Long-term affective and cognitive outcome in depressed older adults

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.