Another potential mechanism of continuity is that individuals are changed in one way or another by their first episode, so that they become more likely to have subsequent ones.
This notion, sometimes referred to as "scarring" or "sensitization", has attracted a good deal of attention from investigators of the neurobiological (Post, 1992) and psychological (Rohde et al., 1990) processes that may be involved in the relapsing and remitting course of depression in adults. Post and colleagues (Post, 1992), for instance, have suggested that the first depressive episode may sensitize people to further episodes. They hypothesized that such sensitization may help to explain three characteristics of depression in adults: the tendency to recur, the decreasing length of interval between episodes, and the greater role of psychosocial stress at the first episode. The idea is that the first episode of depression, which can often be linked to a psychosocial stressor, is associated with long-lasting changes in biology and responsivity to stressors. There may be biochemical and microstructural changes in the central nervous system that put the individual at risk of further episodes (Post et al., 1996).
The idea of scarring may also be relevant to depression in young people. Lewinsohn and colleagues (Lewinsohn et al., 1994b) found in cross-sectional comparisons that formerly depressed individuals shared many psychosocial characteristics with depressed individuals. A subsequent prospective study by the same research group identified 45 adolescents who experienced and recovered from a first episode of depression between two assessment points (Rohde et al., 1994). Psychosocial scars (characteristics evident after but not before the episode) included stressful life events, excessive emotional reliance on others, and subsyndromal depressive symptoms. This level of scarring was more severe than that found in previous research by the same team with depressed adults.
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