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Research suggests new definition of major depressive episode recovery

Recent findings in the Journal of Clinical Psychiatry showed 4 consecutive weeks of asymptomatic recovery following a major depressive episode was comparable to 8 weeks of recovery, suggesting a new definition of major depressive episode recovery.

“The current clinical consensus is that 8 consecutive weeks with no more than ‘minimal’ residual symptoms defines the end of a major depressive episode. DSM-5 is consistent with this position, defining [major depressive episode] recovery, labeled ‘full remission,’ as a period of at least 2 months without significant symptoms of an [major depressive episode]. [Major depressive episode] recovery has been operationalized in clinical trials as ≤ 7 on the 17-item Hamilton Depression Rating Scale or the equivalent on another depression scale by the end of treatment, usually without a duration requirement,” Lewis L. Judd, MD, of the University of California, San Diego, and colleagues wrote. “We have previously demonstrated the importance of distinguishing between these two levels in understanding [major depressive episode] recovery, chronicity, and psychosocial function.”

To test the predictive validity of two resolution levels included in the current consensus definition of major depressive episode recovery, researchers followed 322 participants in the NIMH Collaborative Depression Study with major depressive episode in 1978 to 1981 for 31 years. Participants were divided into groups based on if they had 8 consecutive weeks of asymptomatic major depressive episode recovery or residual subsyndromal depressive symptom resolution of their index major depressive episode. The two levels of recovery were based on weekly symptom status of all depressive conditions assessed by Longitudinal Interval Follow-Up Evaluation interviews conducted every 6 months.

Overall, 61.2% of participants recovered asymptomatically from their index major depressive episode.

According to survival analysis, those who recovered asymptomatically remained free of a depressive episode relapse or recurrence 4.2 times longer than those with subsyndromal depressive symptom resolution (P < .0001). This difference was not attributable to difference in antidepressant intensity, according to researchers.

Subsyndromal depressive symptom resolution was associated with significantly longer and more severe index major depressive episodes, more miscellaneous psychopathology and increased long-term psychosocial dysfunction, and a greater depressive illness burden during subsequent 10 to 20 years, compared with asymptomatic recovery.

Asymptomatic episode resolution was a stronger predictor of well-being compared with any other 18 predictors solely or combined.

Eight consecutive weeks of asymptomatic recovery had 93% overlap with a 4-week definition and had little benefit over 4 weeks.

“Future treatment guidelines should follow the recommendation of a 1993 Depression Guideline Panel and specify that the goals of [major depressive episode] treatment are, in order of priority, ‘1) to reduce and ultimately to remove all signs and symptoms of the depressive syndrome, 2) to restore occupational and psychosocial function to the asymptomatic state, and 3) to reduce the likelihood of relapse and recurrence’,” Judd and colleagues wrote. “Only asymptomatic recovery provides a foundation for all of these treatment goals and should be considered ‘true’ [major depressive episode] recovery... In our study, 4 consecutive weeks of asymptomatic status initiated nearly as stable a well period as 8 weeks, indicating that 4 weeks free of all symptoms of the episode should be the new definition of [major depressive episode] recovery.” – by Amanda Oldt

Disclosure: Judd reports no relevant financial disclosures. Please see the full study for a list of all authors’ relevant financial disclosures.