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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. 


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