Older patients’ aversion to antidepressants

Givens, Lane L.; Datto, Catherine; Ruckdeschel, Katy; Knott, Kathryn; Zubritsky, Cynthia; Oslin, David W.; Nyshadham, Soumya; Vanguri, Poornima; Barg, Frances K.

doi:10.1007/s11606-006-0249-y

Cited by 24 publications

(27 citation statements)

References 32 publications

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“…These results suggest that there may be an ongoing shift in how clinicians are treating depression in older persons. This shift may reflect a diminishing fear of the stigmatization of receiving treatment for depression that has been previously reported in older persons (Givens et al, 2006; Montano, 1999; Sirey et al, 2001) and perhaps a greater acceptance, by both patients and physicians, of nonpharmacologic therapy as an effective treatment.…”

Section: Discussionmentioning

confidence: 83%

Under-treatment of depression in older persons

Barry

Abou

Simen

et al. 2012

Journal of Affective Disorders

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Background Due to the cross-sectional design of most existing studies, longitudinal characterization of treatment for depression in older persons is largely unknown. Method 754 men and women (aged 70+ years) underwent monthly assessments of mental health professional use and 18-month assessments of antidepressant medication use and depressive symptoms over 9 years. Scores of ≥20 on the Center for Epidemiological Studies-Depression (CES-D) scale denoted depression. We evaluated trends in depression treatment over time in the entire sample and among the depressed participants. Using generalized linear models, we determined characteristics associated with receiving treatment for depression in these groups and among those with persistent depression. Results During the 9-year follow-up period (1998–2007), 339 (45.0%) of the participants reported depression treatment. Over time, antidepressant use alone decreased (p trend <0.001) while treatment with both antidepressants and a mental health professional increased (p trend = 0.002). Of the 286 (27.9%) depressed participants, between 43% and 69% did not receive depression treatment during any 18-month interval. 30.5% of the 121 participants with persistent depression did not receive treatment during the study period. Increasing number of years of education, decreasing cognitive status score, and being physically frail were associated with a higher likelihood of receiving treatment in all models. Limitations Pre-baseline depression, pre-baseline treatment, and indication for treatment were unavailable. Conclusions Our findings indicate that the profile of treatment for depression in older persons has changed over time, that depressed older persons, including those with persistent depression, are under-treated, and that patient characteristics influence receipt of treatment.

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Section: Discussionmentioning

confidence: 83%

Under-treatment of depression in older persons

Barry

Abou

Simen

et al. 2012

Journal of Affective Disorders

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“…The efficacy of anti-depressants for mild depression has been questioned (Moncrieff & Kirsch, 2005) and they are not recommended to be used routinely by people with persistent sub-threshold depressive symptoms or mild depression in the first instance (NICE, 2010). There is also a range of side effects (Demyttenaere, 2003), many people do not like taking medicines (Maxwell, 2005;Givens et al, 2006;Townsend, Hunt, & Wyke, 2003;Kessing, Vibe Hansen, Demyttenaere, & Bech, 2005) and early drop-out rates in clinical trials vary from 12% to 40% (Cipriani et al, 2009;Kirsch et al, 2008). Psychological therapies are resource intensive, and may require cognitive capabilities a person with depression cannot attain.…”

Section: Introductionmentioning

confidence: 99%

Walking for depression or depressive symptoms: A systematic review and meta-analysis

Robertson

Jepson

et al. 2012

Mental Health and Physical Activity

201

121

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Problem: Depression is a common disorder worldwide. Most patients are treated within primary care and antidepressant treatment is not recommended for people with mild depression. Physical activity has been shown to alleviate depression but it is not known whether the less vigorous activity of walking -a potentially widely acceptable and safe intervention -confers such benefit.Method: Eleven databases were systematically searched for randomised controlled trials of walking as a treatment intervention for depression, from database inception until January 2012.Meta-analyses were carried out on all trials eligible for inclusion and on sub-groups of outdoor, indoor and group walking.Results: Of the 14,672 articles retrieved, eight trials met the inclusion criteria. The pooled standardised mean difference (effect size) was -0.86 [-1.12, -0.61] showing that walking has a statistically significant, large effect on symptoms of depression. However, there was considerable heterogeneity amongst the interventions and research populations and it is uncertain whether the results can be generalised to specific populations such as primary care patients.Conclusions: Walking has a statistically significant, large effect on the symptoms of depression in some populations, but the current evidence base from randomised, controlled trials is limited.Thus, while walking is a promising treatment for depression or depressive symptoms with few, if any, contraindications, further investigations to establish the frequency, intensity, duration and type(s) of effective walking interventions particularly in primary care populations would be beneficial for providing further recommendations to clinical practitioners.Keywords: depression, physical activity, walking, systematic review, meta-analysis 2 IntroductionDepression is an illness or mood disorder with a variety of symptoms, the most defining being an inexplicable, enduring feeling of sadness (loss of positive affect). It is categorised as mild, moderate or severe depending upon the number and severity of the symptoms (WHO, 2010). It is a common mental health problem, estimated in 2000 to be the fourth leading cause of disease burden worldwide (WHO, 2003;Ustun, Ayuso-Mateos, Chatterji, Mathers, & Murray, 2004). It causes a level of morbidity comparable to or worse than other common chronic diseases such as asthma and diabetes (Moussavi et al., 2007). In the UK over 75% of patients with depression are treated solely within primary care (NICE, 2010) where prevalence is estimated at 7% (Ostler et al., 2001).Depression is commonly treated with anti-depressant medications, psychological therapies or a combination of both. The efficacy of anti-depressants for mild depression has been questioned (Moncrieff & Kirsch, 2005) and they are not recommended to be used routinely by people with persistent sub-threshold depressive symptoms or mild depression in the first instance (NICE, 2010). There is also a range of side effects (Demyttenaere, 2003), many people do not like taking medicines (Ma...

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“…1,2 Although antidepressants and traditional psychotherapy remain mainstays of therapy, cost-effective non pharmacologic treatments are needed, particularly for older adult and minority populations. 3–6 Previous studies have examined the cost-effectiveness of depression treatments involving both pharmacologic agents and non-pharmacological programs or models of care; however, these studies vary widely with regard to the populations studied and the interventions and economic methods employed. Results indicate a wide range of incremental cost-effectiveness ratios (ICERs) from $2,500-$460,000/ quality-adjusted life year (QALY).…”

Section: Introductionmentioning

confidence: 99%

Cost‐Effectiveness of a Community‐Integrated Home‐Based Depression Intervention in Older African Americans

Pizzi

Jutkowitz

Frick

et al. 2014

J American Geriatrics Society

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Objectives To test the cost-effectiveness of a home-based depression program, Beat the Blues (BTB). Design We conducted a cost-effectiveness analysis as part of a previously reported randomized controlled trial that tested BTB versus a wait-list control group. Setting Community-dwelling older African American adults. Participants African Americans who were ≥55 years of age, English speaking, cognitively intact (MMSE ≥24), and had depressive symptoms (PHQ-9 score ≥5) (N=129). Intervention Participants randomly assigned to BTB received up to 10 home visits over a period of 4 months by licensed social workers who provided care management, referral/linkage, stress reduction, depression education, and behavioral activation to help participants achieve self-identified goals. Measurements Incremental cost effectiveness ratios (ICERs) of BTB versus wait-list controls during the 4-month study period. The primary ICER was defined as cost/quality-adjusted life year using the EQ-5D and secondarily using the HUI-3. Additional ICERs were calculated using clinical measures (cost per depression improvement, cost per depression remission). Costs included BTB intervention, depression-related healthcare visits and medications, caregiver time, and social services. Results BTB cost per participant per month was $146. Base case ICERs were $64,896 per QALY (EQ-5D) and $36,875 per QALY (HUI-3). Incremental cost per depression improvement was $2,906 and per remission was $3,507. Univariate and probabilistic sensitivity analyses yielded cost/QALY range of $20,500-$76,500. Conclusion Based on the range of cost effectiveness values resulting from this study, BTB is a cost-effective treatment for managing depressive symptoms in older African Americans that compares favorably with the cost effectiveness of previously tested approaches.

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Older patients’ aversion to antidepressants

Abstract: Many elders resisted the use of antidepressants. Patients expressed concerns that seem to reflect their concept of depression as well as their specific concerns regarding antidepressants. These findings may enhance patient-provider communication about depression treatment in elders.

Cited by 24 publications

References 32 publications

Under-treatment of depression in older persons

Under-treatment of depression in older persons

Walking for depression or depressive symptoms: A systematic review and meta-analysis

Cost‐Effectiveness of a Community‐Integrated Home‐Based Depression Intervention in Older African Americans

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