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Antidepressant usage in over 65s increases, despite fewer depression diagnoses

The number of patients aged 65 and above being prescribed antidepressants has more than doubled over the past two decades, despite a slight decrease in diagnoses of depression, a new study has shown.

Research published in the British Journal of Psychiatry, Cognitive Function and Ageing Studies found the proportion of over 65s on antidepressants leapt from 4.2% in the early 1990s, to 10.7% twenty years later.

However, over the same period the prevalence of depression in this group of older patients dropped from an estimated 7.9% in the early 1990s, to 6.8% now, according to the researchers from the universities of East Anglia, Cambridge, Newcastle and Nottingham.

Those behind the study said regular review of patients was key to identify opportunities to deprescribe safely, but also noted some patients had unrecognised depression, who might benefit from antidepressants.

GP leaders have stressed the increase  in antidepressant use could be down to greater acceptance of mental health conditions leading to more people seeking help - and that GPs only prescribe after a frank conversation with patients.

Researchers interviewed more than 15,000 patients aged over 65 in England and Wales over the course of the study -  between 1991 and 1993, then again from 2008 to 2011.

They found depression and antidepressant use were consistently observed more in women than men, and that depression was also associated with living in more deprived areas.

Lead study author Professor Antony Arthur, from the University of East Anglia, 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.'

He told Pulse: ‘We shouldn’t be complacent and regular review is key to ensure that opportunities to deprescribe where it is safe and sensible to do so are not overlooked.

‘There is also a group of patients who have depression who are not taking antidepressants so GPs need to be vigilant with this group to discern whether it’s unrecognised depression that would be responsive to treatment.’

Commenting on the findings, RCGP chair Professor Helen Stokes-Lampard, said: ‘This increase in antidepressant 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.'

She said GPs will only prescribe antidepressants 'after a full and frank conversation with their patient' and that they also explore alternative options to drug therapy, such as talking therapies.

This comes after a trial looking at how antidepressants work found they tackle symptoms of anxiety, rather than depression. Another recent study has also shown NICE may have inadvertently boosted rates of antidepressant prescriptions in under-18s.

Elsewhere, Public Health England's review of addictive medicines found a quarter of adults in England were prescribed these types of drugs between 2017 and last year - with GPs stressing the lack of alternatives.

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