Older age

Family history of affective disorders

Risk for early onset, chronicity, and non-response. Positive response to a medication by a family member may predict a response in the patient and vice versa

Personality traits

High neuroticism; other associated personality traits (low extraversion, openness, and conscientiousness)

History of abuse

History of physical, emotional, and/or sexual abuse at any stage in life

Any childhood maltreatment

Any form of childhood maltreatment

Multiple childhood maltreatment

Duration of illness

A long duration of illness

Early onset <18

Late onset >60

Recurrent episodes

Risk compared with single MDE

Severity

Greater severity

No. of hospitalizations

If more than 1 psychiatric admission

Suicide risk

Current elevated suicidal risk as indicated by ideations

Quality of remission

Lack of full remission

Anhedonia

Persistent anhedonia a risk for chronicity, lack of remission and relapse

Dysthymia

Increased risk of relapse and lack of full remission

Comorbid anxiety disorder

Comorbid panic disorder

Comorbid social phobia

Comorbid personality disorder

Comorbid PTSD

Comorbid medical illness

Includes endocrine disorders, diabetes (poor glycemic control), neurological disorders, pancreatic carcinoma, connective tissue disorders, vitamin deficiency, viral infections, obesity, and coronary heart disease

Substance abuse

Bidirectional effects – both exacerbate and maintain the other

First antidepressant

Non- or delayed- response to the first antidepressant

Dosage

Sub-optimal dosing

Duration of treatment

Early discontinuation

Tolerance/side effects

Through discontinuation or sub-optimal dosing

Non-adherence

Pharmacokinetics

Rapid metabolism, malabsorption etc. leading to sub-therapeutic serum levels