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Use of antidepressants in over 65s doubles

Yet depression prevalence unchanged

Jo Carlowe

Monday, 07 October 2019

More elderly people are using antidepressants, despite little change in the number of older diagnoses.

Research led by the University of East Anglia shows that the proportion of people aged over 65 on antidepressants has more than doubled in two decades from 4.2% in the early nineties to 10.7% 20 years later

The estimated prevalence of depression among over 65s in the early 1990s was 7.9% compared to 6.8% 20 years later.

The findings* are based on the Cognitive Function and Ageing Studies, conducted at two time points - between 1991 and 1993, and between 2008 and 2011.

Researchers interviewed more than 15,000 over 65s in England and Wales to see whether the prevalence of depression and antidepressant use is changing.

Lead author Professor Antony Arthur, from UEA's School of Health Sciences, said: "Depression is a leading cause of poor quality of life worldwide and we know that older people may be less likely than other age groups to go to their GP with symptoms of depression.

"Until now, little was known about how the relationship between the prevalence of depression and antidepressant use among older people has changed over time. The Cognitive Function and Ageing Studies led by the University of Cambridge have the ability to examine changes in the health needs of older people across generations based on random sampling and diagnostic methods held constant over time.

"We asked participants 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 characterised by minor mood symptoms, such as loss of energy, interest or enjoyment.”

The study's lead investigator Professor Carol Brayne, director of the Cambridge Institute of Public Health, said: "Our research has previously shown a dramatic age-for-age drop in dementia occurrence across generations. This new work reveals that depression has not shown the same reduction even in the presence of dramatically increased prescribing, itself not without concern given potential adverse effects we have also shown that are associated with polypharmacy.”

The study found that both depression and antidepressant use was more common in women than men at both time points, and that depression was associated with living in a more deprived area.

"Between two comparable samples interviewed 20 years apart (1990-93 and 2008-11) we found little change in the prevalence of depression, but the proportion of participants taking antidepressants rose from 4% to almost 11%. This could be due to improved recognition and treatment of depression, overprescribing, or 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. 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.”

Commenting on the findings, Professor Helen Stokes-Lampard, chair of the Royal College of GPs, said: “This increase in anti-depressant use among older people could indicate a greater awareness and acceptance of mental health conditions in society, and show more people over 65 are seeking help for mental health problems which in the past may have been ignored or under-treated - which are both encouraging.

“We also have much better understanding of the effectiveness of antidepressants than we did in the early 90s - and it’s important to remember that current evidence shows these drugs work well when prescribed appropriately.

“GPs will only prescribe anti-depressants after a full and frank conversation with their patient, taking into account the physical, psychological and social factors potentially impacting on their health. But we will also explore alternative options to drug therapy, such as talking therapies - and we know that many older people, who perhaps are lonely, might benefit more from social prescribing schemes, for example joining a class or local community group, than traditional treatments.”

She added: “What these findings also highlight is a worrying link between mental health and social determinates of health, such as deprivation, so we need to make sure that all patients, no matter where they live, have access to alternative therapies and support, if it is felt these are more appropriate than medication.

"NHS England's long-term plan pledges that every GP practice will have access to one of 3,000 new mental health therapists, and one of 1,000 social prescribers or link workers - we need this to be delivered as a matter of urgency, so that we can continue to provide the best possible mental health care to our patients."

*Arthur A, Savva GM, Barnes LE, et al. Changing prevalence and treatment of depression among older people over two decades. Cambridge University Press: 07 October 2019. DOI:10.1192/bjp.2019.193

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