Factors
associated with early as opposed to later age of
onset of major depression
First
onset of major depressive disorder (MDD) can
occur from childhood through old age, and
diagnostic criteria for major depressive
episodes are similar throughout the life cycle.
Although some studies have attempted to find
differences between childhood and adulthood
major depression, distinction may be more
related to patient age than to age of onset.
Numerous different risk factors for
childhood/adolescent onset than for adult-onset
MDD have been described. While the clinical
characteristics and course of MDD in children
and adolescents are well known, most studies
have not simultaneously examined adults with
early-onset MDD compared with those with
adult-onset MDD. The factors associated with
early as opposed to later age of onset of MDD
were explored in the first 1500 patients
entering the Sequenced Treatment Alternative to
Relieve Depression (STAR*D).
Participants were outpatients 18–75 years
of age with non-psychotic MDD and were asked to
estimate the age at which they first experienced
the onset of their major depressive episode.
Group comparisons were made between those with
early-onset (age < 18 years) and late-onset
(age = or >18 years) MDD.
The mean age of onset in the early-onset group
was 12.4 years, while it was 32.4 years in the
later age of onset group. Early-onset patients
were younger than late-onset patients (mean age
35.7 years, vs. 43.3 years) at study entry, yet
they had a longer duration of MDD (mean years of
illness 23.3 years, vs. 10.9 years). In
addition, women were more likely than men to
have an early onset of MDD (40% of women vs. 30%
of men). Longer current episodes, more episodes,
more suicidality, greater symptom severity, more
psychiatric symptoms associated with Axis I
comorbidity, more sadness, irritability,
agitation and atypical symptom features were
observed in the pre-adult onset group (before
age 18). MDD that began before age 18 was
associated with lower educational levels and
marriage rates.
Thus, early age onset MDD is a serious and
chronic disorder that is important to recognize
and treat early to avoid severe continuities
through the life span of individuals suffering
from this disorder. Zisook
S, John Rush A, Albala A, Alpert J,
Balasubramani GK, Fava M, Husain M, Sackeim H,
Trivedi M, Wisniewski S. Factors that
differentiate early vs. later onset of major
depression disorder. Psychiatry Res 129:
127-140, 2004.