Objective: There is an open question whether depression with onset at late life differs from that with earlier onset in terms of clinical picture and neurobiology.
Design: Depressed patients were categorized according to age of onset of illness and compared concerning a variety of neurobiologic, clinical and psychometric variables.
Materials and Methods: 36 depressed patients with age of onset below 35 and 14 patients with age of onset above 35 took part in the study. All were suffering from major depression according to DSM-IV criteria. The diagnosis was made with the use of the SCAN v 2.0 and the IPDE. The symptoms were registered one by one (according both to DSM-IV and ICD-10). The psychometric evaluation included the HDRS, HAS, GAF, the Newcastle scales, the Diagnostic Melancholia Scale (DMS) and the Life Change Units scale of Holmes and Rahe. The neurobiological evaluation included the DST, dexfenfluramine challenge test, brain SPECT, thyroid evaluation and PR-VEPs. The statistcal analysis included One-Way MANCOVA with age as a covariate and scheffe post-hoc test. Chi-square test was also used.
Results: The analysis of results revealed no difference between groups concerning the neurobiological variables. Younger onset patients had better functioning (GAF: 55.89±12.78 versus 41.07±13.18, p=0.006) more personality disorders (0.41±0.55 versus 0.00±0.00, p=0.007) and more life events (2.94±1.97 versus 1.00±1.10, p=0.001). There were no differences between groups concerning individual symptoms or psychometric scales scores.
Conclusion: The current study provides limited data in support for the distinction between early vs. late onset depression. The most important limitations of the current study are the problematic diagnosis of personality disorders in elderly patients, and the relative lack of patients from this group suffering from a comorbid personality disorder, in everyday clinical practice. Also, the relatively higher presence of personality psychopathology in younger onset patients may lead to the over-reporting of stressful life events.
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