Cited by 216Treatment of Major DepressionPsychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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Untreated short-term course of major depression: a meta-analysis of outcomes from studies using wait-list control groups

Posternak, Michael A., Miller, Ivan·2001·Journal of Affective Disorders

DOI 10.1016/s0165-0327(00)00304-9

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Abstract

Introduction While the short-term response rates to antidepressant medication and placebo are well established, very little is known about the short-term course of untreated depression. Knowledge of the course of untreated depression can serve as a benchmark for assessing the true benefits of active treatment.Method A meta-analysis was performed analyzing the outcomes of all psychotherapy studies that randomized adult outpatients with major depressive disorder to a wait-list control group.Results Nineteen studies involving 221 subjects were reviewed. The mean decrease in Hamilton Rating Scale for Depression scores over 2-20 weeks was 11.9%, while the mean decrease in Beck Depression Inventory scores was 15.7%. Using a subsample of studies that reported individual outcomes, we estimated that 15 of 76 subjects (19.7%) improved to a degree comparable to what would be considered a positive response in antidepressant trials.Conclusions In the short-term, depressive symptomatology can be expected to decrease by about 10-15% on average without treatment. As many as 20% of subjects who participate in a short-term antidepressant trial may experience a spontaneous remission.

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Background
Efficacy of narrative reformulation during cognitive analytic therapy for depression: Randomized dismantling trial
Kellett, S., Stockton, C., Marshall, H., Hall, J., Jennings, C., & Delgadillo, J. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.05.070 · Cited by 50
School-based humanistic counseling for psychological distress in young people: Pilot randomized controlled trial
McArthur, K., Cooper, M., & Berdondini, L. (2012) · Psychotherapy Research · doi:10.1080/10503307.2012.726750 · Cited by 54
“Waiting-list or delayed treatment control groups are used widely in psychotherapy research (e.g., Posternak and Miller, 2001) and, although they do not control for the impact of nonspecific therapy effects such as expectations, are an appropriate means of establishing preliminary evidence for the…”
Method
Early improvement and response to antidepressant medications in adults with major depressive disorder. Meta-analysis and study of a sample with treatment-resistant depression
Olgiati, P., Serretti, A., Souery, D., Dold, M., Kasper, S. F., Montgomery, S., Zohar, J., & Mendlewicz, J. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.11.004 · Cited by 49
The Effectiveness of Psychological Interventions Delivered in Routine Practice: Systematic Review and Meta-analysis
Gaskell, C., Simmonds‐Buckley, M., Kellett, S., Stockton, C., Somerville, E., Rogerson, E., & Delgadillo, J. (2022) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-022-01225-y · Cited by 58
Exercise for Adolescents with Depressive Disorders: A Feasibility Study
Dopp, R. R., Mooney, A. J., Armitage, R., & King, C. A. (2012) · Depression Research and Treatment · doi:10.1155/2012/257472 · Cited by 47
Personality Change following Internet-Based Cognitive Behavior Therapy for Severe Health Anxiety
Hedman‐Lagerlöf, E., Andersson, G., Lindefors, N., Gustavsson, P. J., Lekander, M., Rück, C., Andersson, E., & Ljótsson, B. (2014) · PLoS ONE · doi:10.1371/journal.pone.0113871 · Cited by 49
“This trait-like aspect of anxiety disorders was pointed out in a recent review by Brandes and Bienvenu [19] and it is likely that severe health anxiety differs in this regard compared to for example depression, which tends to fluctuate spontaneously to a larger extent [56].”
Background
Cognitive behaviour therapy (CBT) for anxiety and depression in adults with mild intellectual disabilities (ID): a pilot randomised controlled trial
Hassiotis, A., Serfaty, M. A., Azam, K., Strydom, A., Martin, S., Parkes, C., Blizard, R., & King, M. (2011) · Trials · doi:10.1186/1745-6215-12-95 · Cited by 48
Gamma oscillation in functional brain networks is involved in the spontaneous remission of depressive behavior induced by chronic restraint stress in mice
Khalid, A., Kim, B. S., Seo, B. A., Lee, S., Jung, K., Chu, K., Lee, S. K., & Jeon, D. (2016) · BMC Neuroscience · doi:10.1186/s12868-016-0239-x · Cited by 41
A Randomized Controlled Trial of Metacognitive Therapy for Depression: Analysis of 1-Year Follow-Up
Hjemdal, O., Solem, S., Hagen, R., Kennair, L. E. O., Nordahl, H. M., & Adrian Wells, A. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.01842 · Cited by 41
Barriers to Mental Health Service Use Among Workers With Depression and Work Productivity
Dewa, C. S., & Hoch, J. S. (2015) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000000472 · Cited by 41
A randomised controlled trial of memory flexibility training (MemFlex) to enhance memory flexibility and reduce depressive symptomatology in individuals with major depressive disorder
Hitchcock, C., Gormley, S., Rees, C., Rodrigues, E., Gillard, J., Panesar, I., Wright, I. M., Hammond, E. R., Watson, P., Werner‐Seidler, A., et al. (2018) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.08.008 · Cited by 38
There’s More to Placebo-Related Improvement Than the Placebo Effect Alone
Andrade, C. (2012) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.12f08124 · Cited by 37
GETTING STUCK IN THE BLUES: PERSISTENCE OF MENTAL HEALTH PROBLEMS IN AUSTRALIA
Roy, J., & Schurer, S. (2013) · Health Economics · doi:10.1002/hec.2967 · Cited by 37
“Most untreated cases are estimated to be resolved before three months (Posternak and Miller, 2001).”
Background
Symptom improvement and remission in untreated adults seeking treatment for obsessive-compulsive disorder: A systematic review and meta-analysis
Melkonian, M., McDonald, S., Scott, A. J., Karin, E., Dear, B. F., & Wootton, B. M. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.08.037 · Cited by 37
The natural history of subjective tinnitus in adults: A systematic review and meta‐analysis of no‐intervention periods in controlled trials
Phillips, J. S., McFerran, D. J., Hall, D. A., & Hoare, D. J. (2017) · The Laryngoscope · doi:10.1002/lary.26607 · Cited by 35
“This finding contradicts that of a study by Posternak and Miller (2001), which looked at mental health conditions in isolation and found improvement while on waiting-list control groups.(4) It is possible that the null findings in the current study simply represent the relatively low number of tinnitus studies that ha…”
Result
fMRI Neurofeedback-Enhanced Cognitive Reappraisal Training in Depression: A Double-Blind Comparison of Left and Right vlPFC Regulation
Keller, M., Zweerings, J., Klasen, M., Zvyagintsev, M., Iglesias, J., Quiñones, R. M., & Mathiak, K. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.715898 · Cited by 36
“Importantly, the observed clinical improvements in the current study, cannot be directly attributed to specific NF effects due to the nature of the cross-over design; in particular, we cannot differentiate effects of left and right vlPFC NF, the reappraisal training, placebo [see (67)] as well as time passed (116).”
Background
Effectiveness of guided Internet-delivered treatment for major depression in routine mental healthcare - An open study
Nordgreen, T., Blom, K., Andersson, G., Carlbring, P., & Havik, O. E. (2019) · Internet Interventions · doi:10.1016/j.invent.2019.100274 · Cited by 34
“This is a significant limitation as depression is a disorder characterised by fluctuations and does not show a more stable and chronic course as seen in anxiety disorders such as social anxiety disorder (Posternak and Miller, 2001).”
Background
Efficacy and feasibility of a humor training for people suffering from depression, anxiety, and adjustment disorder: a randomized controlled trial
Tagalidou, N., Distlberger, E., Loderer, V., & Laireiter, A. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2075-x · Cited by 39
Does pretreatment testing for serotonin transporter polymorphisms lead to earlier effects of drug treatment in patients with major depression? A decision-analytic model
Smits, K. M., Smits, L. J. M., Schouten, J., Peeters, F. P. M. L., & Prins, M. H. (2007) · Clinical Therapeutics · doi:10.1016/j.clinthera.2007.04.018 · Cited by 34
Representation of mental illness in Christian self-help bestsellers
Webb, M., Stetz, K., & Hedden, K. R. (2008) · Mental Health Religion & Culture · doi:10.1080/13674670801978634 · Cited by 33
“Even in the absence of professional treatment, research has suggested that some individuals can recover from an episode of depression simply as a function of time (Posternak, 2001).”
Background
Depression contributed an unsatisfactory surgery outcome among the posterior decompression of the cervical spondylotic myelopathy patients: a prospective clinical study
Zong, Y., Xue, Y., Zhao, Y., Ding, H., He, D., Li, Z., Tang, Y., & Wang, Y. (2014) · Neurological Sciences · doi:10.1007/s10072-014-1714-8 · Cited by 32
Cost-Effectiveness of Escitalopram versus Citalopram in the Treatment of Severe Depression
Hemels, M. E. H., Kasper, S. F., Walter, E., & Einarson, T. R. (2004) · Annals of Pharmacotherapy · doi:10.1345/aph.1e010 · Cited by 31
Effects of an integrative treatment, therapeutic acupuncture and conventional treatment in alleviating psychological distress in primary care patients - a pragmatic randomized controlled trial
Arvidsdotter, T., Marklund, B. R. G., & Taft, C. (2013) · BMC Complementary and Alternative Medicine · doi:10.1186/1472-6882-13-308 · Cited by 31
“given that many patients experience spontaneous resolution of their symptoms over time [26].”
Background
Regional brain metabolic correlates of self-reported depression severity contrasted with clinician ratings
Milak, M. S., Keilp, J., Parsey, R. V., Oquendo, M. A., Malone, K. M., & Mann, J. J. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.03.002 · Cited by 28
“, 2004), responds more slowly to antidepressant treatment (Adda et al., 1997; Ambrosini et al., 1999; Posternak and Miller, 2001; Thase et al., 1991), and is a stronger predictor of suicide attempts (Grunebaum et al.”
Social inequalities in the demand, supply and utilisation of psychological treatment
Delgadillo, J., Farnfield, A., & North, A. (2018) · Counselling and Psychotherapy Research · doi:10.1002/capr.12169 · Cited by 32
“Previous studies have estimated that approximately 20% of cases diagnosed with major depression randomised to waitlist control groups tend to experience spontaneous remission of symptoms without psychological treatment (Posternak & Miller, 2001).”
Background
A meta‐analytic review of the effectiveness of psychological treatment of functional/dissociative seizures on non‐seizure outcomes in adults
Gaskell, C., Power, N., Nováková, B., Simmonds‐Buckley, M., Reuber, M., Kellett, S., & Rawlings, G. H. (2023) · Epilepsia · doi:10.1111/epi.17626 · Cited by 32
Review of the choice and use of antidepressant drugs
Bleakley, S. (2013) · Progress in Neurology and Psychiatry · doi:10.1002/pnp.311 · Cited by 28
Work-focused therapy for common mental disorders: A naturalistic study comparing an intervention group with a waitlist control group
Gjengedal, R. G. H., Rème, S. E., Osnes, K., Lagerfeld, S. E., Blonk, R. W. B., Sandin, K., Berge, T., & Hjemdal, O. (2020) · Work · doi:10.3233/wor-203208 · Cited by 28
“14), consistent with previous findings of greater symptom fluctuations in depressive disorders than in anxiety disorders [56, 57].”
Result
A randomized controlled trial of combined exercise and psycho-education for low-SES women: Short- and long-term outcomes in the reduction of stress and depressive symptoms
van der Waerden, J. E. B., Hoefnagels, C., Hosman, C. M. H., Souren, P. M., & Jansen, M. W. J. (2013) · Social Science & Medicine · doi:10.1016/j.socscimed.2013.05.015 · Cited by 30
“In their meta-analysis of waiting list controls, Posternak and Miller (2001) suggested that the effect of seeking treatment and obtaining a thorough evaluation in the context of research in itself may very well cause an increased remission rate in depressive symptomatology.”
Background
Recovery From Depressive Symptoms Over the Course of Physical Therapy: A Prospective Cohort Study of Individuals With Work-Related Orthopaedic Injuries and Symptoms of Depression
Wideman, T. H., Scott, W., Martel, M. O., & Sullivan, M. J. L. (2012) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2012.4182 · Cited by 26
Efficacy of psychodynamic short-term psychotherapy for depressed breast cancer patients: Study protocol for a randomized controlled trial
Zwerenz, R., Beutel, M. E., Imruck, B. H., Wiltink, J., Haselbacher, A., Ruckes, C., Schmidberger, H., Hoffmann, G., Schmidt, M., Köhler, U., et al. (2012) · BMC Cancer · doi:10.1186/1471-2407-12-578 · Cited by 25
“For STPP of depression remission rates between 45% and 70% at post-therapy assessment were published [26], while remission rates in primary-care settings (comparable to TAU) ranged between 20% and about 50% (6 months) [27-29].”
Background
Something's got to give: psychiatric disease on the rise and novel drug development on the decline
Chandler, D. J. (2012) · Drug Discovery Today · doi:10.1016/j.drudis.2012.08.003 · Cited by 25
For whom are internet-based occupational mental health interventions effective? Moderators of internet-based problem-solving training outcome
Junge, M. N., Lehr, D., Bockting, C., Berking, M., Riper, H. M., Cuijpers, P. J., & Ebert, D. D. (2014) · Internet Interventions · doi:10.1016/j.invent.2014.11.007 · Cited by 27
“Moreover, it has been demonstrated that even if untreated, depressive symptoms will improve (Lynch et al., 2004; Posternak and Miller, 2001).”
Depressive symptoms predict postoperative disability among patients with lumbar spinal stenosis: A two-year prospective study comparing two age groups
Sinikallio, S., Aalto, T. J., Lehto, S. M., Airaksinen, O., Herno, A., Kröger, H., & Viinamäki, H. T. (2010) · Disability and Rehabilitation · doi:10.3109/09638280903171477 · Cited by 24
“It is known that clinical depression does not recover adequately without appropriate treatment, although short-term depressive symptomatology can be expected to decrease 10–15% without treatment [27].”
Background
Effects of bright light therapy for depression during pregnancy: a randomised, double-blind controlled trial
Bais, B., Kamperman, A. M., Bijma, H. H., Hoogendijk, W. J., Souman, J. L., Knijff, E., & Lambregtse-van den Berg, M. P. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-038030 · Cited by 24
Efficacy of a Brief Blended Cognitive Behavioral Therapy Program for the Treatment of Depression and Anxiety in University Students: Uncontrolled Intervention Study (Preprint)
Atik, E., Stricker, J., Schückes, M., & Pittig, A. (2022) · doi:10.2196/preprints.44742 · Cited by 23
Efficacy of a Brief Blended Cognitive Behavioral Therapy Program for the Treatment of Depression and Anxiety in University Students: Uncontrolled Intervention Study
Atik, E., Stricker, J., Schückes, M., & Pittig, A. (2023) · JMIR Mental Health · doi:10.2196/44742 · Cited by 27
Depressive symptoms during rehabilitation period predict poor outcome of lumbar spinal stenosis surgery: A two-year perspective
Sinikallio, S., Lehto, S. M., Aalto, T. J., Airaksinen, O., Kröger, H., & Viinamäki, H. T. (2010) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-11-152 · Cited by 25
“However, it is known that normal clinical depression does not adequately recover without appropriate treatment, although in the short-term, depressive symptomatology has been found to decrease by 10-15% without treatment [33].”
Background
Recovery from depression among clients transitioning out of poverty.
Ali, A., Hawkins, R. L., & Chambers, D. A. (2010) · American Journal of Orthopsychiatry · doi:10.1111/j.1939-0025.2010.01004.x · Cited by 22
Testing the Analytical Rumination Hypothesis: Exploring the Longitudinal Effects of Problem Solving Analysis on Depression
Ševčíková, M., Maslej, M. M., Štipl, J., Andrews, P. W., Paštrnák, M., Věchetová, G., Bartošková, M., & Preiss, M. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.01344 · Cited by 21

Authors: Posternak, M. A., & Miller, I.
Affiliations: Brown University (US)
Corresponding author: Posternak, Michael A.
ORCID: Miller, Ivan
Venue: Journal of Affective Disorders
Publisher: Elsevier BV
Published: 2001-10
Volume: 66
Issue: 2-3
Pages: 139-146
ISSN: 0165-0327 (ISSN-L)
DOI: 10.1016/s0165-0327(00)00304-9
OpenAlex: W2006252753
Cited by: 215
References: 65
Citations by year: 2026: 2 · 2025: 2 · 2024: 4 · 2023: 19 · 2022: 5 · 2021: 11 · 2020: 7 · 2019: 9 · 2018: 11 · 2017: 10 · 2016: 15 · 2015: 10 · 2014: 10 · 2013: 10 · 2012: 19
FWCI: 0.40
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Affective Disorders (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: untreated depression, major depressive disorder, spontaneous regression, waitlist control, outpatients, placebo response
MeSH terms: Adult, Major Depressive Disorder, Follow-Up Studies, Humans, Psychotherapy, Brief, Waiting Lists, Randomized Controlled Trials as Topic, Treatment Outcome, Benchmarking

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Untreated short-term course of major depression: a meta-analysis of outcomes from studies using wait-list control groups

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