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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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“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
In the citing paper
“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
In the citing paper
“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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“The remission of mental illness using current pharmacotherapies or psychotherapies is partial or short lived, and as much as one third of patients do not respond to the recommended treatments (Keller, Shapiro, Lavori, & Wolfe, 1982; O’Reardon, Brunswick, & Amsterdam, 2000; Ramana et al., 1995).”
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“Particular attention should be paid to minimising or ameliorating residual symptoms, which are strongly linked to increased relapse rates (Kessing and Andersen, 2005; Ramana et al., 1995).”
BackgroundResidual symptoms after partial remission: an important outcome in depression
Paykel, E. S., Ramana, R., Cooper, Z., Hayhurst, H., Kerr, J., & Barocka, A. (1995) · Psychological Medicine · doi:10.1017/s0033291700033146 · Cited by 791
“In a companion paper (Ramana et al. 1995) we describe the course of a longitudinally studied cohort of depressives, with respect to remission and relapse and their predictors.”
BackgroundResultInfluentialSelf-citationCleare, A., Pariante, C., Young, A., Anderson, I., Christmas, D., Cowen, P., Dickens, C., Ferrier, I., Geddes, J., Gilbody, S., et al. (2015) · Journal of Psychopharmacology · doi:10.1177/0269881115581093 · Cited by 759
“, 1995), depression severity (Ramana et al., 1995), longer episode duration (Dotoli et al.”
BackgroundChiesa, A., & Serretti, A. (2011) · Psychiatry Research · doi:10.1016/j.psychres.2010.08.011 · Cited by 650
“g (Ramana et al., 1995; Hollon et al., 2005).”
BackgroundPrevalence and predictors of recurrence of major depressive disorder in the adult population
Hardeveld, F., Spijker, J., De Graaf, R., Nolen, W. A., & Beekman, A. T. F. (2010) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2009.01519.x · Cited by 486
“A high number of included studies found an association between severity and risk of recurrence of MDD (11, 15, 16, 19, 20, 24, 26) but the studies that did not find an association also included CDS studies (10, 23).”
BackgroundResultInfluentialMelfi, C. A., Chawla, A. J., Croghan, T. W., Hanna, M. P., Kennedy, S., & Sredl, K. (1998) · Archives of General Psychiatry · doi:10.1001/archpsyc.55.12.1128 · Cited by 409
FAVA, M., ALPERT, J. E., CARMIN, C. N., WISNIEWSKI, S. R., TRIVEDI, M. H., BIGGS, M. M., SHORES-WILSON, K., MORGAN, D., SCHWARTZ, T., BALASUBRAMANI, G. K., et al. (2004) · Psychological Medicine · doi:10.1017/s0033291704002612 · Cited by 406
“Finally, residual symptoms of anxiety have been reported to be associated with greater risk of relapse in patients with MDD (Ramana et al. 1995; Flint & Rifat, 1997b).”
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Fava, G. A., & Ruini, C. (2003) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/s0005-7916(03)00019-3 · Cited by 386
“For instance, Ramana et al. (1995) reported on the course of depression with respect to remission and relapse in a 2-year prospective study.”
BackgroundCasacalenda, N., Perry, J. C., & Looper, K. J. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.8.1354 · Cited by 256
“Regarding treatment duration, the percentage of patients with major depressive disorder who achieved recovery each month in one naturalistic study (2, 47) was 11%–15% during the first 3 months of follow-up before dropping to 3%–5% for the next 9 months.”
BackgroundBouhuys, A. L., Geerts, E., & Gordijn, M. C. M. (1999) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-199910000-00002 · Cited by 235
Can long-term treatment with antidepressant drugs worsen the course of depression?
Fava, G. A. (2003) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v64n0204 · Cited by 223
Schene, A. H., Koeter, M. W. J., Kikkert, M., Swinkels, J. A., & McCrone, P. (2006) · Psychological Medicine · doi:10.1017/s0033291706009366 · Cited by 207
“…our sample can be described as a more severe population, with long-term depression and work absenteeism, the percentage of patients still meeting DSM-IV criteria for MDE at 12 months is in the 30–40% range described by others on less severe populations (Keitner et al. 1992; Ramana et al. 1995).”
BackgroundPartial remission, residual symptoms, and relapse in depression
Paykel, E. S. (2008) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2008.10.4/espaykel · Cited by 194
“Our attention was first drawn to the importance of residual symptoms in a longitudinal follow-up of remission and relapse in depressed patients treated in Cambridge in the early 1990s.(3,4) A sample of 64 depressed patients meeting the Research Diagnostic Criteria (RDC) for definite primary unipolar major depression w…”
Self-citationFava, M., Rush, A. J., Alpert, J. E., Carmin, C. N., Balasubramani, G., Wisniewski, S. R., Trivedi, M. H., Biggs, M. M., & Shores-Wilson, K. (2006) · The Canadian Journal of Psychiatry · doi:10.1177/070674370605101304 · Cited by 183
“Finally, residual symptoms of anxiety have been reported to be associated with greater risk of relapse in patients with MDD (11,12).”
BackgroundEvidence for clinical progression of unipolar and bipolar disorders
Kessing, L. V., & Andersen, P. K. (2017) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12667 · Cited by 179
Factors associated with chronic depressive episodes: a preliminary report from the STAR‐D project
Gilmer, W. S., Trivedi, M. H., Rush, A. J., Wisniewski, S. R., Luther, J. F., Howland, R. H., Yohanna, D., Khan, A., & Alpert, J. E. (2005) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2005.00633.x · Cited by 187
Effectiveness of psychoeducation for depression: A systematic review
Tursi, M. F. D. S., Baes, C. V. W., Camacho, F. R. D. B., Tofoli, S. M. D. C., & Juruena, M. F. (2013) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867413491154 · Cited by 173
“Major depressive disorder (MDD) is a chronic, long-term disease with a high recurrence rate (Fleck et al., 2009; Kanai et al., 2003; Ramana et al., 1995).”
BackgroundKENNEDY, N., ABBOTT, R., & PAYKEL, E. S. (2003) · Psychological Medicine · doi:10.1017/s003329170300744x · Cited by 165
“…has been defined as at least 8 asymptomatic weeks (o2 RDC symptoms of depression), in contrast to the broader definition of remission of 2 consecutive months below definite RDC major depression used in the original study (Ramana et al. 1995) which permitted considerable residual symptoms.”
BackgroundResultInfluentialSelf-citationResidual symptoms at remission from depression: Impact on long-term outcome
Kennedy, N., & Paykel, E. S. (2004) · Journal of Affective Disorders · doi:10.1016/s0165-0327(03)00054-5 · Cited by 199
“, 1978) for definite primary unipolar major depression were recruited from treatment facilities between 1990 and 1992 (Ramana et al., 1995).”
BackgroundSelf-citationResidual symptoms and recurrence during maintenance treatment of late-life depression
Dombrovski, A. Y., Mulsant, B. H., Houck, P. R., Mazumdar, S., Lenze, E. J., Andreescu, C., Cyranowski, J. M., & Reynolds, C. F. (2007) · Journal of Affective Disorders · doi:10.1016/j.jad.2007.01.020 · Cited by 153
“In longitudinal studies in mixed-age samples, the presence of these residual symptoms consistently predicts increased risk of recurrence (Judd et al., 1998; Kanai et al., 2003; Karp et al., 2004; Paykel et al., 1995; Ramana et al., 1995; Van Londen et al., 1998).”
BackgroundD, M. F. M., & Rush, A. J. (2006) · Psychotherapy and Psychosomatics · doi:10.1159/000091771 · Cited by 151
Prevalence and outcome of partial remission in depression
Tranter, R., O’Donovan, C., Chandarana, P. C., & Kennedy, S. H. (2002) · Journal of Psychiatry and Neuroscience · doi:10.1139/jpn.0242 · Cited by 145
Kaymaz, N., van Os, J., Loonen, A. J. M., & Nolan, W. A. (2008) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v69n0910 · Cited by 135
“In fact, the results support previous findings that patients with 1 or more previous depressive episodes have significantly less benefit from the relapse-reducing effect of the antidepressant than patients with a first episode.(29,54,56) Thus, the results suggest that with longer duration of illness, the risk of relap…”
ResultRavindran, A. V., Anisman, H., Merali, Z., Charbonneau, Y., Telner, J. I., Bialik, R. J., Wiens, A., Ellis, J., & Griffiths, J. (1999) · American Journal of Psychiatry · doi:10.1176/ajp.156.10.1608 · Cited by 130
Six Months of Treatment for Depression: Outcome and Predictors of the Course of Illness
Mulder, R. T., Joyce, P. R., Frampton, C. M. A., Luty, S. E., & Sullivan, P. F. (2006) · American Journal of Psychiatry · doi:10.1176/appi.ajp.163.1.95 · Cited by 127
Spijker, J., de Graaf, R., Bijl, R. V., Beekman, A. T. F., Ormel, J., & Nolen, W. A. (2003) · Journal of Affective Disorders · doi:10.1016/j.jad.2003.08.005 · Cited by 121
“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
Psychosocial impairment and recurrence of major depression
Solomon, D. A., Leon, A. C., Endicott, J., Mueller, T. I., Coryell, W. H., Shea, M. T., & Keller, M. B. (2004) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2004.07.002 · Cited by 116
The Naturalistic Course of Unipolar Major Depression in the Absence of Somatic Therapy
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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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ten Have, M., de Graaf, R., van Dorsselaer, S., Tuithof, M., Kleinjan, M., & Penninx, B. W. J. H. (2018) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12874 · Cited by 106
“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).”
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Remission and Residual Symptomatology in Major Depression
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Self-citationSeverity of depressive episodes according to ICD-10: prediction of risk of relapse and suicide
Kessing, L. V. (2004) · The British Journal of Psychiatry · doi:10.1192/bjp.184.2.153 · Cited by 102
Pramipexole in treatment-resistant depression: An extended follow-up
Cassano, P., Lattanzi, L., Soldani, F., Navari, S., Battistini, G., Gemignani, A., & Cassano, G. B. (2004) · Depression and Anxiety · doi:10.1002/da.20038 · Cited by 101
“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
Fava, G. A., Fabbri, S., & Sonino, N. (2002) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/s0278-5846(02)00226-9 · Cited by 137
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Dysthymia: a review of pharmacological and behavioral factors
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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
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“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
Adamo, D., Ruoppo, E., Leuci, S., Aria, M., Amato, M., & Mignogna, M. D. (2014) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/jdv.12525 · Cited by 91
Remission onset and relapse in depression
O’Leary, D., Costello, F., Gormley, N., & Webb, M. (2000) · Journal of Affective Disorders · doi:10.1016/s0165-0327(99)00086-5 · Cited by 87
Dual-Factor Model of Mental Health: Surpass the Traditional Mental Health Model
Wang, X., Zhang, D., & Wang, J. (2011) · Psychology · doi:10.4236/psych.2011.28117 · Cited by 87
“Incomplete mental illness patients have high PTH and high SWB, and Suldo and Shaffer (2008) also called them “symptomatic but content”.”
Sobocki, P., Ekman, M., ÅGREN, H., Runeson, B., & Jönsson, B. (2006) · International Journal of Clinical Practice · doi:10.1111/j.1742-1241.2006.00997.x · Cited by 83
Prodromal stage of major depression
Fava, G. A., & Tossani, E. (2007) · Early Intervention in Psychiatry · doi:10.1111/j.1751-7893.2007.00005.x · Cited by 85
“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
“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
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“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
“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
Family psychoeducation for major depression: randomised controlled trial
Shimazu, K., Shimodera, S., Mino, Y., Nishida, A., Kamimura, N., Sawada, K., Fujita, H., Furukawa, T. A., & Inoue, S. (2011) · British Journal of Psychiatry · doi:10.1192/bjp.bp.110.078626 · Cited by 95
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“, 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 75
“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
Continuation and maintenance therapy in depression
Paykel, E. S. (2001) · British Medical Bulletin · doi:10.1093/bmb/57.1.145 · Cited by 73
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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
“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
“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. G. (2015) · Current Pharmaceutical Design · doi:10.2174/1381612821666150105125500 · Cited by 69
“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
Claxton, A. J., Li, Z., & McKendrick, J. (2000) · British Journal of Psychiatry · doi:10.1192/bjp.177.2.163 · Cited by 68
Is duration of illness really influencing outcome in major psychoses?
Altamura, A. C., Serati, M., & Buoli, M. (2015) · Nordic Journal of Psychiatry · doi:10.3109/08039488.2014.990919 · Cited by 69
Attentional bias temporal dynamics in remitted depression.
Zvielli, A., Vrijsen, J. N., Koster, E. H. W., & Bernstein, A. (2016) · Journal of Abnormal Psychology · doi:10.1037/abn0000190 · Cited by 70
Treatment of Recurrent Depression
Fava, G. A., Ruini, C., & Sonino, N. (2003) · CNS Drugs · doi:10.2165/00023210-200317150-00005 · Cited by 65
Antidepressant monotherapy: A claims database analysis of treatment changes and treatment duration
Milea, D., Guelfucci, F., Bent‐Ennakhil, N., Toumi, M., & Auray, J. (2010) · Clinical Therapeutics · doi:10.1016/j.clinthera.2010.11.011 · Cited by 64
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
“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 67
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 77
“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
“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
“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
Kessing, L. V., & Andersen, P. K. (2005) · Current Psychiatry Reports · doi:10.1007/s11920-005-0061-0 · Cited by 56
“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
Eckstrand, K. L., Forbes, E. E., Bertocci, M. A., Chase, H. W., Greenberg, T., Lockovich, J., Stiffler, R., Aslam, H. A., Graur, S., Bebko, G., et al. (2019) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2019.0864 · Cited by 51
Efficacy of vilazodone on anxiety symptoms in patients with major depressive disorder
Thase, M. E., Chen, D., Edwards, J., & Ruth, A. (2014) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000045 · Cited by 49
Gormley, N. A., O’Leary, D., & Costello, F. (1999) · Journal of Affective Disorders · doi:10.1016/s0165-0327(98)00133-5 · Cited by 45
Soskin, D. P., Carl, J. R., Alpert, J. E., & D, M. F. M. (2012) · CNS Neuroscience & Therapeutics · doi:10.1111/j.1755-5949.2012.00318.x · Cited by 46
“Perhaps more problematic, between 40% and 60% of responders will relapse within 1 year [6,8].”
BackgroundThase, M. E., Demyttenaere, K., Earley, W. R., Gustafsson, U., Udd, M., & Eriksson, H. (2012) · Depression and Anxiety · doi:10.1002/da.21970 · Cited by 44
Wilkinson, P. O., & Goodyer, I. M. (2008) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/1753-2000-2-3 · Cited by 48
Cearns, M., Opel, N., Clark, S. R., Flint, C., Thalamuthu, A., Heindel, W. L., Winter, T., Teismann, H., Minnerup, H., Dannlowski, U., et al. (2019) · Translational Psychiatry · doi:10.1038/s41398-019-0615-2 · Cited by 45
Protective environments and health status: Cross-talk between human and animal studies
Singer, B. H., Friedman, E., Seeman, T. E., Fava, G. A., & Ryff, C. D. (2005) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2005.08.020 · Cited by 43
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
Ezquiaga, E. (2002) · Journal of Affective Disorders · doi:10.1016/s0165-0327(02)00346-4 · Cited by 40
Achieving gains beyond response
Paykel, E. S. (2002) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.106.s415.3.x · Cited by 40
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
“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
“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
Metadata
- 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 (medical) › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › 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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