Mohammed T. Abou-Saleh

CLINICAL FEATURES OF DEPRESSION AND DYSTHYMIA 41519. Green BH, Copeland JR, Dewey ME et al. Risk factors fordepression in elderly people: a prospective study. Acta PsychiatScand 1992; 86(3): 213–17.20. Prince MJ, Harwood RH, Blizard RA et al. Impairment, disabilityand handicap as risk factors for depression in old age. The GospelOak Project. Psychol Med 1997; 27(2): 311–21.21. Copeland JR, Chen R, Dewey ME et al. Community-based casecontrolstudy of depression in older people. Cases and sub-cases fromthe MRC-ALPHA Study. Br J Psychiat 1999; 175: 340–7.22. Kivela SL. Long-term prognosis of major depression in old age: acomparison with prognosis of dysthymic disorder. Int Psychogeriat1995; 7: 69–82.23. Beekman AT, Deeg DJ, Braam AW et al. Consequences of major andminor depression in later life: a study of disability, well-being andservice utilization. Psychol Med 1997; 27(6): 1397–409.24. Livingston G, Watkin V, Milne B et al. The natural history ofdepression and the anxiety disorders in older people: the Islingtoncommunity study. J Affect Disord 1997; 46(3): 255–62.25. Wilson KC, Copeland JR, Taylor S et al. Natural history ofpharmacotherapy of older depressed community residents. TheMRC-ALPHA Study. Br J Psychiat 1999; 175: 439–44.26. Enzell K. Mortality among persons with depressive symptoms andamong responders and non-responders in a health check-up. ActaPsychiat Scand 1984; 69: 89–102.27. Davidson IA, Dewey ME, Copeland JRM. The relationship betweenmortality and mental disorder: evidence from the Liverpoollongitudinal study. Int J Geriat Psychiat 1988; 3: 95–8.28. Markush RE, Schwab JJ, Farris P et al. Mortality and communitymental health. Arch Gen Psychiat 1977; 34: 1393–401.29. Fredman L, Schoenbach VJ, Kaplan BH et al. The associationbetween depressive symptoms and mortality among older participantsin the epidemiologic catchment area—Piedmont Health Survey. JGerontol 1989; 44(4): 149–56.30. Tannock C, Katona C. Minor depression in the aged. Concepts,prevalence and optimal management. Drugs Aging 1995; 6(4): 278–92.31. Cole MG, Bellavance F. The prognosis of depression in old age. Am JGeriat Psychiat 1997; 5: 4–14.32. Copeland JRM, Kelleher MJ, Kellett JM et al. A semi-structuredclinical interview for the assessment of diagnosis and mental state inthe elderly. The Geriatric Mental State Schedule, 1. Development andreliability. Psychol Med 1976; 6: 439–49.33. Copeland JRM, Dewey ME, Griffith-Jones HM. Computerisedpsychiatric diagnostic system and case nomenclature for elderlysubjects: GMS and AGECAT. Psychol Med 1986; 16; 89–99.34. Sharma VK, Copeland JR, Dewey ME et al. Outcome of thedepressed elderly living in the community in Liverpool: a 5-yearfollow-up. Psychol Med 1998; 28(6): 1329–37.Longitudinal Studies of Mood Disorders in the USADan G. BlazerDuke University Medical Center, Durham, NC, USADepressive disorders in late life tend to recur or persist and changethe course of a person’s life through time. For this reason, theassessment of depression through time necessitates an accurateunderstanding of the longitudinal course of depressive disorders.For this reason, when the Psychobiology of Depression StudyGroup began their extensive study of inpatient and outpatientpersons in adulthood (but not including old age), they incorporatedan extensive longitudinal study into their methodology.Results from this study revealed that 1 year following identificationof an index episode of major depression, 50% of the cohort59 years of age and younger had recovered, but the annual rate ofrecovery decreased to 28% by the second year and to 22% by thethird year. These investigators determined that recovery from anindex episode of major depression was most likely to occur withinthe year following identification of the episode. Among thoseindividuals who do recover, 24% suffered a relapse within 3months of the recovery; 16% of the individuals who identifiedsuffering from an index episode remained ill throughout the firstyear. The cohort has now been followed for 15 years (original ageof 18–59 with the current cohort now between 33–74); 85% ofthose who recovered from the index episode relapsed at least onceover the 15 years and 58% of persons who recovered andremained well for 5 years relapsed over the next 10 years. Femalegender, a longer index episode of depression, more prior episodesand never marrying all contributed to an increased likelihood ofrelapse.There has been no equivalent study of the outcome of late-lifedepression within the USA that has currently been reported in theliterature. However, an ongoing study by Duke Universityinvestigators has found that rates of chronicity, recovery andrelapse are virtually identical to those reported by Keller andcolleagues for younger age groups. The remainder of studies inNorth America have concentrated primarily upon outcome incontrolled treatment trials. The Pittsburgh group found that over3 years, subjects treated with optimal doses of antidepressantmedications relapsed at a rate of between 30% and 40% over 3years.REFERENCES1. Keller MB, Shapiro RW, Lavori PW, Wolf N. Recovery in majordepressive disorders: analysis with the lifetable and aggression models.Arch Gen Psychiat 1982; 39: 905–10.2. Keller MB, Shapiro RW, Lavori PW, Wolf N. Relapse in majordepressive disorder: analysis with the life-table. Arch Gen Psychiat1982; 39: 911–15.3. George LK, Blazer DG, Hughes DC, Fowler N. Social support and theoutcome of major depression. Br J Psychiat 1989; 154: 478–85.4. Mueller TI, Leon AC, Keller MB et al. Recurrence after recovery frommajor depressive disorder during 15 years of observational follow-up.Am J Psychiat 1999; 156: 1000–6.5. Reynolds CF III, Perel JM, Frank E et al. Three-year outcomes ofmaintenance nortriptyline treatment in late-life depression: a study oftwo fixed plasma levels. Am J Psychiat 1999; 156: 1177–81.