The proportion of people aged over 65 on antidepressants has more than doubled in two decades, according to new research led by the University of Cambridge and University of East Anglia (UEA).

Our research has previously shown a major 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

Carol Brayne

Despite this rise in antidepressant use, there has been little change in the number of older people diagnosed with depression.

The findings are based on the Cognitive Function and Ageing Studies, conducted at two time points - between 1991 and 1993, and between 2008 and 2011. 

First author Prof Antony Arthur, from UEA’s School of Health Sciences, said: “Depression is a leading cause of poor quality of life worldwide and we know that older people may be less likely than other age groups to go to their GP with symptoms of depression. Until now, little was known about how the relationship between the prevalence of depression and antidepressant use among older people has changed over time.”

The Cognitive Function and Ageing Studies (CFAS), led by the University of Cambridge, are population based studies of individuals aged 65 with the ability to examine changes in the health needs of older people across generations based on random sampling and diagnostic methods held constant over time.

As part of CFAS, researchers interviewed more than 15,000 over 65s in England and Wales to see whether the prevalence of depression and antidepressant use is changing. They found that the proportion of older people receiving anti-depressant medication more than doubled over two decades – from 4.2 per cent in the early nineties to 10.7 per cent 20 years later. This was despite the estimated prevalence of depression among over 65s falling to 6.8 per cent compared to 7.9 per cent in the 1990s.

Depression and antidepressant use were more common in women than men at both time points. Depression was associated with living in a more deprived area. The proportion of over 65s living in care homes declined, but prevalence of depression in care homes remained unchanged – affecting around one in ten residents.

Lead investigator Prof Carol Brayne, director of the Cambridge Institute of Public Health, said: "Our research has previously shown a major 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, itself not without concern given potential adverse effects we have also shown that are associated with polypharmacy."

Prof Arthur said: “Depression affects one in 15 people aged over 65, and its impact is felt by the individual, their families and friends.

“[The increase in antidepressant use] could be due to improved recognition and treatment of depression, overprescribing, or use of antidepressants for other conditions. 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 University of East Anglia in collaboration with the University of Cambridge, the University of Newcastle and the University of Nottingham.

Reference
Arthur, A. et al. Changing prevalence and treatment of depression among the over-65s over two decades: findings from the Cognitive Function and Ageing Studies. British Journal of Psychiatry; 7 Oct 2019; DOI: 10.1192/bjp.2019.193

Adapted from a press release by the University of East Anglia.


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