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Most patients with a first episode of major depressive disorder experienced multiple levels of depressive symptoms over time

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Question Do patients with major depressive disorder have multiple levels of depressive symptoms and frequent changes in symptom levels over time?


Inception cohort of patients followed for up to 12 years (mean follow up 8.5 y) (National Institute of Mental Health Collaborative Depression Study).


5 tertiary care centres in the US.


431 patients were enrolled in the study, of whom 122 (28%, mean age 39 y, 52% women)* had a first episode of major depressive disorder without dysthymia according to the Research Diagnostic Criteria derived from the Schedule for Affective Disorders and Schizophrenia; spoke English; were white; had an IQ score ≥70; and had no evidence of organic mental disorder, terminal medical illness, bipolar disorder, schizoaffective disorder, or schizophrenia.

Assessment of prognostic factors

Interviews were …

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