The number of people aged 65 years or older who are taking antidepressants has more than doubled over the course of two decades, report researchers.
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However, the increase in antidepressant use was not accompanied by any change in the number of people diagnosed with depression.
The researchers also showed that among older people who are taking antidepressants, the majority do not have symptoms of depression.
The study, which was led by a team at the University of East Anglia, has triggered concerns about the rate at which doctors are dishing out the potentially addictive medication.
Experts have warned that many patients end up staying on the drugs because they are worried about withdrawal symptoms and their doctors fail to review their medication.
Elderly patients must be helped to come off the drugs
Lead author Anthony Arthur says that elderly patients must be given more help to come off the drugs.
“We need to be vigilant about the regular review of people taking antidepressants. Patients who have been on antidepressants for a long time should see their GP to discuss de-prescribing.
The professor of nursing science at the University’s School of Health Sciences says that until now, little has been known about how the relationship between the prevalence of depression and antidepressant use among older people has changed over time.
To investigate, the researchers examined the Cognitive Function and Ageing Studies, two population-based cohort studies covering a total of more than 15,000 people (aged 65 years or older) in England and Wales. The first study was conducted between 1991 and 1993 and the second was conducted between 2008 and 2011. Depression was assessed using the Geriatric Mental State examination and was diagnosed using the Automated Geriatric Examination for Computer-Assisted Taxonomy algorithm.
Participants were asked about their health, daily activities, use of health and social care services, and the medications they were taking.
“We used a standardised interview process to ascertain the presence or absence of symptoms of depression and then applied diagnostic criteria to see whether the participant was considered to have ‘case level’ depression, a level of depression more severe than that characterized by minor mood symptoms, such as loss of energy, interest or enjoyment.
The proportion taking antidepressants more than doubled
As reported in the British Journal of Psychiatry, the proportion of people taking antidepressants rose from 4.2% to 10.7% between 1991 and 2011.
Despite this increase, however, the estimated prevalence of depression among this age group fell from 7.9% to 6.8%.
Depression and the use of antidepressants was more common among women than among men across both time periods and depression was associated with living in a more deprived area.
The proportion of people in residential care homes fell, but the prevalence of depression in the homes stayed the same, with around 10% of individuals affected.
Most people on the medication did not have depression symptoms
At both time points, the majority of people with case-level depression were not on antidepressants, while most of the people who were on antidepressants did not have symptoms of depression.
Arthur says the increase in antidepressant use may be explained by improved recognition and treatment of depression, overprescribing, or the use of antidepressants for other conditions.
“Whatever the explanation, substantial increases in prescribing has not reduced the prevalence of depression in the over-65 population,” says Arthur
Depression affects one in 15 people aged over 65, and its impact is felt by the individual, their families and friends, he adds.
“The causes of depression in older people, the factors that perpetuate it, and the best ways to manage it remain poorly understood and merit more attention.
Changing prevalence and treatment of depression among older people over two decades. Antony Arthur et al. Cambridge University Press. https://doi.org/10.1192/bjp.2019.193