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December 23, 1983, Vol 250, No. 24 >
ARTICLE | December 23, 1983

Predictors of Relapse in Major Depressive Disorder FREE

Gerald L. Klerman, MD; Collins E. Lewis, MD; Philip W. Lavori, PhD; Martin B. Keller, MD
[+] Author Affiliations

Reprint requests to Department of Psychiatry, Massachusetts General Hospital, Fruit Street, Boston, MA 02114 (Dr Keller).


JAMA. 1983;250(24):3299-3304. doi:10.1001/jama.1983.03340240025024
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References

Risk of relapse into an affective episode was high in the months immediately after recovery from a major depressive disorder (MDD) in 141 subjects with nonbipolar depression, without a preexisting dysthymic disorder. The probability of relapse then declined steadily during the duration of the follow-up (median follow-up, 62 weeks from recovery). In patients entering the study during their first affective episode, the Research Diagnostic Criteria secondary subtype of MDD and an older age of onset predicted a significantly greater likelihood of relapse. Three or more prior episodes of depression predicted a significantly shorter time to the first and second prospectively observed relapses and, thus, a significantly greater likelihood of subsequent multiple affective episodes.

(JAMA 1983;250:3299-3304)

REFERENCES

1 +
Zis AP, Goodwin FK:  Major affective disorder as a recurrent illness: A critical review . Arch Gen Psychiatry 1979;;36:835-839.
2 +
Lavori PW, Keller MB, Klerman GL:  Relapse in affective disorders: A reanalysis of the literature using life table methods . Psychiatr Res , in press.
3 +
Stenstedt A:  A study in manic-depressive psychosis: Clinical, social and genetic investigations . Acta Psychiatr Neurol Scand Suppl 1952;; 79:1-111.
4 +
Bratfos O, Haug JO:  The course of manicdepressive psychosis: A follow-up investigation of 215 patients . Acta Psychiatr Scand 1968;; 44:89-112.
5 +
Perris C, D'Elia G:  A study of bipolar (manic-depressive) and unipolar recurrent depressive psychoses: IX. Therapy and prognosis . Acta Psychiatr Scand Suppl 1966;;42:153-171.
6 +
Pollock HM:  Recurrence of attacks in manic-depressive psychoses . Am J Psychiatry 1931;;11:567-574.
7 +
Keller MB, Lavori PW, Endicott J, et al:  Double depression: A two year follow-up . Am J Psychiatry 1983;;140:689-694.
8 +
Katz MM, Secunda SK, Hirschfeld RMA, et al:  NIMH Clinical Research Branch Collaborative Program on the Psychobiology of Depression . Arch Gen Psychiatry 1979;;36:765-771.
9 +
Spitzer RL, Endicott J, Robins E:  Research Diagnostic Criteria: Rationale and reliability . Arch Gen Psychiatry 1978;;35:773-782.
10 +
Keller MB, Shapiro RW, Lavori PW, et al:  Relapse in major depressive disorder: Analysis with the life table . Arch Gen Psychiatry 1982;; 39:911-915.
11 +
Spitzer RL, Endicott J: Schedule for Affective Disorders and Schizophrenia (SADS) , ed 3. New York, Biometric Research, New York State Psychiatric Institute, 1979;.
12 +
American Psychiatric Association Committee on Nomenclature and Statistics: Diagnostic and Statistical Manual of Mental Disorders . ed 3. Washington, DC, American Psychiatric Association, 1980;.
13 +
Williams JBW, Spitzer RL:  Research Diagnostic Criteria and DSM III: An annotated comparison . Arch Gen Psychiatry 1982;;39:1283-1289.
14 +
Shapiro RW, Keller MB:  Initial six month follow-up of patients with major depressive disorder: A preliminary report from the NIMH Collaborative Study of the Psychobiology of Depression . J Affective Disord 1981;;3:205-220.
15 +
Shapiro RW, Keller MB: Longitudinal Interval Follow-up Evaluation (LIFE) . Boston, Massachusetts General Hospital, 1979;.
16 +
Kaplan EL, Meier P:  Non-parametric estimation from incomplete observations . J Am Stat Assoc 1958;;53:457-481.
17 +
Mantel N, Haenszel W:  Statistical aspects of the analysis of data from retrospective studies of disease . JNCI 1959;;22:719-748.
18 +
Kalbfleisch JD, Prentice RL: The Statistical Analysis of Failure Time Data . New York, John Wiley & Sons Inc, 1980;.
19 +
Angst J, Weiss P:  Periodicity of depressive psychoses , in Brill H, Cole JO, Deniker P, et al (eds): Proceedings of the Fifth International Medical Foundation , International Congress series 129. Amsterdam, Excerpta Medica, 1967;, pp 703-710.
20 +
Zis AP, Grof P, Webster M, et al:  Prediction of relapse in recurrent affective disorders . Psychopharmacol Bull 1980;;16:47-49.
21 +
Klerman GL:  Other specific affective disorders , in Freedman AM, Kaplan HI, Sadock BJ (eds): The Comprehensive Textbook of Psychiatry . Baltimore, Williams & Wilkins Co, 1980;.
22 +
Klerman GL, Dimascio A, Weissman M, et al:  Treatment of depression by drugs and psychotherapy . Am J Psychiatry 1974;;131:186-191.
23 +
Prien RF, Klett CJ, Caffey EM Jr:  Lithium prophylaxis in recurrent affective illness . Am J Psychiatry 1974;;131:198-203.

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1 +
Zis AP, Goodwin FK:  Major affective disorder as a recurrent illness: A critical review . Arch Gen Psychiatry 1979;;36:835-839.
2 +
Lavori PW, Keller MB, Klerman GL:  Relapse in affective disorders: A reanalysis of the literature using life table methods . Psychiatr Res , in press.
3 +
Stenstedt A:  A study in manic-depressive psychosis: Clinical, social and genetic investigations . Acta Psychiatr Neurol Scand Suppl 1952;; 79:1-111.
4 +
Bratfos O, Haug JO:  The course of manicdepressive psychosis: A follow-up investigation of 215 patients . Acta Psychiatr Scand 1968;; 44:89-112.
5 +
Perris C, D'Elia G:  A study of bipolar (manic-depressive) and unipolar recurrent depressive psychoses: IX. Therapy and prognosis . Acta Psychiatr Scand Suppl 1966;;42:153-171.
6 +
Pollock HM:  Recurrence of attacks in manic-depressive psychoses . Am J Psychiatry 1931;;11:567-574.
7 +
Keller MB, Lavori PW, Endicott J, et al:  Double depression: A two year follow-up . Am J Psychiatry 1983;;140:689-694.
8 +
Katz MM, Secunda SK, Hirschfeld RMA, et al:  NIMH Clinical Research Branch Collaborative Program on the Psychobiology of Depression . Arch Gen Psychiatry 1979;;36:765-771.
9 +
Spitzer RL, Endicott J, Robins E:  Research Diagnostic Criteria: Rationale and reliability . Arch Gen Psychiatry 1978;;35:773-782.
10 +
Keller MB, Shapiro RW, Lavori PW, et al:  Relapse in major depressive disorder: Analysis with the life table . Arch Gen Psychiatry 1982;; 39:911-915.
11 +
Spitzer RL, Endicott J: Schedule for Affective Disorders and Schizophrenia (SADS) , ed 3. New York, Biometric Research, New York State Psychiatric Institute, 1979;.
12 +
American Psychiatric Association Committee on Nomenclature and Statistics: Diagnostic and Statistical Manual of Mental Disorders . ed 3. Washington, DC, American Psychiatric Association, 1980;.
13 +
Williams JBW, Spitzer RL:  Research Diagnostic Criteria and DSM III: An annotated comparison . Arch Gen Psychiatry 1982;;39:1283-1289.
14 +
Shapiro RW, Keller MB:  Initial six month follow-up of patients with major depressive disorder: A preliminary report from the NIMH Collaborative Study of the Psychobiology of Depression . J Affective Disord 1981;;3:205-220.
15 +
Shapiro RW, Keller MB: Longitudinal Interval Follow-up Evaluation (LIFE) . Boston, Massachusetts General Hospital, 1979;.
16 +
Kaplan EL, Meier P:  Non-parametric estimation from incomplete observations . J Am Stat Assoc 1958;;53:457-481.
17 +
Mantel N, Haenszel W:  Statistical aspects of the analysis of data from retrospective studies of disease . JNCI 1959;;22:719-748.
18 +
Kalbfleisch JD, Prentice RL: The Statistical Analysis of Failure Time Data . New York, John Wiley & Sons Inc, 1980;.
19 +
Angst J, Weiss P:  Periodicity of depressive psychoses , in Brill H, Cole JO, Deniker P, et al (eds): Proceedings of the Fifth International Medical Foundation , International Congress series 129. Amsterdam, Excerpta Medica, 1967;, pp 703-710.
20 +
Zis AP, Grof P, Webster M, et al:  Prediction of relapse in recurrent affective disorders . Psychopharmacol Bull 1980;;16:47-49.
21 +
Klerman GL:  Other specific affective disorders , in Freedman AM, Kaplan HI, Sadock BJ (eds): The Comprehensive Textbook of Psychiatry . Baltimore, Williams & Wilkins Co, 1980;.
22 +
Klerman GL, Dimascio A, Weissman M, et al:  Treatment of depression by drugs and psychotherapy . Am J Psychiatry 1974;;131:186-191.
23 +
Prien RF, Klett CJ, Caffey EM Jr:  Lithium prophylaxis in recurrent affective illness . Am J Psychiatry 1974;;131:198-203.

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