Prodromal Symptoms of Depression: Tests of a Model of the Development and Remission of Depressive Symptoms

Abstract

This study examined the early course of depression by testing a conceptual model for the development and remission of depressive symptoms. In this model, prodromal symptoms emanate from the core pathological processes underlying the disorder and comprise the core syndrome as the earliest symptoms to appear, with episodes of depression representing the more pronounced peaks of symptomatology; the core symptoms would also be the last to remit. Several general hypotheses generated from this model were tested. Additionally, the hopelessness and endogenous subtypes of depression were conceptualized within this model and examined. Cognitive risk for depression and the cognitive personality modes of sociotropy and autonomy were also examined as predictors of specific prodromal and residual symptoms. Correlation and survival analyses were conducted to test the various hypotheses. Results supported the existence of a depressive prodrome as well as the general model being tested. The earliest symptoms to appear in an episode of depression were generally consistent throughout the episode and remained as the last to remit. The order of symptom onset was related to the reverse of the order of symptom remission. The durations for the prodromal and remission phases were significantly correlated. When applied to the hopelessness subtype of depression, and depressions experienced by highly sociotropic individuals, the model held. In the endogenous subtype of depression, and among cognitively high-risk and highly autonomous individuals, the model was not strongly supported.