Factors predictive of outcome

There is evidence that the course of depression in older people is less dependent on psychosocial factors than at other times of life and that it pursues a more 'autonomous' course.(2,29 Clinical features, which have been shown to be associated with a poorer outcome, include a slower initial recovery, more severe initial depression, duration of illness of more than 2 years, three or more previous episodes, a previous history of dysthymia, psychotic symptoms, and some types of brain disease. Other factors that may affect outcome adversely are chronic stress associated with a poor environment, crime, and poverty as well as a new physical illness, becoming a victim of crime, and poor perceived social support.

The practical message is that to improve the prognosis of depression one must treat episodes early and vigorously and attend to the patient's social supports and milieu.

Does depressive disorder predispose to later dementia?

This question is of concern to both patients and their relatives. Naturalistic follow-up studies of cognitively normal depressed psychiatric patients have not found an increased rate of dementia.(26,2Z> However, patients with depression and, in addition, cognitive impairment were found in one study to have a fourfold increase in the risk of developing an irreversible dementia, even though their initial cognitive deficits were reversed with treatment. (i32 Therefore it is good practice to follow up these patients, as 'pseudodementia' may not be so benign after all.

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