USE OF ANTIDEPRESSANTS BY NONPSYCHIATRISTS IN THE TREATMENT OF MEDICALLY ILL HOSPITALIZED DEPRESSED ELDERLY PATIENTS

Objective: The purpose of this study was to examine antidepressant use by nonpsychiatrists in the treatment of depressed elderly medical inp atients. Method: Patients aged GO or older who were admitted to medica l services at Duke Hospital were evaluated by a geropsychiatrist who u sed a structured psychiatric interview to identify major or minor depr essive disorder. Medical records of depressed patients were reviewed f or use of antidepressants and benzodiazepines before admission, during hospitalization, and on discharge; After discharge, depressed patient s were contacted four times by telephone at la-week intervals to inqui re about medication use (median follow-up time=45 weeks). Results: Of 153 depressed patients, 40.5% received antidepressants at some time du ring their hospital stay or follow-up period 25.5% received only benzo diazepines, and 34.0% received neither. The most commonly prescribed a ntidepressant was amitriptyline (45.2% of treated patients), administe red at an average maximum dose oi 49 mg/day. Only 15 of 114 untreated depressed patients started antidepressant therapy during hospitalizati on (nine with amitriptyline). Of 91 depressed patients who did not rec eive antidepressants either before admission or during hospitalization , only 11% received any antidepressant therapy during the median 11-mo nth follow-up; again, half were treated wish amitriptyline at doses of 10-30 mg/day. Intensity of antidepressant therapy tc,as predicted by severity of depressive symptoms, history of psychiatric problems, and higher income. Conclusions: A relatively low, proportion of depressed older medical inpatients receive treatment with antidepressants. Patie nts treated with antidepressants often receive potentially dangerous t ertiary tricyclics at inadequate noses. Unless depression is identifie d and treated during medical hospitalization, it is unlikely to be tre ated adequately after discharge.