UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Unipolar depression in adults and initial treatment: General principles and prognosis

Authors
Gregory Simon, MD, MPH
Paul Ciechanowski, MD
Section Editor
Peter P Roy-Byrne, MD
Deputy Editor
David Solomon, MD

INTRODUCTION

Unipolar depression is highly prevalent and disabling. Community surveys in 14 countries have estimated that the lifetime prevalence of unipolar depressive disorders is 12 percent [1], and the World Health Organization ranks unipolar major depression as the 11th greatest cause of disability and mortality in the world, among 291 diseases and causes of injury [2]. In the United States, major depression ranks second among all diseases and injuries as a cause of disability, and dysthymia as the 20th [3].

In addition, major depression is highly recurrent. Following recovery from one episode, the estimated rate of recurrence over two years is greater than 40 percent; after two episodes, the risk of recurrence within five years is approximately 75 percent [4].

This topic reviews the general principles and prognosis for the initial treatment of depression. Choosing a therapy for the initial treatment of depression and the general evidence of efficacy of standard therapies are discussed separately, as are the evidence for therapies that are not typically used, and the evidence for standard therapies that are used for initially treating depression in primary care patients and in patients with general medical illnesses. Continuation and maintenance treatment of major depression, the treatment of resistant depression and refractory depression, and the clinical manifestations and diagnosis of depression are also discussed elsewhere.

(See "Unipolar major depression in adults: Choosing initial treatment".)

(See "Unipolar depression in adults and initial treatment: Investigational approaches".)

               

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Tue Nov 24 00:00:00 GMT 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Kessler RC, Ormel J, Petukhova M, et al. Development of lifetime comorbidity in the World Health Organization world mental health surveys. Arch Gen Psychiatry 2011; 68:90.
  2. Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380:2197.
  3. Murray CJ, Atkinson C, Bhalla K, et al. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA 2013; 310:591.
  4. Solomon DA, Keller MB, Leon AC, et al. Multiple recurrences of major depressive disorder. Am J Psychiatry 2000; 157:229.
  5. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 1999; 282:1737.
  6. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16:606.
  7. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
  8. Smith DJ, Griffiths E, Kelly M, et al. Unrecognised bipolar disorder in primary care patients with depression. Br J Psychiatry 2011; 199:49.
  9. American Psychiatric Association: Practice Guideline for the Treatment of Patients with Major Depressive Disorder, Third Edition, 2010. http://psychiatryonline.org/guidelines.aspx (Accessed on April 17, 2012).
  10. American Psychiatric Association. Practice Guideline for the Treatment of Patients with Major Depressive Disorder, third edition. Am J Psychiatry 2010; 167 (supplement):1.
  11. Ghio L, Gotelli S, Cervetti A, et al. Duration of untreated depression influences clinical outcomes and disability. J Affect Disord 2015; 175:224.
  12. Ghio L, Gotelli S, Marcenaro M, et al. Duration of untreated illness and outcomes in unipolar depression: a systematic review and meta-analysis. J Affect Disord 2014; 152-154:45.
  13. Qaseem A, Snow V, Denberg TD, et al. Using second-generation antidepressants to treat depressive disorders: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2008; 149:725.
  14. Thase ME. The small specific effects of antidepressants in clinical trials: what do they mean to psychiatrists? Curr Psychiatry Rep 2011; 13:476.
  15. National Institute for Health & Clinical Excellence. The Treatment and Management of Depression in Adults (updated edition). National Clinical Practice Guideline 90, 2010. http://www.nice.org.uk/ (Accessed on December 09, 2012).
  16. Dietrich AJ, Oxman TE, Williams JW Jr, et al. Re-engineering systems for the treatment of depression in primary care: cluster randomised controlled trial. BMJ 2004; 329:602.
  17. McIntyre RS. When should you move beyond first-line therapy for depression? J Clin Psychiatry 2010; 71 Suppl 1:16.
  18. Malhi GS, Hitching R, Berk M, et al. Pharmacological management of unipolar depression. Acta Psychiatr Scand Suppl 2013; :6.
  19. Mead N, Lester H, Chew-Graham C, et al. Effects of befriending on depressive symptoms and distress: systematic review and meta-analysis. Br J Psychiatry 2010; 196:96.
  20. Gaynes BN, Rush AJ, Trivedi MH, et al. Primary versus specialty care outcomes for depressed outpatients managed with measurement-based care: results from STAR*D. J Gen Intern Med 2008; 23:551.
  21. Tursi MF, Baes Cv, Camacho FR, et al. Effectiveness of psychoeducation for depression: a systematic review. Aust N Z J Psychiatry 2013; 47:1019.
  22. Olfson M, Marcus SC, Tedeschi M, Wan GJ. Continuity of antidepressant treatment for adults with depression in the United States. Am J Psychiatry 2006; 163:101.
  23. Mitchell AJ. Depressed patients and treatment adherence. Lancet 2006; 367:2041.
  24. Warden D, Trivedi MH, Wisniewski SR, et al. Predictors of attrition during initial (citalopram) treatment for depression: a STAR*D report. Am J Psychiatry 2007; 164:1189.
  25. Lin EH, Von Korff M, Katon W, et al. The role of the primary care physician in patients' adherence to antidepressant therapy. Med Care 1995; 33:67.
  26. Hahn SR. Adherence to antidepressant medication: patient-centered shared decision making communication to improve adherence. CNS Spectr 2009; 14:6.
  27. Papakostas GI, Fava M. Does the probability of receiving placebo influence clinical trial outcome? A meta-regression of double-blind, randomized clinical trials in MDD. Eur Neuropsychopharmacol 2009; 19:34.
  28. Gartlehner G, Hansen RA, Morgan LC, et al. Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder: an updated meta-analysis. Ann Intern Med 2011; 155:772.
  29. Trivedi MH, Rush AJ, Wisniewski SR, et al. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry 2006; 163:28.
  30. McClintock SM, Husain MM, Wisniewski SR, et al. Residual symptoms in depressed outpatients who respond by 50% but do not remit to antidepressant medication. J Clin Psychopharmacol 2011; 31:180.
  31. Dodd S, Berk M, Kelin K, et al. Treatment response for acute depression is not associated with number of previous episodes: lack of evidence for a clinical staging model for major depressive disorder. J Affect Disord 2013; 150:344.