Subject:
DEPRESSION

Short Description:
Girls More Likely to Have Recurrent Depression

Background:
The Treatment for Adolescents With Depression Study (TADS) taught us that fluoxetine (Prozac) plus cognitive behavioral therapy was superior to medication alone or placebo for short-term recovery from major depressive disorder (MDD). But TADS didn’t tell us anything about long-term recovery. Researchers recently conducted a naturalistic follow-up study of participants in TADS to determine the incidence of long-term recovery from MDD, and predictive factors for recurrence. For this study, 196 participants in TADS were followed for up to five years after the start of that study to monitor recovery and recurrence of MDD. Recovery was defined as the absence of clinically significant symptoms of depression for eight weeks or longer, and recurrence was defined as a new episode of depression after a period of recovery. Almost all of the adolescents who were followed recovered from depression (96.4%) at some point. Of those who recovered, 91.5% did so by two years after enrollment in the trial. Recovery was not associated with having been in the most efficacious treatment group (Prozac plus CBT) in TADS, but rather was most strongly associated with having been a responder to short-term (12 week) treatment (as opposed to being a partial responder or a nonresponder, regardless of which treatment the participant responded to). However, by the end of the five-year follow-up period, 46.6% of participants had a recurrence. The other 53.4% stayed well through the end of the follow-up period. The mean time from recovery to recurrence was 22.3 months. Sex was the strongest predictor of recurrence, with 57% of females experiencing recurrence of MDD vs 32.9% of males (Curry J et al, Arch Gen Psychiatry Nov 1, 2010:online ahead of print).

TCPR's Take:
The good news is that most of the adolescents recovered; however, as seen elsewhere, earlier onset of symptoms predict a worse lifetime course: in this case, more frequent recurrence than later onset (adult) depression. This study also reminds us that there are gender differences in depression. Adolescent females are more likely to become depressed, and this study shows that they are also significantly more likely to experience more than one episode of depression.