Depression is common in older adults, occurring in 2% of those aged 55 years and older and rising with increasing age. Many more — from 10% to 15% — struggle with depressive symptoms, although they may not have been diagnosed with major depression.1
That being said, there’s been a major rise in the number of antidepressants being prescribed for older adults over the last two decades, without a similarly sharp increase in the number depressed, according to a study published in The British Journal of Psychiatry.2
The findings suggest seniors may be being overprescribed antidepressant drugs, which could have serious implications for their health, although the researchers weren’t willing to state this, noting instead, “we can’t infer that older patients are prescribed antidepressants unnecessarily.”3
Antidepressant Use More Than Doubles Among Seniors
In order to investigate whether the prevalence of depression and antidepressant drug use changed from 1990 to 2011 in people aged 65 and over, researchers used data from two English population-based cohort studies involving 15,397 people. The studies took place from 1991 to 1993 and between 2008 and 2011.
In the first study group, 4.2% of the adults were taking antidepressants, but this jumped to 10.7% in the later study. During this time, the prevalence of depression decreased, but only slightly, from 7.9% to 6.8%.4 Also noteworthy, among older adults living in care homes, the prevalence of depression was unchanged but the use of antidepressants rose from 7.4% to 29.2%.5
There were a few suggestions offered for why antidepressant prescribing rates increased so steeply without a similar increase in depression, including overdiagnosis or prescribing the drugs for conditions other than depression. However, most of those prescribed antidepressants had not been diagnosed with depression.
Lead study author Antony Arthur, Ph.D. of the University of East Anglia, Norwich, United Kingdom, told Medscape, “Sometimes treatment is given for mild depression which falls outside of our definition of depression ― much of the evidence for the effectiveness of antidepressants is for people with moderate or severe depression. Antidepressants are also used to treat other conditions, for example, neuropathic pain and sleep disorders.”6
He added that opportunities to deprescribe antidepressants should not be overlooked.7 “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,” he stated.8
A separate study, published in World Psychiatry in 2017, reviewed data collected from 1990 to 2015 from Australia, Canada, England and the U.S. It similarly found that “the prevalence of mood and anxiety disorders and symptoms has not decreased, despite substantial increases in the provision of treatment, particularly antidepressants.”