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Outcome of hospital-treated depression

Published online by Cambridge University Press:  02 January 2018

D. Ridley-Siegert
D. Ridley-Siegert*
Affiliation:
Cardiff and District NHS Trust, Royal Hamadryad Hospital, Cardiff Bay, Cardiff CF11 6UQ
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The British Journal of Psychiatry , Volume 177 , Issue 1 , July 2000, pp. 86 - 87
Copyright
Copyright © 2000 The Royal College of Psychiatrists 

“ ‘Then you should say what you mean’, the March Hare went on. ‘I do,’ Alice hastily replied; ‘at least - I mean what I say-that's the same thing, you know.’ ” (Lewis Carroll, Alice in Wonderland).

Tuma (Reference Tuma2000) gives a ‘recovery’ rate of 24% for depressed elderly patients but this figure actually refers to his category ‘lasting recovery’. If the term recovery may be used to include those who have relapsed but then recovered for a (specified) period of time, the rate from Tuma's study is 44%, or 66% once natural deaths have been removed. Tuma appears to be following Murphy's (Reference Murphy1987) view of recovery in depression as being a pint-pot only half-full.

This is not to disagree with the conclusion drawn from the study's data that elderly patients with depression have a poorer prognosis than younger adults, but there is a need to respond to the call for more clarity, if not unanimity, in what terms mean (Reference Frank, Prien and JarrettFrank et al, 1991). Low detection and treatment rates for depression in older patients in the community are not likely to be improved by ‘term’-inally induced therapeutic nihilism. If we are to avoid such confusion, we should heed the words of another Lewis Carroll character :

“ ‘When I use a word,’ Humpty Dumpty said in a rather scornful tone, ‘it means just what I choose it to mean - neither more nor less.’ ”

References

Frank, E., Prien, R. F., Jarrett, R. B., et al (1991) Conceptualisation and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence. Archives of General Psychiatry, 48, 851–855.Google Scholar
Murphy, E. (1987) The prognosis of depression in old age (letter). British Journal of Psychiatry, 150, 268.Google Scholar
Tuma, T. A. (2000) Outcome of hospital-treated depression at 4.5 years. An elderly and a younger adult cohort compared. British Journal of Psychiatry, 176, 224–228.CrossRefGoogle Scholar

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