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RELAPSE AND RECURRENCE
Relapse is defined
as the return of symptoms of depression before a full remission has been
reached. Recurrence is the appearance of another new episode of depression
after full remission of a previous episode has been achieved.
The term relapse should
be used to describe a re-emergence of symptoms in a patient who has initially
responded to treatment but who is not yet in remission. Relapse usually
occurs within 4 to 6 months of the initial response to treatment, and
is a continuation of the initial episode.
Approximately half
of the patients who have had one major depressive episode go on to have
another. Patients who have been diagnosed with major depressive disorder
typically experience another episode about every four years; that said,
the frequency and severity of episodes increases with age and the greater
the number of episodes, the more likely a suicide attempt will be made.
With the first major
depressive episode, a trigger is often easily identified. With subsequent
episodes, the trigger is not so readily characterized. After three episodes,
the inter-episodic recovery is frequently lost, so that the patient appears
to be in a continuous depressive state.
| Recurrence
Rates |
| Number
of Episodes |
Risk
of Recurrence |
| 1 |
50% |
| 2 |
70% |
| 3 |
90% |
It is important to
differentiate between relapse and recurrence when developing treatment
strategies for prevention of another episode of depression. The initial
therapeutic effect or response occurs during the acute treatment phase
and is characterized by a reduction in depressive symptoms.
Because there is a
delay before response to treatment begins, patients are more susceptible
to relapse if treatment is withdrawn too early (i.e., within the first
eight weeks after symptom resolution).
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