Onset Of Depressive Episode Research Articles

Expressed Emotion-Criticism and Risk of Depression Onset in Children

The primary goal of the current study was to examine the impact of maternal criticism (expressed emotion-criticism; EE-Crit) on the prospective development of depressive episodes in children. In addition to examining baseline levels of EE-Crit, we also sought to determine whether distinct subgroups (latent classes) of mothers could be identified based on the levels of EE-Crit they exhibited over a multiwave assessment and whether that latent class membership would predict depression onset in children. Finally, we examined whether EE-Crit and maternal depression would independently predict children's depression risk or whether EE-Crit would moderate the link between maternal depression and children's depression onset. Children of mothers with or without a history of major depression (N = 100) were assessed 5 times over 20 months. Children completed the Children's Depression Inventory and mothers completed the Five Minute Speech Sample and the Beck Depression Inventory at the baseline assessment, and at 2-, 4-, and 6-month follow-up assessments. Children and mothers completed diagnostic interviews assessing children's onsets of depressive episodes at the 20-month follow-up. Latent class analysis of the 4 waves of EE-Crit assessments revealed two distinct groups, exhibiting relatively lower versus higher levels of EE-Crit across the first 6 months of follow-up. EE-Crit latent class membership predicted children's depression onset over the subsequent 14 months. This finding was maintained after controlling for mother's and children's depressive symptoms during the initial 6 months of follow-up. Finally, maternal depression did not moderate the link between EE-Crit and childhood depression onset. Continued exposure to maternal criticism appears to be an important risk factor for depression in children, risk that is at least partially independent of the risk conveyed by maternal depression. These results highlight the importance of a modifiable risk factor for depression—repeated exposure to maternal criticism.

The effect of prolonged duration of untreated depression on antidepressant treatment outcome

BackgroundThe duration of untreated illness has been considered a likely predictor of the course of psychotic disorders. However, there is only sparse data concerning the influence of treatment delay on the outcome of mood disorders. The present study aimed to assess the effect of prolonged untreated depression on the outcome of antidepressant treatment. MethodPatients aged 18–70 years with recent onset of the first lifetime depressive episode were systematically recruited by the Danish Psychiatric Central Research Register during a 2-year period. A total number of 399 individuals out of 1006 potential participants in the Register were interviewed, and 270 fulfilled the inclusion criteria. The validity of the diagnosis, duration of untreated illness, remission on first-line antidepressant treatment and a number of covariates, including psychiatric co-morbidity, personality disorders and traits, stressful life events prior to onset, and family history of psychiatric illness, were assessed by structured interviews. ResultsThe remission rate was significantly decreased among patients with six months or more of untreated depression as compared to patients who were treated with antidepressant medication earlier after onset (21.1% versus 33.7%, OR=0.5, 95% CI 0.3 to 0.9, p=0.03). The negative influence of a prolonged DUI on the outcome did not seem confounded by any of a wide range of demographic and clinical variables. LimitationsThe outcome was evaluated retrospectively. The findings cannot be generalized to patients outside hospital settings. ConclusionInitiation of antidepressant treatment more than six months after onset of first episode depression reduces the chance of obtaining remission. The results emphasize the importance of early recognition and treatment of patients suffering from depression.

Onset of Depression Inventory (ODI)—Assessment of the speed of onset of depressive episodes

The development of a full blown depressive episode may be very rapid, taking less than one hour, or be very slow, taking up to months. In a previous study with outpatients it was found that the majority (58%) of depressive episodes within bipolar affective disorders (BD) develop within one week whereas this is rarely the case (7.4%) in unipolar depression (UD). Apart from a replication of these findings, the present study aimed to investigate the speed of onset in patients with BD compared to UD patients with either a depressive episode (DE) or recurrent depressive disorder (RD). Speed of onset of depression was assessed using the structured patient interview "Onset of Depression Inventory" (ODI). In total, 24 BD patients, 42 patients with a DE and 80 patients with a RD within unipolar affective disorders were included. The speed of onset of depressive episodes differed significantly between the three patient groups (Kruskal-Wallis-test: Chi²=12.493, p=0.002): 50% of the BD patients developed a depressive episode within a week, compared with only 16.7% of DE patients and 25.0% of RD patients. The ODI has not yet been validated. The earlier finding of a faster onset of depressive episodes in BD compared to UD patients is replicated. Clinicians should consider the possibility of a hidden bipolarity in patients who develop a depressive episode within a few days.

Fast versus slow onset of depressive episodes: A clinical criterion for subtyping patients with major depression

PurposeThe speed of onset of depressive episodes is a clinical aspect of affective disorders that has not been sufficiently investigated. Thus, we aimed to explore whether patients with fast onset of the full-blown depressive symptomatology (≤7 days) differ from those with slow onset (>7 days) with regard to demographic and clinical aspects. Subjects and methodsData were obtained within an observational study conducted in outpatients with major depression who were treated with duloxetine (30–120mg/day). Onset of depression (without any preceding critical life event) was fast in 416 (less than one week) and slower in 2220 patients. ResultsCompared to patients with slow onset, those with fast onset of depression had more suicide attempts in the previous 12 months (2.7% versus 1.3%, P=0.046) and less somatic comorbidity (61.7% versus 74.1%, P<0.0001). In addition, they were slightly younger at onset of depression (mean±SD 40.2±14.6 versus 42.8±14.2 years, P<0.001) and used analgesics at baseline significantly less frequently (22.8% versus 33.4%, P<0.0001). Discussion and conclusionThe speed of onset of depression has to be regarded as a relevant clinical characteristic in patients with unipolar depression.

Cognitive and Neural Aspects of Information Processing in Major Depressive Disorder: An Integrative Perspective

Researchers using experimental paradigms to examine cognitive processes have demonstrated that Major Depressive Disorder (MDD) is associated not with a general deficit in cognitive functioning, but instead with more specific anomalies in the processing of negatively valenced material. Indeed, cognitive theories of depression posit that negative biases in the processing of information play a critical role in influencing the onset, maintenance, and recurrence of depressive episodes. In this paper we review findings from behavioral studies documenting that MDD is associated with specific difficulties in attentional disengagement from negatively valenced material, with tendencies to interpret information in a negative manner, with deficits in cognitive control in the processing of negative material, and with enhanced memory for negative material. To gain a better understanding of the neurobiological basis of these abnormalities, we also examine findings from functional neuroimaging studies of depression and show that dysfunction in neural systems that subserve emotion processing, inhibition, and attention may underlie and contribute to the deficits in cognition that have been documented in depressed individuals. Finally, we briefly review evidence from studies of children who are at high familial risk for depression that indicates that abnormalities in cognition and neural function are observable before the onset of MDD and, consequently, may represent a risk factor for the development of this disorder. By integrating research from cognitive and neural investigations of depression, we can gain a more comprehensive understanding not only of how cognitive and biological factors interact to affect the onset, maintenance, and course of MDD, but also of how such research can aid in the development of targeted strategies for the prevention and treatment of this debilitating disorder.

Childhood adversity and allostatic overload of the hypothalamic–pituitary–adrenal axis: A vulnerability model for depressive disorders

Childhood adversity is associated with increased risk for onset of depressive episodes. This review will present evidence that allostatic overload of the hypothalamic-pituitary-adrenal axis (HPAA) partially mediates this association. The HPAA is the physiological system that regulates levels of the stress hormone cortisol. First, data from animals and humans has shown that early environmental adversity is associated with long-term dysregulation of the HPAA. This may occur due to permanent epigenetic modification of the glucocorticoid receptor. Second, data from humans has demonstrated that HPAA dysregulation is associated with increased risk of future depression onset in healthy individuals, and pharmacological correction of HPAA dysregulation reduces depressive symptoms. HPAA dysregulation may result in corticoid-mediated abnormalities in neurogenesis in early life and/or neurotoxicity on neural systems that subserve emotion and cognition.

Prevalence and characteristics of depressive disorders in early adolescents in central Norway

BackgroundPrevalence of depressive disorders among adolescents has varied across studies. The present study aims to assess current and lifetime prevalence and characteristics of adolescent Major Depressive Disorder (MDD), Dysthymia and Depression NOS among adolescents in Central Norway in addition to socio-demographics and use of mental health care.MethodIn the Youth and Mental Health Study a representative sample of 2432 junior high school students (mean age 14.9 years, SD = 0.6) from two counties in Central Norway were screened with the Mood and Feelings Questionnaire (MFQ). A subset of 345 of these adolescents (72.5% girls), 220 high scorers (MFQ = > 26), 74 middle scorers (MFQ 7-25), and 50 low scorers (MFQ < 7), 1 unknown score, were drawn and interviewed with the Kiddie SADS-PL (Present-Life Version). In all, 79% had parental interviews as well. All estimates of prevalence rates and population shares were weighted back using a sandwich estimator to yield true population estimates.ResultsAlmost one in four subjects (23%) had life-time depression. Prevalences of current Major Depressive Disorder (MDD), Dysthymia and "Double depression" were 2.6%, 1.0% and 0.6%, respectively, and for Depression NOS 6.3%.All depressive disorders were characterized by long duration of episodes with large variations, and for any depressive disorder onset before 12 years of age. In multivariate analyses MDD and Dysthymia were most strongly associated with gender and not living with both biological parents. There was no gender difference for Depression NOS. Although a considerable number of depressed subjects had received mental health care, the reason for contact with services was seldom due to affective symptoms. Less than 20% had been in contact with specialist mental health services.ConclusionHigh rates of Depression NOS, early onset of depressive episodes, long duration, and low use of specialized services point to the need for improved diagnostic assessment and treatment for young individuals.

Brooding rumination and risk for depressive disorders in children of depressed mothers.

The goal of the current study was to examine the role of brooding rumination in children at risk for depression. We found that children of mothers with a history of major depression exhibited higher levels of brooding rumination than did children of mothers with no depression history. Examining potential mechanisms of this risk, we found no evidence for shared genetic influences (BDNF or 5-HTTLPR) or modeling of mothers' rumination. However, we did find that children with a history of prior depressive disorders exhibited higher current levels of brooding rumination than children with no depression history. Importantly, children's brooding predicted prospective onsets of new depressive episodes over a 20-month follow-up even when we statistically controlled for depressive symptom levels at the initial assessment, suggesting that the predictive effect of brooding rumination in children was not due simply to co-occurring depressive symptoms.

What else do you feel when you feel sad? Emotional overproduction, neuroticism and rumination.

Numerous experimental and naturalistic studies have shown the relevant role of ruminative styles in the onset, duration and severity of depressive episodes. Recent research has increasingly focused on the precursors of these ruminative responses. Neuroticism has been found to be closely related to ruminative styles, but the nature of this relationship is unknown. Across three studies, we explored the role of emotional overproduction, conceptualized as the tendency to simultaneously experience an elevated number of negative emotions and feelings during sad episodes. Study 1 showed that emotional overproduction is independently and strongly associated with ruminative styles. Furthermore, emotional overproduction was found to mediate the relationship between neuroticism and ruminative styles. Study 2 replicated these findings in a large community sample even after controlling for mood, personality, and other emotion-related variables. In Study 3, we conducted a laboratory study to increase the internal and external validity of our findings. Implications for personality, for coping and stress literature, and for clinical research and treatment are suggested.

Sticky Thoughts

Cognitive inflexibility may play an important role in rumination, a risk factor for the onset and maintenance of depressive episodes. In the study reported here, we assessed participants’ ability to either reverse or maintain in working memory the order of three emotion or three neutral words. Differences (or sorting costs) between response latencies in backward trials, on which participants were asked to reverse the order of the words, and forward trials, on which participants were asked to remember the words in the order in which they were presented, were calculated. Compared with control participants, depressed participants had higher sorting costs, particularly when presented with negative words. It is important to note that rumination predicted sorting costs for negative words but not for positive or neutral words in the depressed group. These findings indicate that depression and rumination are associated with deficits in cognitive control.

Cognitive vulnerability and frontal brain asymmetry: Common predictors of first prospective depressive episode.

The hopelessness theory of depression proposes that individuals with a depressogenic cognitive style are more likely to become hopeless and experience depression following negative life events. Although the neurophysiological underpinnings of cognitive style remain speculative, research indicates that decreased relative left frontal brain electrical activity holds promise as a traitlike marker of depression. This begs the question: Do measures of depressogenic cognitive style and resting frontal brain asymmetry index a common vulnerability? The present study provides preliminary support for this hypothesis. At baseline assessment, increased cognitive vulnerability to depression was associated with decreased relative left frontal brain activity at rest in individuals with no prior history of, or current, depression. Following baseline assessment, participants were followed prospectively an average of 3 years with structured diagnostic interviews at 4-month intervals. Both cognitive vulnerability and asymmetric frontal cortical activity prospectively predicted onset of first depressive episode in separate univariate analyses. Furthermore, multivariate analyses indicated that cognitive vulnerability and frontal asymmetry represented shared, rather than independent, predictors of first depression onset.

Association between cyclothymic temperament and clinical predictors of bipolarity in recurrent depressive patients

Recent studies have suggested that clinicians may under diagnose bipolarity in a substantial proportion of depressive patients, and proposed that affective temperaments particularly cyclothymic temperament (CT), may predict bipolarity in these patients. The objectives of this study were to assess CT in patients with recurrent depressive disorder (RDD) and to explore its associations with clinical predictors of bipolarity. 98 patients (43 men and 55 women, mean age=46.8±9.9years), followed for RDD according to DSM-IV-TR criteria, were recruited. CT was assessed using the Tunisian version of the TEMPS cyclothymic subscale with the threshold score of 10/21. The mean score of CT was 6.5±5.2. One-third of patients (33.7%) had a CT score ≥10. These patients with high CT scores had significantly early age at onset of first depressive episode and high number of previous depressive episodes, and had more psychotic and melancholic features and suicidal ideations and attempts during the last depressive episode compared to patients with low CT scores. The multiple regression analysis showed an association between CT scores and psychotic, melancholic and atypical features and suicide attempts during the last depressive episode. This is a cross-sectional study with a relatively small number of patients. The Tunisian version of the CT subscale was not yet validated. CT was associated with some clinical predictive factors of bipolarity. These results suggest the relevance of the CT screening in RDD, considering the change of polarity risk and misdiagnosis of unipolar depression.

Polymorphisms in BDNF (Val66Met) and 5-HTTLPR, morning cortisol and subsequent depression in at-risk adolescents

BackgroundThere is increasing evidence for genetic effects on the hypothalamic–pituitary axis system. More than one gene is likely to moderate corticoid-mediated activity.AimsTo investigate whether the brain-derived neurotrophic factor (BDNF) polymorphism (rs6265, Val66Met) is associated with morning waking salivary cortisol and moderates the corticoid-mediated risk for subsequent depressive episode onset independently of the known effects of 5-HTTLPR (the serotonin transporter gene promoter).MethodHigh-risk adolescents (n = 401) were genotyped for Val66Met BDNF and 5-HTTLPR. Salivary samples were obtained on four consecutive school days within 1 h of waking. There were 365 (91%) remaining participants reassessed at 12 months for episodes of psychiatric disorder in the follow-up period. Of these, 357 (89%) had complete data for multivariate modelling.ResultsThere were 41 (11.2%) individuals who reported a new episode of clinical depression over the follow-up period. Increased risk for subsequent depression was found in carriers of the Val66Val genotype in BDNF with higher morning waking cortisol. This remained present when the known interaction between carriers of a short allele of 5-HTTLPR with higher morning salivary cortisol was taken into account.ConclusionsBoth BDNF and 5-HTTLPR genes show evidence of modifying the risk of a subsequent new depressive episode associated with elevated morning salivary cortisol. In adolescents morning salivary cortisol levels may constitute a biomarker for some forms of unipolar depression.

The short-term outcome of depressive disorder in adolescents attending primary care: a cohort study

Depressive disorder is common amongst adolescents attending primary care, but little is known about its time course. To determine the 6-month outcome of depressive disorder in adolescent primary care attendees with regard to the time to recovery from (1) the date of index GP consultation and (2) the date of depressive episode onset, and to identify risk factors associated with time to recovery. A prospective cohort study of 13-18-year-olds attending a general practice in northwest London. Attendees were screened for depressive disorder at consultation: high scorers underwent a psychiatric research interview. Six months later, adolescents who were depressed at consultation were interviewed using a research psychiatric follow-up interview. Of the 274 young people who completed the baseline questionnaires, 26 had a depressive disorder at consultation; over 50% failed to recover by the 6-month follow-up. Median episode duration from illness onset was 13 months. Multivariate cox regression showed that fewer positive life events and more physical symptoms predicted a longer time to recovery from consultation. Younger age, fewer recent positive life events and more depressive symptoms predicted a longer time to recovery from illness onset. Adolescent depressive disorders in general practice attendees are persistent, highlighting the appropriateness of intervention.

Cognitive vulnerability-stress interaction predicts prospective increases of depressive symptoms and onsets of new depressive episodes in the transition from early to middle adolescence

Cognitive vulnerability-stress interaction predicts prospective increases of depressive symptoms and onsets of new depressive episodes in the transition from early to middle adolescence

Age at onset of first depressive episode as a predictor for escitalopram treatment of major depression comorbid with alcohol dependence

The aim of this study was to determine predictors of the response to escitalopram, a selective serotonin re-uptake inhibitor antidepressant and memantine, a non-competitive glutamate NMDA receptor blocker, for the treatment of major depression comorbid with alcohol dependence. Eighty alcohol dependent treatment-seeking adult patients with comorbid major depressive disorder were randomized to receive either memantine 20 mg or escitalopram 20 mg for 26 weeks. In both treatment groups, depression was reduced significantly. Comparisons were made between patients in remission (final Montgomery-Åsberg Depression Rating Scale (MADRS) ≤ 12) and non-responding patients (MADRS decrease < 50%). The age at onset of the first major depressive episode significantly correlated with the treatment response in the escitalopram group; the mean age at onset of depression among patients on the non-responders group was 13.7 ± 4.0 years and 31.9 ± 11.9 years in remission. These results are significantly different from those with memantine. Our study provides evidence that the onset of the first major depressive episode might be a clinically relevant predictor of a response to escitalopram treatment in patients with major depression and comorbid alcohol dependence.

Avaliação da sintomatologia depressiva de mulheres no climatério com a escala de rastreamento populacional para depressão CES-D

INTRODUÇÃO: O objetivo deste estudo foi avaliar a sintomatologia depressiva em mulheres climatéricas com a escala de depressão CES-D (Center for Epidemiological Studies Depression Scale), do National Institute of Mental Health (EUA). MÉTODO: Estudo transversal com 151 mulheres entre 40 e 65 anos de idade, usuárias de serviço de ginecologia geral em unidade de atenção básica à saúde no Rio de Janeiro. Aplicou-se a escala CES-D e um questionário estruturado para a obtenção de dados sociodemográficos, clínicos e ginecológicos. O nível de corte &gt; 15 pontos na CES-D foi considerado como indicativo de quadro depressivo. RESULTADOS: A média de pontuação da amostra foi de 9,2 pontos (desvio padrão = 9,0). Os itens mais pontuados da escala foram relativos à insônia, tristeza e desânimo. Não houve associação significativa entre os escores e o período climatérico, características sociodemográficas, clínicas ou ginecológicas, exceto para as mulheres com presença de sintomas psíquicos, histórico depressivo pregresso e uso atual de antidepressivos (p = 0,000). Entre as 32 mulheres (21%) com pontuação &gt; 15 na CES-D, 72% referiram episódio depressivo pregresso. Dentre as participantes sem histórico depressivo, as perimenopáusicas apresentaram escores &gt; 15 com maior freqüência. CONCLUSÃO: Essa casuística, oriunda de serviço não-especializado em menopausa ou saúde mental, revelou baixas pontuações médias na escala de sintomas depressivos CES-D, e o item insônia foi o mais pontuado. O histórico de depressão foi fator de associação com a alta pontuação na escala, mas não a fase climatérica em que a mulher se encontrava. A maior freqüência de pontuação acima do nível de corte nas mulheres sem histórico depressivo pregresso que estavam na perimenopausa sugere a maior vulnerabilidade, nessa fase, a episódios depressivos novos.

Intima-media thickness and age of first depressive episode

Background Late life depression, including patients with vascular depression, has been associated with higher levels of intima-media thickness (IMT). Although individuals with vascular depression tend to report a later onset of depression, the relationship of IMT and age of first depressive episode is uncertain in younger adults. We therefore investigated the relationship between IMT and age of first depressive episode in a sample of 202 adults (age range 40–81 years) with major depression (MDD). Methods Depression status was assessed using the Structured Clinical Interview Schedule and the Hamilton Depression Rating Scale. Patients underwent a physical examination in which a medical history was obtained. IMT was measured from the left and right common carotid arteries. Simple regression analyses were used to investigate the association between IMT and self-reported age of first depressive episode. Results IMT was associated with a later onset of first major depressive episode ( b = .225, P = .0005) and this association remained significant after controlling for age, Framingham Stroke Risk Profile, smoking pack years, physical activity, high- and low-density lipoprotein, body mass index, triglyceride levels, and history of chronic medical conditions ( b = .142, P = .028). Each .10 mm increase in IMT was associated with a 2.6-year later reported occurrence of first major depressive episode (MDE). Similarly, higher levels of IMT were associated with fewer previous MDEs ( b = −.149, P = .020) and this effect remained significant in our multivariate model ( b = −.140, P = .030). In contrast, IMT was not associated with current depressive severity ( b = −.024, P = .720). Conclusions Greater levels of IMT are associated with a later onset of depression and fewer previous depressive episodes among middle-aged and older adults, independent of cardiovascular co-morbidities. These findings provide preliminary evidence that increased vascular burden may be associated with a later onset of depression.

Onset of Depressive Episodes Is Faster in Patients With Bipolar Versus Unipolar Depressive Disorder

Depressive episodes can have a very fast onset (< 1 hour) or start very slowly (> 1 month). This interesting aspect, pointing to different neurophysiological pathomechanisms, has not been systematically evaluated so far. The aim of this study was to describe speed of onset of depressive episodes in a consecutive sample of patients with at least 1 depressive episode and to investigate potential differences between patients with major depression versus bipolar affective disorders concerning this variable. We examined 158 consecutive adult patients with major depression (N = 108) and bipolar disorder (N = 50) diagnosed according to criteria of the International Statistical Classification of Diseases, 10th revision, by applying the structured Onset-of-Depression Inventory. Patients with acute critical life events preceding the onset were excluded from final analyses. Data were collected between December 2001 and January 2007. There was a significant positive association between speed of onset of the present depressive episode and that of the preceding depressive episode (rho = 0.66, p < .001). Patients with bipolar disorder developed full-blown depressive episodes significantly faster than patients with major depression (p < .001): Whereas depressive episodes began within 1 week in 58% of patients with bipolar disorder, this was the case in only 7.4% of patients with major depression. Intraindividually, the speed of onset of depression is similar across different episodes. In the absence of acute critical life events, fast onset of depressive episodes (within 1 week) is common in bipolar disorder but rare in major depression. This aspect might be useful to identify depressive episodes occurring within a bipolar affective illness and might characterize a subgroup of patients with a distinct neurobiology.

Age of Onset Doesn't Affect Treatment Response in Elderly

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessAge of Onset Doesn't Affect Treatment Response in ElderlyJun YanJun YanSearch for more papers by this authorPublished Online:1 Feb 2008https://doi.org/10.1176/pn.43.3.0019Elderly patients who have their first episode of major depression late in life may differ from those with early-onset depression in disease pathology, but their responses to antidepressant treatment appear similar, a group of University of Texas researchers concluded after parsing data from the large Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study.Among the participants in the STAR*D study, the authors focused on 574 who were 55 to 75 years old with a diagnosis of major depression. They compared the patients (72 percent) who had their first depressive episode at or before age 55 (early-onset depression) and the patients who had their first episode after age 55 (late-onset depression) (28 percent), and found that both groups had similar outcomes after getting up to 14 weeks of treatment with citalopram. The dosage of citalopram was adjusted according to the study protocol for all participants.The percentage of patients who achieved remission was similar in both types of patients (see chart), as were several other clinical measurements, such as rates of response, percent change from baseline in standardized depression assessment score, and time to remission. There were, however, some subtle differences between elderly patients with early- and late-onset depression. Patients in the early-onset group reported that their first depressive episode occurred on average at 31 years old, and thus they had lived with the illness for decades; the late-onset group reported that their first episode occurred around age 62. The early-onset group also had a higher proportion of comorbid social phobia and posttraumatic stress disorder than the late-onset group.The authors also noted that the average citalopram dose at the end of the study was statistically significantly higher in the early-onset patients than the late-onset patients, with the actual mean doses at 39.2 mg versus 35.7 mg, respectively.Previous research has suggested that depression emerging later in life may be related to vascular changes in the brain and different from the etiology of the early-onset type, according to the authors. Such changes, however, do not seem to affect the treatment of elderly patients with depression and their outcomes.“The findings should inspire some enthusiasm for clinicians to treat depression aggressively and keep at it,” said Robert Roca, M.D., chair of APA's Council on Aging and vice president and medical director of Sheppard Pratt Health System. He cited past research indicating that patients with cerebral vascular diseases, especially after a stroke, are at heightened risks for depression.“There has been a presumption that these patients with late-onset depression might be less responsive to treatment for mood disorder.” He believes physicians should maintain “an expectation of recovery or remission for their patients” despite the vascular aspects of the disorder as the study findings support the effectiveness of antidepressant treatment.Roca also emphasized that treating elderly patients for depression requires a comprehensive approach and collaboration with the patient's primary care physician, specialists, and caregivers.“We must employ other modalities and be mindful of comorbidities such as pain and medical conditions that can be very demoralizing for the patient,” he said. “In these elderly patients, the social network and connection with other people are particularly important to their psychiatric recovery.”To achieve optimal outcomes, he recommended that psychiatrists attend to patients' psychosocial needs and make appropriate interventions in addition to pharmacological treatment.The study was funded by grants from the National Institute of Mental Health and published in the January American Journal of Geriatric Psychiatry.An abstract of “Treatment Outcomes for Older Depressed Patients With Earlier Versus Late Onset of First Depressive Episode” is posted at<www.ajgponline.org/cgi/content/abstract/16/1/58>.▪ ISSUES NewArchived