***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Data on the duration of major depressive episodes ( MDE ) in the general population are sparse . AIMS To assess the duration of MDE and its clinical and socio-demographic determinants in a study group drawn from the general population with newly originated episodes of major depression . METHOD The Netherl and s Mental Health Survey and Incidence Study is a prospect i ve epidemiological survey in the adult population ( n=7076 ) , using the Composite International Diagnostic Interview . Duration of MDE over 2 years was assessed with a Life Chart Interview . RESULTS The median duration of MDE was 3.0 months ; 50 % of participants recovered within 3 months , 63 % within 6 months , 76 % within 12 months and nearly 20 % had not recovered at 24 months . Determinants of persistence were severity of depression and comorbid dysthymia . A recurrent episode predicted shorter duration . CONCLUSIONS Although half of those affected with MDE recovered rapidly , the risk of chronicity ( duration 24 months or more ) was considerable . This underlines the necessity of diagnosing and treating those at risk The main goal in the treatment of major depressive disorder ( MDD ) is to achieve remission , defined as the resolution of symptoms and the return to normal levels of functionality . However , the clinical assessment of remission is usually merely based on scores of symptomatic rating scales . One of the most widely used scales to measure remission is the HAM-D(17 ) , in which remission is defined as a score ≤ 7 . Nevertheless , several studies have shown that this cutoff could be too high when also functioning is considered . This is a post-hoc analysis of a 6-month prospect i ve study , performed over a sample of 292 Spanish patients with MDD , in order to find the optimal cutoff in the HAM-D(17 ) scale , considering normal levels of functionality , evaluated by the SOFAS ; by means of plotting Receiver Operating Characteristics ( ROC ) curves . Our results show that a score of ≤ 5 maximized both sensitivity and specificity for identifying normal levels of functionality with respect to other scores , and thus agree with previous works , which suggest that a cutoff ≤ 7 might be too high to consider remission in patients with MDD , when normal levels of functioning are taken into account OBJECTIVE The authors of this study examined multiple recurrences of unipolar major depressive disorder . METHOD A total of 318 subjects with unipolar major depressive disorder were prospect ively followed for 10 years within a multicenter naturalistic study . Survival analytic techniques were used to examine the probability of recurrence after recovery from the index episode . RESULTS The mean number of episodes of major depression per year of follow-up was 0 . 21 , and nearly two-thirds of the subjects suffered at least one recurrence . The number of lifetime episodes of major depression was significantly associated with the probability of recurrence , such that the risk of recurrence increased by 16 % with each successive recurrence . The risk of recurrence progressively decreased as the duration of recovery increased . Within subjects , there was very little consistency in the time to recurrence . CONCLUSIONS Major depressive disorder is a highly recurrent illness . The risk of the recurrence of major depressive disorder progressively increases with each successive episode and decreases as the duration of recovery increases BACKGROUND This paper extends previous work describing course in depression using a recommended operational model that defines remission onset and relapse . We test whether a similar course pattern would emerge using this model in a new cohort of depressed participants . METHODS We recruited a cohort of 86 participants , first-time in patients , with DSM-IV major depression . Outcome was assessed prospect ively over a 13-month minimum follow-up period . Remission onset was defined as a Ham-D score < 8 for two consecutive weeks ; relapse as a Ham-D score > 16 for two consecutive weeks and meeting DSM-IV criteria for major depressive disorder . RESULTS The cumulative probability of remission onset was 0.62 ( SE=0.05 ) and 0.80 ( SE=0.05 ) at 3 and 6 months following study entry . The relapse risk was 0.28 ( SE=0.05 ) at 6 months post remission onset ; 53 % of those relapsing did so in the first 2 months post remission onset . Predictors of longer times to remission onset included : longer illness length , higher anxiety scores and unemployment ; higher anxiety scores predicted relapse . The course pattern is similar to that reported previously . LIMITATIONS These findings apply to in patients only . Course was not rated blind to all of the participants ' baseline data . CONCLUSIONS Defining remission onset and relapse using this model is associated with a replicable course pattern . A singular clinical advantage of the model is the identification of those participants at highest risk of relapse 2 months post remission onset BACKGROUND Depression is a serious illness with a high recurrence rate , mortality , and suicide rate , and a substantial loss of quality of life . Long-term course of depression , in particular of patients not referred to specialist care , is not completely clear . We performed a study in which the course of depression in general practice was studied for 10 years after the first diagnosis . AIM To learn more about long-term course and outcome of patients with depressive illness for a full 10 years after diagnosis . METHOD A historic cohort study with 386 patients classified as depressive before January 1984 , recruited from four general practice s belonging to the Continuous Morbidity Registry of the University of Nijmegen in The Netherl and s. This cohort was followed up for 10 years . Mortality was compared with a control group matched for age , sex , social class , and practice . Of 222 patients out of this cohort who could be followed up for a full 10 years after diagnosis , the case records were studied in detail . RESULTS No statistically significant difference was found in mortality between the 386 patients and the control group .  Recurrence of depressive episodes did not occur in about 60 % of the 222 patients ( confidence interval 54 % to 67 % ) . Of the depressive patients , 15 % were referred to secondary care and 9 % were admitted to hospital . CONCLUSION Mortality , suicide , and recurrence rate were lower than expected , taking into account what is known from depression studies in psychiatry . These results stress the importance of long-term prospect i ve follow-up studies of all patients with depression because of the emphasis on case-finding and treatment without exact knowledge of long-term course and outcome of patients who were not referred BACKGROUND Depression is a remitting but recurring disease . However , there is a paucity of prospect ively recorded data on the course of depression after recovery . METHOD A multi-centre prospect i ve serial follow-up study of an inception cohort of hitherto untreated unipolar major depression ( N = 95 ) for 6 years . We report the time to recurrence after recovery from the index depressive episode and their predictors . RESULTS The cumulative probability of remaining well without subthreshold symptoms was 57 % ( 95 % CI , 46 to 68 % ) at 1 year , 47 % ( 95 % CI , 36 to 58 % ) at 2 years and 35 % ( 95 % CI , 23 to 47 % ) at 5 years . The same without full relapse was 79 % ( 95 % CI , 70 to 88 % ) at 1 year , 70 % ( 95 % CI , 60 to 80 % ) at 2 years and 58 % ( 95 % CI , 46 to 70 % ) at 5 years . The median duration of well-interval from the end of the index episode to the beginning of the subthreshold episode was 19 - 0 months ( 95 % CI , 2 - 4 to 35 - 7 ) , and that to the end of the full episode was over 6 years . Residual symptoms at time of recovery predicted earlier recurrence . CONCLUSIONS The median length of the well-interval was much longer than previously reported in studies employing similar definitions but dealing with a more severe spectrum of patients . However , the sobering fact remains that less than half of the patients can expect to remain virtually symptom-free for 2 years or more after recovery from the depressive episode BACKGROUND Most information about the lifetime prevalence of  mental disorders  comes from retrospective surveys , but how much these surveys have undercounted due to recall failure is unknown . We compared results from a prospect i ve study with those from retrospective studies . METHOD The representative 1972 - 1973 Dunedin New Zeal and birth cohort ( n=1037 ) was followed to age 32 years with 96 % retention , and compared to the national New Zeal and Mental Health Survey ( NZMHS ) and two US National Comorbidity Surveys ( NCS and NCS-R ) . Measures were research diagnoses of anxiety , depression , alcohol dependence and cannabis dependence from ages 18 to 32 years . RESULTS The prevalence of lifetime disorder to age 32 was approximately doubled in prospect i ve as compared to retrospective data for all four disorder types . Moreover , across disorders , prospect i ve measurement yielded a mean past-year-to-lifetime ratio of 38 % whereas retrospective measurement yielded higher mean past-year-to-lifetime ratios of 57 % ( NZMHS , NCS-R ) and 65 % ( NCS ) . CONCLUSIONS Prospect i ve longitudinal studies complement retrospective surveys by providing unique information about lifetime prevalence . The experience of at least one episode of DSM-defined disorder during a lifetime may be far more common in the population than previously thought . Research should ask what this means for etiological theory , construct validity of the DSM approach , public perception of stigma , estimates of the burden of disease and public health policy In r and omized controlled trials , maintenance treatment for relapse prevention has been proven to be efficacious in patients responding in acute treatment , its efficacy in long-term outcome in “ real-world patients ” has yet to be proven . Three-year long-term data from a large naturalistic multisite follow-up were presented . Severe relapse was defined as suicide , severe suicide attempt , or rehospitalization . Next to relapse rates , possible risk factors including antidepressant medication were identified using univariate generalized log-rank tests and multivariate Cox proportional hazards model for time to severe relapse . Overall data of 458 patients were available for analysis . Of all patients , 155 ( 33.6 % ) experienced at least one severe relapse during the 3-year follow-up . The following variables were associated with a shorter time to a severe relapse in univariate and multivariate analyses : multiple hospitalizations , presence of avoidant personality disorder , continuing antipsychotic medication  , and no further antidepressant treatment . In comparison with other studies , the observed rate of severe relapse during 3-year period is rather low . This is one of the first reports demonstrating a beneficial effect of long-term antidepressant medication on severe relapse rates in naturalistic patients . Concomitant antipsychotic medication may be a proxy marker for treatment resistant and psychotic depression OBJECTIVE This study investigated the influence of incomplete recovery from first lifetime major depressive episodes on long-term outcome . METHOD After their first lifetime major depressive episode , patients were divided into asymptomatic ( N=70 ) and residual subthreshold depressive symptom ( N=26 ) recovery groups  and compared on longitudinal course during up to 12 years of prospect i ve naturalistic follow-up . RESULTS Patients with residual subthreshold depressive symptoms during recovery had significantly more severe and chronic future courses . Those with residual symptoms relapsed to major and minor depressive episodes faster and had more recurrences , shorter well intervals , and fewer symptom-free weeks during follow-up than asymptomatic patients . CONCLUSIONS Resolution of major depressive episodes with residual subthreshold depressive symptoms , even the first lifetime episode , appears to be the first step of a more severe , relapsing , and chronic future course . When ongoing subthreshold symptoms continue after major depressive episodes , the illness is still active , and continued treatment is strongly recommended Little is known about the clinical relevance of the Hamilton Rating Scale for Depression ( HAMD-17 ) total scores . It is unclear how total scores translate into clinical severity , or what commonly used measures for response ( reduction from baseline of ≥ 50 % in the total score ) and remission ( total HAMD-17 score ≤ 7 ) mean from a clinical perspective . We therefore compared : ( a ) the percentage and absolute change in the HAMD-17 total scores with Clinical Global Impression-Improvement ( CGI-I ) ; ( b ) the absolute and percentage change in the HAMD-17 total scores with Clinical Global Impression-Severity ( CGI-S ) absolute change ; and ( c ) the percentage and absolute change in the HAMD-17 total scores with CGI-I in the subgroups of patients with ≤ median and > median HAMD-17 total scores at baseline . The method used was equipercentile linking of HAMD-17 and CGI ratings from 43 drug trials in patients with Major Depressive Disorder ( MDD ) ( n = 7131 ) . Our results confirm the validity of the commonly used measures for remission and response in MDD trials : a CGI-I score of 2 ( ' much improved ' ) corresponded to a reduction from baseline of > 50 % and < 60 % , and a CGI-I score of 1 ( ' very much improved ' ) to a reduction of > 75 % and < 85 % . The CGI-S score of 1 ( ' normal . , not at all ill ' ) corresponded to the HAMD-17 total score of < 5 and the CGI-S score of 2 ( ' borderline mentally ill ' ) to the score between 6 and 8 . An effect of baseline illness severity was observed Background : Many patients with major depressive disorder ( MDD ) who achieve full remission after  antidepressant treatment  still have residual depressive symptoms . In this study , we 
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Additionally , specific duration thresholds to separate remission from recovery did not add any predictive value to the notion that increased remission duration alleviates the risk of reoccurrence of depressive symptoms .
Remission can best be defined as a less symptomatic state than previously assumed ( Hamilton Rating Scale for Depression , 17-item version ( HAMD-17 ) ⩽4 instead of ⩽7 ) , without applying a duration criterion .
Duration thresholds to separate remission from recovery are not meaningful .