Residual symptoms after partial remission: an important outcome in depression

Paykel, E. S.; Ramana, R.; Cooper, Z.; Hayhurst, H.; Kerr, J.; Barocka, A.

doi:10.1017/s0033291700033146

Cited by 791Treatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and Access

Residual 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

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Abstract

Synopsis: This paper draws attention to an important adverse outcome in depression, the occurrence of residual symptoms after partial remission. Among patients with definite major depression followed every 3 months to remission and thereafter, residual symptoms reaching 8 or more on the Hamilton Depression Scale 17-item total were present in 32% (19) of the 60 who remitted below major depression by 15 months. The pattern was of mild but typical depressive symptoms. Residual symptoms were more common in subjects with more severe initial illness, but were not related to any other predictors, including longer prior illness, dysthymia, or lower dose of drug treatment during the illness episode. There were weak associations with personality that might have been consequences of symptom presence. Residual symptoms were very strong predictors of subsequent early relapse, which occurred in 76% (13/17) of those with residual symptoms and 25% (10/40) of those without.

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Remission as defined by Frank et al. (HAMD-17 ≤7) is associated with a better prognosis than not achieving this level of remission.
“Some studies also showed that remission as defined by Frank et al. (1991), HAMD-17 ⩽7, is associated with a better prognosis than not achieving this level of remission (Paykel et al. 1995; Pintor et al. 2004).”
From Empirical evidence for definitions of episode, remission, recovery, relapse and recurrence in depression: a systematic review (2019) · cites this paper as Paykel et al. 1995
Several studies show some indication of a sudden drop in relapse/recurrence rate a certain time after remission/recovery was obtained.
“Several studies show some indication of a sudden drop in relapse/recurrence rate a certain time after remission/recovery was obtained”
From Empirical evidence for definitions of episode, remission, recovery, relapse and recurrence in depression: a systematic review (2019) · cites this paper as Paykel et al. 1995
Multiple studies showed that those who scored below a certain threshold on depressive symptom scales had a better prognosis than those who scored above it.
“Multiple studies showed that those who scored below a certain threshold on depressive symptom scales had a better prognosis than those who scored above it”
From Empirical evidence for definitions of episode, remission, recovery, relapse and recurrence in depression: a systematic review (2019) · cites this paper as Paykel et al. 1995
Some studies show that the currently often-used threshold (HAMD-17 ≤7; Frank et al. 1991) also differentiates prognosis.
“Indeed, some studies show that the currently often-used threshold (HAMD-17 ⩽7; Frank et al. 1991) also differentiates in this regard (Paykel et al. 1995; Pintor et al. 2004).”
From Empirical evidence for definitions of episode, remission, recovery, relapse and recurrence in depression: a systematic review (2019) · cites this paper as Paykel et al. 1995

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“A third possible underlying phenomenon is that the residual symptoms reflect a cognitive vulnerability of dysfunctional attitudes of the kind that has been postulated to underlie depression (Teasdale, 1988).”
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“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.”
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Predictors of long‐term work disability in Major Depressive Disorder: a prospective study
Rytsälä, H. J., Melartin, T. K., Leskelä, U. S., Sokero, T. P., Lestelä‐Mielonen, P. S., & Isometsä, E. T. (2007) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2006.00878.x · Cited by 54 · see citing works
Anhedonia Reduction and the Association Between Left Ventral Striatal Reward Response and 6-Month Improvement in Life Satisfaction Among Young Adults
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 · see citing works
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The Curious Neglect of High Functioning After Psychopathology: The Case of Depression
Rottenberg, J., Devendorf, A. R., Kashdan, T. B., & Disabato, D. J. (2018) · Perspectives on Psychological Science · doi:10.1177/1745691618769868 · Cited by 40 · see citing works
Comorbid migraine is associated with a negative impact on quality of life in patients with major depression
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Prevention of Relapse in Residual Depression by Cognitive Therapy: A Controlled Trial
Paykel, E. S., Scott, J., Teasdale, J. D., Johnson, A. L., Garland, A., Moore, R., Jenaway, A., Cornwall, P. L., Hayhurst, H., Abbott, R., et al. (1999) · Archives of General Psychiatry · doi:10.1001/archpsyc.56.9.829 · Cited by 20 · see citing works
Self-citation
Long-term outcome of patients with dysthymia and panic disorder: A naturalistic 9-year follow-up study
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Dysfunctional self-reported interoception predicts residual symptom burden of fatigue in major depressive disorder: an observational study
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“The prevention and treat-ment of residual symptoms of fatigue is not adequately addressed in available guidelines, although their clinical and psychosocial impact is increasingly recognized [4, 5].”
Background
Functional impairment in patients with major depression in clinical remission: results from the VIVAL-D-Rem, a nationwide, naturalistic, cross-sectional survey
Sacchetti, E., Frank, E., Siracusano, A., Racagni, G., Vita, A., & Turrina, C. (2015) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000074 · Cited by 11 · see citing works

Authors: Paykel, E. S., Ramana, R., Cooper, Z., Hayhurst, H., Kerr, J., & Barocka, A.
Affiliations: University of Cambridge (GB)
Corresponding author: Paykel, E. S.
ORCID: Cooper, Z.
Venue: Psychological Medicine
Publisher: Cambridge University Press (CUP)
Published: 1995-11
Volume: 25
Issue: 6
Pages: 1171-1180
ISSN: 0033-2917 (ISSN-L)
1469-8978
DOI: 10.1017/s0033291700033146
OpenAlex: W2088302707
Cited by: 791
References: 6
Citations by year: 2026: 3 · 2025: 6 · 2024: 16 · 2023: 13 · 2022: 14 · 2021: 14 · 2020: 12 · 2019: 11 · 2018: 22 · 2017: 31 · 2016: 21 · 2015: 29 · 2014: 27 · 2013: 49 · 2012: 38
FWCI: 5.68
Type: journal article
Language: en
Open access: closed
Licence: www.cambridge.org/core/terms (unspecified, 4999 d)
Locations: Psychological Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords: residual depressive symptoms, partial remission, major depressive disorder, recurrence prediction, Hamilton Depression Rating Scale, dysthymia, antidepressant dose, personality traits, treatment outcomes
MeSH terms: Adolescent, Adult, Aged, Depressive Disorder, Humans, Longitudinal Studies, Middle Aged, Recurrence, Remission, Spontaneous

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Residual symptoms after partial remission: an important outcome in depression

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