Remission and relapse in major depression: a two-year prospective follow-up study
Abstract
Synopsis: This paper reports the course with respect to remission and relapse of a cohort of predominantly in-patient RDC major depressive subjects, who were followed at 3-monthly intervals to remission and for up to 15 months thereafter. Remission was comparatively rapid with 70% of subjects remitting within 6 months. Only 6% failed to do so by 15 months. However, 40% relapsed over the subsequent 15 months, with all the relapses occurring in the first 10 months. Greater severity of the depression and longer duration of the illness predicted a longer time to remission. Greater initial severity of depression also predicted relapse. Subjects with a worse outcome had not received less adequate treatment than the remainder. Our results confirm the comparatively poor outcome subsequent to remission that has been reported in recent literature, in spite of the availability of modern methods of treatment. The clustering of relapses in the first 10 months gives some support to the distinction between relapse and later recurrence.
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Relapse rates after treatment are 29-54% during 1-2 years posttreatment.
“The benefits are also likely to be temporary, with studies showing 29–54% relapse rates during the time span of 1–2 years posttreatment (Dobson et al., 2008; Gortner, Gollan, Dobson, & Jacobson, 1998; Ramana et al., 1995; Shea et al., 1992; Vittengl, Clark, Dunn, & Jarrett, 2007).”
From A mindful yoga intervention for young women with major depressive disorder: Design and baseline sample characteristics of a randomized controlled trial (2020) · cites this paper as Ramana et al., 1995
Current evidence-based treatment packages for MDD are suboptimal in relapse.
“and (c) relapse (Dobson et al., 2008; Gortner et al., 1998; Ramana et al., 1995; Shea et al., 1992; Vittengl et al., 2007)”
From A mindful yoga intervention for young women with major depressive disorder: Design and baseline sample characteristics of a randomized controlled trial (2020) · cites this paper as Ramana et al., 1995
Subjective experiences of loneliness are distinctive aspects of the phenomenology of depression among youth across cultural groups in high-income and low- and middle-income countries.
“Subjective experiences of loneliness are distinctive aspects of the phenomenology of depression among youth across cultural groups in high-income and lowand middle-income countries. 124-126”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [125]
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“In accordance with the literature (Sargeant et al., 1990; Scott et al., 1992; Keller, 1994; Ramana et al., 1995; Mueller et al., 1996; Furukawa et al., 2000; Spijker et al., 2000), we found illness-related factors (severity of the index episode and duration of prior episodes) to be the strongest predictors for persist…”
ResultEpidemiology of subtypes of depression
Kessing, L. V. (2007) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2007.00966.x · Cited by 118 · see citing works
Psychosocial impairment and recurrence of major depression
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“Finally, it should also be pointed out that the present study did not examine the risk for recurrence, which may be as high as 50% in the first year following recovery (Coryell et al., 1991; Faravelli et al., 1986; Keller et al., 1983; Ramana et al., 1995).”
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Life events, social support and marital relationships in the outcome of severe depression
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“In analyses already reported (Ramana et al. 1995; Paykel et al. 1995), marital status did not predict outcome.”
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“Within this category, the number of previous episodes and severity have been most frequently studied (in seven of the eight studies), and much evidence was found for a higher number of previous depressive episodes (8, 14, 16–18, 20) as risk indicator for recurrence than for severe depression at baseline (10, 16, 19).”
BackgroundRush, A. J., Trivedi, M. H., Carmody, T. J., Biggs, M. M., Shores‐Wilson, K., Ibrahim, H. M., & Crismon, M. L. (2004) · Biological Psychiatry · doi:10.1016/j.biopsych.2004.04.005 · Cited by 103 · see citing works
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“8% rate of sustained remission at Week 13, which is consistent with the range of 45–50% at Week 12 reported in naturalistic studies on depressed (but not treatment-resistant) patients [Keller et al., 1984; Ramana et al., 1995].”
InfluentialResidual symptoms in depression
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Cognitive therapy in relapse prevention in depression.
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“The large majority of subjects (87%), had achieved full remission by 15 months, and 94% had achieved at least partial remission (Ramana et al., 1995).”
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Clinical practice recommendations for depression
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Longitudinal syndromal and sub-syndromal symptoms after severe depression: 10-year follow-up study
Kennedy, N., Abbott, R., & Paykel, E. S. (2004) · The British Journal of Psychiatry · doi:10.1192/bjp.184.4.330 · Cited by 94 · see citing works
Self-citationChiesa, A., Castagner, V., Andrisano, C., Serretti, A., Mandelli, L., Porcelli, S., & Giommi, F. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2015.02.003 · Cited by 89 · see citing works
“Furthermore, even patients who meet remission criteria following pharmacological and/or psychological treatments carry a high risk for relapse (Ramana et al., 1995; Hollon et al., 2005) especially when they continue to experience residual depressive symptoms (Paykel et al., 1995; Judd et al., 1999;…”
BackgroundInfluentialSleep disturbances, anxiety and depression in patients with oral lichen planus: a case–control study
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“Incomplete mental illness patients have high PTH and high SWB, and Suldo and Shaffer (2008) also called them “symptomatic but content”.”
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Prodromal stage of major depression
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“reported on the course of depression with respect to remission and relapse in a 2-year prospective follow up.(93) Remission was rapid with 70% of subjects remitting within 6 months and only 6% failing to do so by 15 months.”
BackgroundThe Clinical Interview for Depression: A Comprehensive Review of Studies and Clinimetric Properties
Guidi, J., Fava, G. A., Bech, P., & Paykel, E. S. (2010) · Psychotherapy and Psychosomatics · doi:10.1159/000317532 · Cited by 78 · see citing works
“Depressed mood, guilt, hopelessness, impaired work and interests, psychic anxiety, and anorexia of moderate degree were present in at least 37p of the sample. Mean scores on all symptoms (except for delayed insomnia, retardation, agitation, and panic attacks) significantly differentiated patients with residual symptom…”
BackgroundSelf-citationExpressed emotion and depression
Hayhurst, H., Cooper, Z., Paykel, E. S., Ramana, R., & Vearnals, S. (1997) · The British Journal of Psychiatry · doi:10.1192/bjp.171.5.439 · Cited by 77 · see citing works
Self-citationPintor, L., Torres, X., Navarro, V., Matrai, S., & Gastó, C. (2004) · Journal of Affective Disorders · doi:10.1016/j.jad.2003.11.008 · Cited by 76 · see citing works
“Numerous 2-year follow-up studies in recent years have shown low relapse rates for the unipolar major depression after complete remission and high relapse rates in patients who achieved only partial remission (Ramana et al., 1995; Paykel et al., 1995; Van Londen et al., 1998; Pintor et al., 2003).”
Backgroundten Have, M., Penninx, B. W. J. H., Tuithof, M., van Dorsselaer, S., Kleinjan, M., Spijker, J., & de Graaf, R. (2017) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12753 · Cited by 76 · see citing works
“However, two consistent predictors of longer duration were found: depression severity (15,18–21) and longer depression duration before entry into care (18,20,22).”
BackgroundClinical Applications of Well‐Being Therapy
Ruini, C., & Fava, G. A. (2004) · Wiley eBooks · doi:10.1002/9780470939338.ch23 · Cited by 75 · see citing works
Family psychoeducation for major depression: randomised controlled trial
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Papakostas, G. I., Trivedi, M. H., Alpert, J. E., Seifert, C. A., Krishen, A., Goodale, E. P., & Tucker, V. L. (2007) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2007.05.012 · Cited by 75 · see citing works
“, 1994), and a greater risk of depressive relapse (Ramana et al., 1995; Flint and Rifat, 1997).”
BackgroundTreatment-Resistant Depression: Critique of Current Approaches
Wijeratne, C., & Sachdev, P. S. (2008) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/00048670802277206 · Cited by 73 · see citing works
“There have been several studies that found no relationship between depressive subtype and treatment response [23,73,74].”
BackgroundCognitive therapy for depression
Rupke, S. J., Blecke, D., & Renfrow, M. (1999) · PsycEXTRA Dataset · doi:10.1037/e528002004-001 · Cited by 74 · see citing works
Continuation and maintenance therapy in depression
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Partial remission in depressive disorders
Cornwall, P. L., & Scott, J. L. (1997) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1997.tb09630.x · Cited by 71 · see citing works
“Investigators at the University of Cambridge have attempted to describe the characteristics of residual symptoms and the patients who experience them (31, 39).”
BackgroundCusack, J., Deane, F. P., Wilson, C. J., & Ciarrochi, J. (2006) · Psychology of Men & Masculinity · doi:10.1037/1524-9220.7.2.69 · Cited by 70 · see citing works
“For example, one study showed that after remission of depression, 40% of patients had relapsed over the subsequent 15 months (Ramana et al., 1995).”
MethodJuruena, M. F., Baes, C. V. W., Menezes, I. C., & Graeff, F. (2015) · Current pharmaceutical design · doi:10.2174/1381612821666150105125500 · Cited by 60 · see citing works
“disability and impairment of physical health [22-24].”
Psychosocial predictors of outcome in major depression: a prospective 12-month study
Ezquiaga, E., Garcı́a, A., Pallarés, T., & Bravo‐Ortiz, M. F. (1999) · Journal of Affective Disorders · doi:10.1016/s0165-0327(98)00057-3 · Cited by 69 · see citing works
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Is duration of illness really influencing outcome in major psychoses?
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Attentional bias temporal dynamics in remitted depression.
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Treatment of Recurrent Depression
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Predictors for 2-year outcome of major depressive episode
Szádóczky, E., Rózsa, S., Zámbori, J., & Füredi, J. (2004) · Journal of Affective Disorders · doi:10.1016/j.jad.2004.05.001 · Cited by 64 · see citing works
“In this study, we tested the possible prognostic value of variables which were already suspected to play a role in sustaining depression for several years (Andrew et al., 1993; Angst et al., 1996; Dunayevich et al., 2000; Keitner et al., 1992; Keller, 1994; Paykel et al., 1996; Ramana et al., 1995; Riso et al., 2002;…”
BackgroundPaterniti, S., Sterner, I., Caldwell, C., & Bisserbe, J. C. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1270-x · Cited by 63 · see citing works
O'Sullivan, D. T., Gordon, B. R., Lyons, M., Meyer, J. D., & Herring, M. P. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115322 · Cited by 66 · see citing works
“Further, there were no post-intervention followups in the current study; given the commonality of relapse following the cessation of treatment among patients with MDD (Ramana et al., 1995), long-term follow-ups are needed to examine whether depressive symptom reductions, and involvement in RET, are maintained.”
Remission in depression: definition and initial treatment approaches
Israel, J. A. (2006) · Journal of Psychopharmacology · doi:10.1177/1359786806064306 · Cited by 61 · see citing works
“Adequate dosing and time on medications Patients receiving acute antidepressant treatment often receive lower than the recommended dosages (Ramana et al., 1995).”
BackgroundInfluentialCo-morbidity and stability of melancholic features in DSM-IV major depressive disorder
Melartin, T. K., Leskelä, U. S., Rytsälä, H. J., Sokero, P., Lestelä-Mielonen, P. S., & Isometsä, E. T. (2004) · Psychological Medicine · doi:10.1017/s0033291704002806 · Cited by 60 · see citing works
“This finding is consistent with most earlier in-patient studies reporting no differences in outcome between melancholic and non-melancholic depression (Keller et al. 1984, 1986; Kiloh et al. 1988; Parker et al. 1992; Ramana et al. 1995; Brodaty et al. 2001; Kennedy et al. 2003), but not all (Lee & Murray, 1988; Duggan…”
BackgroundResultInfluentialThe Four-Year Course of Major Depressive Disorder: The Role of Staging and Risk Factor Determination
Boschloo, L., Schoevers, R. A., Beekman, A. T. F., Smit, J. H., van Hemert, A. M., & Penninx, B. W. J. H. (2014) · Psychotherapy and Psychosomatics · doi:10.1159/000362563 · Cited by 60 · see citing works
Kessing, L. V., & Andersen, P. K. (2005) · Current Psychiatry Reports · doi:10.1007/s11920-005-0061-0 · Cited by 56 · see citing works
“5-year [36], 1-year [37], and 2-year [38] prospective studies did not.”
Mischoulon, D., Hylek, L., Yeung, A., Clain, A. J., Baer, L., Cusin, C., Ionescu, D. F., Alpert, J. E., Soskin, D. P., & D, M. F. M. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.08.029 · Cited by 55 · see citing works
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Efficacy of vilazodone on anxiety symptoms in patients with major depressive disorder
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“Perhaps more problematic, between 40% and 60% of responders will relapse within 1 year [6,8].”
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Protective environments and health status: Cross-talk between human and animal studies
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Definitions of recovery and outcomes of major depression: results from a 10‐year follow‐up
Furukawa, T. A., Fujita, A., Harai, H., Yoshimura, R., Kitamura, T., & Takahashi, K. (2007) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2007.01119.x · Cited by 40 · see citing works
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Achieving gains beyond response
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Self-citationPrefrontal cortex function in remitted major depressive disorder
Nixon, N. L., Liddle, P. F., Worwood, G., Liotti, M., & Nixon, E. (2013) · Psychological Medicine · doi:10.1017/s0033291712002164 · Cited by 39 · see citing works
“Based on clinical evidence (Maj et al. 1992 ; Ramana et al. 1995) we estimated a 40% 1-year recurrence rate in our patient population and in the secondary, more exploratory analysis we aimed to investigate both task-related activity and delayed effects of task observable in postevent processing (i.”
BackgroundEighteen months of drug treatment for depression: Predicting relapse and recovery
Mulder, R., FRAMPTON, C. M. A., Luty, S. E., & Joyce, P. R. (2008) · Journal of Affective Disorders · doi:10.1016/j.jad.2008.08.002 · Cited by 39 · see citing works
“The association of recurrent depression and, more consistently, residual depressive symptoms, with relapse has been reported before (e.g., Pintor et al., 2004; Ramana et al., 1995).”
Background
- Authors
- Ramana, R., Paykel, E. S., Cooper, Z., Hayhurst, H., Saxty, M., & Surtees, P. G.
- Affiliations
- University of Cambridge (GB)
- Corresponding author
- Ramana, R.
- ORCID
- Cooper, Z.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 1995-11
- Volume
- 25
- Issue
- 6
- Pages
- 1161-1170
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2099075065
- Cited by
- 236
- References
- 53
- Citations by year
- 2025: 4 · 2024: 2 · 2023: 4 · 2022: 5 · 2021: 5 · 2020: 5 · 2019: 4 · 2018: 3 · 2017: 9 · 2016: 8 · 2015: 9 · 2014: 9 · 2013: 5 · 2012: 10
- FWCI
- 3.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- major depressive disorder, remission, relapse, recurrence, inpatient depression, depression severity, disease duration, treatment outcomes, recurrence prediction
- MeSH terms
- Adolescent, Adult, Aged, Antidepressive Agents, Depressive Disorder, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Psychiatric Status Rating Scales, Recurrence, Remission, Spontaneous
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