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Depression is a pervasive and debilitating mental health disorder that affects people of all ages, genders, and backgrounds.¹ Although various factors contribute to the development of depression, the age of onset is a crucial consideration for the management of the disorder.¹ The aim of the new study is to investigate effective management strategies for individuals diagnosed with a single depressive episode who experience new onset and severe depression, with the goal of providing insights into best practices for treatment.

The study included 1486 individuals diagnosed with a single depressive episode, with 301 selected for further analysis using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR). The participants were divided into two groups based on their age of onset: early onset (before age 30) and late onset (after age 30).¹

The results showed that patients with early-onset depression had higher rates of comorbid personality disorders, higher levels of neuroticism, and lower rates of stressful life events in the six months preceding onset. Additionally, they reported more drug abuse, but this difference may be partly due to the higher prevalence of comorbid borderline personality disorder in this group.¹

Despite these differences, after adjustment for gender and neuroticism, the patients with early onset did not differ significantly from those with later onset in terms of subjective depressive symptoms, remission rates following first-line antidepressant treatment, or severity of depression at endpoint. Furthermore, age-of-onset did not have any impact on the severity of the depressive episode, or the prevalence of family history of psychiatric illness. These findings suggest that effective management of new onset and severe depression should consider the potential for comorbid personality disorders and history of substance abuse, especially among patients with early-onset depression.¹

The study also found that there may be differences in treatment settings for patients with late-onset depression, with a trend for more patients with late-onset depression to be treated in inpatient settings. However, there were no significant differences in the type or number of antidepressant trials needed for management between patients with early- and late-onset depression.¹

Overall, these findings can inform more targeted and effective management strategies for individuals with new onset and severe depression. Effective management of depression should consider potential comorbidities and history of substance abuse, particularly among patients with early-onset depression. The study highlights the need for personalized treatment plans that consider the unique characteristics and needs of each patient.

While previous studies have focused on childhood and late-life depression, more recent studies have included early adult-onset of depression, which has been associated with higher family loading for affective disorders, more prevalent comorbid anxiety, and greater symptom severity and suicidal ideation compared to middle and late adult onset. However, the significance of age-of-onset in relation to treatment outcomes is still unclear and requires further research.¹

In conclusion, the age of onset is a significant factor to consider in managing new onset and severe depression. Understanding the impact of age-of-onset on the presentation and treatment of depression can help health care providers develop more personalized and effective treatment plans. The study findings provide insight into the potential comorbidities and unique characteristics of patients with early-onset depression, highlighting the need for targeted and individualized treatment approaches. Further research is needed to clarify the significance of age-of-onset in relation to treatment outcomes, and to develop more effective management strategies for individuals experiencing depression.

References:

1.    Bukh JD, Bock C, Vinberg M, Gether U, Kessing LV. Differences between early and late onset adult depression. Clin Pract Epidemiol Ment Health. 2011;7:140-147. doi:10.2174/1745017901107010140