New Study Analyzes Different Depression Trajectories

There are numerous classifications of depression, including dysthymic disorder (Dysth), major depressive disorder (MDD), and double depression (DD), which represents the presence of both Dysth and MDD. Identifying these classes individually is challenging because often there is an overlap in symptoms and varying degrees of severity. Some types of depression remit and others are chronic conditions. The DSM-IV currently has several different categories of depression that influence treatment approaches and outcome. However, it is imperative that these categories be properly assessed for accuracy and illness trajectory in order to ensure that individual clients are receiving the proper care for their unique classification of depression. To do this, D. Rhebergen of the Department of Psychiatry and the EMGO Institute for Health and Care Research at the University Medical Center Amsterdam in the Netherlands recently led a study that examined trajectory and symptomology in 804 individuals diagnosed with unipolar depression.

Rhebergen analyzed the data from the Netherlands Study of Depression and Anxiety (NESDA) and found that five specific trajectories existed among MDD, Dysth, and DD. The trajectories ranged from swift remission to extreme and chronic symptom severity. Over half of the participants diagnosed with DD and Dysth had favorable outcomes. In addition, the youngest female participants with the fewest psychological and social barriers were the most likely to have positive course trajectories, while the participants with the earliest onset age and highest levels of introversion had the poorest trajectories. In this study, just over 40% of the participants had swift remission, and only 20% had chronic and severe trajectories. These findings suggest that the current categories outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), do not accurately represent the existing varying degrees of depression. “To conclude, MDD, Dysth, and DD did not adequately match empirically derived course trajectories for unipolar depression,” said Rhebergen. Clinical interventions could be improved if they included assessments of both depression symptoms and trajectory.

Rhebergen, D., Lamers, F., Spijker, J., De Graaf, R., Beekman, A. T. F. (2012). Course trajectories of unipolar depressive disorders identified by latent class growth analysis. Psychological Medicine, 42.7, 1383-1396.

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  • Claire


    June 5th, 2012 at 3:34 PM

    There are so many different levels of depression- what one person feels while depressed could be completely different from how another experiences the same thing. So how could there NOT be varied classifications that are assigned to this diagnosis? It doesn’t have to be anything too complicated, just something that all therapists can refer to and can understand across the board when discussing treatment planning for patients. There has to be a more objective way to look at the varied states of depression so that clinicians and patients alike understand up fron what they are dealing with and the best treatment methods which are going to be available for treating those specific symptoms.

  • Verna


    June 5th, 2012 at 4:55 PM

    Although I have been fortunate enough to have never experienced depression, or what I would consider true clinical depression, I feel like there are a lot of people like me who have probably experienced situational depression. It might just be something going on at a certain point in time that kind of throws you off for a bit, makes you not be yourself and can even get you down for a while. But then when that passes you are able to dust yourself off and it’s over. I am lucky in that this is the only kind of depressed feelings I have ever known, so this goes to show though just how wide ranging the spectrum can be.

  • eileen


    June 6th, 2012 at 4:13 AM

    So it looks like, as with most things, those who get help the soonest and have the fewest additional barriers working against them are going to be the ones who benefit the most from treatment. Those who face multiple issues are the ones who are going to continue to struggle and have to work the hardest to overcome their numerous obstacles.

  • Selma


    June 6th, 2012 at 11:21 AM

    Eileen- it seems to me that you have made the right conclusion here. I think that any time you have an illness, the earlier that you receive treatment for it then you are certain to have a better chance for recovery and success. Also, the more people that you have around to support you, then not only does that give you a shoulder to cry on when you may need it, but it also gives you that added motivation to get better. I can’t imagine being depressed and having to go through that alone; I can imagine that those who do have to go it on their own are going to be those who experience the disease at a much more profound level. That makes it pretty easy to see why there are indeed so many varying levels of depression.

  • kendall Raines

    kendall Raines

    June 7th, 2012 at 4:40 AM

    Very informative- I will admit that I was one of those who just thought that depression is depression, deal with it.

    Guess this opened my eyes to the fact that that style of thinking is very wrong, that this is a whole lot more complicated than I would have presumed.

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