UNIPOLAR DEPRESSION IN ADOLESCENTS - CLINICAL OUTCOME IN ADULTHOOD

Objective: This study examined the longitudinal clinical course and ad ult sequelae of adolescent unipolar major depressive disorder (MDD) us ing a controlled longitudinal design. Method: Subjects were 28 adolesc ents (15.4 +/- 1.3 years) with systematically diagnosed unipolar MDD a nd 35 group-matched control subjects who participated in a cross-secti onal electroencephalogram sleep and neuroendocrine study, Using standa rdized instruments, interviewers who were blind to subjects' initial d iagnoses conducted follow-up clinical assessments 7.0 +/- 0.5 years la ter in 94% of the original cohort. Results: The depressed group showed high rates of recurrence of MDD episodes during the interval period ( 69%). They also had elevated rates of new-onset bipolar disorder (19%) . Twenty-three percent of subjects with an initial diagnosis of MDD ha d no additional depressive episodes after the index assessment. The ra te of new onset of depression in the controls was 21%. Low socioeconom ic status predicted recurrence of depressive episodes in the MDD group . MDD subjects with recurrence(s) and controls with new onset of depre ssion during the follow-up period had significant psychosocial morbidi ty, as evidenced by disruption in interpersonal relationships and diss atisfaction with life and decrease in global functioning, compared wit h both MDD subjects with no further episodes and control subjects who had never been psychiatrically ill. These psychosocial deficits persis ted after remission from depressive episode(s). Conclusions: Adolescen t unipolar MDD predicts continued risk for recurrences with persistenc e of depressive episodes and psychosocial morbidity into adulthood. A sizable minority, however, have sustained periods of remission associa ted with good social adjustment.