Prognosis of Late-Life Depression: Clinical and Immunological Characteristics

Objectives. To study the outcomes of depression in late age in a three-year prospective follow-up study in patients with different immunophenotypes. Materials and methods. A cohort of patients with depressive disorders who were treated in a geriatric psychiatric hospital were followed up at one and three years. A group with immunophenotype A (with increased leukocyte elastase (LE) activity and complex depression comorbid with anxiety and senestho-hypochondriacal disorders) consisted of 20 patients: six men (30.0%) and 14 women (70.0%), median age 68 years. Depressive episode (DE) as part of recurrent depressive disorder (RDD) was diagnosed in 13 patients (65.0%) and as part of bipolar affective disorder (BAD) in seven patients (35.0%). A group with immunophenotype B (with reduced LE activity and prolonged apathetic- adynamic depression) consisted of 31 patients: 10 (32.3%) men and 21 (67.7%) women, median age 68 years. Twenty patients (64.5%) were diagnosed with DE in the framework of RDD and nine patients (29.0%) in the framework of BAD, while two patients (6.5%) had single-episode DE. Patients were examined using clinical, psychometric, immunological, and clinical follow-up methods (at one and three years). Results. A more favorable course of illness with high-quality remissions was observed in patients with immunophenotype A (in 95% of cases at one and three years; χ² = 10.44; p = 0.001 and χ² = 11.97; p = 0.001, respectively). Patients with immunophenotype B showed a prevalence of an unfavorable course of illness (in 83.9% and 87.1% of cases at one and three years; χ² = 11.32; p = 0.001 and χ² = 11.77; p = 0.001, respectively), with low-quality remissions (with residual depressive disorders, developing on the background of repeated depressive episodes and chronicization of depression). Conclusions. This study revealed a relationship between clinical and biological features and the course of late-life depression.