Editing Major depressive disorder (section)

==Prognosis==
Studies have shown that 80% of those with a first major depressive episode will have at least one more during their life,<ref>{{cite journal |vauthors=Fava GA, Park SK, Sonino N |title=Treatment of recurrent depression |journal=Expert Review of Neurotherapeutics |volume=6 |issue=11 |pages=1735–40 |date=November 2006 |pmid=17144786 |doi=10.1586/14737175.6.11.1735 |s2cid=22808803 }}</ref> with a lifetime average of four episodes.<ref>{{cite journal |vauthors=Limosin F, Mekaoui L, Hautecouverture S |title=[Prophylactic treatment for recurrent major depression] |journal=Presse Médicale |volume=36 |issue=11 Pt 2 |pages=1627–33 |date=November 2007 |pmid=17555914 |doi=10.1016/j.lpm.2007.03.032 }}</ref> Other general population studies indicate that around half those who have an episode recover (whether treated or not) and remain well, while the other half will have at least one more, and around 15% of those experience chronic recurrence.<ref>{{cite journal |vauthors=Eaton WW, Shao H, Nestadt G, et al |title=Population-based study of first onset and chronicity in major depressive disorder |journal=Archives of General Psychiatry |volume=65 |issue=5 |pages=513–20 |date=May 2008 |pmid=18458203 |pmc=2761826 |doi=10.1001/archpsyc.65.5.513 }}</ref> Studies recruiting from selective inpatient sources suggest lower recovery and higher chronicity, while studies of mostly outpatients show that nearly all recover, with a median episode duration of 11 months. Around 90% of those with severe or psychotic depression, most of whom also meet criteria for other mental disorders, experience recurrence.<ref>{{cite journal |vauthors=Holma KM, Holma IA, Melartin TK, Rytsälä HJ, Isometsä ET |title=Long-term outcome of major depressive disorder in psychiatric patients is variable |journal=The Journal of Clinical Psychiatry |volume=69 |issue=2 |pages=196–205 |date=February 2008 |pmid=18251627 |doi=10.4088/JCP.v69n0205 }}</ref><ref>{{cite journal |vauthors=Kanai T, Takeuchi H, Furukawa TA, et al |title=Time to recurrence after recovery from major depressive episodes and its predictors |journal=Psychological Medicine |volume=33 |issue=5 |pages=839–45 |date=July 2003 |pmid=12877398 |doi=10.1017/S0033291703007827 |s2cid=10490348 }}</ref> Cases when outcome is poor are associated with inappropriate treatment, severe initial symptoms including psychosis, early age of onset, previous episodes, incomplete recovery after one year of treatment, pre-existing severe mental or medical disorder, and [[family dysfunction]].<ref>{{cite web|url=http://www.mdguidelines.com/depression-major/prognosis|title=Depression, Major: Prognosis|website=MDGuidelines|publisher=[[The Guardian Life Insurance Company of America]]|access-date=16 July 2010|url-status=live|archive-url=https://web.archive.org/web/20100420055044/http://www.mdguidelines.com/depression-major/prognosis|archive-date=20 April 2010}}</ref>

A high proportion of people who experience full symptomatic remission still have at least one not fully resolved symptom after treatment.<ref name=Culpepper2015>{{cite journal | vauthors = Culpepper L, Muskin PR, Stahl SM | title = Major Depressive Disorder: Understanding the Significance of Residual Symptoms and Balancing Efficacy with Tolerability | journal = The American Journal of Medicine | volume = 128 | issue = 9 Suppl | pages = S1–S15 | date = September 2015 | pmid = 26337210 | doi = 10.1016/j.amjmed.2015.07.001 | doi-access = free }}</ref> Recurrence or chronicity is more likely if symptoms have not fully resolved with treatment.<ref name=Culpepper2015/> Current guidelines recommend continuing antidepressants for four to six&nbsp;months after remission to prevent relapse. Evidence from many [[randomized controlled trial]]s indicates continuing antidepressant medications after recovery can reduce the chance of relapse by 70% (41% on placebo vs. 18% on antidepressant). The preventive effect probably lasts for at least the first 36&nbsp;months of use.<ref>{{cite journal | vauthors = Geddes JR, Carney SM, Davies C, et al | title = Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review | journal = Lancet | volume = 361 | issue = 9358 | pages = 653–61 | date = February 2003 | pmid = 12606176 | doi = 10.1016/S0140-6736(03)12599-8 | s2cid = 20198748 }}</ref>

Major depressive episodes often resolve over time, whether or not they are treated. Outpatients on a waiting list show a 10–15% reduction in symptoms within a few months, with approximately 20% no longer meeting the full criteria for a depressive disorder.<ref>{{cite journal |vauthors=Posternak MA, Miller I |title=Untreated short-term course of major depression: a meta-analysis of outcomes from studies using wait-list control groups |journal=Journal of Affective Disorders |volume=66 |issue=2–3 |pages=139–46 |date=October 2001 |pmid=11578666 |doi=10.1016/S0165-0327(00)00304-9 }}</ref> The [[median]] duration of an episode has been estimated to be 23 weeks, with the highest rate of recovery in the first three months.<ref>{{cite journal |vauthors=Posternak MA, Solomon DA, Leon AC, et al |title=The naturalistic course of unipolar major depression in the absence of somatic therapy |journal=The Journal of Nervous and Mental Disease |volume=194 |issue=5 |pages=324–29 |date=May 2006 |pmid=16699380 |doi=10.1097/01.nmd.0000217820.33841.53 |s2cid=22891687 }}</ref> According to a 2013 review, 23% of untreated adults with mild to moderate depression will remit within 3 months, 32% within 6 months and 53% within 12 months.<ref>{{cite journal | vauthors= Whiteford HA, Harris MG, McKeon G, et al | title=Estimating remission from untreated major depression: a systematic review and meta-analysis | journal=Psychological Medicine | publisher=Cambridge University Press (CUP) | volume=43 | issue=8 | date=10 August 2012 | issn=0033-2917 | pmid=22883473 | doi=10.1017/s0033291712001717 | pages=1569–1585| s2cid=11068930 }}</ref>

===Ability to work===
Depression may affect people's ability to work. The combination of usual clinical care and support with return to work (like working less hours or changing tasks) probably reduces sick leave by 15%, and leads to fewer depressive symptoms and improved work capacity, reducing sick leave by an annual average of 25 days per year.<ref name=Nieuwenhuijsen2020>{{cite journal |vauthors=Nieuwenhuijsen K, Verbeek JH, Neumeyer-Gromen A, et al |title=Interventions to improve return to work in depressed people |journal=Cochrane Database Syst Rev |volume=10 |issue= 12|pages=CD006237 |date=October 2020 |pmid=33052607 |doi=10.1002/14651858.CD006237.pub4 |pmc=8094165 }}</ref> Helping depressed people return to work without a connection to clinical care has not been shown to have an effect on sick leave days. Additional psychological interventions (such as online cognitive behavioral therapy) lead to fewer sick days compared to standard management only. Streamlining care or adding specific providers for depression care may help to reduce sick leave.<ref name=Nieuwenhuijsen2020/>

===Life expectancy and the risk of suicide===
Depressed individuals have a shorter [[life expectancy]] than those without depression, in part because people who are depressed are at risk of dying of suicide.<ref>{{cite journal |vauthors=Cassano P, Fava M |title=Depression and public health: an overview |journal=Journal of Psychosomatic Research |volume=53 |issue=4 |pages=849–57 |date=October 2002 |pmid=12377293 |doi=10.1016/S0022-3999(02)00304-5 }}</ref> About 50% of people who die of suicide have a [[mood disorder]] such as major depression, and the risk is especially high if a person has a marked sense of hopelessness or has both depression and [[borderline personality disorder]].{{sfn|Barlow|Durand|2005|pp=248–49}}<ref>{{cite journal |vauthors=Bachmann S |title=Epidemiology of Suicide and the Psychiatric Perspective |journal=International Journal of Environmental Research and Public Health |date=6 July 2018 |volume=15 |issue=7 |page=1425 |doi=10.3390/ijerph15071425 |pmid=29986446|pmc=6068947 |quote=Half of all completed suicides are related to depressive and other mood disorders|doi-access=free }}</ref> About 2–8% of adults with major depression die by [[suicide]].<ref name="z273">{{cite journal |last1=Arnone |first1=Danilo |last2=Karmegam |first2=Sendhil Raj |last3=Östlundh |first3=Linda |last4=Alkhyeli |first4=Fatima |last5=Alhammadi |first5=Lamia |last6=Alhammadi |first6=Shama |last7=Alkhoori |first7=Amal |last8=Selvaraj |first8=Sudhakar |title=Risk of suicidal behavior in patients with major depression and bipolar disorder – A systematic review and meta-analysis of registry-based studies |journal=Neuroscience & Biobehavioral Reviews |volume=159 |date=2024 |doi=10.1016/j.neubiorev.2024.105594 |doi-access=free |page=105594|pmid=38368970 }}</ref><ref>{{cite book | vauthors = Strakowski S, Nelson E |title=Major Depressive Disorder |date=2015 |publisher=Oxford University Press |isbn=978-0-19-026432-1 |page=PT27 |url=https://books.google.com/books?id=nD8FCgAAQBAJ&pg=PT27 }}</ref> In the US, the lifetime risk of suicide associated with a diagnosis of major depression is estimated at 7% for men and 1% for women,<ref>{{cite journal |vauthors=Blair-West GW, Mellsop GW |title=Major depression: does a gender-based down-rating of suicide risk challenge its diagnostic validity? |journal=The Australian and New Zealand Journal of Psychiatry |volume=35 |issue=3 |pages=322–28 |date=June 2001 |pmid=11437805 |doi=10.1046/j.1440-1614.2001.00895.x |s2cid=36975913 }}</ref> even though suicide attempts are more frequent in women.<ref>{{cite journal |vauthors=Oquendo MA, Bongiovi-Garcia ME, Galfalvy H, et al |title=Sex differences in clinical predictors of suicidal acts after major depression: a prospective study |journal=The American Journal of Psychiatry |volume=164 |issue=1 |pages=134–41 |date=January 2007 |pmid=17202555 |pmc=3785095 |doi=10.1176/ajp.2007.164.1.134 }}</ref>

Depressed people also have a higher [[mortality rate|rate of dying]] from other causes.<ref>{{cite journal |vauthors=Rush AJ |title=The varied clinical presentations of major depressive disorder |journal=The Journal of Clinical Psychiatry |volume=68 |issue=Supplement 8 |pages=4–10 |year=2007 |pmid=17640152 }}</ref> There is a 1.5- to 2-fold increased risk of [[cardiovascular disease]], independent of other known risk factors, and is itself linked directly or indirectly to risk factors such as smoking and obesity. People with major depression are less likely to follow medical recommendations for treating and preventing [[cardiovascular disorders]], further increasing their risk of medical complications.<ref>{{cite journal |vauthors=Swardfager W, Herrmann N, Marzolini S, et al |title=Major depressive disorder predicts completion, adherence, and outcomes in cardiac rehabilitation: a prospective cohort study of 195 patients with coronary artery disease |journal=The Journal of Clinical Psychiatry |volume=72 |issue=9 |pages=1181–88 |date=September 2011 |pmid=21208573 |doi=10.4088/jcp.09m05810blu}}</ref> [[Cardiologists]] may not recognize underlying depression that complicates a cardiovascular problem under their care.<ref>{{cite journal|vauthors=Schulman J, Shapiro BA|year=2008|journal=Psychiatric Times|volume=25|issue=9|title=Depression and Cardiovascular Disease: What Is the Correlation?|url=http://www.psychiatrictimes.com/depression/article/10168/1171821|access-date=10 June 2009|archive-date=6 March 2020|archive-url=https://web.archive.org/web/20200306051101/http://www.psychiatrictimes.com/depression/article/10168/1171821}}</ref>