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Veltman, E.M. (2020)

Patterns of late-life depression: On the nature of depressive subtypes and the role of aging

Doctoral Thesis
In this thesis the heterogeneity of late-life depression is being examined. The first part of the thesis focuses on data-driven analyses as a way of identifying subtypes of late-life depression. Through latent class analysis, we have identified three subtypes: a severe melancholic subtype, an atypical subtype, and a moderately severe subtype. These subtypes had different sociodemographic and clinical characteristics, but no specific biological disturbances could be addressed to the different subtypes. This is probably because of the tangle of (patho)physiological processes in aging itself, muddling the results. The stability of these subtypes over a two-year follow-up was however high, strengthening the clinical relevance of found subtypes.
The second part of this thesis examines psychomotor disturbances in melancholic depression as a possible predicting symptom of response in electroconvulsive therapy. We have found that psychomotor disturbances...Show moreIn this thesis the heterogeneity of late-life depression is being examined. The first part of the thesis focuses on data-driven analyses as a way of identifying subtypes of late-life depression. Through latent class analysis, we have identified three subtypes: a severe melancholic subtype, an atypical subtype, and a moderately severe subtype. These subtypes had different sociodemographic and clinical characteristics, but no specific biological disturbances could be addressed to the different subtypes. This is probably because of the tangle of (patho)physiological processes in aging itself, muddling the results. The stability of these subtypes over a two-year follow-up was however high, strengthening the clinical relevance of found subtypes.
The second part of this thesis examines psychomotor disturbances in melancholic depression as a possible predicting symptom of response in electroconvulsive therapy. We have found that psychomotor disturbances predict to a certain amount the response to electroconvulsive therapy, but this effect was overruled by the predictive value of psychotic symptoms in depression. Finally, we have examined the speed of response of different depressive symptoms on electroconvulsive therapy in older depressed persons, and have found that all ten symptoms show response in two weeks, underlining the safety and efficacy of electroconvulsive therapy in older persons.Show less
Late-life depression
Melancholic depression
Atypical depression
Depressive subtypes
Metabolic syndrome
Electroconvulsive therapy
Psychomotor disturbances in depression
All authors
Veltman, E.M.
Supervisor
Mast, R.C. van der; Stek, M.L.
Co-supervisor
Rhebergen, D.
Committee
Deeg, D.J.H.; Gussekloo, J.; Hemert, A.M. van; Penninx, B.W.J.H.
Qualification
Doctor (dr.)
Awarding Institution
Leiden University of Medical Center [LUMC], Leiden University
Date
2020-03-03
ISBN (print)
9789463806770