Monitoring Symptom Fluctuations Can Help Predict Depression Relapse, Recurrence

person filling out feelings checklist
person filling out feelings checklist
Some measures were associated with specific patterns of relapse/recurrence.

Patterns in symptom fluctuations in major depressive disorder (MDD) may be helpful in determining a patient’s risk for relapse or recurrence, according to study findings presented in Depression & Anxiety.

Investigators of this analysis used the composite international diagnostic interview to collect depressive symptom ratings from primary care patients with MDD (n=213). Additionally, researchers identified patient groups with varying patterns of relapse and/or recurrence using latent class growth analyses. The investigators also assessed the groups’ associations with baseline predictors as well as 3- and 11-year follow-up MDD outcomes.

During a 24-week period after patients no longer fulfilled criteria for their initial major depressive episode, latent class growth analyses identified heterogeneity in relapse/recurrence as described by 4 different patterns: quick symptom decline (14.0%), slow symptom decline (23.3%), steady residual symptoms (38.7%), and high residual symptoms/slow symptom increase (24.1%).

Patients in the “steady residual symptoms” and “high residual symptoms/slow symptom increase” classes had significantly lower self-esteem scores than people in the other 2 class groups (F [3, 200]=7.7, P <.001). Compared with the other classes, those in the “slow symptom increase” class had significantly lower extraversion (F [3, 198]=5.4, P =.001) and higher neuroticism (F [3, 198]=7.2, P <.001).

Additionally, patients in the “high residual symptoms/slow symptom increase” class had higher scores on the Beck Depression Inventory than patients in the “slow symptom decline” and “quick symptom decline” classes, as well as fewer symptom-free weeks between study initiation and the 3-year follow-up period (both: P <.001). Those in the “steady residual symptoms” class also experienced fewer symptom-free weeks during this period when compared with the “quick symptom decline” class (P <.001).

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Among those in the “high residual symptoms/slow symptom increase” class, lower social functioning and lower vitality were found compared with those in the “slow” and “quick symptom decline” classes.

The small sample size of this study limits the ability to generalize these findings across several different demographic groups.

“Paying attention to symptom patterns after clinical criteria [for MDD] are no longer met, done by patients themselves using diary methods or by professionals in aftercare groups, could be a way to move forward in clinical practice,” the investigators concluded.


Verhoeven FEA, Wardenaar KJ, Ruhé HGE, Conradi HJ, de Jonge P. Seeing the signs: using the course of residual depressive symptomatology to predict patterns of relapse and recurrence of major depressive disorder [published online December 11, 2017]. Depress Anxiety. doi:10.1002/da.22695.