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

1999; Elsevier BV; Volume: 55; Issue: 2-3 Linguagem: Inglês

10.1016/s0165-0327(99)00020-8

1573-2517

Daniel N. Klein, Alan F. Schatzberg, James P. McCullough, Frank Dowling, Daniel Goodman, Robert H. Howland, John C. Markowitz, Christine Smith, Michael E. Thase, A. John Rush, Lisa M. LaVange, Wilma Harrison, Martin B. Keller,

Bipolar Disorder and Treatment

Background: The clinical and etiological significance of the early–late onset distinction in chronic major depressive disorder was explored. Method: Subjects 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 received comprehensive evaluations using semi-structured interviews and rating scales. Results: Early-onset chronic major depression was associated with a longer index major depressive episode and higher rates of recurrent major depressive episodes, comorbid personality disorders, lifetime substance use disorders, depressive personality traits, and a history of psychiatric hospitalization. In addition, more early-onset patients tended to have a family history of mood disorders. The early-late onset distinction was not associated with differences in symptom severity, functional impairment, or treatment response. Limitations: Family members were not interviewed directly; there were a large number of statistical comparisons; and interrater reliability 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.