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Longitudinal syndromal and sub-syndromal symptoms after severe depression: 10-year follow-up study

Institute of Psychiatry, London

ROSEMARY ABBOTT, PhD and EUGENE S. PAYKEL, FRCPsych

University of Cambridge, Cambridge, UK

Correspondence: Dr N. Kennedy, Box 63, Section of General Psychiatry, Division of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. Tel: 020 784 80135; e-mail: N.Kennedy{at}iop.kcl.ac.uk

Declaration of interest None. Funding detailed in Acknowledgements.

Background Few follow-up studies of depression have evaluated depressive symptomatology over time at both threshold and sub-threshold levels.

Aims To evaluate long-term longitudinal symptomatic course after an episode of severe depression.

Method A total of 61 participants from a previous study cohort underwent a detailed interview covering the longitudinal course of depression and pharmacological treatment over 8–11 years of follow-up.

Results Of the follow-up months, 52% were spent at an asymptomatic level, 15% at minor symptom level, 20% at residual symptom level and 13% at full depression level. Also, 30% of follow-up months were spent in an episode of depression, and 18% of patients never achieved asymptomatic status during follow-up. The percentage of patients at each symptom level remained relatively stable after the first 2 years, but levels in individuals fluctuated, with a mean of two changes in symptom levels per follow-up year.

Conclusions After severe episodes, sub-syndromal levels of depression are common and persistent, with considerable fluctuation suggesting a continuum between sub-syndromal subtypes and full depression.

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