title: Clinical differences between first and recurrent episodes in depressive patients.
abstract: BACKGROUND
  Depressive disorder is one of the most common mental disorders in primary care. Depression is often a chronic disorder with recurrent episodes. Little is known about the differences in clinical profile between first and recurrent episodes. The aim of the study is to analyze the differences between clinical presentation of first and subsequent episodes of depressive disorders in primary care patients.
  
  
  METHODS
  A cross-sectional epidemiologic study in primary care centers in Spain was designed. A total of 10,257 primary care patients having a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition major depressive episode were analyzed. Clinical symptoms were measured using the Montgomery Asberg Depression Scale. Patient Health Questionnaire was used to assess somatic symptoms.
  
  
  RESULTS
  There were 40.6% of patients who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for recurrent depression. Compared with those diagnosed of their first major depressive disorder, recurrent patients had greater rates and severity of depressive (t = -7.85, P < .001) and somatic symptoms (t = 5.64, P < .001). The severity of symptoms also increases with number of episodes (F = 40.2, P < .001, for depressive symptoms; F = 27.8, P < .001, for somatic symptoms). First-episode patients were more likely to experience reduced appetite (adjusted odds ratio, 1.2) and suicidal thoughts (adjusted odds ratio, 1.2).
  
  
  CONCLUSIONS
  There are differences in the clinical profile of initial and recurrent episodes in primary care depressive patients. Each recurrent depressive episode seems to have a greater impact on symptoms and well-being. The identification of a specific depression symptom profile in first or recurrent episodes is needed to improve the long-term management of major depressive episode patients in primary care settings.
authors.affiliation: Institut Universitari d'Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Palma de Mallorca, Red de Investigación de Actividades Preventivas y de Promoción de la Salud (RedIAPP), Spain. mroca@uib.es
authors.forename: Miquel
authors.initials: M
authors.lastname: Roca
authors.forename: Silvia
authors.initials: S
authors.lastname: Armengol
authors.forename: Margarida
authors.initials: M
authors.lastname: García-García
authors.forename: Antonina
authors.initials: A
authors.lastname: Rodriguez-Bayón
authors.forename: Isabel
authors.initials: I
authors.lastname: Ballesta
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Serrano
authors.forename: Angels
authors.initials: A
authors.lastname: Comas
authors.forename: Margalida
authors.initials: M
authors.lastname: Gili
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult