BMJ 1998;317:982-984 ( 10 October )

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Severe deep white matter lesions and outcome in elderly patients with major depressive disorder: follow up study

John O'Brien, senior lecturer in old age psychiatry, a David Ames, associate professor of psychiatry of old age, b Edmond Chiu, associate professor of psychiatry of old age, b Isaac Schweitzer, associate professor of psychiatry, b Patricia Desmond, radiologist, c Brian Tress, professor of radiology. c

a Department of Psychiatry and Institute for the Health of the Elderly, University of Newcastle upon Tyne, Newcastle General Hospital, Newcastle upon Tyne NE4 6BE, b University of Melbourne Department of Psychiatry, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia, c Department of Radiology, Royal Melbourne Hospital, Australia

Correspondence to Dr O'Brien j.t.o'brien{at}ncl.ac.uk

Objective To determine the difference in outcome among elderly people with major depression who do and do not have severe white matter lesions on magnetic resonance imaging.
Design Follow up study.
Setting Two psychiatric and two general hospitals in Melbourne, Australia.
Subjects 60 depressed subjects aged over 55 referred to hospital psychiatric services with major depressive disorder meeting American Psychiatric Association (DSM-IIIR) criteria.
Main outcome measure Proportion with good outcome as determined by full recovery from initial illness and no evidence of depressive relapse or cognitive decline during follow up among those with and without lesions.
Results Mean (SD) follow up was 31.9 (9.9) months. Survival analysis showed a significant effect of severe lesions on time to poor outcome (P=0.04), with median survival 136 days in those with severe lesions compared with 315 days in those without.
Conclusion Severe white matter change on magnetic resonance imaging is associated with poor outcome in elderly depressed subjects.

Key messages

  • Severe deep white matter lesions on magnetic resonance imaging are common in elderly patients with depression

  • Patients with these lesions are at greater risk of poor long term outcome (chronicity and relapse) than those without lesions

  • The neuropathogical and neurochemical correlates of these white matter changes need investigation



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