Appraisal of prodromal symptoms of unipolar depression may complement the traditional cross-sectional approach and provide a longitudinal perspective, according to a staging model of the illness. The gola of this study was to provide an updated systematic review of clinical studies concerned with prodromal symptoms of unipolar depression, according to PRISMA guidelines. Longitudinal studies on prodromal symptoms and signs in adult patients primarily diagnosed with unipolar depression were selected from different sources. Findings were examined separately according to study design (i.e., retrospective or prospective).

Twenty-five studies met the criteria for inclusion in this systematic review. Findings indicate that a distinct prodromal symptomatology—commonly characterized by anxiety, tension, irritability, and somatic complaints—exists before the onset of unipolar depression. The duration of the prodromal phase was highly variable across studies, ranging from less than a month to several years. Prodromal symptoms profile and duration were consistent within individuals across depressive episodes. There was a close relationship between prodromal and residual symptoms of the same depressive episode.

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