Is liability to recurrent major depressive disorder present before first episode onset in adolescence or acquired after the initial episode?

Abstract

Many individuals who experience a major depressive episode will subsequently develop recurrent episodes. Although numerous studies have investigated predictors of recurrent episodes, methodological limitations have made it difficult to determine the extent to which liability to recurrent major depressive disorder (rMDD) exists prior to first onset or develops after first onset. This study used a prospective design in a community sample of adolescents to examine variables before and after first onset MDD as predictors of rMDD over a 12 year follow-up. Among 59 adolescents who experienced first onset MDD, 72.88% developed rMDD during the follow-up period. Parental history of rMDD and lifetime history of minor depression prior to MDD onset significantly predicted rMDD. These two effects replicated in ancillary analyses in an expanded sample of N=205. Following MDD onset, a higher number of major life events significantly predicted rMDD. Liability to rMDD exists prior to MDD onset in the form of familial risk and less severe mood disturbances, whereas liability to rMDD in the form of elevated stress may develop following a first onset in adolescence.

Premorbid risk factors for major depressive disorder: Are they associated with early onset and recurrent course?

“…Our finding of increased rates of parental MDD for early-onset MDD is consistent with evidence from family and twin studies that early-onset depressive disorders are more heritable than later-onset depressive disorders (Bland et al, 1986; Klein et al, 2002; Klein et al, 2001; Klein et al, 2004; McGuffin et al, 1996; Pettit et al, 2013; Weissman et al, 1984). In contrast, our finding that MDD recurrence was not associated with increased rates of parental psychiatric disorders, after accounting for age of onset, suggests that previous evidence of greater heritability for recurrent MDD may be attributable to its typically earlier age of onset.…”

“…We expected to find increased rates of parental MDD and other psychiatric disorders for offspring with early-onset and recurrent MDD, as suggested in earlier research (Bland et al, 1986; Klein et al, 2002; Klein et al, 2004; Pettit et al, 2013; Weissman et al, 1984). We further hypothesized that (a) premorbid negative emotionality would be highest for early-onset, recurrent MDD, as suggested by our findings in late adolescence and young adulthood (Wilson et al, 2014; Wilson et al, in press); (b) higher disconstraint would predict early-onset MDD, as suggested in our previous work (Wilson et al, 2014); and (c) lower premorbid positive emotionality would be specific to recurrent MDD.…”

“…Importantly, parental MDD predicted the development of offspring MDD, as well as an earlier onset of MDD. This finding, coupled with the literature reviewed above indicating that the genetic influence on early-onset MDD may be particularly strong (Bland et al, 1986; Klein et al, 2002; Klein et al, 2001; Klein et al, 2004; McGuffin et al, 1996; Pettit et al, 2013; Weissman et al, 1984), prompted us to undertake a molecular genetic investigation of MDD to determine if we could identify specific genetic variants associated with MDD, and with early-onset MDD.…”

Future Directions in Research on Psychotherapy for Adolescent Depression

“…Can we identify and ameliorate the factors associated with higher risk of recurrence and help those more vulnerable to recurrence to cope effectively with stressful life events? Although it is not possible at baseline to predict with a high degree of certainty which adolescents are most likely to have a recurrence, we know that gender, anxiety, a parental history of recurrent depression, and pre-MDE experiences of subthrehold depression are likely to be among the risk factors (Curry et al, 2011;Pettit, Hartley, Lewinsohn, Seeley, & Klein, 2013). These findings suggest that recurrence prevention programs could be tailored to address such specific risk factors.…”

Diagnostic Efficiency of the Child and Adolescent Symptom Inventory (CASI-4R) Depression Subscale for Identifying Youth Mood Disorders

“…Youth with depression may still face impairment even following remission or successful treatment (Garber & Horowitz, 2002; Rao et al, 1995), and depression earlier in life predicts impairment into adulthood (Birmaher et al, 2002; Dunn & Goodyer, 2006; Lewinsohn, Rohde, Seeley, Klein, & Gotlib, 2003). Although most children and adolescents with a major depressive episode recover naturally (Essau, 2007), relapse rates are high, with the majority of youth experiencing another episode within several years later (Birmaher et al, 2002; Kovacs, 1996; Pettit, Hartley, Lewinsohn, Seeley, & Klein, 2013). …”