title: Age of onset in chronic major depression: relation to demographic and clinical variables, family history, and treatment response.
abstract: 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.
authors.affiliation: Department of Psychology, State University of New York at Stony Brook, NY 11794-2500, USA. dklein@ccvm.sunysb.edu
authors.forename: D N
authors.initials: DN
authors.lastname: Klein
authors.forename: A F
authors.initials: AF
authors.lastname: Schatzberg
authors.forename: J P
authors.initials: JP
authors.lastname: McCullough
authors.forename: F
authors.initials: F
authors.lastname: Dowling
authors.forename: D
authors.initials: D
authors.lastname: Goodman
authors.forename: R H
authors.initials: RH
authors.lastname: Howland
authors.forename: J C
authors.initials: JC
authors.lastname: Markowitz
authors.forename: C
authors.initials: C
authors.lastname: Smith
authors.forename: M E
authors.initials: ME
authors.lastname: Thase
authors.forename: A J
authors.initials: AJ
authors.lastname: Rush
authors.forename: L
authors.initials: L
authors.lastname: LaVange
authors.forename: W M
authors.initials: WM
authors.lastname: Harrison
authors.forename: M B
authors.initials: MB
authors.lastname: Keller
mesh_terms: 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
chemical_list: D000929:Antidepressive Agents, Tricyclic; D007099:Imipramine