What can we expect regarding the course of illness for people presenting for treatment of major depressive disorder (MDD)? In this issue of JAMA Psychiatry, Musliner and colleagues1 try to identify illness trajectory patterns within subgroups of patients with MDD who are treated in psychiatry specialty settings based on the likelihood of contact with mental health specialty services following initial treatment. This approach continues a tradition of longitudinal observations of mental illness beginning with Emil Kraepelin and others based, in part, on contact with hospitals. For example, one of the earliest divisions of mood disorders (manic depressive insanity) from primary psychotic disorders (dementia praecox) was based on observations2 regarding the frequency and duration of contact. The former showed a pattern of illness, recovery, and relapse, and the latter demonstrated a progressive downhill course following initial treatment.
Shelton RC. The Course of Illness After Initial Diagnosis of Major Depression. JAMA Psychiatry. 2016;73(4):321-322. doi:10.1001/jamapsychiatry.2015.3457