In a prospective study, 34 patients with delusional depression were compared with 100 non-psychotically depressed patients and a subgroup of 30 age-and sex-matched control patients. Depressed patients with delusions were more likely to be single, especially single men. The most common delusions were those of persecution and hypochondriasis. There were no striking differences in other depression symptoms and no evidence for the hypothesis that delusional depression is associated with a later age of depression onset.
KEY womsdepression; delusions; psychotic; ageing; elderly
Delusional depression is a distinct subtype of major depression. In studies of mixed-aged or younger adults, compared with non-delusional depression there are differences in glucocorticoid and dopamine-P-hydroxylase activity, levels of dopamine and serotonin metabolites, sleep measures and ventricle-to-brain ratios (summarized by Schatzberg and Rothschild, 1992). Furthermore, the presence of delusions tends to run true through relapses of depression (Charney and Nelson, 1980).
In an earlier study, I confirmed that a number of the above distinguishing features of delusional depression are valid for elderly patients (Baldwin, 1988). Nevertheless, delusional depression in older patients remains a relatively neglected area of research.
There are clinical and theoretical reasons for studying delusional forms of depression as a separate entity. First, the treatment of the delusional variant of depressive illness differs from nondelusional depression (Baldwin, 1988). Second, Meyers and Greenberg (1986) found an increase in delusional forms of depression with increasing age at onset. In an elderly sample of 161 patients,