Antidepressant use in over 65s more than doubles in 20 years – study

Antidepressant use amongst older people has more than doubled in 20 years, despite the estimated prevalence of depression dropping slightly, a study has found.

Just over 10% of over-65s in the research used antidepressants in 2008-2011 – up from 4.2% in the early 1990s.

Over the same period, the estimated prevalence of depression in the same age group fell from 7.9% to 6.8%, according to the University of East Anglia-led study.

Researchers interviewed more than 15,000 over 65s in England and Wales between 1990/1-1993, and 2008-2011 as part of the Cognitive Function and Ageing Studies.

They asked participants about their health, daily activities, use of health and social care services, and medications.

They also identified people showing symptoms of case level depression – more severe than minor mood – including loss of energy, interest or enjoyment.

During both time periods, the researchers found that most people with symptoms indicating they had case-level depression were not on antidepressants.

And most of those on antidepressants did not have case-level depression.

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 authors said it is unclear whether the increases in treatment reflect “overdiagnosis, better recognition and prescribing, or the prescribing of antidepressant medication for conditions other than depression”.

Lead author Professor Antony Arthur, from UEA’s School of Health Sciences, said: “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.”

The research was led by the UEA in collaboration with the University of Cambridge, the University of Newcastle and the University of Nottingham.

The findings are published in the British Journal of Psychiatry.

Professor Helen Stokes-Lampard, chairwoman 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.”