This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Predictors of Pathways Toward Recovery in the Elderly

Mary Amanda Dew, PhD; Charles F. Reynolds III, MD; Patricia R. Houck, MS; Martica Hall, PhD; Daniel J. Buysse, MD; Ellen Frank, PhD; David J. Kupfer, MD

Arch Gen Psychiatry. 1997;54(11):1016-1024.

Abstract
Background
Predictors of treatment response and recovery from depression in late life remain poorly understood. Previous studies have focused on a narrow range of response and recovery variables; namely, whether patients achieve or do not achieve a defined outcome or time to achieve the outcome. Whether patients vary in their pathways toward those outcomes—and the extent to which such variation can be anticipated by patient characteristics prior to treatment—has not been empirically examined.

Methods
Depression symptom levels were monitored for 18 weeks in 95 persons aged 60 years or older who were experiencing a recurrence of major depression. Subjects received standardized combined nortriptyline treatment and interpersonal psychotherapy throughout the period. Cluster analysis was used to identify depression recovery patterns. Multivariate analyses considered whether recovery patterns were predicted by pretreatment psychosocial, clinical, and electroencephalographic sleep characteristics.

Results
Four subgroups of elders were identified who differed in rate, stability, and direction of recovery, ie, those showing (1) rapid sustained improvement, (2) delayed but sustained improvement, (3) partial or mixed response, or (4) no response. Pretreatment characteristics reliably predicted subjects' group membership. Higher levels of acute and chronic stressors, poorer social supports, younger age at first depressive episode, endogenous depression, higher current anxiety, older current age, and poorer subjective and objective (electroencephalographic) sleep predicted poorer response profiles.

Conclusions
There are multiple pathways by which individuals begin to emerge from depression; these pathways can be identified empirically. Variables from diverse psychobiologic domains can be used to predict which persons are likely to advance along which trajectories toward recovery.

Author Affiliations
From the Departments of Psychiatry (Drs Dew, Reynolds, Hall, Buysse, Frank, and Kupfer and Ms Houck), Epidemiology (Dr Dew), and Psychology (Dr Dew), University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pa.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Empirically Derived Decision Trees for the Treatment of Late-Life Depression
Andreescu et al.
Focus 2009;7:79-87.
ABSTRACT | FULL TEXT  

Empirically Derived Decision Trees for the Treatment of Late-Life Depression
Andreescu et al.
Am. J. Psychiatry 2008;165:855-862.
ABSTRACT | FULL TEXT  

Depression, Immunity, and Survival in Patients With Hepatobiliary Carcinoma
Steel et al.
JCO 2007;25:2397-2405.
ABSTRACT | FULL TEXT  

Effect of comorbid anxiety on treatment response and relapse risk in late-life depression: controlled study
Andreescu et al.
Br. J. Psychiatry 2007;190:344-349.
ABSTRACT | FULL TEXT  

Prognosis of Depression in Old Age Compared to Middle Age: A Systematic Review of Comparative Studies
Mitchell and Subramaniam
Am. J. Psychiatry 2005;162:1588-1601.
ABSTRACT | FULL TEXT  

Citalopram Treatment of Depression in Parkinson's Disease: The Impact on Anxiety, Disability, and Cognition
Menza et al.
J. Neuropsychiatry Clin. Neurosi. 2004;16:315-319.
ABSTRACT | FULL TEXT  

Pharmacological Treatment of Depression in Older Primary Care Patients: The PROSPECT Algorithm
Mulsant et al.
Focus 2004;2:253-259.
ABSTRACT | FULL TEXT  

Prognostic value of frontal functional neuroimaging in late-onset severe major depression
NAVARRO et al.
Br. J. Psychiatry 2004;184:306-311.
ABSTRACT | FULL TEXT  

An 8-Week Multicenter, Parallel-Group, Double-Blind, Placebo-Controlled Study of Sertraline in Elderly Outpatients With Major Depression
Schneider et al.
Am. J. Psychiatry 2003;160:1277-1285.
ABSTRACT | FULL TEXT  

Depression and Bipolar Support Alliance Consensus Statement on the Unmet Needs in Diagnosis and Treatment of Mood Disorders in Late Life
Charney et al.
Arch Gen Psychiatry 2003;60:664-672.
ABSTRACT | FULL TEXT  

Effect of Increasing the Dose and Duration of Sertraline Trial in the Treatment of Depressed Nursing Home Residents
Weintraub et al.
J Geriatr Psychiatry Neurol 2003;16:109-111.
ABSTRACT  

The Challenge of Depression in Late Life: Bridging Science and Service in Primary Care
Gallo and Coyne
JAMA 2000;284:1570-1572.
FULL TEXT  

Depression and Aging: A Look to the Future
Reynolds and Kupfer
Psychiatr. Serv. 1999;50:1167-1172.
ABSTRACT | FULL TEXT  

Dose of Tricyclic Antidepressants in Elderly Patients
Tan and Reynolds III
JAMA 1999;281:1891-1892.
FULL TEXT  

Effects of Age at Onset of First Lifetime Episode of Recurrent Major Depression on Treatment Response and Illness Course in Elderly Patients
Reynolds et al.
Am. J. Psychiatry 1998;155:795-799.
ABSTRACT | FULL TEXT  

The Clinical Course of Unipolar Major Depressive Disorders
Judd
Arch Gen Psychiatry 1997;54:989-991.
ABSTRACT