The Utilization of Antidepressants in Community-Dwelling and Institutionalized Elderly - Results from a Representative Survey in Germany

Abstract

Given its widespread occurrence and consequences, old-age depression has to be regarded as a major public health problem. Drug treatment has been proven effective in the majority of elderly individuals suffering from depression. This study presents pharmacoepidemiological data regarding the use of prescribed antidepressants and those purchased over the counter in the elderly. Furthermore, it links the data to simultaneously assessed depressive symptomatology. A representative survey on the utilization of prescription and over-the-counter antidepressant drugs and depressive symptomatology in community-dwelling (n = 1193) and institutionalized elderly individuals (n = 470) aged 75 and over was conducted in an urban region of Germany. Antidepressant use was found to be remarkably low (synthetic antidepressants: 2.2% of community dwelling individuals, 3.6% of institutionalized individuals; phytopharmaca containing hypericum perforatum: 4.2% of community dwelling individuals, 2.8% of institutionalized individuals). Two-thirds of the individuals treated with synthetic antidepressants received tri- and tetracyclic drugs, which were given at lower dosages than recommended for depression treatment. Selective serotonin reuptake inhibitors (SSRIs) were introduced in community-dwelling individuals only; none of the individuals cared for in residential and nursing homes received SSRIs. Only a minority of individuals with depressive symptoms were treated with antidepressants. The data suggests underutilization of antidepressants in the elderly, in which institutionalized elderly seem especially disadvantaged. The results call for increased efforts to discuss mental health issues in the public and to share scientific knowledge about symptoms, course and treatment options for depression. Furthermore, geronto-psychiatric competence of medical professionals, especially GPs, has to be systematically developed.

Pattern of prescriptions issued by nursing home‐based physicians versus office‐based physicians for frail elderly patients in German nursing homes

“…16 In addition, benzodiazepines and neuroleptics may cause falls and hip fractures in frail people. 7,10 Fifteen percent of patients were treated with antidepressants, which can be regarded as an improvement in comparison to earlier studies, 12,22 but still is indicative for undertreatment. Tricyclic antidepressants are frequently used, despite the fact that they should no longer be first choice in the elderly because of their anticholinergic and cardiovascular side effects.…”

“…28 We found a high rate of patients with prescriptions of neuroleptics (39%) which is higher than in other German studies in the same setting. 22,27 About 20% of patients received sedating agents, usually benzodiazepines, which have a high dependence potential. 16 In addition, benzodiazepines and neuroleptics may cause falls and hip fractures in frail people.…”

“…1,26 For Germany, the prescribing pattern in nursing homes has not been investigated so far, with the exception of a few studies focusing on the use of psychopharmacologic drugs in this setting. 22,25,27 Therefore, we analyzed the prescriptions for a large sample of nursing home residents (1) to describe the prescription pattern of physicians for this special patient group and (2) to compare the prescriptions issued by nursing home-based physicians with those by office-based physicians.…”

Who is diagnosed as suffering from depression in the German statutory health care system? An analysis of health insurance data

“…However, the prevalence of depression is particularly high in people living in nursing homes [27,28]. While institutionalisation concerns only a few people in the age group 50-60, it becomes increasingly relevant in the very old.…”

Service provision for elderly depressed persons and political and professional awareness for this subject: a comparison of six European countries

“…In a German study very low treatment rates for depressed nursing home residents were found (Riedel-Heller et al, 2001) and there are no indications that the situation might be profoundly better in any of the other studied countries. * Except for Switzerland and the UK (through the community psychiatric nurse) home nursing services are not intentionally used to treat elderly depressed persons and service providers are usually not trained for this purpose.…”