RECOVERY IN GERIATRIC DEPRESSION

Background: Clinical characteristics of depression, age at illness ons et, medical burden, disability, cognitive impairment, lack of social s upport, and poor living conditions may influence the course of depress ion. This study investigates the timetable of recovery and the role of the above factors in predicting recovery in elderly patients with maj or depression. Methods: Recovery was studied in 63 elderly (age >63 ye ars) and 23 younger patients with depression who were followed up for an average of 18.2 months (SD, 13.1 months) under naturalistic treatme nt conditions. Diagnosis was assigned according to Research Diagnostic Criteria after administration of the Schedule for Affective Disorders and Schizophrenia. The Longitudinal Follow-up Interval Examination wa s used to identify recovery. Results: The recovery rate of depressed e lderly patients was similar to that of younger depressed patients. In the elderly patients, age, antidepressant treatment, age at onset, and chronicity of episode were significantly associated with time to reco very since entry. Among these parameters, late age at onset was the st rongest predictor of slow recovery. In younger patients, long time to recovery was predicted by weak social support, younger age, cognitive impairment, and low intensity of antidepressant treatment. In the elde rly, the intensity of antidepressant treatment began to decline within 16 weeks from entry and approximately 10 weeks prior to recovery. Con clusions: These findings challenge the view that geriatric depression has a worse outcome than depression in younger adults. However, depres sed patients with onset of first episode in late life may be at higher risk for chronicity. Antidepressant treatment prescribed by clinician s may decline prior to recovery despite evidence that high treatment i ntensity is effective in preventing relapse.