Chronically depressed patients have more interrelated symptoms

The interaction between depression symptoms is a predictor of whether patients suffering from depression will recover. There appear to be more symptoms that reinforce each other in the network of symptoms in patients who will suffer from depression for two years than in patients who will recover. As the symptoms affect each other, a small external influence is more likely to flip more vulnerable patients from a healthy state to a depressed one. These are the findings of research by psychiatrists and psychologists from the UMCG and the University of Amsterdam led by Claudia van Borkulo. They publish these findings today in the leading scientific journal JAMA Psychiatry.

In this new statistical approach to psychiatry, depression or any other disorder is interpreted as a system or network constituting of symptoms that may influence each other. In her research, Claudia van Borkulo looked at the development of patients who were suffering from depression at the start of the study. She followed them for two years. Some patients remained depressed at the end of the study, whereas others had recovered. Van Borkulo divided them into two groups on this basis. There was no difference between the two groups at the first measurement: the patients in both groups were depressed, and the severity of their depression did not differ greatly either. The symptoms proved to be much more interconnected in the network of those patients who did not recover than of those who recovered. An event, mood or other factor could thus have a much greater effect on them. This suggests that in people with chronic depression the symptoms reinforce each other and thus maintain the depression. In patients who recovered there was a less clear pattern of symptoms resulting in a more loosely connected network.

Individual treatment plan

Focusing on individual patterns of symptoms can help treatment providers develop an individual treatment plan for patients suffering from depression. For instance, a patient can use a smartphone to record a few times a day which symptoms are present and how these relate to the circumstances and activities. The patient and treatment provider thus gain a much better idea of how often and how long these symptoms are present during a day, what they relate to and how they affect each other.

In the future, patients starting treatment with a psychiatrist or psychologist could start keeping such a diary of symptoms straight away. Thiswould make it easier to determine a pattern of symptoms and thus more specific treatment. It might also be possible to predict a patient’s risk of developing chronic depression. The researchers have called for further research into this.

Source: press release UMCG, tel. (050) 361 22 00

Study of Depression and Anxiety

The researchers used data from the Netherlands Study of Depression and Anxiety (NESDA). This collaborative project between departments of psychiatry from three university hospitals and a large number of psychiatry and first-line organizations has followed 3000 patients and healthy people for nine years already. One of its aims is to find predictors of the course that depression and anxiety disorders will take.

Curriculum Vitae

Claudia van Borkulo works at the Department of Psychiatry at the University Medical Center Groningen (UMCG, Professor Schoevers) and the University of Amsterdam (UvA, Professor Borsboom). As a methodologist, she is working on a thesis on the network theory of psychiatric disorders. Van Borkulo’s research is one aspect of research at the Department of Psychiatry at the UMCG that focuses on unravelling classic but too general diagnostic concepts of psychopathology. Multidisciplinary teams are applying revolutionary statistical techniques in order to gain a better idea of the patterns of symptoms found in patients.