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Research Article| Volume 26, ISSUE 6, P551-564, October 1989

Chronicity and relapse in geriatric depression

  • George S Alexopoulos
    Correspondence
    Address reprint requests to Dr. George S. Alexopoulos, 21 Bloomingdale Road, White Plains, NY 10605.
    Affiliations
    From the Department of Psychiatry, Division of Geriatric Services, New York Hospital-Cornell Medical Center, Westchester Division, White Plains, NY, and Cornell University Medical College, New York, NY.U.S.A.
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  • Robert C Young
    Affiliations
    From the Department of Psychiatry, Division of Geriatric Services, New York Hospital-Cornell Medical Center, Westchester Division, White Plains, NY, and Cornell University Medical College, New York, NY.U.S.A.
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  • Robert C Abrams
    Affiliations
    From the Department of Psychiatry, Division of Geriatric Services, New York Hospital-Cornell Medical Center, Westchester Division, White Plains, NY, and Cornell University Medical College, New York, NY.U.S.A.
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  • Barnett Meyers
    Affiliations
    From the Department of Psychiatry, Division of Geriatric Services, New York Hospital-Cornell Medical Center, Westchester Division, White Plains, NY, and Cornell University Medical College, New York, NY.U.S.A.
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  • Charles A Shamoian
    Affiliations
    From the Department of Psychiatry, Division of Geriatric Services, New York Hospital-Cornell Medical Center, Westchester Division, White Plains, NY, and Cornell University Medical College, New York, NY.U.S.A.
    Search for articles by this author
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      Abstract

      Recent advances in the methodology of longitudinal investigations have permitted the identification of predictors of chronicity and relapse of depression. However, findings from mixed-age populations may not be directly applicable to geriatric depression. The effects of medical illness, cognitive dysfunction, and neuroradiological abnormalities on the outcome of geriatric depression merit further evaluation. Late-onset depression requires special attention, since medical and neurological disorders may be particularly important factors in these cases.
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      References

        • Abrams RC
        • Alexopoulos GS
        • Young RC
        Geriatric depression and DSM III-R personality disorder criteria.
        J Am Geriatr Soc. 1987; 35: 383-386
        • Akiskal HS
        Dysthymic disorder: Psychopathology of proposed chronic depressive subtypes.
        Am J Psychiatry. 1983; 140: 11-20
        • Akiskal HS
        • Rosenthal TL
        • Haykal RF
        • et al.
        Characterological depressions: Clinical and sleep EEG findings separating “subaffective dysthymias” from “character-spectrum disorders.”.
        Arch Gen Psychiatry. 1980; 37: 777-783
        • Alexopoulos GS
        • Lieberman KW
        • Young RC
        • Shamoian CA
        Platelet MAO activity and age of onset of depression in elderly depressed women.
        Am J Psychiatry. 1984; 141: 1276-1278
        • Alexopoulos GS
        • Abrams RC
        • Young RC
        • Shamoian CA
        Late-life depression and dementing disorders.
        American College of Neuropsychopharmacology, 1987 (Abstracts)
        • Alexopoulos GS
        • Young RC
        • Meyers BS
        • Shamoian CA
        Age of onset in geriatric depression with dementia.
        in: New Research, Abstracts. American Psychiatric Association, 1987
        • Alexopoulos GS
        • Young RC
        • Abrams RC
        • Shamoian CA
        Brain CT findings in late-onset depression.
        in: New Research Abstracts, American Psychiatric Association, annual meeting, Montreal1988
        • Alexopoulos GS
        • Young RC
        • Meyers BS
        • Abrams RC
        • Shamoian CA
        Late-onset depression.
        Psychiatr Clin North Am. 1988; 11: 101-115
        • American Psychiatric Association Committee on Nomenclature and Statistics
        ed 3 revised. Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association, Washington. DC1980 (DSM III-R).
        • Angst J
        Premorbid personality, onset, and course of unipolar and bipolar disorders.
        in: Abstracts, annual meeting, American College of Neuropsychopharmacology, Washington, DC1986
        • Angst J
        • Weiss P
        Periodicity of depressive psychoses.
        in: Brill H Cole JO Deniker P Proceedings of the 5th International Medical Foundation, Amsterdam Excerpts Medica, 1967
        • Baldwin RC
        • Jolley DJ
        The prognosis of depression in old age.
        Br J Psychiatry. 1986; 149: 574-583
        • Baron M
        • Mendlewicz J
        • Klotz J
        Age-of-onset and genetic transmission in affective disorders.
        Acta Psychiatr Scand. 1981; 64: 373-380
        • Bee HL
        Changes in personality, motivations, and values over the adult years.
        in: Bee HL The Journal of Adulthood. Macmillan, New York1986
        • Bird JM
        • Levy R
        • Jacoby RJ
        Computed tomography in the elderly: Change over time in the normal population.
        Br J Psychiatry. 1986; 148: 80-86
        • Blazer D
        • Williams CD
        Epidemiology of dysphoria and depression in an elderly population.
        Br J Psychiatry. 1980; 137: 439-444
        • Brown RP
        • Sweeney J
        • Loutsch E
        Involutional melancholia revisited.
        Am J Psychiatry. 1984; 141: 24-28
        • Cadoret RJ
        • Winokur G
        • Dorzab J
        • et al.
        Depressive illness: Life events and onset of illness.
        Arch Gen Psychiatry. 1972; 26: 133-136
        • Cawley RH
        • Post F
        • Whitehead A
        Barbiturate tolerance and psychological functioning in elderly depressed patients.
        Psychol Med. 1973; 3: 39-52
        • Cooper AM
        • Michels R
        Book view, American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders.
        Am J Psychiatry. 1981; 138 (third edition): 128-129
        • Dolan RJ
        • Calloway SP
        • Mann AH
        Cerebral ventricular size in depressed subjects.
        Psychol Med. 1985; 15: 873-878
        • Eastwood MR
        • Corbin SL
        The relationship between physical illness and depression in old age.
        in: Murphy E Affective Disorders in the Elderly. Churchill Livingstone, New York1986
        • Editorial
        Predicting chronicity of depression.
        Lancet. 1986; ii: 897-898
        • Fisch RZ
        • Nesher G
        Masked depression. Help for the hidden misery.
        Postgrad Med. 1986; 80: 165-169
        • Grof P
        • Angst J
        • Haines T
        The clinical course of depression: Practical issues.
        in: Angst J Classification and Prediction of Outcome of Depression. Symposia Medica Hoechst and Schattauer FK, Stuttgart1973: 141-148
        • Gynther MD
        Aging and personality.
        in: Butcher JN New Developments in the Use of the MMPI. University of Minnesota Press, Minneapolis1979 (1979)
        • Hirschfeld RMA
        • Klerman GL
        Personality attributes and affective disorders.
        Am J Psychiatry. 1979; 136: 67-70
        • Hirschfeld RMA
        • Klerman GL
        • Andreason NC
        • et al.
        Situational major depressive disorder.
        Arch Gen Psychiatry. 1985; 42: 1109-1114
        • Hirschfeld RMA
        • Klerman GL
        • Keller MB
        • Andreason NC
        • Clayton PJ
        Personality of recovered patients with bipolar affective disorder.
        J Affect Dis. 1986; 11: 81-89
        • Hopkinson G
        A genetic study of affective illness in patients over 50.
        Br J Psychiatry. 1964; 110: 244-254
        • Jacobs SC
        • Prusoff BA
        • Paykel ES
        Recent life events in schizophrenia and depression.
        Psychol Med. 1974; 4: 444-453
        • Jacoby RJ
        • Levy R
        Computed tomography in the elderly. 3. Affective disorder.
        Br J Psychiatry. 1980; 136: 270-275
        • Jacoby RJ
        • Dolan RJ
        • Levy R
        • et al.
        Quantitative computer tomography in elderly depressed patients.
        Br J Psychiatry. 1983; 143: 124-127
        • Kahn E
        The depressive character.
        Folia Psychiatry Neurol Jpn. 1975; 29: 291-303
        • Kay DWK
        Observations on the natural history and genetics of old age psychoses: A Stockholm material. 1931–1937 (Abridged).
        in: Proc R Soc Med. 52. 1959: 791-794
        • Kay DWK
        Outcome and cause of death in mental disorders of old age: A long-term followup of functional and organic psychoses.
        Acta Psychiatr Scand. 1962; 38: 249-276
        • Kay DWK
        • Bergmann K
        Physical disability and mental health in old age. A follow-up study of a random sample of elderly people seen at home.
        J Psychosom Res. 1966; 10: 3-12
        • Kay DWK
        • Roth M
        • Hopkins B
        Affective disorders arising in the senium.
        J Ment Sci. 1955; 101: 302-316
        • Keller MB
        Chronic and recurrent affective disorders: Incidence, course, and influencing factors.
        in: Racagnio G Chronic Treatment in Neuropsychiatry. Raven Press, New York1985
        • Keller MB
        • Shapiro RW
        Major depressive disorder. Initial results from a one-year prospective naturalistic follow-up study.
        J Nerv Ment Dis. 1981; 169: 761-768
        • Keller MB
        • Shapiro RW
        “Double depression”: Superimposition of acute depressive episodes on chronic depressive disorders.
        Am J Psychiatry. 1982; 139: 438-442
        • Keller MB
        • Lavori PW
        Double depression, major depression and dysthymia: Distinct entity or different phases of a single disorder?.
        Psychopharmacol Bull. 1984; 20: 399-402
        • Keller MB
        • Shapiro RW
        • Lavori PW
        • et al.
        Recovery in major depressive disorder. Analysis with the life table and regression models.
        Arch Gen Psychiatry. 1982; 39: 905-910
        • Keller MB
        • Lavori PW
        • Lewis CE
        • et al.
        Predictors of relapse in major depressive disorder.
        JAMA. 1983; 250: 3299-3304
        • Keller MB
        • Klerman GL
        • Lavori PW
        Long-term outcome of episodes of major depression.
        JAMA. 1984; 252: 788-792
        • Keller MB
        • Lavori PW
        • Rice J
        • et al.
        The persistent risk of chronicity in recurrent episodes of nonbipolar major depressive disorder. A prospective follow-up.
        Am J Psychiatry. 1986; 143: 24-28
        • Keller MB
        • Lavori PW
        • Friedman B
        • et al.
        The Longitudinal Interval Follow-up Evaluation.
        Arch Gen Psychiatry. 1987; 44: 540-548
        • Kielholz P
        Masked depressions and depressive equivalents.
        in: Kielholz P Masked Depression: An International Symposium. Hans Huber, Berne, Switzerland1973
        • Kiloh L
        • Andrews E
        • Nilson M
        Longitudinal study of depressive illness.
        Br J Psychiatry. 1988; (in press).
        • Klein DF
        • Gittelman R
        • Quitkin F
        • et al.
        Diagnosis and Drug Treatment of Psychiatric Disorders: Adults and Children.
        in: ed 2. Williams & Wilkins, Baltimore1980
        • Krause N
        Life stress as a correlate of depression among older adults.
        Psychiatry Res. 1986; 18: 227-237
        • Kukull WA
        • Koepsell TD
        • Inui TS
        • et al.
        Depression and physical illness among elderly general medical clinic patients.
        J Affect Dis. 1986; 10: 153-162
        • Lavori PW
        • Keller MB
        Application of Survival Analysis to Psychiatric Research.
        Spectrum Publications, New York1983
        • Lesse S
        The multivariant masks of depression.
        Am J Psychiatry. 1968; 124: 35-40
        • Lesse S
        The masked depression syndrome: Results of a seventeen-year clinical study.
        Am J Psychother. 1983; 37: 456-475
        • Levi LD
        • Fales CH
        • Stein M
        • et al.
        Separation and attempted suicide.
        Arch Gen Psychiatry. 1966; 15: 158-165
        • Lishman WA
        Brain damage in relation to psychiatric disability after head injury.
        Br J Psychiatry. 1968; 114: 373-410
        • Lundquist G
        Prognosis and course in manic-depressive psychosis.
        Acta Psychiatr Scand. 1945; 35: 1-96
        • Majer O
        Beitrag zur Erbbiologie involutiver, Klimacteriscer and reaktiver Depressionen.
        Z Neurol Psychiat. 1941; 172: 737
        • Mendlewicz J
        • Baron M
        Morbidity risks in subtypes of unipolar depressive illness: Differences between early and late onset forms.
        Br J Psychiatry. 1981; 134: 463-466
        • Meyers BS
        • Greenberg R
        Late-life delusional depression.
        J Affect Dis. 1986; 11: 133-137
        • Moore JT
        Dysthymia in the elderly.
        J Affect Dis. 1985; 10 (Suppl): 515-521
        • Murphy E
        The prognosis of depression in old age.
        Br J Psychiatry. 1983; 142: 111-119
        • Paykel ES
        Life events and early environment.
        in: Handbook of Affective Disorders. Guilford Press, New York1982
        • Paykel ES
        • Myers JK
        • Dienett MN
        • et al.
        Life events and depression. A controlled study.
        Arch Gen Psychiatry. 1969; 21: 753-760
        • Pissot P
        • Hassan S
        Masked depression and depressive equivalents.
        in: Kielholz P Masked Depression: An International Symposium. Hans Huber, Berne. Switzerland1973
        • Pollock HM
        Recurrence of attacks in manic-depressive psychoses.
        Am J Psychiatry. 1931; 11: 568-573
        • Post F
        The Significance of Affective Symptoms in Old Age.
        in: Maudsley Monographs 10. Oxford University Press, London1962
        • Post F
        The management and nature of depressive illness in late life: A follow-through study.
        Br J Psychiatry. 1972; 121: 393-404
        • Post F
        Diagnosis of depression in geriatric patients and treatment modalities appropriate for the population.
        in: Gallant DM Simpso GM Behavioral, Biochemical, Diagnosis, and Treatment Concepts. Spectrum Publications, New York1975
        • Reifler BV
        • Larson E
        • Hanley R
        Coexistence of cognitive impairment and depression in geriatric outpatients.
        Am J Psychiatry. 1982; 139: 623-626
        • Robinson RG
        • Price TR
        Post stroke depressive disorders: A follow-up study of 103 patients.
        Stroke. 1982; 13: 635-641
        • Ross CE
        • Mirowsky II, J
        A comparison of life-event-weighting schemes: Change, undesirability, and effect-proportional indices.
        J Health Soc Behav. 1979; 20: 166-175
        • Ross ED
        • Russ J
        Diagnosis and neuroanatomical correlates of depression in brain-damaged patients: Implications for a neurology of depression.
        Arch Gen Psychiatry. 1981; 38: 1344-1354
        • Rossi A
        • Stratta P
        • Petruzzi C
        • et al.
        A computerized tomographic study in DSM-II1 affective disorders.
        J Affect Dis. 1987; 12: 259-262
        • Roth M
        • Kay DWK
        Affective disorders arising in the senium. ii. Physical disability as an aetiological factor.
        J Ment Sci. 1956; 102: 141-150
        • Schaie KW
        Longitudinal Studies of Adult Psychological Development.
        Guilford Press, New York1983
        • Serry D
        • Serry M
        Masked depression and the use of antidepressants in general practice.
        Med J Aust. 1969; 56: 334-338
        • Shea MT
        • Glass DR
        • Pilkonis PA
        • Watkins J
        • Docherty JP
        Frequency and implications of personality disorders in a sample of depressed outpatients.
        J Pers Dis. 1987; 1: 27-42
        • Spitzer R
        • Endicott J
        • Robins E
        Research Diagnostic Criteria.
        Arch Gen Psychiatry. 1978; 35: 773-782
        • Stenstedt A
        Involutional melancholia.
        Acta Psychiatr Scand (Suppl). 1959; : 127
        • Stewart JW
        • McGrath PJ
        • Liebowitz MR
        • et al.
        Treatment outcome validation of DSM-III depressive subtypes.
        Arch Gen Psychiatry. 1985; 42: 1148-1153
        • Taschev T
        The course and prognosis of depression on the basis of 652 patients deceased.
        in: Angst J Classification and Prediction of Outcome of Depression. Schattauer Verlag, New York1974: 156-172
        • Uhlenhuth EH
        • Paykel ES
        Symptom configuration and life events.
        Arch Gen Psychiatry. 1973; 28: 743-748
        • von Zerrsen D
        Personality and affective disorders.
        in: Handbook of Affective Disorders. Guilford Press, New York1982
        • Winokur G
        Unipolar depression: Is it divisible into autonomous subtypes?.
        Arch Gen Psychiatry. 1979; 36: 47-52
        • Winokur G
        • Behar D
        • Schiesser M
        Clinical and biological aspects of depression in the elderly.
        in: Cole JO Barrett JE Psychopathology in the Aged. Raven Press, New York1980: 145-153
        • Woodruff RA
        • Guze SE
        • Clayton PJ
        The medical and psychiatric implications of antisocial personality (sociopathy).
        Dis Nerv Syst. 1971; 32: 712-714
        • Young RC
        • Nambudiri D
        • Alexopoulos GS
        • Roe R
        • Deck M
        Ventricle-brain ratio (VBR) and response to nortriptyline in geriatric depression.
        in: Abstract, annual meeting, Society of Biological Psychiatry. 1988
        • Zis AP
        • Goodwin FK
        Major affective disorder as a recurrent illness. A critical review.
        Arch Gen Psychiatry. 1979; 36: 835-839