Administrative criteria in the relapse of depressive disorder: a critical appraisal

Major depressive disorder (MDD) is a leading cause of disability globally, with high relapse rates. Currently, there is no standardized consensus on administrative criteria for defining relapses in MDD.

A comprehensive literature search was conducted for texts published from January 1980 to April 2026. Articles were included if they described a depressive episode/major depressive episode or unipolar depression. The initial electronic search identified 4148 documents, and 51 were finally included in this review.

Over two thirds of the articles focus directly on relapse of MDD, either describing the overall prognosis of the disorder in various populations, the outcome of a given intervention, or the impact of certain factors. 44 of the 51 articles provide a definition of relapse based on either clinical criteria, psychometric measures or what we will establish as administrative criteria. Among those who use scales for definition there is not much uniformity. Among the administrative criteria the most cited is hospitalization, followed by changes in treatment and the need for electroconvulsive therapy.

We suggest a conceptual model based on these criteria to define relapse in depression by drawing some preliminary conclusions: A minimum period of time from the remission of the previous episode to the emergence of what is considered a relapse is necessary, as well as the presence of at least one high-specificity criterion-hospitalization (including emergency room visit), ECT, or suicide attempt-and, in a complementary role, structured pharmacological changes that reflect guideline-based therapeutic steps.