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Symptoms of Late-Life Depression

Frequency and Change During Treatment

Received September 10, 2003; revised May 14, 2004; accepted June 17, 2004. From the Dept. of Psychiatry, Univ. of California San Francisco (JCN), Pfizer Inc, New York, NY (CMC), the Dept. of Psychiatry, Weill Medical College, Cornell University, New York, NY (ACL), and the Dept. of Psychiatry and Behavioral Sciences, Keck School of Medicine and the Leonard Davis School of Gerontology, Univ. of Southern CA (LSS). Send correspondence and reprint requests to J. Craig Nelson, M.D., Dept. of Psychiatry, UCSF, 401 Parnassus Ave, Box 0984-F, San Francisco, CA 94143. e-mail: craign{at}lppi.ucsf.edu
© 2005 American Association for Geriatric Psychiatry

Objective: The authors determined the symptoms frequently present in older patients with major depression that showed the greatest change during treatment and that best correlated with an independent measure of improvement (the Clinical Global Impression scale [CGI]). Methods: Subjects included 728 patients over the age of 60 years with major depression who were selected for entry into a clinical trial. Authors determined the frequency of symptoms on the 17-item Hamilton Rating Scale for Depression (Ham-D) and the effect size of symptom change during treatment. Results: Nine symptoms were identified that were frequent, showed the greatest change during treatment, and best correlated with CGI. The items included depressed mood; loss of interest in work and activities; psychic anxiety; somatic symptoms, general (decreased energy); somatic anxiety; guilt; middle insomnia; late insomnia; and suicidal ideation. These nine items accounted for 92% of the variance in the 17-item Ham-D score, correlated with the CGI at a level similar to the 17-item Ham-D, and were at least as sensitive as the 17-item Ham-D for detecting drug–placebo differences. A comparison with five other similar approaches in non-geriatric samples suggested that the symptoms identified were relatively similar in both age-groups. Conclusions: Symptoms frequent in patients with late-life depression are similar to those in mixed-aged samples. Nine of the Ham-D items appear most useful for assessment of change during treatment.

Key Words: Depression Symptoms • Depression Treatment

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