Age of onset in chronic major depression: relation to demographic and clinical variables, family history, and treatment response

Background: The clinical and etiological significance of the early-late ons et distinction in chronic major depressive disorder was explored. Method: S ubjects were 289 outpatients with DSM-III-R chronic major depression drawn from a multi-site study comparing the efficacy of sertraline and imipramine in the acute and long-term treatment of chronic depression. Patients recei ved comprehensive evaluations using semi-structured interviews and rating s cales. Results: Early-onset chronic major depression was associated with a longer index major depressive episode and higher rates of recurrent major d epressive episodes, comorbid personality disorders, lifetime substance use disorders, depressive personality traits, and a history of psychiatric hosp italization. In addition, more early-onset patients tended to have a family history of mood disorders. The early-late onset distinction was not associ ated with differences in symptom severity, functional impairment, or treatm ent response. Limitations: Family members were not interviewed directly; th ere were a large number of statistical comparisons; and interrater reliabil ity of the assessments was not evaluated. Conclusions: Early-onset chronic major depression has a more malignant course and is associated with greater comorbidity than late-onset chronic major depression. (C) 1999 Elsevier Sc ience B.V. All rights reserved.