Historical Overview of Outcome of Depression

Kraepelin established manic-depressive disorder on the psychiatric map as a remitting but recurrent disorder. As the concept of affective disorder became broader, its potentially chronic nature was also recognised in long-term follow-up studies. However, the advent of antidepressants in the late 1950s gave rise to more therapeutic optimism, and a tendency to regard unremitting and chronic features as reflecting characterological rather than affective disorders. In the late 1970s, an era of reappraisal started, and it is now clear from long-term follow-up studies that recurrence is common and chronicity occurs, although probably in a smaller proportion than previously. The wheel has come full circle recently in Britain, as the Department of Health and the Medical Research Council have established relapse and chronicity in depression as major health service research priorities.