Characteristics of persistent depression in the long-term: Randomized controlled trial and two-year observational study

Yosuke Koshikawa; Ai Onohara; Masataka Wakeno; Yoshiteru Takekita; Toshihiko Kinoshita; Masaki Kato

doi:10.1016/j.heliyon.2023.e20917

Characteristics of persistent depression in the long-term: Randomized controlled trial and two-year observational study

Heliyon. 2023 Oct 13;9(10):e20917. doi: 10.1016/j.heliyon.2023.e20917. eCollection 2023 Oct.

Authors

Yosuke Koshikawa¹, Ai Onohara², Masataka Wakeno¹, Yoshiteru Takekita¹, Toshihiko Kinoshita¹, Masaki Kato¹

Affiliations

¹ Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan.
² Social Welfare Corporation Uminoko Gakuen Ikejimaryo, Osaka, Japan.

Abstract

Major depressive disorder is a chronic condition that can recur and relapse. It would be clinically useful to know the patient background to predict the chronicity of depressive symptoms, and the change in diagnosis of bipolar disorder. This study included 197 patients enrolled in a six-week randomized controlled trial with a two-year follow-up. We conducted multiple logistic regression analyses to identify the clinical and sociodemographic characteristics associated with persistent depressive disorder (PDD), relapse, and changes in bipolar disorder diagnosis. The significantly correlated factors were residual symptoms, including insight, work and activity, and general somatic symptoms at week six. We could not identify any factors that contributed to relapse or change in the diagnosis of bipolar disorder. We found that the specific residual symptoms of acute treatment affected long-term treatment outcomes for depression. Attention should be paid to the residual symptoms of depression in the early stages of treatment, and measures should be considered to improve them. There are several limitations to this study, including the fact that PDD may exist among patients who discontinued treatment, treatment was not standardized during the study period, and adherence was confirmed verbally.

Keywords: General somatic symptoms; Insight; Persistent depressive disorder; Work and activities; change the diagnosis to bipolar; major depressive disorder.