A diagnosis of major depressive disorder can be made after a single or multiple major depressive episodes. Establishment of whether the depressive episode is the first to occur is of utmost importance as the risk of subsequent major depressive episodes is of 50% after a single episode, 70% after two episodes and almost 100% after more than two episodes . Ten to 15 years after an index major depressive episode, about 80-90% of patients can be expected to have a recurrence.
Patients with dysthymic and minor depressive disorders will often experience one or recurrent major depressive episodes. This is referred to as 'double depression'. Furthermore, recent studies have highlighted the importance of also recognizing sub-syndromal forms of depression, as these are associated with a risk of developing a major depressive episode
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