EFFECTS OF AGE AT ONSET OF FIRST LIFETIME EPISODE OF RECURRENT MAJOR DEPRESSION ON TREATMENT RESPONSE AND ILLNESS COURSE IN ELDERLY PATIENTS

Objective: The goal of this study was to eh-amine treatment outcome di fferences in relation to age at onset of first lifetime episode of rec urrent major depression in elderly patients. Method: Patients were gro uped as having early-onset (N=129) or late-onset (N=58) depression. Ea rly onset was defined as having a first lifetime episode of major depr ession at age 59 or earlier; late onset was defined as age 60 or Inter . The two groups of patients were compared with respect to demographic and clinical characteristics, types of treatment given (nortriptyline and intel personal psychotherapy), and treatment outcomes. Results: T he groups did not differ in the percentage of patients who remitted re covered or relapsed during continuation treatment or in the percentage who experienced a recurrence of major depression during the first yea r of maintenance treatment. However, early-onset patients took 5-6 wee ks longer to achieve remission than did late-onset patients, and a hig her proportion had a history of suicide attempts. Conclusions: These d elta suggest that age at lifetime onset of recurrent major depression does not influence short-or long-term treatment response in elderly pa tients treated with combined interpersonal psychotherapy and nortripty line, with the exception of slowing the speed of remission in early-on set cases. Difference in remission speed may reflect the greater numbe r of previous episodes in the early-onset patients. Nevertheless, the likelihood of a longer time to remission, together with a higher rate of past suicide attempts, suggests that elderly depressed patients wit h a history of early-onset illness need particularly careful managemen t.