Results show very high rates of lifetime but not current major depression. Rates of current phobia and suicidal ideation in the very elderly are also high compared with other studies. The rates reported are likely to be underestimates.

No abstract

Escitalopram is significantly more effective than paroxetine in the long-term treatment of severely depressed patients.

There is compelling evidence that serotonin system dysfunction is associated with certain behavioral disorders, such as suicidal behavior and impulsive aggression. A functional polymorphism in the promoter region of the serotonin transporter gene (5-HTTLPR) was recently identified and the presence of the short allele found to be associated with a lower level of expression of the gene, lower levels of 5-HT uptake, suicidal behavior and anxiety-related traits. We genotyped 51 West European Caucasians who had made violent suicide attempts and 139 controls of the same ethnic origin, with no history of suicidal behavior. The frequencies of the S allele and the SS genotype were significantly higher in the violent suicide attempters than in the controls. The odds ratio for the SS genotype vs the LL genotype was 3.63 (95% CI (1.27-10.40)). This suggests that a change in expression of the gene encoding the 5-HT transporter may be involved in violent suicidal behavior. Molecular Psychiatry (2001) 6, 338-341. Since the seminal studies by Asberg and collaborators in the mid 1970s, 1 most studies have shown that impulsive aggression and suicidal behavior are correlated with low levels of 5-HT transmission.2 This association is stronger for more severe phenotypes: lethal and/or violent suicidal behavior and violent aggressive behavior.3-5 The magnitude and duration of serotonergic activity is believed to be regulated mainly by the human serotonin transporter (5-HTT), which controls the uptake of serotonin from the synaptic junction.6,7 The human 5-HTT is in a presynaptic location and Lesch et al 7 have demonstrated that it is identical in platelets and in the brain. Conflicting results have been obtained in studies of the platelet 5-HT transporter in individuals with suicidal behavior. Some studies have shown a decrease in the number of 5-HT transporter recognition sites in such individuals, as shown by the radiolabeled ligand-binding technique, and in the amount of 5-HT transporter protein, as shown by 5-HT uptake measurements. 8,9 Despite differences in the results obtained, probably due to differences in the ligands used, studies of radioligand binding in the brainstem of individuals who have committed suicide and in platelets have provided evidence that there is a negative association between serotonin dysfunction and impulsive aggression and violent or suicidal behavior. [8][9][10][11] Coccaro et al 11 studied patients with personality disorders and found a negative correlation between aggression and tritiated paroxetine binding to platelet serotonin transporter sites. Roy 9 recently reported that the affinity of the serotonin uptake protein for serotonin is lower in depressed patients displaying suicidal behavior than in depressed patients who have never attempted suicide and in controls. This lower affinity for serotonin was also found to have predictive value for subsequent suicide attempts and suicides during a 5-year follow-up period.Pharmacological studies have also provided evidence that the serotonin transport...