Is time course of onset ( rapid vs slow) important in depression? European psych. June 2013

23.07.2013

Bipolar depression is generally faster in onset than unipolar depression. A recent study showed that in 58% of patients with bipolar depression, the symptomatology developed within 1 week, whereas this was the case in only 7.4% of patients with unipolar depression.   Time course of onset is observed to be similar across depressive episodes in those with recurrent depressive disorder.( i.e. it is a disease-associated trait ). Insidious onset of psychosis is well recognised as a poor prognostic factor. Do the same apply to depression as well? ie within unipolar depression,  do patients with fast versus slow onset of depression  differ in respect of clinical and pathophysiological aspects? 

U. Hegerl , R. Mergl , D. Quail b, E. Schneider , M. Strauß   and H.-P. Hundemer  from Germany reports on this question.

4517 Adult outpatients  attending 693 centres in Germany, with clinical signs and symptoms of depressive episodes (according to ICD-10 criteria) who intended to start treatment with the antidepressant duloxetine were included in the study.

Findings:

15.8%had a fast onset of the current depressive episode (less than 8 days), 2220 patients (84.2%) a slower one (more than 7 days). Patients with fast onset of the current depressive episode were  1.   slightly younger  2.  lower age at onset of depression 3. lower rate of somatic comorbidity 4. higher proportion of patients with anxiety disorders/obsessive-compulsive disorder 5 . More suicide  attempts in the last 12 months 

Response to treatment did not differ meaningfully between groups.

It is possible that the faster onset subgroup may have ‘yet unexpressed’ bipolar patients.The earlier age at the onset of depression and the higher comorbidity with addictive disorders might point in this direction.

Limitations:

This analysis is based on data from PADRE study  which was designed as an observational study in daily clinical practice. There is no control group and randomisation and many patients were lost to follow-up. Post hoc analysis has its limitations.

Conclusions: Those with rapid onset of depression might be different from those with slow onset in terms of nature of illness, associated features and risks.

Summary of the article:

Fast versus slow onset of depressive episodes: A clinical criterion for subtyping patients with major depression.

Hegerl U, Mergl R, Quail D, Schneider E, Strauß M, Hundemer HP, Linden M.Eur Psychiatry. 2013 Jun;28(5):288-92

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