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In 1993, a survey was conducted in 46 of the 47 nursing homes in a health district of Sydney. Medication cards and notes of all residents (N = 2414) were studied. Subjects who were willing and able to answer questions were interviewed by research assistants (senior nurses). Using the Mini‐Mental State Examination and Mental Status Questionnaire, about 80% were found to be cognitively impaired. Of 874 subjects assessed with the Geriatric Depression Scale (GDS), 30.4% scored in the clearly depressed range (14 or more) of whom 27.4% were taking antidepressants. From a subsample of 26 with GDS scores of 14+, the psychiatrist concluded that only one‐third would fulfil DSM‐III‐R criteria for major depression, with or without dementia. The dosages of antidepressants used in these nursing homes were relatively low. Of residents taking a tricyclic or mianserin, 48% were taking less than 30 mg daily, even though in 72% of cases their doctors stated the primary reason they were having this medication was to treat or prevent recurrence of depression. Opinions and evidence concerning the efficacy of such low dosage are conflicting. There is a need for further research, including correlation of efficacy with blood levels of antidepressants.