title: Effects of age at onset of first lifetime episode of recurrent major depression on treatment response and illness course in elderly patients.
abstract: OBJECTIVE
  The goal of this study was to examine treatment outcome differences in relation to age at onset of first lifetime episode of recurrent major depression in elderly patients.
  
  
  METHODS
  Patients were grouped as having early-onset (N = 129) or late-onset (N = 58) depression. Early onset was defined as having a first lifetime episode of major depression at age 59 or earlier; late onset was defined as age 60 or later. The two groups of patients were compared with respect to demographic and clinical characteristics, types of treatment given (nortriptyline and interpersonal psychotherapy), and treatment outcomes.
  
  
  RESULTS
  The groups did not differ in the percentage of patients who remitted, recovered, or relapsed during continuation treatment or in the percentage who experienced a recurrence of major depression during the first year of maintenance treatment. However, early-onset patients took 5-6 weeks longer to achieve remission than did late-onset patients, and a higher proportion had a history of suicide attempts.
  
  
  CONCLUSIONS
  These data suggest that age at lifetime onset of recurrent major depression does not influence short- or long-term treatment response in elderly patients treated with combined interpersonal psychotherapy and nortriptyline, with the exception of slowing the speed of remission in early-onset cases. Difference in remission speed may reflect the greater number of previous episodes in the early-onset patients. Nevertheless, the likelihood of a longer time to remission, together with a higher rate of past suicide attempts, suggests that elderly depressed patients with a history of early-onset illness need particularly careful management.
authors.affiliation: Department of Psychiatry, Graduate School of Public Health, University of Pittsburg Medical Center, PA, USA.
authors.forename: C F
authors.initials: CF
authors.lastname: Reynolds
authors.forename: M A
authors.initials: MA
authors.lastname: Dew
authors.forename: E
authors.initials: E
authors.lastname: Frank
authors.forename: A E
authors.initials: AE
authors.lastname: Begley
authors.forename: M D
authors.initials: MD
authors.lastname: Miller
authors.forename: C
authors.initials: C
authors.lastname: Cornes
authors.forename: S
authors.initials: S
authors.lastname: Mazumdar
authors.forename: J M
authors.initials: JM
authors.lastname: Perel
authors.forename: D J
authors.initials: DJ
authors.lastname: Kupfer
mesh_terms: D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000175:diagnosis* / Q000517:prevention & control* / Q000628:therapy; D005260:Female; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009661:Nortriptyline / Q000627:therapeutic use; D011613:Psychotherapy; D012008:Recurrence; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D009661:Nortriptyline