Melancholic and atypical latent subtypes of late-life depression do not tend to transition to other subtypes over time, and symptoms of depression may be confused with the normal symptoms of aging, a study in the Journal of Affective Disorders suggests.

Eveline Veltman, of the Department of Psychiatry, Leiden University Medical Center, The Netherlands, and colleagues collected data from both the baseline and 2-year follow-up periods of the Netherlands Study of Depression in Older persons (NESDO). A total of 111 older patients (mean age, 70.9±7.7 years; 67% women) with a 6-month diagnosis of major depressive disorder at baseline and at 2 years were included in the analysis. To identify depression subtypes in participants at baseline and 2-year follow-up, a latent class analysis was performed. The stability of these subtypes over time was assessed using a latent transition analysis. Additionally, researchers examined transition rates between subtypes, characteristics of groups, and depressive symptom severity with use of the Inventory of Depressive Symptomatology.

In the study, there was a melancholic depressive subtype prevalence of 80.2% at baseline and 62.2% at 2 years, whereas the atypical subtype had a prevalence of 19.8% at baseline and 37.8% at 2-year follow-up. Symptoms associated with the melancholic subtype included decreased appetite and weight loss, and atypical subtype symptoms included increased appetite and weight gain. The stabilities of each subtype were 0.86 for melancholic and 0.93 for atypical depression.

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The investigators found differences between stable and transitioning subgroups in regards to mean age (P =.04) and mean education level (P =.05). However, 1 limitation of the study was the small sample size, which the researchers suggest may have reduced the reliability of the latent transition analysis.

According to the investigators, the findings from this study “stress the importance of taking the pathophysiological tangle of aging into account when searching for a better approach to diagnosis, treatment and prevention of late-life depression.”


Veltman EM, Kok AAL, Lamers F, et al. Stability and transition of depression subtypes in late life [published online January 14, 2020]. J Affect Disord. doi: 10.1016/j.jad.2020.01.049