The lifetime course of illness in older outpatient men who remained symptomatic despite adequate pharmacologic treat ment for depression was examined. A bimodal distribution of age of onset of first major depression was found, with 75% having onset before age 35 years and 25% having onset after age 50 years. At all ages, episodes of chronic depression developed after episodes of major depression and appeared to be partially resolved major depression. In 88% of patients, anxiety disorders developed before age 35 years, preceded onset of other disorders, and continued throughout the patient's lifetime. Seventy percent developed alcoholism and 25% had a medical illness that impaired function to a signifi cant degree. The importance of obtaining a lifetime course of illness in older patients is discussed. ( J Geriatr Psychiatry Neurol 1989;2:89-95).
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References
1.
Weissman MM, Leaf PJ, Bruce ML, et al: The epidemiology of dysthymia in five communities: Rates, risks, comorbidity, and treatment. Am J Psychiatry1988;145:815-819.
2.
German PS, Shapiro S., Skinner EA, et al: Detection and management of mental health problems of older patients by primary care providers. JAMA1987 ;257:489.
3.
Rounsaville BJ, Sholomskas D., Prusoff BA: Chronic mood disorders in depressed outpatients: Diagnosis and response to pharmacotherapy. J Affect Disord1980;2:73-88.
4.
Keller MB, Shapiro RW: "Double depression": Superimposition of acute depressive episodes on chronic depressive disorders. Am J Psychiatry1982;139:438-442.
5.
Keller MB, Lavori PW, Endicott J., et al: "Double depression": Two year followup. Am J Psychiatry1983;140:689-694.
6.
Keller MB, Klerman GL, Lavori PW, et al: Long-term outcome of episodes of major depression: Clinical and public health significance. JAMA19834;252:788-792. '
7.
Robbins E., Guze SB: Classification of affective disorders: The primary-secondary, endogenous-reactive and neurotic-psychotic concepts, in Williams TA, Katz MM, Shields JA (eds): Recent Advances in the Psychobiology of the Depressive Illnesses. Government Printing Office, 1972.
8.
Keller MB, Lavori PW, Rice J., et al: The persistence risk of chronicity in recurrent episodes of non-bipolar major depressive disorder: A prospective followup. Am J Psychiatry1986; 143:24-28.
9.
Spitzer RL, Endicott J., Robbins E.: Research Diagnostic Criteria: Rationale and reliability. Arch Gen Psychiatry1978;35:773-782.
10.
Diagnostic and Statistical Manual of Mental Disorders, ed 3. Washington, DC, American Psychiatric Association, 1980.
11.
Akiskal HS: Dysthymic disorder: Psychopathology of proposed chronic depressive subtypes . Am J Psychiatry1983;140: 11-20.
12.
Diagnostic and Statistical Manual of Mental Disorders, ed 3, revised. Washington, DC, American Psychiatric Association, 1987.
13.
Post RM, Roy-Byrne PP, Uhde TW: Graphic representation of the life course of illness in patients with affective disorder. Am J Psychiatry1988;145:844-848.
14.
Spitzer RL, Endicott J.: Schedule of Affective Disorders and Schizophrenia. New York, New York State Psychiatric Institute, 1979.
15.
Hollingshead AB: Two Factor Index of Social Position. New Haven, CT, Yale University, 1957.
16.
Bailey DN, Jatlow PI: Gas chromatographic analysis for therapeutic concentration of amitriptyline and nortriptyline in plasma, with use of a nitrogen detector. Clin Chem1976;22: 777-781.
17.
Weissman MM: Anxiety disorders: An epidemiological perspective, in Roth M, Noyes R, Burrows G (eds): Handbook of Anxiety Disorders. New York, Elsevier Science Publishers, 1987.
18.
Akiskal HS: Subaffective disorders: Dysthmic, cyclothymic and bipolar II disorders in the "borderline" realm. Psychiatr Clin North Am1981;4:25-46.
19.
Weissman MM , Gershon ES, Kidd KK, et al: Psychiatric disorders in the relatives of probands with affective disorders: The Yale NIMH Collaborative Family Study . Arch Gen Psychiatry1984;41:13-21.
20.
Torgersen S. : Genetic factors in moderately severe and mild affective disorders. Arch Gen Psychiatry1986 ;43:222-227.
21.
VanValkenburg C., Akiskal HS, Puzantian V., et al: Anxious depressions. Clinical, family history, and naturalistic outcome —comparisons with panic and major depressive disorders. J Affect Disord1984 ;6:67-82.
22.
Uhde TW, Boulenger JP, Roy-Byrne PP, et al: Longitudinal course of panic disorder: Clinical and biological considerations. Prog Neuropsychopharmacol Biol Psychiatry1985;9:39-51.
23.
Koehler K., Vartzopoulos D., Ebel H.: Agoraphobia and depression: Relationships and severity in hospitalized women . Compr Psychiatry1986;6:553-539.
24.
Weiss KJ, Rosenberg DJ: Prevalence of anxiety disorder among alcoholics. J Clin Psychiatry1985;46:3-5.
25.
Talley NJ, Fung LH, Gilligan IJ, et al: Association of anxiety, neuroticism, and depression with dyspepsia of unknown cause. A case control study. Gastroenterology1986;90:886-892.
26.
Merikangas K. : Comorbidity of alcoholism, anxiety and depression . Presented at American Psychiatric Association Annual Meeting, Washington DC, May, 1986.
27.
Smail P., Stockwell T., Canter S., et al: Alcohol dependence and phobic anxiety states: I. A prevalence study. Br J Psychiatry1984;144:53-57.
28.
Stockwell T. , Smail P., Hodgson R., et al: Alcohol dependence and phobic anxiety states: II. A retrospective study. Br J Psychiatry1984;144:58-63.
29.
Akiskal HS: Factors associated with incomplete recovery in primary depressive illness . J Clin Psychiatry1982;43:266-271.
