Major Depression and Its Recurrences: Life Course Matters

Major depression is one of the most prevalent and debilitating personal and public health conditions worldwide. Less appreciated is that depression's tremendous burdens are not shared equally among all who become depressed. Some will suffer recurrences over the rest of their lives, whereas half or more will never have a recurrence. Based on these two distinctive life course prototypes, we propose a subtype distinction for research on the origins and lifetime course of major depression. A pressing goal is to determine at the time of depression's first onset who will follow which clinical trajectory. The lack of recognition of this distinction has resulted in many obstacles, including conceptual biases, methodological oversights, and definitional dead ends. Current theories are reviewed and compared. The implications for contemporary diagnostic controversies, reevaluating research on treatment and prevention, and enhancing the predictive strength of traditionally weak indicators of recurrences and recurrent depression are discussed.

Automated summary

Major depression is a common and debilitating condition that affects individuals and public health worldwide. However, not all individuals with depression experience the same level of burden, as some will have recurrent episodes while others will not. This study proposes a subtype distinction to understand the origins and lifetime course of major depression. The lack of recognition of this distinction has hindered research and led to conceptual biases and methodological oversights. The implications of this research are discussed in terms of diagnostic controversies, treatment and prevention approaches, and improving the predictive strength of indicators for recurrences and recurrent depression.