Co-occurring somatic diseases exhibit complex clinical profiles, which can differentially impact the development of late-life depression. Within a community-based cohort, we aimed to explore the association between somatic disease burden, both in terms of the number of diseases and their patterns, and the incidence of depression in older people.

We analysed longitudinal data of depression- and dementia-free individuals aged 60+ years from the population-based Swedish National Study on Aging and Care in Kungsholmen. Depression diagnoses were clinically ascertained following the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision over a 15-year follow-up. Somatic disease burden was assessed at baseline through a comprehensive list of chronic diseases obtained by combining information from clinical examinations, medication reviews and national registers and operationalized as (i) disease count and (ii) patterns of co-occurring diseases from latent class analysis. The association of somatic disease burden with depression incidence was investigated using Cox models, accounting for sociodemographic, lifestyle and clinical factors.

The analytical sample comprised 2904 people (mean age, 73.2 [standard deviation (SD), 10.5]; female, 63.1%). Over the follow-up (mean length, 9.6 years [SD, 4 years]), 225 depression cases were detected. Each additional disease was associated with the occurrence of any depression in a dose–response manner (hazard ratio [HR], 1.16; 95% confidence interval [CI]: 1.08, 1.24). As for disease patterns, individuals presenting with sensory/anaemia (HR, 1.91; 95% CI: 1.03, 3.53), thyroid/musculoskeletal (HR, 1.90; 95% CI: 1.06, 3.39) and cardiometabolic (HR, 2.77; 95% CI: 1.40, 5.46) patterns exhibited with higher depression hazards, compared to those without 2+ diseases (multimorbidity). In the subsample of multimorbid individuals (85%), only the cardiometabolic pattern remained associated with a higher depression hazard compared to the unspecific pattern (HR, 1.71; 95% CI: 1.02, 2.84).

Both number and patterns of co-occurring somatic diseases are associated with an increased risk of late-life depression. Mental health should be closely monitored among older adults with high somatic burden, especially if affected by cardiometabolic multimorbidity.

Octogenarians of today are better educated, and physically and cognitively healthier, than earlier born cohorts. Less is known about time trends in mental health in this age group. We aimed to study time trends in the prevalence of depression and psychotropic drug use among Swedish 85-year-olds.

We derived data from interviews with 85-year-olds in 1986–1987 (N = 348), 2008–2010 (N = 433) and 2015–17 (N = 321). Depression diagnoses were made according to the Diagnostic and Statistical Manual of Mental Disorders. Symptom burden was assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS). Information on psychotropic drug use, sociodemographic, and health-related factors were collected during the interviews.

The prevalence of major depression was lower in 2015–2017 (4.7%, p < 0.001) and 2008–2010 (6.9%, p = 0.010) compared to 1986–1987 (12.4%). The prevalence of minor depression was lower in 2015–2017 (8.1%) compared to 2008–2010 (16.2%, p = 0.001) and 1986–1987 (17.8%, p < 0.001). Mean MADRS score decreased from 8.0 in 1986–1987 to 6.5 in 2008–2010, and 5.1 in 2015–2017 (p < 0.001). The reduced prevalence of depression was not explained by changes in sociodemographic and health-related risk factors for depression. While psychoactive drug use was observed in a third of the participants in each cohort, drug type changed over time (increased use of antidepressants and decreased use of anxiolytics and antipsychotics).

The prevalence of depression in octogenarians has declined during the past decades. The decline was not explained by changes in known risk factors for depression. The present study cannot answer whether changed prescription patterns of psychoactive drugs have contributed to the decline.

Structural neuroimaging studies have revealed a consistent pattern of volumetric reductions in both the hippocampus and the anterior cingulate cortex (ACC) of individuals with a major depressive episode (MDE). This study investigated hippocampal and ACC volume differences in the elderly comparing currently depressed individuals and individuals with a past lifetime history of MDE versus healthy controls.

We studied non-demented individuals from a cohort of community-dwelling people aged 65 and over (ESPRIT study). T1-weighted magnetic resonance images were used to acquire anatomical scans from 150 currently depressed individuals, 79 individuals with at least one past MDE, and 310 healthy controls. We derived quantitative regional estimates of subcortical volume of hippocampus and ACC using FreeSurfer Software (automated method). Concerning hippocampus, we also used a manual method of measurement. General Linear Model was used to study brain volumes in current and past depression adjusting for gender, age, education level, total brain volume, and anxiety disorder comorbidity.

After adjustment, current depression was associated with a lower left posterior hippocampal volume (F = 10.38, P = 0.001) using manual estimation of volume. No other significant differences were observed. A positive correlation was found between time since the last MDE and left posterior hippocampal volume.

The finding of left posterior hippocampal volume reduction in currently depressed individuals but not in those with a past MDE compared to healthy controls could be related to brain neuroplasticity. Additionally, our results suggest manual measures to be more sensitive than automated methods.

The authors have not supplied their declaration of competing interest.

Both morbidity and mortality are elevated for individuals with subsyndromal depression (SSD) compared to non-depression (ND) in those of younger ages, but scientific studies are scarce for very old individuals. The aim of this study was therefore to compare the morbidity and mortality in very old individuals with SSD and ND.

An 8-year prospective population-based study was undertaken on 85-year-old individuals in Sweden.

Data were collected from postal questionnaires and clinical assessments at baseline, after 1, 5, and 8 years. Depressive symptoms were measured with Geriatric Depression Scale and the results were classified into ND, SSD, and syndromal depression. Mortality was investigated using multivariable cox regressions, and variables of morbidity were investigated using linear mixed models.

Compared to ND, in people with SSD, mortality was elevated in the univariate regression, but this association vanished when controlling for relevant covariates. Morbidity was elevated with regard to basic activities of daily living (ADLs), instrumental ADLs, loneliness, self-perceived health, and depressive symptoms for individuals with SSD compared to ND, whereas cognitive speed, executive functions, and global cognitive function were not significantly impaired when adjusting for covariates.

SSD among very old individuals is longitudinally associated with elevated morbidity but not mortality, when controlling for relevant covariates. Considering the high prevalence of SSD and the demographic development of increasing numbers of very old people, the findings highlight the need to develop clinical and societal strategies to prevent SSD and associated negative outcomes.

Use latent class analysis (LCA) to identify patterns of cognitive functioning in a sample of older adults with clinical depression and without dementia and assess demographic, psychiatric, and neurobiological predictors of class membership.

Neuropsychological assessment data from 121 participants in the Alzheimer’s Disease Neuroimaging Initiative-Depression project (ADNI-D) were analyzed, including measures of executive functioning, verbal and visual memory, visuospatial and language functioning, and processing speed. These data were analyzed using LCA, with predictors of class membership such as depression severity, depression and treatment history, amyloid burden, and APOE e4 allele also assessed.

A two-class model of cognitive functioning best fit the data, with the Lower Cognitive Class (46.1% of the sample) performing approximately one standard deviation below the Higher Cognitive Class (53.9%) on most tests. When predictors of class membership were assessed, carrying an APOE e4 allele was significantly associated with membership in the Lower Cognitive Class. Demographic characteristics, age of depression onset, depression severity, history of psychopharmacological treatment for depression, and amyloid positivity did not predict class membership.

LCA allows for identification of subgroups of cognitive functioning in a mostly cognitively intact late life depression (LLD) population. One subgroup, the Lower Cognitive Class, more likely to carry an APOE e4 allele, may be at a greater risk for subsequent cognitive decline, even though current performance on neuropsychological testing is within normal limits. These findings have implications for early identification of those at greatest risk, risk factors, and avenues for preventive intervention.

Late life depression (LLD) confers significant morbidity and mortality but is well recognized that it often goes undetected or untreated. The objective of this study is to quantify the burden of untreated depression and death ideation (DI) at a population level.

Cross-sectional study ascertaining the prevalence of, and factors associated with, untreated depression and DI.

This study, embedded within the Irish Longitudinal Study on Ageing, involves over 7,000 community-dwelling people aged ≥50 years.

Depression was defined as Centre for Epidemiological Studies Depression scale ≥16 indicating current clinically relevant depressive symptoms or Composite International Diagnostic Interview indicative of major depressive episode within the last year. Participants not prescribed antidepressants/antipsychotics were defined as untreated. To define DI, participants were asked “In the last month, have you felt like you would rather be dead?”

In total, 12% (839/7,055) met criteria for depression with 29% (241/839) on pharmacological therapy. Those with untreated depression were less likely to endorse symptoms of persistent low mood or worthlessness, but there was no difference in age or general practitioner (GP) visits compared to those on treatment. Over 3% (223/7,055) of participants had DI and less than one-third had visited their GP within the last year.

This study demonstrates that two-thirds of depressed older people are not prescribed antidepressant/antipsychotic therapy. It is important to raise awareness of depression among older people and healthcare professionals, with particular focus on the fact that LLD is not an inevitable consequence of ageing and effective treatment is available.

To compare response, remission and switch (to other pulse width and/or electrode placement) rates and number of treatments between groups receiving right unilateral ultra-brief (RUL-UB), Bitemporal brief (BT), Bifrontal Brief (BF) and Right unilateral brief (RUL-B).

Data was collected from case notes in three centers. There were 133 in total, grouped as RUL-UB (50), BT (43), BF (23), RUL-B (17). Two of the three centers had a preferred electrode placement and pulse width.

Apart from age, the groups did not differ significantly on sex distribution, proportion of bipolar depression and psychotic symptoms. 56% of patients in RUL-UB switched compared to 12.5% in RUL-B, 4.9% in BT and none in BF (p value < 0.0001). When we considered patients who switched as treatment failures, remission rates were significantly different (p value < 0.0001) 40% in RUL-UB, 81.3% in RUL-B, 73.9% in BF and 78.0% in BT. Mean number of treatments in each group was significantly different (p value < 0.0001); 12.02 in RUL-UB, 10.2 in RUL-B, 7 in BF and 7.5 in BT. Post-hoc analysis indicated that RUL-UB differed significantly from BT and BF. Final response and remission rates including patients who switched were 98% and 82% in RUL-UB, 100% and 93.8% in RUL-B, 100% and 73.9% in BF and 97.7% and 83.7% in BT.

Majority commencing RUL-UB switched and received 4–5 more treatments compared to bilateral placements. RUL-UB ECT appears less effective and might not be appropriate as first line for all older adults as some patients at higher anaesthetic risk would benefit from having reduced number of treatments.

Although previous studies on late life depression (LLD) have shown morphological abnormalities in frontal–striatal–temporal areas, alterations in coordinated patterns of structural brain networks in LLD are still poorly understood. The aim of this study was to investigate differences in gray matter structural brain network between LLD and healthy controls.

We used gray matter volume measurement from magnetic resonance imaging to investigate large-scale structural brain networks in 37 LLD patients and 40 normal controls. Brain networks were constructed by thresholding gray matter volume correlation matrices of 90 regions and analyzed using graph theoretical approaches.

Although both LLD and control groups showed a small-world organization of group networks, there were no differences in the clustering coefficient, the path length, and the small-world index across a wide range of network density. Compared with controls, LLD patients showed decreased nodal betweenness in the medial orbitofrontal and angular gyrus regions. In addition, LLD patients showed hub regions in superior temporal gyrus and middle cingulate gyrus, and putamen. On the other hand, the control group showed hub regions in the medial orbitofrontal gyrus, middle cingulate gyrus, and cuneus.

Our findings suggest that the gray matter structural networks are not globally but regionally altered in LLD patients. This multivariate structural analysis using graph theory might provide a more appropriate paradigm for understanding complicated neurobiological mechanism of LLD.