It is important to distinguish between long-term continuities/discontinuities in the course of depressive disorders and the prognosis for the index attack. Indeed, the available data suggest that the majority of children with major depression will recover within 2 years. For example, Kovacs et al. (1984b) reported that the cumulative probability of recovery from major depression by 1 year after onset was 74% and by 2 years, 92%. The median time to recovery was about 28 weeks. This study included many subjects who had previous emotional-behavioural problems and some form of treatment, and might therefore have been biased towards the most severe cases. However, very similar results were reported by Keller et al. (1988) in a retrospective study of recovery from first episode of major depression in young people who had mostly not received treatment (Keller et al., 1991), and by Warner et al. (1992) in a study of the children of depressed parents. In a community survey, Garrison et al. (1997) found that only one-fifth of those with major depression at baseline continued to have it at 1 year. The probability of recovery for adolescent inpatients with major depression also appears to be about 90% by 2 years (Strober, 1992), though those with long-standing depression seem to recover less quickly than those whose presentation was acute (Shain et al., 1991).
How do young people recover from an episode of depression? The paucity of systematic studies among the young makes it impossible to draw firm conclusions about this issue. Indeed, even the adult literature is sparse and has for the most part been concerned with recovery in the context of treatment trials rather than with the process itself. It has provided, however, a number of pointers about the mechanisms that could be involved in young people. It may be, for instance, that environmental circumstances change. For example, perhaps there is a reduction in adversity. Alternatively, it could be that some kind of positive event needs to occur before depression will abate (Brown et al., 1992; Needles & Abramson, 1990).
There are also a number of biological explanations for the periodicity of affective disorders. It could be, for instance, that the physiological systems involved in recurrent affective conditions oscillate "endogenously". The recovery phase occurs because homeostatic mechanisms come into force in order to correct underlying biochemical imbalances. Or, it might be that there is some kind of external photic or temperature-related seasonal cue that leads to cycling. Recovery occurs when the external biological cue has ceased.
Treatment may also influence recovery from depression. There is quite a lot of evidence that some psychological therapies, particularly cognitive-behavioural therapies, are effective in mild or moderately severe depression in this age group (Harrington et al., 1998b). Pharmacological treatments, too, may be effective (Emslie et al., 1997a).
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