Depression

Depression Course Worsens With Age

The course of major depressive disorder (MDD) tends to be poorer among older individuals with the condition, according to new research.

These findings emerged from a study of 1042 patients with MDD aged 18 to 88 years who were enrolled in the Netherlands Study of Depression and Anxiety (NESDA) and the Netherlands Study of Depression in Older Persons (NESDO) cohorts. Data from baseline through 2-year follow-up were assessed.

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Multivariate analyses were performed in order to determine associations between continuous age and 4 indicators of MDD:

  • Having a diagnosis of depression—defined as MDD or dysthymia—after 2 years.
  • Having a chronic symptom course—defined as the presence of depressive symptoms during 80% or more of 2-year follow-up.
  • Time to remission.
  • Change in the severity of depression.

The primary outcome—defined as the 2-year course of MDD—was also assessed using these 4 indicators. In addition, the researchers also investigated the impact of various prognostic clinical, social, and health factors on differences in MDD course between age groups.

Results of the study demonstrated that older age was significantly associated with a poorer 2-year course of MDD for all 4 indicators. Odds ratios (ORs) were 1.08 for MDD diagnosis, 1.24 for chronic symptom course. The hazard ratio for time to remission was 0.91, and the regression coefficient for change in the severity of depression was 1.06.

The researchers found that the course of MDD worsened with age, with the worst outcomes observed among patients aged 70 years and older compared with those aged 18 to 29 years. ORS were 2.02 for MDD diagnosis and 3.19 for chronic symptom course. The hazard ratio for time to remission was 0.60, and the regression coefficients for the change in the severity of depression were -12.64 for patients aged 12 to 29 years and -5.57 for patients aged 70 years and older.

These findings remained mostly significant following adjustment for prognostic clinical, social, and health factors.

“Older age was found to be a consistent and important risk factor for a poorer MDD course, which could not be explained by a range of well-established risk factors,” the researchers concluded. “Further investigation of potential underlying mechanisms—including the effect of cognitive impairment, for example—is needed to prevent the negative consequences of a long-term MDD burden in older people.”

—Christina Vogt

Reference:

Schaakxs R, Comijs H, Lamers F, Kok RM, Beekman ATF, Penninx WJH. Associations between age and the course of major depressive disorder: a 2-year longitudinal cohort study. Lancet Psychiatry. 2018;5(7):581-590. https://doi.org/10.1016/S2215-0366(18)30166-4