A recent study, led by A. J. Rush of the Office of Clinical Sciences at Duke-NUS Graduate Medical School in Singapore demonstrated the importance of continuous care for individuals who have various types of major depressive disorder (MDD). Rush looked at a sample of 2,656 participants who had experienced chronic MDD (more than 2-year duration) that was recurrent, nonchronic but recurrent, nonrecurrent but chronic, or neither chronic nor recurrent to determine which course of treatment would produce the most effective outcome. Based on previous data gathered from primary-care doctors, chronic MDD appears to be more treatment resistant than other forms of MDD. Other factors that have been examined in previous research are symptom severity, onset age, and family history.
For his study, Rush looked at all of these factors in relation to the classification of MDD in the participants. He evaluated the participants prior to starting them on a 14-week course of antidepressant medication and again 1 year after treatment. He found that the participants with the most chronic and recurrent MDD had the least favorable outcomes. The results also showed that the individuals with chronic MDD were more medically and socially impaired than the recurrent participants. However, the participants with recurrent MDD were more likely to have a family history of depression, earlier onset age, and substance misuse.
The findings demonstrated that the individuals least likely to respond to treatment were those with both chronic and recurring MDD, while those most likely to respond well were those with neither chronic nor recurring MDD. Rush also found that the addition of alternative treatments was very beneficial for some of the participants. He said, “For those with a recurrent course of illness, the addition of psychotherapy after successful antidepressant treatment has been shown to reduce the risk of relapse and recurrence.” Integrating medication with long-term therapeutic intervention may be the most effective course of action for individuals most at risk for future episodes of MDD.
Rush, A. J., Wisniewski, S. R., Zisook, S., Fava, M., Sung, S. C. (2012). Is prior course of illness relevant to acute or longer-term outcomes in depressed out-patients? A STAR*D report. Psychological Medicine, 42.6, 1131-1149.
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