A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders

被引:589
作者
Judd, LL
Akiskal, HS
Maser, JD
Zeller, PJ
Endicott, J
Coryell, W
Paulus, MP
Kunovac, JL
Leon, AC
Mueller, TI
Rice, JA
Keller, MB
机构
[1] Univ Calif San Diego, Dept Psychiat, La Jolla, CA 92093 USA
[2] Vet Affairs Med Ctr, Psychiat Serv, San Diego, CA 92161 USA
关键词
D O I
10.1001/archpsyc.55.8.694
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Background: Investigations of unipolar major depressive disorder (MDD) have focused primarily on major depressive episode remission/recovery and relapse/ recurrence. This is the first prospective, naturalistic, longterm study of the weekly symptomatic course of MDD. Methods: The weekly depressive symptoms of 431 patients with MDD seeking treatment at 5 academic centers were divided into 4 levels of severity: (1) depressive symptoms at the threshold for MDD; (2) depressive symptoms at the threshold for minor depressive or dysthymic disorder (MinD); (3) subsyndromal or subthreshold depressive symptoms (SSDs),below the thresholds for MinD and MDD; and (4) no depressive symptoms. The percentage of weeks at each level, number of changes in symptom level, and medication status were analyzed overall and for 3 subgroups defined by mood disorder history. Results: Patients were symptomatically ill in 59% of weeks. Symptom levels changed frequently (1.8/y), and 9 of 10 patients spent weeks at 3 or 4 different levers during follow-up. The MinD (27%) and SSD (17%) symptom levels were more common than the MDD (15%) symptom level. Patients with double depression and recurrent depression had more chronic symptoms than patients with their first lifetime major depressive episode (72% and 65%, respectively, irs 46% of follow-up weeks). Conclusion: The long-term weekly course of unipolar MDD is dominated by prolonged symptomatic chronicity. Combined MinD and SSD level symptoms were about 3 times more common (43%) than MDD level symptoms (15%). The symptomatic course is dynamic and changeable, and MDD, MinD, and SSD symptom levels commonly alternate over time in the same patients as a symptomatic continuum of illness activity of a single clinical disease.
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页码:694 / 700
页数:7
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