Females at Higher Risk of Relapsing After Major Depressive Episode, Study Finds

A new study of adolescents with major depressive disorder found that almost all the participants recovered from their depressive episode after treatment, but nearly half of them relapsed within five years. Females were at a much higher risk of having another major depressive episode, according to the study by researchers at Duke University Medical Center.

John Curry, Ph.D., lead author of the study and professor in the Duke Department of Psychiatry and Behavioral Sciences, said that more research needs to be done to discover why females in this age group are at a higher risk of relapsing after making a recovery.

The study follows an examination of 86 male and 100 female adolescents who participated in the Treatment for Adolescents with Depression Study (TADS), a 12-week depression treatment study. Adolescents must have at least five of the following symptoms to be classified as having major depressive disorder: depressed mood, loss of interest in activities, loss of appetite, changes in sleep, lack of energy, poor concentration, feelings of worthlessness, and suicidal thoughts or behavior. In TADS, the participants were all moderately to severely depressed, and had been depressed for an average of 40 weeks before treatment started.

After the initial 12-week treatment, the participants were followed for five years by the current study, called the Survey of Outcomes Following Treatment for Adolescent Depression (SOFTAD). This study found that 96.4 percent of the participants had recovered for at least 8 weeks after the initial treatment. Those who responded well to the treatment were significantly more likely to recover within the next two years, compared to those who partially responded to the treatment or didn’t respond at all.

The study found that the most effective treatment was a combination of the antidepressant fluoxetine (Prozac) and cognitive behavioral therapy. Recovering within two years seemed to be dependent on whether the participants responded to the treatment.
Some participants were given only fluoxetine, some were given fluoxetine and cognitive behavioral therapy, and some were given placebo. After the initial 12 weeks, those given placebo were offered their treatment of choice.

Of the 189 patients who recovered, nearly half of them (88 people) experienced another bout of major depression. Those who responded fully or partially were less likely to relapse (42.9 percent) than those who didn’t respond (67.6 percent). More than half of the females (57.6 percent) relapsed, whereas only 32.9 percent of the males had a recurrence.

Curry said that females may be at an increased risk of depression relapse if they feel that they can’t personally make an impact, which can affect their motivation to set or reach goals. They may also be more likely to relapse if they have a tendency toward repetitive thoughts that focus on their negative experiences or perceived personal weaknesses.

Adult women are not more likely than men to have a second major depression, but females are more likely to become depressed than males during adolescence and adulthood.

Source: Science Daily, Nearly All Depressed Adolescents Recover With Treatment, but Half Relapse, Study Finds, November 2, 2010

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