Longitudinal course specifiers (with and without full interepisode recovery)
Longitudinal Course Specifiers (With and Without Full Interepisode Recovery)
The specifiers With Full Interepisode Recovery and Without Full Interepisode Recovery are provided to help characterize the course of illness in individuals with Recurrent Major Depressive Disorder, Bipolar I Disorder, or Bipolar II Disorder. These specifiers should be applied to the period of time between the two most recent episodes. The characterization of course is further enhanced by noting the presence of antecedent Dysthymic Disorder.
The four graphs below depict prototypical courses. A shows the course of Major Depressive Disorder, Recurrent, in which there is no antecedent Dysthymic Disorder and there is a period of full remission between the episodes. This course pattern predicts the best future prognosis. B shows the course of Major Depressive Disorder, Recurrent, in which there is no antecedent Dysthymic Disorder but in which prominent symptoms persist between the two most recent episodes-that is, no more than partial remission is attained. C shows the rare pattern (present in fewer than 3% of individuals with Major Depressive Disorder) of Major Depressive Disorder, Recurrent, with antecedent Dysthymic Disorder but with full interepisode recovery between the two most recent episodes. D shows the course of Major Depressive Disorder, Recurrent, in which there is antecedent Dysthymic Disorder and in which there is no period of full remission between the two most recent episodes. This pattern, commonly referred to as "double depression" (see p. 377), is seen in about 20%-25% of individuals with Major Depressive Disorder.
In general, individuals with a history of Without Full Interepisode Recovery have a persistence of that pattern between subsequent episodes. They also appear more likely to have more Major Depressive Episodes than those with full interepisode recovery. Dysthymic Disorder prior to the first episode of Major Depressive Disorder is most likely to be associated with lack of full interepisode recovery subsequently. These specifiers may also be applied to the period of time between the most recent mood episodes in Bipolar I Disorder or Bipolar II Disorder to indicate presence or absence of mood symptoms.
Criteria for Longitudinal Course Specifiers
Specify if (can be applied to Recurrent Major Depressive Disorder or
Bipolar I or Bipolar II Disorder):
- With Full Interepisode Recovery: if full remission is attained between the two most recent Mood Episodes
- Without Full Interepisode Recovery: if full remission is not attained between the two most recent Mood Episodes