Age of onset in chronic major depression: relation to demographic and clinical variables, family history, and treatment response.
BACKGROUND
The clinical and etiological significance of the early-late onset distinction in chronic major depressive disorder was explored.


METHODS
Subjects were 289 outpatients with DSM-III-R chronic major depression drawn from a multi-site study comparing the efficacy of sertraline and imipramine in the acute and long-term treatment of chronic depression. Patients received comprehensive evaluations using semi-structured interviews and rating scales.


RESULTS
Early-onset chronic major depression was associated with a longer index major depressive episode and higher rates of recurrent major depressive episodes, comorbid personality disorders, lifetime substance use disorders, depressive personality traits, and a history of psychiatric hospitalization. In addition, more early-onset patients tended to have a family history of mood disorders. The early-late onset distinction was not associated with differences in symptom severity, functional impairment, or treatment response.


CONCLUSIONS
Family members were not interviewed directly; there were a large number of statistical comparisons; and interrater reliability of the assessments was not evaluated.


CONCLUSIONS
Early-onset chronic major depression has a more malignant course and is associated with greater comorbidity than late-onset chronic major depression.
Klein
D N
DN
Department of Psychology, State University of New York at Stony Brook, NY 11794-2500, USA. dklein@ccvm.sunysb.edu
Schatzberg
A F
AF
McCullough
J P
JP
Dowling
F
F
Goodman
D
D
Howland
R H
RH
Markowitz
J C
JC
Smith
C
C
Thase
M E
ME
Rush
A J
AJ
LaVange
L
L
Harrison
W M
WM
Keller
M B
MB
D000328:Adult; D017668:Age of Onset; D000368:Aged; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D015897:Comorbidity; D003710:Demography; D003866:Depressive Disorder / Q000188:drug therapy / Q000235:genetics / Q000523:psychology*; D005192:Family Health; D005260:Female; D006801:Humans; D007099:Imipramine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016896:Treatment Outcome
D000929:Antidepressive Agents, Tricyclic; D007099:Imipramine