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Rates and predictors of remission, recurrence and conversion to bipolar disorder after the first lifetime episode of depression – a prospective 5-year follow-up study

Published online by Cambridge University Press:  08 January 2016

J. D. Bukh ,
P. K. Andersen  and
L. V. Kessing
J. D. Bukh*
Affiliation:
Psychiatric Centre Copenhagen, Research Unit for Affective Disorders, Department O, Rigshospitalet, Copenhagen, Denmark
P. K. Andersen
Affiliation:
Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
L. V. Kessing
Affiliation:
Psychiatric Centre Copenhagen, Research Unit for Affective Disorders, Department O, Rigshospitalet, Copenhagen, Denmark
*
*Address for correspondence: J. D. Bukh, Ph.D., Psychiatric Centre Copenhagen, Rigshospitalet, Research Unit for Affective Disorders, Department 6233, Blegdamsvej 9, DK-2100 København Ø, Denmark. (Email: jens.bukh@regionh.dk)
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Abstract

Background

In depression, non-remission, recurrence of depressive episodes after remission and conversion to bipolar disorder are crucial determinants of poor outcome. The present study aimed to determine the cumulative incidences and clinical predictors of these long-term outcomes after the first lifetime episode of depression.

Method

A total of 301 in- or out-patients aged 18–70 years with a validated diagnosis of a single depressive episode were assessed from 2005 to 2007. At 5 years of follow-up, 262 patients were reassessed by means of the life chart method and diagnostic interviews from 2011 to 2013. Cumulative incidences and the influence of clinical variables on the rates of remission, recurrence and conversion to bipolar disorder, respectively, were estimated by survival analysis techniques.

Results

Within 5 years, 83.3% obtained remission, 31.5% experienced recurrence of depression and 8.6% converted to bipolar disorder (6.3% within the first 2 years). Non-remission increased with younger age, co-morbid anxiety and suicidal ideations. Recurrence increased with severity and treatment resistance of the first depression, and conversion to bipolar disorder with treatment resistance, a family history of affective disorder and co-morbid alcohol or drug abuse.

Conclusions

The identified clinical characteristics of the first lifetime episode of depression should guide patients and clinicians for long-term individualized tailored treatment.

Keywords

Conversion to bipolar disordercourse of illnessdepressionrecurrenceremission
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 6 , April 2016 , pp. 1151 - 1161
Copyright
Copyright © Cambridge University Press 2016 

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References

Akiskal, HS, Walker, P, Puzantian, VR, King, D, Rosenthal, TL, Dranon, M (1983). Bipolar outcome in the course of depressive illness. Phenomenologic, familial, and pharmacologic predictors. Journal of Affective Disorders 5, 115–128.Google Scholar
Andreasen, NC, Endicott, J, Spitzer, RL, Winokur, G (1977). The family history method using diagnostic criteria. Reliability and validity. Archives of General Psychiatry 34, 1229–1235.Google Scholar
Angst, J, Sellaro, R, Stassen, HH, Gamma, A (2005). Diagnostic conversion from depression to bipolar disorders: results of a long-term prospective study of hospital admissions. Journal of Affective Disorders 84, 149–157.Google Scholar
Bech, P, Kastrup, M, Rafaelsen, OJ (1986). Mini-compendium of rating scales for states of anxiety depression mania schizophrenia with corresponding DSM-III syndromes. Acta Psychiatrica Scandinavica. Supplementum 326, 1–37.Google Scholar
Bukh, JD (2009). First Episode Depression. Gender, Age-of-Onset, and Gene–Environment Interactions. Ph.D. Thesis, University of Copenhagen.Google Scholar
Bukh, JD, Bock, C, Vinberg, M, Gether, U, Kessing, LV (2010). Gender differences among patients with a single depressive episode. Psychopathology 43, 159–169.Google Scholar
Bukh, JD, Bock, C, Vinberg, M, Gether, U, Kessing, LV (2011). Differences between early and late onset adult depression. Clinical Practice and Epidemiology in Mental Health 7, 140–147.Google Scholar
Burcusa, SL, Iacono, WG (2007). Risk for recurrence in depression. Clinical Psychology Review 27, 959–985.Google Scholar
Cohen, P, Cohen, J (1984). The clinician's illusion. Archives of General Psychiatry 41, 1178–1182.Google Scholar
Coryell, W, Endicott, J, Maser, JD, Keller, MB, Leon, AC, Akiskal, HS (1995). Long-term stability of polarity distinctions in the affective disorders. American Journal of Psychiatry 152, 385–390.Google Scholar
Costello, CG, Comrey, AL (1967). Scales for measuring depression and anxiety. Journal of Psychology 66, 303–313.Google Scholar
Eaton, WW, Neufeld, K, Chen, LS, Cai, G (2000). A comparison of self-report and clinical diagnostic interviews for depression: Diagnostic Interview Schedule and Schedules for Clinical Assessment in Neuropsychiatry in the Baltimore Epidemiologic Catchment Area follow-up. Archives of General Psychiatry 57, 217–222.Google Scholar
Eaton, WW, Shao, H, Nestadt, G, Lee, HB, Bienvenu, OJ, Zandi, P (2008). Population-based study of first onset and chronicity in major depressive disorder. Archives of General Psychiatry 65, 513–520.Google Scholar
Fiedorowicz, JG, Endicott, J, Leon, AC, Solomon, DA, Keller, MB, Coryell, WH (2011). Subthreshold hypomanic symptoms in progression from unipolar major depression to bipolar disorder. American Journal of Psychiatry 168, 40–48.Google Scholar
Gilman, SE, Dupuy, JM, Perlis, RH (2012). Risks for the transition from major depressive disorder to bipolar disorder in the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry 73, 829–836.Google Scholar
Goldberg, JF, Harrow, M, Whiteside, JE (2001). Risk for bipolar illness in patients initially hospitalized for unipolar depression. American Journal of Psychiatry 158, 1265–1270.CrossRefGoogle ScholarPubMed
Hardeveld, F, Spijker, J, de, Graaf R, Nolen, WA, Beekman, AT (2010). Prevalence and predictors of recurrence of major depressive disorder in the adult population. Acta Psychiatrica Scandinavica 122, 184–191.Google Scholar
Hardeveld, F, Spijker, J, de, Graaf R, Nolen, WA, Beekman, AT (2013). Recurrence of major depressive disorder and its predictors in the general population: results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Psychological Medicine 43, 39–48.Google Scholar
Holma, KM, Melartin, TK, Holma, IA, Isometsä, ET (2008). Predictors for switch from unipolar major depressive disorder to bipolar disorder type I or II: a 5-year prospective study. Journal of Clinical Psychiatry 69, 1267–1275.Google Scholar
Judd, LL, Paulus, MJ, Schettler, PJ, Akiskal, HS, Endicott, J, Leon, AC, Maser, JD, Mueller, T, Solomon, DA, Keller, MB (2000). Does incomplete recovery from first lifetime major depressive episode herald a chronic course of illness? American Journal of Psychiatry 157, 1501–1504.Google Scholar
Kalbfleisch, JD, Prentice, RL (2002). The Statistical Analysis of Failure Time Data, 2nd edn. Wiley: New York.Google Scholar
Kanai, T, Takeuchi, H, Furukawa, TA, Yoshimura, R, Imaizumi, T, Kitamura, T, Takahashi, K (2003). Time to recurrence after recovery from major depressive episodes and its predictors. Psychological Medicine 33, 839–845.Google Scholar
Keller, MB, Lavori, PW, Friedman, B, Nielsen, E, Endicott, J, Donald-Scott, P, Andreasen, NC (1987). The Longitudinal Interval Follow-up Evaluation. A comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry 44, 540–548.Google Scholar
Kennedy, N, Abbott, R, Paykel, ES (2003). Remission and recurrence of depression in the maintenance era: long-term outcome in a Cambridge cohort. Psychological Medicine 33, 827–838.Google Scholar
Kessing, LV, Hansen, MG, Andersen, PK (2004 a). Course of illness in depressive and bipolar disorders. Naturalistic study, 1994–1999. British Journal of Psychiatry 185, 372–377.Google Scholar
Kessing, LV, Hansen, MG, Andersen, PK, Angst, J (2004 b). The predictive effect of episodes on the risk of recurrence in depressive and bipolar disorders – a life-long perspective. Acta Psychiatrica Scandinavica 109, 339–344.Google Scholar
Li, CT, Bai, YM, Huang, YL, Chen, YS, Chen, TJ, Cheng, JY, Su, TP (2012). Association between antidepressant resistance in unipolar depression and subsequent bipolar disorder: cohort study. British Journal of Psychiatry 200, 45–51.Google Scholar
Mattisson, C, Bogren, M, Horstmann, V, Munk-Jorgensen, P, Nettelbladt, P (2007). The long-term course of depressive disorders in the Lundby Study. Psychological Medicine 37, 883–891.Google Scholar
Mueller, TI, Leon, AC, Keller, MB, Solomon, DA, Endicott, J, Coryell, W, Warshaw, M, Maser, JD (1999). Recurrence after recovery from major depressive disorder during 15 years of observational follow-up. American Journal of Psychiatry 156, 1000–1006.Google Scholar
Munk-Jorgensen, P, Mortensen, PB (1997). The Danish Psychiatric Central Register. Danish Medical Bulletin 44, 82–84.Google Scholar
Nelson, JC, Baumann, P, Delucchi, K, Joffe, R, Katona, C (2014). A systematic review and meta-analysis of lithium augmentation of tricyclic and second generation antidepressants in major depression. Journal of Affective Disorders 168, 269–275.Google Scholar
O'Leary, D, Costello, F, Gormley, N, Webb, M (2000). Remission onset and relapse in depression. An 18-month prospective study of course for 100 first admission patients. Journal of Affective Disorders 57, 159–171.Google Scholar
Post, RM, Roy-Byrne, PP, Uhde, TW (1988). Graphic representation of the life course of illness in patients with affective disorder. American Journal of Psychiatry 145, 844–848.Google Scholar
Posternak, MA, Young, D, Sheeran, T, Chelminski, I, Franklin, CL, Zimmerman, M (2004). Assessing past treatment history: test–retest reliability of the Treatment Response to Antidepressant Questionnaire. Journal of Nervous and Mental Disease 192, 95–102.Google Scholar
Riihimäki, KA, Vuorilehto, MS, Melartin, TK, Isometsä, ET (2014). Five-year outcome of major depressive disorder in primary health care. Psychological Medicine 44, 1369–1379.Google Scholar
Robins, LN, Helzer, JE, Croughan, J, Ratcliff, KS (1981). National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. Archives of General Psychiatry 38, 381–389.Google Scholar
Simpson, HB, Nee, JC, Endicott, J (1997). First-episode major depression. Few sex differences in course. Archives of General Psychiatry 54, 633–639.Google Scholar
Solomon, DA, Keller, MB, Leon, AC, Mueller, TI, Lavori, PW, Shea, MT, Coryell, W, Warshaw, M, Turvey, C, Maser, JD, Endicott, J (2000). Multiple recurrences of major depressive disorder. American Journal of Psychiatry 157, 229–233.Google Scholar
Spijker, J, de, Graaf R, Bijl, RV, Beekman, AT, Ormel, J, Nolen, WA (2002). Duration of major depressive episodes in the general population: results from The Netherlands Mental Health Survey and Incidence Study (NEMESIS). British Journal of Psychiatry 181, 208–213.Google Scholar
Tondo, L, Visioli, C, Preti, A, Baldessarini, RJ (2014). Bipolar disorders following initial depression: modeling predictive clinical factors. Journal of Affective Disorders 167, 44–49.Google Scholar
Wilhelm, K, Parker, G, Whurst-Savellis, J, Asghari, A (1999). Psychological predictors of single and recurrent major depressive episodes. Journal of Affective Disorders 54, 139–147.Google Scholar
Wing, JK, Babor, T, Brugha, T, Burke, J, Cooper, JE, Giel, R, Jablenski, A, Regier, D, Sartorius, N (1990). SCAN. Schedules for Clinical Assessment in Neuropsychiatry. Archives of General Psychiatry 47, 589–593.Google Scholar
World Health Organization (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. World Health Organization: Geneva.Google Scholar
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