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Unipolar depression in adults: Course of illness

William Coryell, MD
Section Editor
Peter P Roy-Byrne, MD
Deputy Editor
David Solomon, MD


Major depressive disorder (unipolar major depression) and persistent depressive disorder (dysthymia) represent depressive syndromes that are distinguished by the type and number of symptoms that occur as well as their duration. Depressive symptoms can include depressed mood, loss of interest or pleasure in most or all activities, insomnia or hypersomnia, change in appetite or weight, psychomotor retardation or agitation, low energy, poor concentration, thoughts of worthlessness or guilt, and recurrent thoughts about death or suicide [1]. The World Health Organization estimated that major depressive disorder was the 11th greatest cause of disability and mortality in the world among 291 diseases and causes of injuries [2].

Preliminary studies suggest that course of illness may be associated with structural brain changes. As an example, a one-year prospective magnetic imaging study followed patients with treatment resistant unipolar major depression (n = 26) who were treated with pharmacotherapy, and found that remission was associated with subtle increases in hippocampal volume and cortical thickness, whereas nonremission was associated with decreased volume and thickness [3].

This topic reviews the course of illness in patients with major depressive disorder and persistent depressive disorder (dysthymia). The course of illness in psychotic depression and minor depression is discussed separately, as is the epidemiology, clinical features, diagnosis, and treatment of depression:

(See "Unipolar major depression with psychotic features: Maintenance treatment and course of illness", section on 'Course of illness'.)

(See "Unipolar minor depression in adults: Epidemiology, clinical presentation, and diagnosis", section on 'Course of illness'.)


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