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Clinical staging and profiling of affective disorders

Neuropsychopharmacology (2026)Cite this article

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Abstract

Clinical staging models are used to classify the stages of development of disorders across medicine. In this narrative review we explored whether staging in affective disorders may (i) improve the prediction of clinical outcomes, (ii) provide a more precise allocation of treatments to specific patients (iii) whether staging may serve as a framework to proactively integrate prevention and early intervention in the treatment of patients, and (iv) to direct research to studies of factors determining illness progression. Finally we examined (v) why staging may be especially salient in geriatric psychiatry and whether specific staging models are necessary for older patients. Our scope with regard to affective disorders was broad, including both unipolar and bipolar disorders. Although psychiatry has been late in resuming an interest in clinical staging, empirically tested models are available, which may be reliably used to stage the development of affective disorders. Clinical staging, in combination with data about comorbidity and clinical profilers may serve to improve treatment allocation. Progression from early at-risk stages to first episodes remains understudied, but there is sufficient evidence to conclude that prevention or postponement of early progression and the recurrence of affective disorders is effective. Given the change in risk factors, increase in comorbidity and worse prognosis of depression in later life, staging may be especially helpful in older patients. However, this does not mean that other staging models need to be developed, specifically for later life.

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Fig. 1: Predicting the two-year prognosis of Major Depression using staging at basline: the % with MDD at follow-up (a and b); the time spent with depressive symptoms (c and d) and levels of disability at follow-up (e and f).
Fig. 2: The prognosis of Major Depression.
Fig. 3: The prognosis of depression  deteriorates with age.

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  1. Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit and GGzinGeest in Amsterdam, Amsterdam, The Netherlands

    Aartjan TF Beekman, Ralph W. Kupka & Eric van Exel

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All three authors were jointly responsible for creating the outline and research questions driving this review. The literature search and first draft was done by Beekman for the introduction, text concerning unipolar depression and the discussion; RWK for the texts regarding bipolar disorder and van Exel with regard to older age and neuropsychiatric issues. All three authors contributed to revising and finally approving the manuscript. All authors agree to be accountable for all aspects, including accuracy and integrity of the work presented.

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Correspondence to Aartjan TF Beekman.

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Beekman, A.T., Kupka, R.W. & van Exel, E. Clinical staging and profiling of affective disorders. Neuropsychopharmacol. (2026). https://doi.org/10.1038/s41386-026-02325-1

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