title: Late onset dysthymic disorder and major depression differ from early onset dysthymic disorder and major depression in elderly outpatients.
abstract: BACKGROUND
  Age of onset may affect clinical features and prognosis in elderly patients with major depression (MDD), but there is a lack of such data in elderly patients with dysthymic disorder (DD) and systematic comparisons of late onset MDD and DD have not been conducted.
  
  
  METHODS
  In a Late Life Depression Clinic, patients > or = 60 years old who met DSM-III-R or DSM-IV criteria for MDD or DD were studied. The 24-item Hamilton Rating Scale for Depression (HRSD) and SCID-P were completed, family history was obtained, and medical illnesses were assessed.
  
  
  RESULTS
  In the total sample (n=370; 211 MDD and 159 DD), compared to early onset patients, late onset (onset > or =60 years) patients had a higher rate of cardiovascular disease (chi(2)=4.12, df=1, P<0.05), lower rate of anxiety disorder (chi(2)=4.19, df=1, P<0.05), and a lower rate of family history of affective disorder (chi(2)=9.37, df=1, P<0.002). Late onset DD patients were more likely to have cardiovascular disease than early onset DD patients (chi(2)=5.63, df=1, P<0.02), but the rate of cardiovascular disease did not differ between late and early onset MDD patients (chi(2)=0.35, df=1, P<0.6). Late onset MDD patients were less likely to have a family history of affective disorder than early onset MDD patients (chi(2)=10.71, df=1, P<0.001). Prevalence of anxiety disorders did not differ between the early and late onset MDD patients (chi(2)=0.07, df=1, P<0.79), but was more common in the early onset DD compared to the late onset DD patients (17.98% versus 4.29%, chi(2)=6.98, df=1, P<0.01). Late onset DD did not differ from late onset MDD in the rates of cardiovascular disease, anxiety disorders, and family history of affective disorder. Excluding patients with double depression (n=32) did not alter the cardiovascular or family history findings, but the difference in anxiety disorders between early and late onset DD patients was no longer significant.
  
  
  CONCLUSIONS
  Academic clinic sample results may not generalize to community populations.
  
  
  CONCLUSIONS
  In the elderly, late-onset DD is typically different from early onset DD. Cerebrovascular disease appears to play a role in the etiology of late onset DD. The similarities between late onset DD and late onset MDD suggest a single condition along a continuum.
authors.affiliation: Late Life Depression Clinic, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA. dpd3@columbia.edu
authors.forename: D P
authors.initials: DP
authors.lastname: Devanand
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Adorno
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Cheng
authors.forename: Tal
authors.initials: T
authors.lastname: Burt
authors.forename: G H Gregory H
authors.initials: GH
authors.lastname: Pelton
authors.forename: S P Steven P
authors.initials: SP
authors.lastname: Roose
authors.forename: H A Harold A
authors.initials: HA
authors.lastname: Sackeim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications / Q000523:psychology; D002561:Cerebrovascular Disorders / Q000150:complications / Q000523:psychology; D003866:Depressive Disorder / Q000523:psychology*; D019263:Dysthymic Disorder / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors