Bertschy G
Hôpitaux universitaires et Université de Strasbourg, Service de psychiatrie 2, Hôpital civil, 1 place de l'Hôpital, 67091 Strasbourg cedex.
Encephale. 2009 Dec;35 Suppl 7:S257-60. doi: 10.1016/S0013-7006(09)73481-5.
This review paper deals with the question of the relationships between clinical severity of depression, recurrence risk and chronicity risk. About 60% of the subjects with a first episode of major depression will present a second episode lifetime. The risk of recurrence increases slightly with the severity of the index episode. Conversely, depression severity tends to be slightly higher in recurrent episodes as compared with first episodes. This is supported by a few studies of consecutive episodes within the same patients but it could also result from a selection effect. The risk that a depressive episode is still meeting the criteria of a major depressive episode two years after onset is between 10 and 20%. Neither the severity of the index episode nor its recurrent character clearly increases the risk of its chronic evolution. Finally, minor depression (as a dysthymic disorder or residual symptoms) increases the risk of a new major depressive episode. We may conclude that there are only moderate interactions between the clinical severity of depression and the risks of chronicity and recurrence. Worsening of one of these three variables will not result into a dramatic worsening of the two others. In fact, chronicity and recurrence do not specifically contribute to the severity of the next episode, they only contribute to the long-term severity of depressive disorders, which is already by itself a major issue.
这篇综述论文探讨了抑郁症临床严重程度、复发风险和慢性化风险之间的关系问题。约60%首次发作重度抑郁症的患者在一生中会出现第二次发作。复发风险随首发发作的严重程度略有增加。相反，与首次发作相比，复发发作时的抑郁严重程度往往略高。这一点得到了一些针对同一患者连续发作情况的研究的支持，但也可能是选择效应导致的。抑郁发作在起病两年后仍符合重度抑郁发作标准的风险在10%至20%之间。首发发作的严重程度及其复发特征均未明显增加其慢性演变的风险。最后，轻度抑郁症（如恶劣心境障碍或残留症状）会增加新的重度抑郁发作的风险。我们可以得出结论，抑郁症的临床严重程度与慢性化风险和复发风险之间只有适度的相互作用。这三个变量中任何一个的恶化都不会导致另外两个变量急剧恶化。事实上，慢性化和复发并非特别导致下一次发作的严重程度加重，它们只是导致抑郁症的长期严重程度增加，而这本身就是一个主要问题。
