psychiatryПСИХИАТРИЯPsychiatry (Moscow) (Psikhiatriya)1683-83192618-6667FSBSI “The Mental Health Research Centre”; LLC «Publisher «MIA»10.30629/2618-6667-2022-20-3-39-46psychiatry-859Research ArticleПСИХОПАТОЛОГИЯ, КЛИНИЧЕСКАЯ И БИОЛОГИЧЕСКАЯ ПСИХИАТРИЯPSYCHOPATHOLOGY, CLINICAL AND BIOLOGICAL PSYCHIATRYИсходы депрессий позднего возраста (клинико-катамнестическое исследование)Outcomes of Late-Life Depression (Clinical and Follow-Up Study)https://orcid.org/0000-0002-3509-1622СафароваТ. П.SafarovaT. P.

Татьяна Петровна Сафарова, кандидат медицинских наук

Москва

Tatiana P. Safarova, Cand. of Sci. (Med.)

Moscow

saftatiana@mail.ruФГБНУ «Научный центр психического здоровья»РоссияMental Health Research CentreRussian Federation2022280920222033946Copyright © Сафарова Т.П., 20222022Сафарова Т.П.Safarova T.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.journalpsychiatry.com/jour/article/view/859

Обоснование: в настоящее время актуальность проблемы поздних депрессий и изучение их исходов определяется увеличением их распространенности, трудностями диагностики и терапии.Цель: изучение исходов депрессий в позднем возрасте на протяжении трехлетнего катамнестического наблюдения.Пациенты и методы: когорта больных с депрессивным расстройством, проходивших лечение в геронтопсихиатрическом стационаре ФГБНУ НЦПЗ и повторно обследованных через один год и спустя три года. В исследуемую выборку на момент включения вошли 55 человек в возрасте 60 лет и старше: 17 мужчин (30,91%) и 38 женщин (69,09%). Медиана возраста составила 68 лет [63; 76]. В соответствии с классификацией МКБ-10 у всех больных был диагностирован депрессивный эпизод: у 37 человек (67,27%) депрессивная фаза в рамках рекуррентного депрессивного расстройства (РДР — F33), у 16 (29,1%) — депрессивная фаза в рамках биполярного аффективного расстройства (БАР — F31) и у двух (3,63%) пациентов однократный депрессивный эпизод (ДЭ — F32). Все больные были обследованы c применением клинического, психометрического, иммунологического и катамнестического методов (катамнестическая оценка проводилась через один год после госпитализации и три года спустя). К благоприятному течению было отнесено становление полных ремиссий или рецидивирование депрессии на фоне полной ремиссии за период катамнеза, к неблагоприятному — рецидивирование депрессии на фоне неполной ремиссии, хронификация депрессии, исход в деменцию и летальный исход.Результаты и заключение: сравнительное изучение ближайших (один год) и отдаленных (три года) исходов депрессий показало в обоих случаях преобладание неблагоприятного течения заболевания (52,9 и 54,9% соответственно). Через год у 27 человек (52,9%) формировалась неполная ремиссия с резидуальными депрессивными расстройствами; через три года у 20 пациентов (39,2%) отмечалась неполная ремиссия, а у восьми больных (15,7%) констатирована хронификация депрессии. С одинаковой частотой (по три случая; 5,9%) наблюдался исход в деменцию или наступление смерти за период катамнеза. Все случаи развития деменции и смерти отмечались в группе больных с неблагоприятным течением заболевания. Настоящая публикация содержит клиническую характеристику исследуемой когорты пациентов с депрессией позднего возраста. В следующей статье будут изложены результаты клинико-иммунологического исследования, проведенного на этой же когорте больных с целью поиска прогностических признаков различного исхода депрессий в позднем возрасте.

Background: currently the relevance of the problem of late depression and the study of their outcomes is determined by the increase in their prevalence, difficulties in diagnosis and therapy.Objective: to study the outcomes of depression during a 3-year follow-up. This publication contains a clinical description of the study cohort of patients with late-life depression.Patients and methods: a cohort of patients with depressive disorders who were treated in the gerontopsychiatric hospital of the FSBSI MHRC, followed up and re-examined 1 and 3 years after the discharge. The study sample at the time of inclusion made up 55 people aged 60 years and older: 17 men (30.91%) and 38 women (69.09%). The median age was 68 years [63; 76]. According to the ICD-10 classification, all patients were diagnosed with a depressive episode: 37 people (67.27%) had a depressive phase within recurrent depressive disorder (DDR — F33), 16 people (29.1%) had a depressive phase within bipolar affective disorder (BD — F31) and a single depressive episode (DE — F32) — in 2 patients (3.63%). All patients were examined using clinical, psychometric, immunological and follow-up methods (follow-up assessment was carried out after 1 year and 3 years). The favorable course was attributed to the formation of complete remissions or the recurrence of depression against the background of complete remission during the period of follow-up. An unfavorable option is the recurrence of depression against the background of incomplete remission, chronification of depression, the outcome of dementia and death.Results and conclusion: a comparative study of the short-term (1 year) and remote (3 years) outcomes of depression showed in both cases a predominance of unfavorable cases of the course of the disease (52.9 and 54.9%, respectively). One year after 27 patients (52.9%) had incomplete remission with residual depressive disorders, and in 3 years follow-up 20 people (39.2%) had incomplete remission and 8 people (15.7%) had chronic depression. With the same frequency (three patients each; 5.9%), the outcome in dementia was observed, and 3 patients (5.9%) died. All cases of dementia and death were registered in the group of patients with an unfavorable course of the disease. This publication contains a clinical description of the study cohort of patients with late-life depression. The next communication will content the results of clinical and immunological comparison to search some predictive features in different types of depression outcome in aged.

депрессияпоздний возрастблагоприятные исходынеблагоприятные исходынеполные ремиссиисмертностьдеменцияdepressionlate agefavorable outcomesunfavorable outcomesincomplete remissionsmortalitydementiaReferencesKessler R, Bromet E. The Epidemiology of Depression Across Cultures. Annu. Rev. Public. Health. 2013;4(1):119–138. doi: 10.1146/annurevpublhealth-031912-114409Kessler R, Bromet E. The Epidemiology of Depression Across Cultures. Annu. Rev. Public. Health. 2013;4(1):119–138. doi: 10.1146/annurevpublhealth-031912-114409Kok RM, Reynolds CF 3rd. Management of depression in older adults: A review. JAMA. 2017;20:2114–2122. doi: 10.1001/jama.2017.57062Kok RM, Reynolds CF 3rd. Management of depression in older adults: A review. JAMA. 2017;20:2114–2122. doi: 10.1001/jama.2017.57062Alexopoulos GS. Mechanisms and treatment of latelife depression. Transl Psychiatry. 2019;9:188–204. doi: 10.1038/s41398-019-0514-6Alexopoulos GS. Mechanisms and treatment of latelife depression. Transl Psychiatry. 2019;9:188–204. doi: 10.1038/s41398-019-0514-6Protsenko E, Yang R, Nier B, Reus V, Hammamieh R, Rampersaud R, Wu G, Hough CM, Epel E, Prather AA, Jett M, Gautam A, Mellon SH, Wolkowitz OM. “Grim Age”, an epigenetic predictor of mortality, is accelerated in major depressive disorder. Transl Psychiatry. 2021;11(1):193. doi: 10.1038/s41398-021-01302-0Protsenko E, Yang R, Nier B, Reus V, Hammamieh R, Rampersaud R, Wu G, Hough CM, Epel E, Prather AA, Jett M, Gautam A, Mellon SH, Wolkowitz OM. “Grim Age”, an epigenetic predictor of mortality, is accelerated in major depressive disorder. Transl Psychiatry. 2021;11(1):193. doi: 10.1038/s41398-021-01302-0Nelson JC. Management of Late-Life Depression. Handb Exp Pharmacol. 2019;250:389–413. doi: 10.1007/164_2018_170Nelson JC. Management of Late-Life Depression. Handb Exp Pharmacol. 2019;250:389–413. doi: 10.1007/164_2018_170Green RC, Cupples LA, Kurz A. Depression as a risk factor for Alzheimer’s disease: the MIRAGE study. Arch Neurol. 2003;60:753–759. doi: 10.1001/archneur.60.5.753Green RC, Cupples LA, Kurz A. Depression as a risk factor for Alzheimer’s disease: the MIRAGE study. Arch Neurol. 2003;60:753–759. doi: 10.1001/archneur.60.5.753Modrego PJ, Fernandez J. Depression in patients with mild cognitive impairment increases the risk of developing dementia of the Alzheimer type. Arch Neurol. 2004;61:1290–1293.Modrego PJ, Fernandez J. Depression in patients with mild cognitive impairment increases the risk of developing dementia of the Alzheimer type. Arch Neurol. 2004;61:1290–1293.Riddle M, Potter GG, McQuoid DR, Steffens DC, Beyer JL, Taylor WD. Longitudinal Cognitive Outcomes of Clinical Phenotypes of Late-Life Depression. Am J Geriatr Psychiatry. 2017;25(10):1123–1134. doi: 10.1016/j.jagp.2017.03.016Riddle M, Potter GG, McQuoid DR, Steffens DC, Beyer JL, Taylor WD. Longitudinal Cognitive Outcomes of Clinical Phenotypes of Late-Life Depression. Am J Geriatr Psychiatry. 2017;25(10):1123–1134. doi: 10.1016/j.jagp.2017.03.016Husain-Krautter S, Ellison JM. Late Life Depression: The Essentials and the Essential Distinctions. Focus (Am Psychiatr Publ). 2021;19(3):282–293. doi: 10.1176/appi.focus.20210006Husain-Krautter S, Ellison JM. Late Life Depression: The Essentials and the Essential Distinctions. Focus (Am Psychiatr Publ). 2021;19(3):282–293. doi: 10.1176/appi.focus.20210006Post F. The management and nature of depressive illnesses in late life: a follow-through study. Br J Psychiatry. 1972;121(563):393–404. doi: 10.1192/bjp.121.4.393Post F. The management and nature of depressive illnesses in late life: a follow-through study. Br J Psychiatry. 1972;121(563):393–404. doi: 10.1192/bjp.121.4.393Baldwin RC, Gallagley A, Gourlay M, Jackson A, Burns A. Prognosis of late life depression: a threeyear cohort study of outcome and potential predictors. Int J Geriatr Psychiatry. 2006;21(1):57–63. doi: 10.1002/gps.1424Baldwin RC, Gallagley A, Gourlay M, Jackson A, Burns A. Prognosis of late life depression: a threeyear cohort study of outcome and potential predictors. Int J Geriatr Psychiatry. 2006;21(1):57–63. doi: 10.1002/gps.1424Hybels CF, Blazer DG, Steffens DC. Predictors of partial remission in older patients treated for major depression: the role of comorbid dysthymia. Am J Geriatr Psychiatry. 2005;13(8):713–721. doi: 10.1176/appi.ajgp.13.8.713Hybels CF, Blazer DG, Steffens DC. Predictors of partial remission in older patients treated for major depression: the role of comorbid dysthymia. Am J Geriatr Psychiatry. 2005;13(8):713–721. doi: 10.1176/appi.ajgp.13.8.713Beekman ATF, Geerlings SW, Deeg DJH, Smit JH, Schoevers RS, Beurs E, Braam AW, Penninx JH, Tilburg W. The natural history of late-life depression: a 6-year prospective study in the community. Arch Gen Psychiatry. 2002;59(7):605–611. doi: 10.1001/archpsyc.59.7.605Beekman ATF, Geerlings SW, Deeg DJH, Smit JH, Schoevers RS, Beurs E, Braam AW, Penninx JH, Tilburg W. The natural history of late-life depression: a 6-year prospective study in the community. Arch Gen Psychiatry. 2002;59(7):605–611. doi: 10.1001/archpsyc.59.7.605Сафарова ТП, Яковлева ОБ, Андросова ЛВ, Симонов АН, Клюшник ТП. Некоторые факторы воспаления и иммунофенотипы при депрессиях у пожилых больных. Журнал неврологии и психиатрии имени С.С. Корсакова. 2020;120(2):53–58. doi: 10.17116/jnevro202012002153Safarova TP, Yakovleva OB, Androsova LV, Simonov AN, Klyushnik TP. Some factors of inflammation and immunophenotypes in depression in elderly patients. S.S. Korsakov Journal of Neurology and Psychiatry/Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2020;120(2):53–58. (In Russ.). doi: 10.17116/jnevro202012002153Frank E. Prien RF, Jarrett RB, Keller MB, Kupfer DJ, Lavori PW, Rush AJ, Weissman MM. Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence. Arch Gen Psychiatry. 1991;48(9):851. doi: 10.1001/archpsyc.1991.01810330075011Frank E. Prien RF, Jarrett RB, Keller MB, Kupfer DJ, Lavori PW, Rush AJ, Weissman MM. Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence. Arch Gen Psychiatry. 1991;48(9):851. doi: 10.1001/archpsyc.1991.01810330075011Bennett S, Thomas AJ. Depression and dementia: cause, consequence or coincidence? Maturitas. 2014;79(2):184–190. doi: 10.1016/j.maturitas.2014.05.009Bennett S, Thomas AJ. Depression and dementia: cause, consequence or coincidence? Maturitas. 2014;79(2):184–190. doi: 10.1016/j.maturitas.2014.05.009Diniz BS, Butters MA, Albert SM, Dew MA, Reynolds CF. Late-life depression and risk of vascular dementia and Alzheimer’s disease: systematic review and meta-analysis of community based cohort studies. Br J Psychiatry. 2013;202(5):329–335. doi: 10.1192/bjp.bp.112.118307Diniz BS, Butters MA, Albert SM, Dew MA, Reynolds CF. Late-life depression and risk of vascular dementia and Alzheimer’s disease: systematic review and meta-analysis of community based cohort studies. Br J Psychiatry. 2013;202(5):329–335. doi: 10.1192/bjp.bp.112.118307Kiosses DN, Alexopoulos GS. The prognostic significance of subsyndromal symptoms emerging after remission of late-life depression. Psychol Med. 2013;43(2):341–350. doi: 10.1017/S0033291712000967Kiosses DN, Alexopoulos GS. The prognostic significance of subsyndromal symptoms emerging after remission of late-life depression. Psychol Med. 2013;43(2):341–350. doi: 10.1017/S0033291712000967Deng Y, McQuoid DR, Potter GG, Steffens DC, Albert KA, Riddle M, Beyer JL, Taylor WD. Predictors of recurrence in remitted late-life depression. Depress Anxiety. 2018;35(7):658–667. doi: 10.1002/da.22772Deng Y, McQuoid DR, Potter GG, Steffens DC, Albert KA, Riddle M, Beyer JL, Taylor WD. Predictors of recurrence in remitted late-life depression. Depress Anxiety. 2018;35(7):658–667. doi: 10.1002/da.22772Mueller TI, Kohn R, Leventhal N, Leon AC, Solomon D, Coryell W, Endicott J, Alexopoulos GS, Keller MB. The course of depression in elderly patients. Am J Geriatr Psychiatry. 2004;12(1):22–29.Mueller TI, Kohn R, Leventhal N, Leon AC, Solomon D, Coryell W, Endicott J, Alexopoulos GS, Keller MB. The course of depression in elderly patients. Am J Geriatr Psychiatry. 2004;12(1):22–29.Mulsant BH, Houck PR, Gildengers AG, Andreescu C, Dew MA, Pollock BG, Miller MD, Stack JA, Mazumdar S, Reynolds CF 3rd. What is the optimal duration of a short-term antidepressant trial when treating geriatric depression? J Clin Psychopharmacol. 2006; 26(2):113–120.Mulsant BH, Houck PR, Gildengers AG, Andreescu C, Dew MA, Pollock BG, Miller MD, Stack JA, Mazumdar S, Reynolds CF 3rd. What is the optimal duration of a short-term antidepressant trial when treating geriatric depression? J Clin Psychopharmacol. 2006; 26(2):113–120.Reynolds CF 3rd, Dew MA, Pollock BG. Maintenance treatment of major depression in old age. N Engl J Med. 2006;354(11):1130–1138.Reynolds CF 3rd, Dew MA, Pollock BG. Maintenance treatment of major depression in old age. N Engl J Med. 2006;354(11):1130–1138.Tew JD Jr, Mulsant BH, Houck PR, Lenze EJ, Whyte EM, Miller MD, Stack JA, Bensasi S, Reynolds CF 3rd. Impact of prior treatment exposure on response to antidepressant treatment in late life. Am J Geriatr Psychiatr. 2006;14(11):957–965.Tew JD Jr, Mulsant BH, Houck PR, Lenze EJ, Whyte EM, Miller MD, Stack JA, Bensasi S, Reynolds CF 3rd. Impact of prior treatment exposure on response to antidepressant treatment in late life. Am J Geriatr Psychiatr. 2006;14(11):957–965.Jeuring HW, Stek ML, Huisman M, Oude Voshaar RC, Naarding P, Collard RM, van der Mast RC, Kok RM, Beekman ATF, Comijs HC. A Six-Year Prospective Study of the Prognosis and Predictors in Patients with Late-Life Depression. Am J Geriatr Psychiatry. 2018;26(9):985–997. doi: 0.1016/j.jagp.2018.05.005Jeuring HW, Stek ML, Huisman M, Oude Voshaar RC, Naarding P, Collard RM, van der Mast RC, Kok RM, Beekman ATF, Comijs HC. A Six-Year Prospective Study of the Prognosis and Predictors in Patients with Late-Life Depression. Am J Geriatr Psychiatry. 2018;26(9):985–997. doi: 0.1016/j.jagp.2018.05.005Сафонова НЮ, Семенова НВ. Проблема взаимосвязи депрессии и деменции в контексте влияния на показатели смертности. Психиатрия. 2021;19(4):100–108. doi: 10.30629/2618-6667-2021-19-4-100-108Safonova NYu, Semenova NV. The relationship between depression and dementia in the context of the impact on mortality rates. Psychiatry (Moscow) (Psikhiatriya). 2021;19(4):100–108. (In Russ.). doi: 10.30629/2618-6667-2021-19-4-100-108Яковлева ОБ, Федоров ВВ, Ряховский ВВ. Исходы депрессий в позднем возрасте. Психиатрия. 2011;02(50):5–12.Yakovleva OB, Fedorov VV, Ryakhovskiy VV. Outcomes of depression at a later age. Psychiatry (Moscow) (Psikhiatriya). 2011;02(50):5–12. (In Russ.).Корнилов ВВ. Роль патологической реакции горя в развитии деменции позднего возраста. Психиатрия. 2018;1(77):5–15. doi: 10.30629/2618-6667-2018-77-5-15Kornilov VV. The role of the pathological reaction of grief in the development of late-stage dementia. Psychiatry (Moscow) (Psikhiatriya). 2018;1(77):5–15. (In Russ.). doi: 10.30629/2618-6667-2018-77-5-15Cai W, Mueller C, Shetty H, Perera G, Stewart R. Predictors of mortality in people with late-life depression: A retrospective cohort study. J Affect Disord. 2020;266:695–701. doi: 10.1016/j.jad.2020.01.021Cai W, Mueller C, Shetty H, Perera G, Stewart R. Predictors of mortality in people with late-life depression: A retrospective cohort study. J Affect Disord. 2020;266:695–701. doi: 10.1016/j.jad.2020.01.021Petersen RC, Lopez O, Armstrong MJ, Getchius TS, Ganguli M, Gloss D, Gronseth GS, Marson D, Pringsheim T, Day GS, Sager M, Stevens J, Rae-Grant A. Practice guideline update summary: Mild cognitive impairment: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2018;90(3):126–135. doi: 10.1212/WNL.0000000000004826Petersen RC, Lopez O, Armstrong MJ, Getchius TS, Ganguli M, Gloss D, Gronseth GS, Marson D, Pringsheim T, Day GS, Sager M, Stevens J, Rae-Grant A. Practice guideline update summary: Mild cognitive impairment: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2018;90(3):126–135. doi: 10.1212/WNL.0000000000004826Leonard BE. In-ammation, depression and dementia: are they connected? Neurochem Res. 2007;32(10):1749–1756. doi: 10.1007/s11064-007-9385-yLeonard BE. In-ammation, depression and dementia: are they connected? Neurochem Res. 2007;32(10):1749–1756. doi: 10.1007/s11064-007-9385-y

The authors declare that there are no conflicts of interest present.