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Oude Voshaar RC. The 'discontinuity hypothesis' of depression in later life-clinical and research implications. Age Ageing 2023; 52:afad239. [PMID: 38156879 PMCID: PMC10756079 DOI: 10.1093/ageing/afad239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 01/08/2023] [Indexed: 01/03/2024] Open
Abstract
The term depression is overused as an umbrella term for a variety of conditions, including depressed mood and various psychiatric disorders. According to psychiatric diagnostic criteria, depressive disorders impact nearly all aspects of human life and are a leading cause of disability worldwide. The widespread assumption that different types of depression lie on a continuum of severity has stimulated important research on subthreshold depression in later life. This view assumes that depressed mood is a precursor of a depressive disorder. The present narrative review argues why in later life depressed mood might either (i) lie on a continuum with depressive disorders among people vulnerable for a depressive disorder or (ii) be an ageing-related epiphenomenon of underlying physical illnesses in people who are resilient to depressive disorders ('discontinuity hypothesis'). Three arguments are discussed. First, the course of depressed mood and depressive disorders differs across the life span. Second, screening instruments for depression have low predictive value for depressive disorders in later life. Third, a dose-response relationship has not been consistently found across different types of depression and detrimental health outcomes. Using the umbrella term depression may partly explain why pharmacological treatment is less effective with increasing age, and negative health-related outcomes might be overestimated. The discontinuity hypothesis may prevent pharmacological overtreatment of milder subtypes of depression and may stimulate comprehensive multidisciplinary assessment as well as the development of separate treatment algorithms for depressed mood and depressive disorders.
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Affiliation(s)
- Richard C Oude Voshaar
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherland
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Bergua V, Blanchard C, Amieva H. Depression in Older Adults: Do Current DSM Diagnostic Criteria Really Fit? Clin Gerontol 2023:1-38. [PMID: 37902598 DOI: 10.1080/07317115.2023.2274053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
OBJECTIVES The great heterogeneity in symptoms and clinical signs of depression in older adults makes the current diagnostic criteria difficult to apply. This scoping review aims to provide an update on the relevance of each of the diagnostic criteria as defined in the DSM-5. METHODS In order to limit the risk of bias inherent in the study selection process, a priori inclusion and exclusion criteria were defined. Articles meeting these criteria were identified using a combination of search terms entered into PubMed, PsycINFO, PsycARTICLES and SocINDEX. RESULTS Of the 894 articles identified, 33 articles were selected. This review highlights a different presentation of depression in older adults. Beyond the first two DSM core criteria, some symptoms are more common in older adults: appetite change, sleep disturbance, psychomotor slowing, difficulty concentrating, indecisiveness, and fatigue. CONCLUSIONS This review provides an updated description of the clinical expression of depressive symptoms in the older population while highlighting current pending issues. CLINICAL IMPLICATIONS Somatic symptoms should be systematically considered in order to improve the diagnosis of depression in older adults, even if, in some cases, they may reflect symptoms of age-related illnesses.
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Affiliation(s)
- Valérie Bergua
- Public health - Psychology, University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Cécile Blanchard
- Public health - Psychology, University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
- Psychiatry, Centre Hospitalier Cadillac, Bordeaux, France
| | - Hélène Amieva
- Public health - Psychology, University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
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da Cruz Jung IE, da Cruz IBM, Barbisan F, Trott A, Houenou LJ, Osmarin Turra B, Duarte T, de Souza Praia R, Maia-Ribeiro EA, da Costa Escobar Piccoli J, Bica CG, Duarte MMMF. Superoxide imbalance triggered by Val16Ala-SOD2 polymorphism increases the risk of depression and self-reported psychological stress in free-living elderly people. Mol Genet Genomic Med 2019; 8:e1080. [PMID: 31891227 PMCID: PMC7005615 DOI: 10.1002/mgg3.1080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/03/2019] [Accepted: 11/14/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Oxidative stress and chronic inflammatory states triggered by a single-nucleotide polymorphism (SNP) in superoxide dismutase manganese-dependent gene (Val16Ala-SOD2) have been associated with the risk of developing several chronic, nontransmissible diseases. However, it is still not clear whether the VV-SOD2 genotype that causes higher basal superoxide anion levels has any impact on the risk for depression and self-reported psychological stress in elderly people. METHODS In the present study, we tested this hypothesis using a case-control study where depression was detected using the Geriatric Depression Scale-15 (GDS-15). A total of 612 Brazilian free-living elderly subjects with a mean age of 67.1 ± 7.1 years old (number of controls, C = 497, and depressive individuals, D = 115) were included in this study. All participants had similar social, health, and lifestyle variables, with the exception of polypharmacy (≥5 medicines daily intake), which was higher in the D group, compared to C subjects. RESULTS Our results showed that the VV-SOD2 genotype significantly increased the risk for depression and psychological stress in the elderly subjects, independently of sex/gender, age, and other prior diseases and health indicators (depression risk = 1.842, 1.109-3.061 95% CI, p = .018). VV-subjects also had a higher daily intake of antidepressants, anxiolytics, and anti-inflammatory drugs than A-allele subjects. CONCLUSION Our findings support the hypothesis that genetically induced oxidative superoxide-hydrogen peroxide imbalance may be involved in an increased risk for developing depression and psychological stress in free-living elderly people without other chronic nontransmissible diseases.
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Affiliation(s)
- Ivo Emilio da Cruz Jung
- Programa de Pós-Graduação em Farmacologia, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - Ivana Beatrice Mânica da Cruz
- Programa de Pós-Graduação em Farmacologia, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil.,Programa de Pós-Graduação em Gerontologia, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - Fernanda Barbisan
- Programa de Pós-Graduação em Farmacologia, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil.,Programa de Pós-Graduação em Gerontologia, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - Alexis Trott
- Departamento de Ciências da Vida, Universidade Regional do Noroeste do Estado do Rio Grande do Sul, Ijuí, RS, Brazil
| | - Lucien J Houenou
- Biotechnology Department, Forsyth Technical Community College, Winston-Salem, NC, USA
| | - Bárbara Osmarin Turra
- Programa de Pós-Graduação em Farmacologia, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - Thiago Duarte
- Programa de Pós-Graduação em Farmacologia, Centro de Ciências da Saúde, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | | | | | | | - Claudia Giugliano Bica
- Programa de Pós-Graduação em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
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Dorow M, Stein J, Pabst A, Weyerer S, Werle J, Maier W, Miebach L, Scherer M, Stark A, Wiese B, Moor L, Bock JO, König HH, Riedel-Heller SG. Categorical and dimensional perspectives on depression in elderly primary care patients - Results of the AgeMooDe study. Int J Methods Psychiatr Res 2018; 27:e1577. [PMID: 28948667 PMCID: PMC6877261 DOI: 10.1002/mpr.1577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 06/29/2017] [Accepted: 07/03/2017] [Indexed: 02/04/2023] Open
Abstract
An accurate diagnosis is essential for the management of late-life depression in primary care. This study aims to (1) provide information on the agreement on depression diagnoses between general practitioners (GPs), dimensional tools (Geriatric Depression Scale [GDS], Hospital Anxiety and Depression Scale [HADS]) and a categorical tool (Structured Clinical Interview for DSM-IV criteria [SCID]) and (2) identify factors associated with different diagnoses. As part of the multicenter study "Late-life depression in primary care: needs, health care utilization and costs (AgeMooDe)" a sample of 1113 primary care patients aged 75 years and older was assessed. The proportion of depression was 24.3% according to GPs, 21.8% for the GDS, 18.9% for the HADS and 8.2% for the SCID. Taking GDS, HADS and SCID as reference standards, recognition of GPs was 47%, 48% and 63%. Cohen's Kappa values indicate slight to moderate agreement between diagnoses. Multinomial logistic regression models showed that patient related factors of depression were anxiety, intake of antidepressants, female gender, a low state of health, intake of medication for chronic diseases and functional impairment. GPs performed better at ruling out depression than ruling in depression. High levels of disagreement between different perspectives on depression indicate that they may be sensitive to different aspects of depression.
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Affiliation(s)
- Marie Dorow
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jochen Werle
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Wolfgang Maier
- Department of Psychiatry, University of Bonn and German Center for Neurodegenerative Diseases within the Helmholtz Association, Bonn, Germany
| | - Lisa Miebach
- Department of Psychiatry, University of Bonn and German Center for Neurodegenerative Diseases within the Helmholtz Association, Bonn, Germany
| | - Martin Scherer
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Stark
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgitt Wiese
- Institute for General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Hannover, Germany
| | - Lilia Moor
- Institute for General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Hannover, Germany
| | - Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
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