After Lewis Judd, M.D., resigned as director of the National Institute of Mental Health (NIMH) in 1990, he pursued his research interest in the long-term structure of depression.

Judd and his colleague Hagop Akiskal, M.D., at the University of California at San Diego (UCSD) studied patients with major depressive disorders and also analyzed data from the Collaborative Depression Study, a long-term prospective study funded by the NIMH. That ongoing study began in 1978, and patients were followed for up to 12 years.

Judd is the Mary Gilman Professor and chair of the department of psychiatry at UCSD. Akiskal is a professor and director of the International Center on Mood Disorders at UCSD.

"We were surprised to find that the course of major depression is expressed by fluctuating symptoms that represent stages in the disorder rather than discrete depressive disorders. Thus, depressive symptoms at the major, mild, dysthymic and subthreshold levels are all part of the long-term clinical structure of major depression," explained Judd.

"We also found that residual subthreshold symptoms were significant enough to affect the quality and completeness of recovery," said Judd. Patients who retained these symptoms when they recovered were more likely to experience a chronic course of illness and relapses than patients whose recovery was symptom free, said Judd.

The finding that patients were symptomatic 60 percent of the follow-up period confirmed the chronic nature of the illness.

The researchers also learned that the degree of psychosocial impairment was directly related to the severity of depressive symptoms. "Patients functioned poorly when their symptoms were severe and functioned well when they were asymptomatic," he observed.

Judd and his colleague recommended that clinicians treat all levels of symptoms in major depression including residual sub-threshold ones so that patients experience a complete recovery.

The paper by Judd and Akiskal explaining their research was recognized with the Anna-Monika Prize last October for its contribution to research on endogenous depression. The paper is "Delineating the Longitudinal Structure of Depressive Illness: Beyond Thresholds and Subtypes."

The international cash prize by the German Anna-Monika Foundation was presented to Judd and Akiskal last year during the biannual meeting of the German College of Neuropsychopharmacology in Nuremberg, Germany, according to Judd.—C.L.