One Depressive Episode May Not Lead to More

June 4, 2008— -- Good news for a change.

About half of people who have a first episode of major depression are likely, upon recovery, to stay well — to stay depression-free, according to a new study.

This rate, based on a large study of 1,831 people, including 92 with depression, is reported in the May issue of the Archives of General Psychiatry by researchers William Eaton, Peter Zandi and colleagues at the Johns Hopkins School of Public Health.

The results should be encouraging to patients and their families, and to the doctors and therapists who treat them, because they suggest a better prognosis than do other studies of this kind.

This study, which followed people in Baltimore over a 23-year period, is unique in focusing on those in the community, rather than on those who have sought psychiatric attention. That means the results tell us a lot about depression in general, rather than simply telling us about the more severe cases of the illness.

To understand the value of such a study, consider an analogy. If we wanted to understand the full range of singing ability in the population, we would not want to only sample those who showed up for American Idol competitions, because these are (mostly) people with some talent. By contrast, if every United States citizen had to participate, we would see a wider range of abilities, including those with more modest talents.

Similarly, sampling the general population tells us more about milder depressions than does studying groups of patients found through clinics.

Prognosis is an ancient medical art. It refers to the physician's ability to see into the future and predict how an illness is likely to unfold. For millennia, this was the physician's skill par excellence as practitioners had relatively little in their bag of tricks with which to actually cure patients of disease.

Sometimes prognosis can be as good as a cure. For example, if a patient has huge lymph nodes and is afraid that he has a form of cancer, but the physician determines that it is only a viral infection which will likely clear up within a couple of weeks, then the patient is much relieved, knowing that a return to good health is imminent.