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• W2893944034 abstract "We would like to thank Pooja Patnaik Kuppili and Naresh Nabhinani for their interest in our Article.1Schaakxs R Comijs HC Lamers F Kok RM Beekman ATF Penninx BWJH Associations between age and the course of major depressive disorder: a 2-year longitudinal cohort study.Lancet Psychiatry. 2018; 5: 581-590Summary Full Text Full Text PDF PubMed Scopus (71) Google Scholar They point out that we did not address all potentially relevant variables when trying to explain why depression is more chronic in older people (as we acknowledged). Indeed, future research into the roles of treatment adherence and symptom profiles (eg, psychotic features) is worthwhile. Not all participants were given treatment. We did analyses comparing those who were recruited in primary care settings with those from specialised care settings, and those using and not using antidepressants. The results of these comparisons suggested a more unfavourable disease course for older patients than younger patients, and that non-adherence to treatment could not be the only explaining factor. Nevertheless, further examination of the role of age in treatment studies is useful, in which treatment adherence or non-adherence should not be ignored. Kuppili and Nabhinani further noted limitations regarding our consideration of dysthymia and depression severity. However, instead of considering these factors as covariates, we incorporated these concepts in our definitions of major depressive disorder (MDD) course outcomes. First, we looked at having any depression diagnosis after 2 years, including both MDD and dysthymia. Second, we analysed MDD and dysthymia separately, which indicated that older age was most strongly associated with an increased likelihood of having dysthymia after 2 years. Third, we looked at life chart information and symptom (inventory of depressive symptomatology [IDS]) scores2Rush AJ Gullion CM Basco MR Jarrett RB Trivedi MH The inventory of depressive symptomatology (IDS): psychometric properties.Psychol Med. 1996; 26: 477-486Crossref PubMed Google Scholar in which even lower levels of symptomatology (ie, not meeting diagnostic thresholds) were considered. For all approaches, older age was a consistent predictor of poor MDD course outcome, suggesting that this effect of age is visible at all levels of depression severity, from mild or chronic symptoms to full-blown disorders. Finally, we unfortunately see there is an error in the flow chart (figure 1 in the Article). Not 43 outpatients, but 43 inpatients were excluded from the NESDO study. Our final NESDA and NESDO samples both included a mix of participants from primary care and outpatient mental health-care facilities, making them comparable. We declare no competing interests. Associations between age and the course of major depressive disorder: a 2-year longitudinal cohort studyOlder age was found to be a consistent and important risk factor for a poorer MDD course, which could not be explained by a range of well established risk factors. Further investigation of potential underlying mechanisms—including the effect of cognitive impairment, for example—is needed to prevent the negative consequences of a long-term MDD burden in older people. Full-Text PDF Age and major depressive disorder: what factors should be investigated?We read with great interest the Article by Roxanne Schaakxs and colleagues in The Lancet Psychiatry investigating the associations between age and the course of major depressive disorder (MDD).1 The authors used baseline and 2-year follow-up data from the Netherlands Study of Depression and Anxiety (NESDA) and the Netherlands Study of Depression in Older Persons (NESDO) cohorts to investigate the 2-year course of major depressive disorder (MDD). Although older age was found to be a consistent and important risk factor for poor MDD course, the association between age and the course of MDD could not be explained by the clinical, health, and social variables investigated in the study. Full-Text PDF" @default.
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• W2893944034 title "Age and major depressive disorder: what factors should be investigated? – Authors' reply" @default.
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• W2893944034 doi "https://doi.org/10.1016/s2215-0366(18)30352-3" @default.
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