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GPs should refer more elderly depression patients for non-drug treatments

Older adults diagnosed with depression could benefit from non-drug treatment such as psychological therapies from their primary care providers, according to a new study.

Researchers from University College London found there may be ‘reduced efficacy’ or potential adverse effects of antidepressants with increased age in patients, and warned the use of antidepressants has not been comprehensively studied in old age groups, such as over-85s.

The paper, published in the BJGP, analysed qualitative data from 27 studies on how GPs and primary care staff treat older people with depression, focusing on referrals to psychological therapies. 

The researchers found 81% of depressed elderly people are prescribed an antidepressant, but ‘over-85s are five times less likely to be referred for psychological therapies as those aged 55-59, and one-third more likely to be prescribed an antidepressant.’

Referrals to Improving Access to Psychological Therapies (IAPT) services are overall as low as 3.5%, which increases with age, according to the researchers, and although social solutions such as day centres were considered the most appropriate approach, they are constrained by stark differences in provision across different areas.

The research team said: ‘Mental ill health needs to be a more prominent concern in the care of older adults, with greater provision of psychological services tailored to later life. This may facilitate future identification and management of depression.'

RCGP chair Professor Helen Stokes-Lampard said: ‘GPs are highly trained to prescribe and will only ever recommend antidepressants after a full and frank discussion with the patient sitting in front of us, based on their individual circumstances, and if we genuinely believe they will help them.

‘We will always try to explore alternative therapies, such as CBT and talking therapies, but access to these therapies in the community is patchy across the country – and there is also a lack of variety, to allow us to match these services to the specific needs of our patients,' she added.

NHS England pledged to improve staff training and links to other services in the GP Foward View and NHS long-term plan, and promised 3,000 new mental health therapists by 2021.

But a Pulse investigation last year found patients referred to IAPT services were increasingly not actually receiving treatment sessions and were ending up back with their GP. 

Readers' comments (9)

  • this was not a new study but a review of lots of different studies put together and analysed. out of the 27 used only 8 were based in the uk (out of a total of 1471 studies assessed). low numbers in many of the studies, nurses, gps, secondary care and counsellors all put together so not comparing like with like. many of the studies were poor quality. how this is in pulse with this leading title is poor journalism. if you don't know how to interpret a research paper you should not be reporting on it.

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  • National Hopeless Service

    Isolation and loneliness isn't an illness that can be counselled better its a general society issue

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  • If my boiler wasn’t working and nobody took time to visit and chat with me, I’d be less than happy as well.

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  • National Hopeless Service hits the nail on the head

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  • David Banner

    Our referrals for these services are routinely bounced back or ignored , and if anyone makes it into the service they are discharged tout de suite. So our fall back position of doling out SSRIs, then being criticised for not referring, will continue.

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  • Mental health is our priority they say, well it doesn't seem like it on the front line.More of the same from the armchair generals talking to the front line grunts, with precious little action on the executives part.Yawn.

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  • Maybe the low referral rate is because the undertaker takes over further management before the psychological therapy slot arrives.......

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  • GPs know what to do but their efforts are either blocked or changed due to the system by way of time constraints, lack of funding, changed referrals or bounced referrals, pressure and attacks on the GP not to do what is best for patients.

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  • when the 2 options are: 1) manage ourselves with ADs, or 2) refer for anything you like but they will NOT get non-drug therapies, they will only get BZDs and addictive major tranquillisers and then discharged as soon as they are hooked; what is the option in the best interests of the patient and society as a whole?
    Certainly NOT referal!

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