ABSTRACT
Six out of ten people who become depressed find that their depression tends to lift spontaneously after some time. It used to be thought that once the depression had lifted, the person could return to a normal life without any great fear that they would become depressed again. It is now clear that this is not the case. Depression tends to be a chronic relapsing condition. A typical depressed outpatient can be expected to have a new episode approximately every three years (Lavori et al., 1984). Over half of those successfully treated with antidepressant medication will relapse over the following two years (see Chapter Four). Added to these are the people who never responded to the treatment. Weissman et al. (1978) found that 25–30 per cent of patients have long episodes or do not benefit from treatment. Keller et al. (1984) found a 20 per cent rate of chronicity in patients with major depressive disorders. Many of these patients are admitted as daypatients or inpatients, and some will have many such admissions. These patients appear not to respond to physical or psychological treatment. Some become long-stay patients. Indeed between 5 and 15 per cent of new long-stay patients in England and Wales are there because of chronic affective disorders (Mann and Cree, 1976).
