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Major depression is more persistent in older people

Major depressive disorder in patients aged 70 or older is associated with a poorer prognosis than in younger people

Ingrid Torjesen

Friday, 08 June 2018

Older patients with major depressive disorder have a poorer prognosis than younger patients, a two-year-long observational study* published in The Lancet Psychiatry has shown.

Researchers used data from two cohort studies in the Netherlands to track 1042 people with major depressive disorder aged between 18 and 88 years. They looked at how depression developed over time by comparing measures of depression in participants at the start of the study and two years later.

They also recorded participants’ social factors (loneliness, social network size, and social support), health factors (functional limitations, pain, chronic diseases, body-mass index), whether they were taking antidepressants, had an anxiety disorder, and whether they had had major depressive disorder before.

Compared to the youngest age group (18-29 year olds), people aged 70 or over were more likely to be lonely, have less social support, and have more pain and chronic diseases. They were also more likely to use antidepressants and have had more than one major depressive disorder episode.

The researchers found that the course of depression seemed to worsen with age, overall, and that outcomes were worst for older people compared with younger age groups.

Compared to the youngest age group (18-29 year olds), people aged 70 or over were two to three times more likely to still have a diagnosis of major depressive disorder after two years (51% [50/99] people aged 70 or older vs 36% [61/170] 18-29 year olds), and have a more chronic symptom course (41% [39/96] older people vs 18% [31/170] younger people). They also took longer to achieve remission (six cases per 100 person-months in older people vs 19 cases per 100 person-months in younger people), and had smaller improvements in the severity of their depression than the younger age group (an improvement of 5.5 points in older people vs 12 points in younger people).

The link could not be explained by a range of clinical, social, or health factors, and more research, including into cognitive decline, will be needed to understand and help prevent the effects of long-term major depressive disorder in older people, the researchers said. However, the study did not assess cognitive function and the effect this has on major depressive disorder; or assess participants’ physical fitness, or cardiovascular and neurobiological functioning, which might further explain age differences in major depressive disorder.

“Our findings suggest a growing need for age-tailored treatment of major depressive disorder,” said lead author Dr Roxanne Schaakxs, VU University Medical Center, the Netherlands.

“Older people with major depressive disorder are often treated in a similar way to younger patients. However, we believe that older people may need multidisciplinary and highly structured treatment, because major depressive disorder in this life phase appears to be much more persistent than in other phases.

“Older age might be a prognostic factor for major depressive disorder course because of the increased likelihood of other unfavourable factors, such as comorbid diseases, physical and functional impairment, and cognitive decline. Cognitive decline has been shown to hamper recovery from major depressive disorder and reduces treatment effectiveness, and it will be vital to investigate its role in future research of this kind.”

*Schaakxs R, Comijs H C., Lamers F, et al. Associations between age and the course of major depressive disorder: a 2-year longitudinal cohort study. The Lancet Psychiatry, published: 07 June 2018, 2018 Elsevier Ltd, DOI: 10.1016/S2215-0366(18)30166-4

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