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Treatment Outcomes for Older Depressed Patients With Earlier Versus Late Onset of First Depressive Episode

A Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Report

From the Department of Psychiatry, University of Texas Southwestern Medical Center (FAK, MHT, MMH, AJR), Dallas, TX; the Epidemiology Data Center, Graduate School of Public Health, University of Pittsburgh (SRW, SM), Pittsburgh, PA; the Department of Psychiatry, Harvard University, Massachusetts General Hospital (MF), Boston, MA; the Department of Psychiatry, University of California at San Diego (BL), San Diego, CA; the Department of Psychiatry, University of California at San Diego and San Diego VA Medical Center (SZ), La Jolla, CA; and the Department of Clinical Sciences, University of Texas Southwestern Medical Center (AJR), Dallas, TX.

Objective: Controversy exists whether age at onset of the first depressive episode predicts chance of response and remission or the timing of such outcome. In this study of older depressed outpatients, the authors evaluated whether the age at onset of the first major depressive episode (MDE) was related to clinical outcomes.

Design: Post-hoc dataset analysis for older participants treated with citalopram in the Sequenced Treatment Alternatives to Relieve Depression trial was performed. Side effects, remission rates, and baseline characteristics were compared for participants whose first MDE began at or before age 55 (earlier onset) versus those with their first MDE after age 55 (late onset).

Setting: Participants were enrolled from 23 psychiatric and 18 primary care settings.

Participants: There were 574 treatment-seeking outpatients (age range: 55–75 years) with nonpsychotic major depressive disorder who had a baseline 17-item Hamilton Rating Scale for Depression score of 14.

Intervention: Participants received citalopram treatment for up to 14 weeks.

Measurements: Remission was defined by a 16-item Quick Inventory of Depressive Symptomatology–Self-Rated score of 5 at study exit. Side effects were measured by the Frequency, Intensity, and Burden of Side Effects Rating.

Results: Of 574 participants, 72.1% had earlier-onset depression and 27.9% had late-onset depression. Remission rates were not statistically different between earlier-onset (30.8%) and late-onset (31.9%) participants. Time to remission did not differ as well.

Conclusion: The self-reported age at onset of the first MDE being after age 55 was not related to clinical outcomes for participants 55 to 75 years of age.

Key Words: depression • Sequenced Treatment Alternatives to Relieve Depression (STAR*D) • citalopram • late onset

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