Emotional withdrawal, CT abnormalities and drug response in late life depression

In this study, the authors investigated if CNS degenerative abnormalities could correlate with depressive symptoms in elderly patients, if the presence of mild/moderate cognitive impairment could be related to the response to treatment and the role of peculiar clinical features in influencing the response to treatment. Fifty-three patients (60–75 years) diagnosed as affected by late onset (after 60 years) Major Depressive Episodes according to DSM-IV criteria were studied. Brain vascular and degenerative markers were assessed by computed tomography (CT) through measurements of a lateralized version of the bifrontal index and a rating scale addressing subcortical disease. The presence of mild/moderate cognitive impairment [(24–28 total score at the Mini-Mental State Examination (MMSE)], and of specific symptoms were assessed at baseline and evaluated with respect to the antidepressant response. Patients with CT abnormalities showed higher baseline scores on Hamilton Rating Scale for Depression (HAM-D) items “late insomnia” ( t=−2.674, P=.002), “somatic symptoms” ( t=−3.355 P=.002), and Brief Psychiatric Rating Scale (BPRS) item “emotional withdrawal” ( t=−3.355, P=.002). No significant correlation was found between the vascular index and baseline clinical symptoms, while the HAM-D “depressed mood” item was negatively correlated to the right frontal index ( R=−0.692, P=.006). Patients with CT abnormalities showed a lower reduction of HAM-D total scores than patients with normal CT (time effect: F=29.277, P