Age of onset in major depression (MDD) has been shown to be predictive of several negative outcomes. The younger a person is when he or she experiences a first depressive episode, the more likely the person is to have additional episodes, more severe episodes, more negative symptoms, lower academic and professional achievement, more relationship problems, and increased risk of suicide attempt or completion. Other factors that raise the risk of negative course trajectory are childhood abuse or neglect, family history of mood issues or mental illness, and being a female.
Although all of these factors have been scrutinized at length with relation to MDD, how age of onset affects antidepressant outcome has been overlooked. S.C. Sung of the Office of Clinical Sciences at the Duke-NUS Graduate Medical School in Singapore recently led a study that looked at how people with early onset (under age 18) MDD fared on antidepressants compared to individuals with adult onset depression.
Sung enrolled 665 participants receiving outpatient care for MDD and evaluated their progress after 12 and 28 weeks on either a combination of antidepressant and placebo, or a combination of two antidepressants. Sung found that although there were significant differences in physical health, comorbidity, quality of life, and history of abuse, there were relatively no differences in how the adult-onset and early-onset groups responded to the antidepressant conditions at either follow-up.
These findings show that although nearly half of the participants reported experiencing their first episode of MDD in adolescence or childhood, the treatment response and retention rates were the same regardless of what age MDD first occurred. However, the early onset participants did report more prevalent and chronic MDD, more childhood maltreatment, and more past and current suicidal ideation.
Although these findings did not shed any light on how different types of MDD are influenced by antidepressants, it did highlight the importance of identifying and addressing MDD in adolescents and children as it appears that early onset MDD results in greater duration of MDD and higher risk of suicide. Sung added, “Clinicians who are treating adult patients with a history of early-onset MDD should closely monitor these patients for the presence of suicide risk.”
Reference:
Sung, S. C., et al. (2013). Does Early-Onset Chronic Or Recurrent Major Depression Impact Outcomes with Antidepressant Medications? A CO-MED Trial Report. Psychological Medicine 43.5 (2013): 945-60. ProQuest. Web.
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