[Spontaneous course of depression]

Abstract

The study of the spontaneous course of depressions nowadays comes up against a number of obstacles. The most important of these is the necessity of using untreated cases, which virtually forces the contemporary researcher to refer to studies performed in the pretherapeutic era, if conclusions are not be drawn only from classical descriptions. Unfortunately, these studies are marked by the absence of strict diagnostic criteria, the heterogeneity of patients included in them, the lack of preciseness of evaluations and the primitive statistical methods used. They are concerned essentially with the duration of depressive phases and the factors which influence it. Among these latter are regularly found age, sex, the number of episodes, the duration of the preceding symptom-free interval, the severity and semiology of the attack, heredity, mode of onset, level of intelligence, the presence or absence of associated pathology and the presence or absence of hospitalisation. Chronicization of depression and the factors concerned with it have also been the object of several studies. A small number of investigations compare the course of the illness in untreated populations. The study of the spontaneous course of depression evidences the necessity of having consensus definitions, and may serve as a basis for a better comprehension of the process of cure and of the real impact of therapies designed to treat depression.