Objective:
The symptomatology of late life depression in the community can be atypical, and the initial presentation may predominately be anxiety, somatic, or occasionally cognitive symptoms. This presentation may affect both detection and treatment. The aim of this study was to examine the pattern of co-morbid symptoms in late life depression in the community.
The subjects for this study were 180 older people with GMS-AGECAT case level depression, identified following screening of those on general practice patient lists. In addition to the primary diagnosis, GMS-AGECAT also allocated a level of confidence on other diagnostic clusters (organic, paranoid, mania, obsessional, hypochondriacal, phobic, anxiety). Therefore, the presence of symptoms co-occurring with the principal diagnosis of depression was recorded. Current psychotropic drug use was recorded.
Four subjects with depression had subcase organic symptoms but there were no cases of true depressive pseudodementia (co-morbid organic case level). The symptom pattern of depressive disorder was characterised by co-occurring anxiety (anxiety, phobic, obsessional), with case level anxiety in 35 (19%) and subcase level in a further 114 (63%). Depressives with case level anxiety were taking psychotropic drugs in 60% of subjects, falling to 46% for depression with subcase anxiety, and 26% for depression with no anxiety (p=0.02). This decrease in treatment with less co-morbid anxiety also occurred for antidepressant drugs (p=0.046).
The model of depression which psychiatry offers to primary care is not always appropriate for older people in the community. Depression with psychotic symptoms or cognitive dysfunction is uncommon in the community. Depression with co-occurring anxiety is very common. Depressive disorders with prominent anxiety tend to be picked up and receive some treatment (whether specific antidepressant treatment or not), with the anxiety apparently rendering the disorder ‘loud’. The corollary to ‘loud’ depression is that depression which is not flagged by the more striking anxiety and related symptoms may remain “silent” and not be detected.
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