Under-treatment of depression in older persons

Abstract

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.

Phytopharmaceutical treatment of anxiety, depression, and dementia in the elderly: evidence from randomized, controlled clinical trials

“…Concerns about bothersome or even disabling side effects of antidepressant drugs, benzodiazepines, and neuroleptics may contribute to the significant undertreatment of mood disorders in the elderly [16,78,79]. The results of our meta-analyses show, however, that for anxiety disorders and major depression, efficacious phytopharmaceutical alternatives are available that are associated with only minimal treatment emergent risk: in patients ≥ 60 years of age with syndromal or subsyndromal anxiety disorders, lavender oil preparation silexan was superior to placebo with respect to its anxiolytic effect as well as regarding the over-all mental condition of the patients.…”

Physical Activity in Depressed Elderly. A Systematic Review

“…Randomized clinical trials performed on depressed older adults samples have demonstrated moderate to large effect sizes for selective serotonin re-uptake inhibitors, tricyclic antidepressants and monoamine oxidase inhibitors [21]. Nevertheless, only a small proportion of older adults with depression (around 20%) receive adequate treatment [22, 23]. Lack of treatment among older adults may reflect, in part, the difficulty of detecting depression in older adults, due to age-specific presentation of disease: compared with young adults, older patients tend to present less emotional symptoms of depression, such as sadness, worthlessness/guilt, worry, and fear, and are less accurate at identifying depressive symptoms overall [24].…”

Depressive Symptoms in Recipients of Home- and Community-Based Services in the United States: Are Older Adults Receiving the Care They Need?

“…Assessing unmet need for depression treatment is important because depressive symptoms are undertreated in older adults (8) and outcomes for older adults with undetected depression are poor (9). For example, depressive symptoms are associated with increased disability (10), even among older adults with mild depressive symptoms (11).…”