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Depression Symptoms Vary From One Episode to Next

Psychiatrists should not assume that the symptoms that characterize a first episode of major depression will be the ones manifest in a second such episode.

Her name is "Tanya," and at age 16, she experienced a major depression. She has now made it to age 26 without experiencing another one.

Nonetheless, her chances of developing another major depression in the future are considerable, perhaps as high as 58 percent, research has suggested. And if and when that time comes, she may well sustain symptoms that differ from those she endured the first time around, a study reported in the February American Journal of Psychiatry found.

The investigation was headed by Maria Oquendo, M.D., an associate professor of clinical psychiatry at Columbia University.

Oquendo and her colleagues focused on 185 persons who were being treated for a major depressive disorder as inpatients at university hospitals in New York or Pittsburgh. The researchers assessed these individuals with the 24-item Hamilton Depression Rating Scale to identify their symptoms, then contacted them three months, one year, and two years later to learn whether they had experienced another major depression. If the subject had developed a second depressive episode, the researchers assessed them again with the Hamilton scale.

At the end of two years, 78 of the 185 subjects had once again incurred a major depression, so the investigators were able to compare the symptoms of the two major depression episodes.

The symptoms that the 78 had experienced the first time were usually not those they encountered the second time, the scientists found. The most robust, although still weak, links across episodes were for anxiety and suicidal behavior. Even the depression subtype—melancholic, psychotic, or atypical—was likely to differ the second time, the investigators discovered.

This "lack of robust consistency of symptoms or depressive subtype across episodes is striking," Oquendo and her team concluded in their study report, "in that, by definition, we require subjects to meet criteria for depression. . . increasing chances of finding an association."

The study report, "Instability of Symptoms in Recurrent Major Depression: A Prospective Study," is posted online at http://ajp.psychiatryonline.org/cgi/content/full/161/2/255?.

Am J Psychiatry 2004 161 255[Abstract/Free Full Text]

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