Remission after affective episodes is frequently incomplete. Residual symptoms are common in psychiatric and general practitioner patients and in cases identified in community studies. Comparatively little is currently known about the residual symptoms of mania, although they do exist. Residual symptoms of major depression, defined by a score of 8 or more on the 17-item Hamilton Depression Scale, were found in 32 per cent of 60 patients 12 to 15 months after remission. (23) Residual symptoms represent a strong risk factor for further recurrence; a survival analysis by Paykel et al.(23) found a threefold higher risk of recurrence (76 per cent) in patients with residual symptoms than in those without (25 per cent). Chronic residual symptoms are those typical of depression: mood, anxiety, genital symptoms, (24) insomnia, headaches, neurasthenic complaints, reduced libido, and gastrointestinal symptoms. They are frequently treated by long-term antidepressant medication, which should not be withdrawn until the patient has had 4 months completely free of symptoms.
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