Late-onset major depression: clinical and treatment-response variability.
OBJECTIVE
To explore clinical and treatment-response variability in late-onset vs early-onset non-bipolar, non-psychotic major depression.


METHODS
We grouped patients from a late-life depression treatment study according to illness-course characteristics: those with early-onset, recurrent depression (n = 59), late-onset, recurrent depression (n = 27), and late-onset, single-episode depression (n = 95). Early-onset was defined as having a first lifetime episode of major depression at age 59 or earlier; late-onset was defined as having a first episode of major depression at age 60 or later. We characterized the three groups of patients with respect to baseline demographic, neuropsychological, and clinical characteristics, use of augmentation pharmacotherapy to achieve response, and treatment outcomes.


RESULTS
Rates of response, remission, relapse, and termination were similar in all three groups; however, patients with late-onset, recurrent major depression took longer to respond to treatment than those with late-onset, single-episode depression (12 weeks vs 8 weeks) and had more cognitive and functional impairment. Additionally, patients with recurrent depression (whether early or late) were more likely to require pharmacotherapy augmentation to achieve response than patients with a single lifetime episode.


CONCLUSIONS
Late-onset, recurrent depression takes longer to respond to treatment than late-onset single-episode depression and is more strongly associated with cognitive and functional impairment. Further study of biological, neuropsychologic, and psychosocial correlates of late-onset, recurrent depression is needed.
Driscoll
Henry C
HC
Intervention Research Center for Late-Life Mood Disorders, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA.
Basinski
James
J
Mulsant
Benoit H
BH
Butters
Meryl A
MA
Dew
Mary Amanda
MA
Houck
Patricia R
PR
Mazumdar
Sati
S
Miller
Mark D
MD
Pollock
Bruce G
BG
Stack
Jacqueline A
JA
Schlernitzauer
Mary Ann
MA
Reynolds
Charles F
CF
D000203:Activities of Daily Living; D017668:Age of Onset; D000368:Aged; D000704:Analysis of Variance; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D003072:Cognition Disorders / Q000209:etiology; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D017374:Paroxetine / Q000627:therapeutic use; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome
D018687:Antidepressive Agents, Second-Generation; D017374:Paroxetine