Single episode of major depressive disorder. First episode of recurrent mood disorder or distinct subtype of late-onset depression?
Of 687 consecutive inpatients and outpatients with primary major depressive illness, 213 (31%) were categorized as single episode (SE) by DSM-III-R criteria. Systematic evaluation of familial, sociodemographic, temperamental and symptomatological characteristics permitted the nearly equal division of SE into two categories: a. early-onset (< 45 years) "first episode" superimposed on either depressive or hyperthymic temperaments (against a bipolar and unipolar familial background), more severe depression, higher rates of suicide attempts, greater anxiety-somatization and psychotic tendencies, and with the potential for recurrence; b. late-onset (> or = 45 years) isolated episode (against an unipolar familial background) with greater life stressors, pursuing a protracted course with less likelihood of recurrence. In most other respects, early-onset SE was intermediate between recurrent major depression and late-onset SE. The implications of these findings for the now largely abandoned category of "involutional melancholia" are discussed.
Cassano
G B
GB
II Psychiatric Clinic, University of Pisa, Italy.
Akiskal
H S
HS
Savino
M
M
Soriani
A
A
Musetti
L
L
Perugi
G
G
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care; D001714:Bipolar Disorder / Q000175:diagnosis; D003866:Depressive Disorder / Q000145:classification / Q000175:diagnosis* / Q000523:psychology; D003865:Major Depressive Disorder / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006760:Hospitalization; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D012737:Sex Factors; D013315:Stress, Psychological / Q000175:diagnosis / Q000523:psychology; D013694:Temperament