Remission and Residual Symptomatology in Major Depression

This paper reports the course of remission of 64 major depressives, predominantly inpatients, whose course was followed longitudinally with repeated assessment. Remission was comparatively rapid for many of the subjects so that 70% had remitted by 6 months. Only 6% failed to remit by 15 months. Slower remission occurred in those subjects who were initially more severely ill and had longer episodes. Detailed examination at the time of remission revealed that residual symptoms reaching 8 or more on the Hamilton Depression Scale were present in 32% of subjects who remitted below major depression. The pattern was of mild typical depressive symptoms without major biological symptoms. Residual symptoms were more common in subjects with more severe initial depression, but were unrelated to other predictors including longer prior illness, dysthymia or lower dose of drug treatment during the index episode. There were weak associations with passive dependent personality traits, which might however have been reflections of persisting symptom presence. Neither remission nor residual symptoms were related to life stress. Residual symptoms were strong predictors of subsequent relapse. Residual symptoms comprise an important adverse outcome in depression which is common and has received comparatively little attention in the past.