Course

A study of the natural history of late-life depression found that long-term outcomes are poor (Beekman et al., 2002). Over the six years of follow-up, the average symptom severity remained above the 85th percentile of the population average. Symptoms were short-lived in only 14%, remission was achieved in 23%, an unfavorable but fluctuating course in 44%, and a severe chronic course in 32%. Individuals with subthreshold disorders had the best outcome, followed by those with MDD, dysthymic disorder, and double depression. However, the prognosis of subthreshold disorders was unfavorable in most cases (Beekman et al., 2002). Relapse rates without ongoing treatment are high, supporting the importance of long-term maintenance therapy (Flint et al., 1999; Thorpe et al., 2001).

Comorbid anxiety disorders, which are common in this population (23-48%), are associated with a more severe course of depressive illness (Beekman et al., 2000; Lenze et al., 2000).

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