Antidepressant Use In Over-65s Has Doubled In 20 Years – Why?

“The causes of depression in older people, the factors that perpetuate it, and the best ways to manage it remain poorly understood."

Antidepressant use among older people has more than doubled in 20 years –despite depression among the same age-group slightly dropping, a study has found.

Just over 10% of over-65s in the research used antidepressants in 2008-2011 – up from 4.2% in the early 1990s. Over the same period, the estimated prevalence of depression in the same age group fell from 7.9% to 6.8%, according to the University of East Anglia-led study.

Earlier this year, NHS Digital figures showed that overall prescriptions of antidepressants in England have almost doubled in the last decade, with 70.9 million items given out in 2018 to treat conditions including depression and anxiety.

But the cause of this rise among the older generation isn’t fully understood.

More than 15,000 over-65s in England and Wales were interviewed between 1990-1993, and 2008-2011 as part of the Cognitive Function and Ageing Studies.

They were asked about their health, daily activities, use of health and social care services, and medications. Researchers also identified those people who showed symptoms of ‘case level’ depression – more severe than a minor mood – including loss of energy, interest or enjoyment.

During both time periods, the researchers found most people with symptoms of case-level depression were not on antidepressants. And most of those on antidepressants did not have case-level depression.

The study’s lead investigator Professor Carol Brayne, director of the Cambridge Institute of Public Health, said: “Our research has previously shown a dramatic age-for-age drop in dementia occurrence across generations. This new work reveals that depression has not shown the same reduction even in the presence of dramatically increased prescribing.”

Professor Brayne said this was cause for concern, given the potentially adverse effects associated with ‘polypharmacy’ – or the use of multiple medications.

The authors said it is unclear whether the increases in treatment reflect over-diagnosis, better recognition and prescribing, or the prescribing of antidepressant medication for conditions other than depression.

Lead author Professor Antony Arthur, from UEA’s School of Health Sciences, said: “Whatever the explanation, substantial increases in prescribing has not reduced the prevalence of depression in the over-65 population.

“The causes of depression in older people, the factors that perpetuate it, and the best ways to manage it remain poorly understood and merit more attention.”

The research was led by the UEA in collaboration with the University of Cambridge, the University of Newcastle and the University of Nottingham and the findings are published in the British Journal of Psychiatry.

Professor Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said the increase in antidepressant use among older people could indicate a greater awareness and acceptance of mental health conditions in society.

It could also “show more people over 65 are seeking help for mental health problems which in the past may have been ignored or under-treated”, she said.

“We also have much better understanding of the effectiveness of antidepressants than we did in the early 90s – and it’s important to remember that current evidence shows these drugs work well when prescribed appropriately,” she continued. “GPs will only prescribe anti-depressants after a full and frank conversation with their patient, taking into account the physical, psychological and social factors potentially impacting on their health.”

Stokes-Lampard said GPs will explore alternative options to drug therapy such as talking therapies with their patients, “and we know that many older people, who perhaps are lonely, might benefit more from social prescribing schemes, for example joining a class or local community group, than traditional treatments.”

A study from September 2019 found the commonly used antidepressant sertraline does little to relieve symptoms of depression.

Most people taking sertraline saw little or no effect on depressive symptoms – such as low mood, lack of interest in things and poor sleep – in the first six to 12 weeks of taking the drug, the study revealed. However it was effective at improving anxiety.

Useful websites and helplines:

  • Mind, open Monday to Friday, 9am-6pm on 0300 123 3393
  • Samaritans offers a listening service which is open 24 hours a day, on 116 123 (UK and ROI - this number is FREE to call and will not appear on your phone bill.)
  • The Mix is a free support service for people under 25. Call 0808 808 4994 or email: help@themix.org.uk
  • Rethink Mental Illness offers practical help through its advice line which can be reached on 0300 5000 927 (open Monday to Friday 10am-4pm). More info can be found on www.rethink.org.