June 07, 2018
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Major depression worsens with age

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Older age was associated with poorer major depressive disorder course, according to 2-year follow-up data published in The Lancet Psychiatry.

“There is insufficient unequivocal evidence that older people truly have a poorer MDD course, because it requires a large-scale study that includes a broad age range and consistent course assessments,” Roxanne Schaakxs, PhD, from Amsterdam Public Health Research Institute, VU University Medical Center, and colleagues wrote. “On the one hand ... the prognosis of MDD might be worse in old age than in younger ages. On the other, an increased depression burden during life might be associated with premature mortality, and people with an increased burden who do reach old age might have acquired effective coping skills, which might reduce differences between age groups in the course of depression.”

In this longitudinal cohort study, researchers examined the potential association between older age and poorer naturalistic trajectory of major depression compared with that of the younger population. They also assessed whether prognostic clinical, social and health factors contributed to older adult’s MDD course.

Using baseline and 2-year follow-up data from two large cohorts in the Netherlands, Schaakxs and colleagues assessed adults aged 18 to 88 years with MDD diagnosis at baseline and clinical assessment data at follow-up to determine the 2-year course. MDD course was examined using four indictors: diagnosis of MDD or dysthymia after 2 years, chronic symptom course, time to remission and depression severity change. The investigators then examined the links between continuous age and these indicators using multivariate analyses.

Longitudinal study findings showed that older age was associated with poorer major depressive disorder course.
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Researchers obtained baseline and 2-year follow-up data from 1,042 participants. Continuous age showed significant association with poorer 2-year course of major depression across all indicators: diagnosis of MDD or dysthymia after 2 years (OR = 1.08; 95% CI, 1-1.17), chronic symptom course (OR = 1·24; 95% CI, 1.13-1.35), time to remission (HR = 0.91; 95% CI, 0.87-0.96) and depression severity change (P < .0001).

Analysis showed that MDD course worsened linearly as the participants aged, with older adults aged 70 years or older exhibiting poorer outcomes compared with young adults aged 18 to 29 years across all indicators: MDD diagnosis (OR = 2.02; 95% CI, 1.18-3.45); chronic symptom course (OR = 3.19; 95% CI, 1.74-5.84); time to remission (HR = 0.6; 95% CI, 0.44-0.83); and depression severity change (–12·64 in the younger group and –5·57 in the older group). These results did not change significantly when researchers adjusted for prognostic clinical, social and health factors.

“For clinical practice, our findings suggest that there might be a growing need for age-tailored treatment of MDD. Currently, older people are treated with almost similar treatment guidelines as those used in younger ages, but our findings suggest that older people might require more maintenance treatment,” Schaakxs and colleagues wrote. “Although this conclusion raises the need to examine other explanatory factors, with cognitive impairment among the most important ones, it also shows that it is appropriate to implement optimal treatment or devise specific treatment regimens for depression in later life.”

Prior research has demonstrated the effectiveness of antidepressants and collaborative care management in avoiding remission and improving response among older patients with chronic conditions, Tze Pin Ng, PhD, of the department of psychological medicine, Yong Loo Lin School of Medicine, National University of Singapore, wrote in an accompanying comment.

“Further research should reveal more options for targeted treatment alternatives with insulin sensitizers, such as pioglitazone, for the treatment of major depressive disorder (and cognitive impairments) with a metabolic subtype in older patients,” he wrote. “Notwithstanding the poorer prognosis of depression in old age, the prospect for better treatment and prevention is good.” – by Savannah Demko

Disclosures: Schaakxs reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. Ng reports no relevant financial disclosures.