Am J Psychiatry 1993; 150:896-900
Copyright © 1993 by American Psychiatric Association
Long-term affective and cognitive outcome in depressed older adults
A Stoudemire, CD Hill, R Morris, D Martino-Saltzman and B Lewison
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine.
OBJECTIVE: The purpose of this naturalistic study was to examine the
long-term (15 months and 4 years) cognitive and affective outcome following
treatment with either cyclic antidepressants or ECT in depressed older
adults. METHOD: Fifty-five patients meeting criteria for major depression
were rated as to cognitive impairment and were treated as clinically
indicated with either a cyclic antidepressant or ECT. Long-term outcome was
determined through psychometric retesting 15 months (N = 47) and
approximately 4 years (N = 44) after treatment. RESULTS: Analysis of
15-month and 4-year outcome evaluations revealed that the majority of
patients improved over time with respect to their depression, regardless of
whether they exhibited pretreatment cognitive impairment or were treated
with cyclic antidepressants or ECT. Fifteen months and 4 years after
treatment, 72.3% and 83.7% of patients, respectively, exhibited clinically
meaningful improvement. However, patients given both cyclic antidepressants
and ECT demonstrated a relatively high rate of rehospitalization (50%) over
the course of the 4 years. Except for patients who developed dementia,
cognitive functioning remained stable or improved for the majority of
patients. In patients who received ECT, those with normal pretreatment
cognition had stable cognitive functioning over time and those who had
pretreatment cognitive dysfunction showed improvement over the 4-year
follow-up period. CONCLUSIONS: Results of this study indicate that the
long-term prognosis of depression in older adults is generally favorable,
although they may be prone to relapse and recurrence, which points to the
need for rigorous monitoring and follow-up care.
