Increasing age linked to poorer clinical course of depression
Increasing age in adults with depression may be associated with a less favourable long-term disease course. A new study published in BMJ Mental Health by researchers at Karolinska Institutet and Amsterdam University Medical Center shows that depressive and anxiety symptoms declined more slowly with age and that older participants were more likely to experience a chronic course of depression.
Depression and anxiety often have a long-lasting or recurring course, but previous studies have provided conflicting results on whether prognosis differs with age. It has also been unclear whether possible age differences can be explained by factors that change with aging such as physical health, lifestyle, social circumstances or treatment.
Researchers examined 1,701 individuals aged 18–65 years with a current depressive disorder, anxiety disorder, or both from the Netherlands Study of Depression and Anxiety (NESDA). Participants were clinically assessed every two years over a six-year period.
Slower improvement in depression
Although symptoms tended to decline over time, depressive and anxiety symptoms decreased more slowly with increasing age. The researchers also examined whether participants experienced early remission, late remission, recurrence or a chronic course of illness, finding that a chronic course was more common with increasing age. This association was mainly driven by depression, while there was no indication of age differences in the course of anxiety disorders.
“Our findings suggest that age itself may provide clinically relevant information about the long-term prognosis of depression. Even across adulthood, we see a gradual tendency towards slower improvement and greater chronicity with increasing age,” says Federico Triolo, postdoctoral researcher at the Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and first author of the study.
Interestingly, taking social, lifestyle, physical health and clinical factors that varied with age into account did not explain the slower decline in depressive symptoms associated with increasing age. This suggests that other processes related to ageing may also be involved.
Results may call for more age-adapted depression care
According to the researchers, the findings highlight the importance of sustained clinical attention to depression throughout adulthood, particularly as patients get older.
“Age should not be interpreted as determining an individual patient’s outcome, but our results suggest that clinicians may need to be particularly attentive to the risk of persistent depression as people age. Closer follow-up and timely optimisation of treatment may be especially important,” says Federico Triolo.
The researchers emphasise that the study was observational and therefore cannot determine why depression had a less favourable course with increasing age. The study also included people only up to the age of 65, meaning that the findings cannot automatically be extended to people in older age groups.
The study was conducted using data from the Netherlands Study of Depression and Anxiety and involved researchers from Karolinska Institutet and Amsterdam UMC, and was supported by the Svenska Sällskapet för Medicinsk Forskning (SSMF).
Publication
Six-year clinical course of depressive and anxiety disorders: analysis by age
Federico Triolo, Laura KM Han, Hans W Jeuring, Erik J Giltay, Brenda WJH Penninx
BMJ Mental Health, 6 October 2026. Doi: 10.1136/bmjment-2026-302895