Depression

Course

Depression is often treated as a chronic condition due to the frequent relapses that patients endure. More than half of patients who have a first episode of depression will develop two or more subsequent episodes. This fact highlights the need for adequate treatment duration to prevent a quick relapse of the disorder but also that good follow-up and disease education is needed to assist in the early detection of future episodes.

However, for any current episode the prognosis is quite good. 70-75% of patients will respond to the first antidepressant and achieve full remission within 3-4 months. If treatment is continued for a further 6-9 months there seems to be a reduced chance for relapse of the depressive symptoms and the patient's prognosis is good.

Suicide is a major problem in psychiatry. Up to 60% of suicides occur in patients suffering from depression. The rate of successful suicide is between 7 and 14% depending on how the reporting is done and the social climate of certain countries. In the northern European countries the reported suicide rates are higher than anywhere else in the world. This may be related to the cold, dark winters and also to the high rate of alcohol use in these countries. However, in southern Europe, many catholic countries and the UK, the stigma of suicide is still great and many suicides are not reported as such to avoid embarrassment for the families or society.

Men have a 3:1 ratio of successful suicides in comparison to women despite the far higher attempted suicide rate in women. This is mostly due to the violent nature of male suicide attempts, but could also be attributed to the fact that men less seldom seek help when they feel sick or depressed than women and that male depression is often called alcoholism or seen as aggression.