative Program on the Psychobiology of Depression. Methods: Survival a nalysis was used to examine the 10-year course of the 431 probands wit h major depressive disorder with a specific focus on the 35 probands w ho were observed to be continuously ill for the first 5 years. Univari ate analytic techniques were used to describe the demographic and clin ical variables in the group that recovered and the group that did not. By study design, somatic treatment was assessed but not controlled by the investigators. Results: By year 10, 93% (Kaplan-Meier estimate) o f probands had recovered from their intake episode of major depressive disorder. In those ill for the first 5 years, 38% had recovered withi n the next 5 years. Shorter duration of illness prior to intake and be ing married were associated with the group that recovered. Pharmacolog ical treatment dosages averaged 100 mg of imipramine hydrochloride equ ivalent in the chronically ill group. Conclusions: Despite lengthy per iods of illness, people continued to recover from major depressive dis order for up to 10 years of prospective follow-up. Few demographic and clinical variables distinguished those who recovered from those who d id not. Treatment, as observed in this naturalistic study, was at a lo w level despite lengthy illness.