Older Ages Increases Risk for Nonremitting Depression

Monday, May 25, 2009

Older adults who are depressed are more likely to stay depressed as they age, especially those who rate themselves as patient, a study presented here at the American Geriatrics Society Annual Scientific Meeting found.

"The take-home message is: depression is not going to treated on its own, especially among sick patients," said Stephen Thielke, MD, a geriatric psychiatrist at the University of Washington, in Seattle, and the study's lead author in an interview with Medscape Internal Medicine.

The study was a retrospective analysis of longitudinal data from the Cardiovascular Health Study and involved nearly 5900 Medicare recipients in 4 American communities who were surveyed between 1990 and 1999. Patients answered a single question to rate their overall health, and depressive symptoms were determined by a score of 10 or more on the Center for Epidemiologic Studies Depression Scale.

More than 70% of subjects with self-rated sickness who were initially depressed still had symptoms of depression when they were evaluated 1 year later, the investigators reported. But even among individuals who reported themselves as healthy, more than 50% who had depressive symptoms were still depressed a year later.

Advancing age was not associated with becoming depressed in older people with self-rated sickness, but it was in those with self-rated health, the authors found.

Although the researchers looked at the relation between depression and specific illnesses, Dr. Thielke told Medscape Internal Medicine that self-rated health in general was a better predictor of depression than specific illness.

They did not study why depression was unlikely to remit in older adults, but Dr. Thielke speculated that one reason, besides poor health, could be an inadequate social network.

"We should not give up on these patients who get stuck in depression," Dr. Thielke said. "There are very effective treatments of depression in older adults."

Treatment of depression in older adults is not as simple as just giving medication, said Rosanne Leipzig, MD, PhD, professor and vice chair of the Department of Geriatrics, Mount Sinai School of Medicine, in New York City. Dr. Leipzig, who was not involved with the study, said that some older adults might not tolerate the effects of antidepressant medication, or they might be unwilling to take medication for other reasons.

"Evidence shows you're more likely to improve a patient's depression with a system of care, including social support, such as talk therapy, combined with medication," she said.

Dr. Leipzig said a drawback of the current study is that it did not report whether patients received any therapy for depression. It also is not clear whether patients actually stayed depressed or improved and then suffered a recurrent episode of depression before re-evaluation, she said.

"Other studies show that older people are more likely than younger people to suffer recurrent depression," Dr. Leipzig said.


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