Late-Life Depression Prognosis — MRCPsych Paper B MCQ

Correct answer: C — Acute response and remission are broadly similar, but relapse or further episodes are more likely.

Explanation lettering: D = shown as B · B = shown as C · C = shown as D

B is correct. Comparative evidence suggests that older and middle-aged adults do not differ sufficiently in acute response or remission rates for age alone to imply treatment resistance. However, older patients appear more likely to experience relapse or further depressive episodes. Medical comorbidity, functional impairment and previous episodes may contribute to the poorer longer-term course and reduced treatment tolerability. Late-life depression is also associated with cognitive impairment and subsequent dementia, although this does not prove that depression directly causes dementia; it may sometimes represent shared vascular or neurodegenerative pathology or a prodromal presentation. A incorrectly predicts a better course. C ignores relevant age-associated and comorbidity-related prognostic factors. D and E incorrectly portray depression as either acutely untreatable or reliably self-limiting.

Reference: Mitchell AJ, Subramaniam H. Prognosis of depression in old age compared to middle age: a systematic review of comparative studies. American Journal of Psychiatry. 2005;162:1588–1601. https://pubmed.ncbi.nlm.nih.gov/40687743/