Clinical Implications Implications for initial management

The time course of major depression in young people is highly regular across studies (see above). Once triggered, 50% of all episodes last around 7 months and 80% last 1 year. Only 10% or less last 2 years or longer. It is important, therefore, that clinicians enquire carefully about the duration of depressive symptoms. Patients who present shortly after the onset of symptoms have a good chance of recovering within the next few months. In such cases, a sensible initial approach might consist of a relatively brief intervention, especially as there is evidence that the response rate to inactive interventions or placebo is around 30-40% (Harrington et al., 1998a; Hazell et al., 1995). By contrast, those who present for treatment after, say, 6 months may be less likely to recover spontaneously within the next 4 weeks. In such cases, there is a stronger case for initiating an intensive form of treatment straight away.

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