The prognosis of depression in late life versus mid-life: implications for the treatment of older adults

Subramaniam, Hari; Mitchell, Alex J.

doi:10.1017/s1041610205002437

Cited by 7 publications

(6 citation statements)

References 14 publications

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“…By examining the natural history of depressed older patients, Roth found that many of them recovered fully, even when they were quite old. Subsequent research has explored the differences between younger and older adults in the incidence, prevalence, natural history, and treatment outcomes of depression (Schneider, Reynolds, Lebowitz, & Friedhoff, 1994; Subramaniam & Mitchell, 2005), but among older adults the association of advancing age with depression is less clear.…”

Section: Introductionmentioning

confidence: 99%

“…Sickness and poor health have been posited as a cause of depression in aging adults; as a recent textbook of geriatric mental health notes, “depressive symptoms can be a part of a reaction to medical illness, disability, and/or discomfort” (Zarit & Zarit, 2007). Epidemiological studies suggest that chronic health problems mediate the association between advancing age and depression (Roberts et al, 1997), and depression treatment trials suggest that medical comorbidities, which increase during aging, are risk factors for inferior treatment response (Subramaniam & Mitchell, 2005). Health status thus merits consideration in analyzing changes in mental health with advancing age.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence, incidence, and persistence of major depressive symptoms in the Cardiovascular Health Study

Thielke

Diehr

Unützer

2010

Aging & Mental Health

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Purpose To explore the association of major depressive symptoms with advancing age, sex, and self-rated health among older adults. Design and methods We analyzed 10 years of annual assessments in a longitudinal cohort of 5888 Medicare recipients in the Cardiovascular Health Study. Self-rated health was assessed with a single question, and subjects categorized as healthy or sick. Major depressive symptoms were assessed using the Center for Epidemiologic Studies Short Depression Scale, with subjects categorized as nondepressed (score < 10) or depressed (≥ 10). Age-, sex-, and health-specific prevalence of depression and the probabilities of transition between depressed and nondepressed states were estimated. Results The prevalence of a major depressive state was higher in women, and increased with advancing age. The probability of becoming depressed increased with advancing age among the healthy but not the sick. Women showed a greater probability than men of becoming depressed, regardless of health status. Major depressive symptoms persisted over one-year intervals in about 60% of the healthy and 75% of the sick, with little difference between men and women. Implications Clinically significant depressive symptoms occur commonly in older adults, especially women, increase with advancing age, are associated with poor self-rated health, and are largely intransigent. In order to limit the deleterious consequences of depression among older adults, increased attention to prevention, screening, and treatment is warranted. A self-rated health item could be used in clinical settings to refine the prognosis of late-life depression.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevalence, incidence, and persistence of major depressive symptoms in the Cardiovascular Health Study

Thielke

Diehr

Unützer

2010

Aging & Mental Health

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“…Alternatively, patients presenting with depression for the first time in later life have an increased risk of physical comorbidities, and physical comorbidity has been associated with a poorer prognosis. 9 While there have been many studies investigating response to pharmacological treatments in middle-aged persons, there have been remarkably few studies specifically focused on assessing interventions in older persons, particularly those with LLD.…”

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confidence: 99%

Transcranial direct current stimulation for depression in a 92‐year‐old patient: a case study

et al. 2014

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Dear Editor, The prevalence of clinically significant depressive syndromes in people 60 years and older (i.e. late-life depression (LLD)) ranges from 9% to 18%, with incidence rates of 19.3 per 1000 person years. 1,2 LLD has been linked to increased rates of suicide and premature mortality and more frequent use of health care with significantly higher health-care costs. 3 There is considerable heterogeneity in the clinical presentation of major depression across the life cycle. Younger patients may have clinical profiles characterized by high trait anxiety and variable patterns of circadian, sleep, energy, and appetite disturbance. 4 Those in midlife present the more stereotypic picture of anhedonia in combination with sleep disturbance, weight loss, and cognitive and motor impairments. In later life, clinical phenotypes are again more variable. 5 This may well reflect different neuropathological pathways to illness and largely differentiate those with earlier onset who have grown older from those experiencing clinical depression for the first time. The prognosis of LLD is typically poor and is characterized by chronicity, mortality, and increased risk for cognitive impairment and progression to dementia. 6 We aim to evaluate the clinical effects of using a transcranial direct current stimulation (tDCS) protocol -a non-invasive therapeutic strategy in terms of safety and clinical impact -on depressive symptoms. The rationale for using tDCS for depression is based on its properties of increasing (anodal) and decreasing (cathodal) cortical excitability. A larger study on depression and tDCS was recently published by Brunoni et al. 7 The authors performed a controlled trial involving 120 patients with major depression. The results of this factorial study, in which subjects were randomized to receive active or sham tDCS and verum or placebo sertraline, showed a significant improvement in depressive symptoms for tDCS alone or combined with sertraline. Favourable results have also been found by other groups studying major depressive disorder. 8 To the best of our knowledge, this has not yet been evaluated specifically for the old-old population.Mr J is a 92-year-old patient who has had major depression for the last 3 years. The patient presented no significant changes in complementary tests. Neuroimaging evaluation (magnetic resonance imaging) showed no volumetric or structural modifications other than age-related changes. At presentation, the patient was using escitalopram 10 mg/day without clinical response. Given the availability of tDCS device in our centre, it was decided the patient should undergo a tDCS protocol for major depression. The patient provided written informed consent in accordance with the requirements of Santa Casa Medical School's institutional review board. Intervention protocol was as follows: 10 sessions with 2 mA for 30 min (only on weekdays). The anode was placed over the left dorsolateral prefrontal cortex (F3 according to the 10/20 electroencephalogram system) and the cathode was placed ext...

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“…Moreover, a higher risk of depressive episode onset may be observed among people with a history of depression in comparison to those who do not show any previous episode. Since first episodes tend to appear from adolescence to middle age, late-life depression relapses may adopt more enduring statuses with a poorer prognosis in comparison to other life periods[ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for suicidal behaviour in late-life depression: A systematic review

Fernandez-Rodrigues¹,

Sanchez-Carro²,

Lagunas³

et al. 2022

WJP

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BACKGROUND Suicide is a leading cause of preventable death worldwide, with its peak of maximum incidence in later life. Depression often puts an individual at higher risk for suicidal behaviour. In turn, depression deserves particular interest in old age due to its high prevalence and dramatic impact on health and wellbeing. AIM To gather integrated evidence on the potential risk factors for suicide behaviour development in depressive older adults, and to examine the effects of depression treatment to tackle suicide behaviour in this population. METHODS A systematic review of empirical studies, published from 2000 onwards, was conducted. Suicidal behaviour was addressed considering its varying forms ( i.e. , wish to die, ideation, attempt, and completed suicide). RESULTS Thirty-five papers were selected for review, comprising both clinical and epidemiological studies. Most of studies focused on suicidal ideation (60%). The studies consistently pointed out that the risk was related to depressive episode severity, psychiatric comorbidity (anxiety or substance use disorders), poorer health status, and loss of functionality. Reduced social support and loneliness were also associated with suicide behaviour in depressive older adults. Finally, the intervention studies showed that suicidal behaviour was a robust predictor of depression treatment response. Reductions in suicidal ideation were moderated by reductions in risk factors for suicide symptoms. CONCLUSION To sum up, common and age-specific risk factors seem to be involved in suicide development in depressive older adults. A major effort should be made to tackle this serious public health concern so as to promote older people to age healthily and well.

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The prognosis of depression in late life versus mid-life: implications for the treatment of older adults

Cited by 7 publications

References 14 publications

Prevalence, incidence, and persistence of major depressive symptoms in the Cardiovascular Health Study

Prevalence, incidence, and persistence of major depressive symptoms in the Cardiovascular Health Study

Transcranial direct current stimulation for depression in a 92‐year‐old patient: a case study

Risk factors for suicidal behaviour in late-life depression: A systematic review

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