Clinical course of depression is worse in older people

While major depression appears to follow a worse clinical course in older people, this study is important in providing robust evidence of poorer prognostic outcomes and addresses some major methodological limitations of previous studies.

One limitation, acknowledged by the authors, is the absence of a sufficient measure of cognitive function. Cognitive impairment is associated with major depression, slows recovery from depression, and reduces treatment effectiveness. The study did exclude people with dementia or with Mini-Mental State Examination scores of 18 or lower, but this may not have excluded other variations in cognitive impairment that could have contributed to the age-related differences in outcomes.

Tze Pin Ng, MD, is with the department of psychological medicine at the National University of Singapore. These comments are taken from an accompanying editorial (Lancet Psychiatry. 2018 Jun 7. doi: 10.1016/S2215-0366[18]30186-X). No conflicts of interest were declared.