USE OF ANTIDEPRESSANTS, AND THE PREVALENCE OF DEPRESSION AND COGNITIVE IMPAIRMENT IN SYDNEY NURSING-HOMES

In 1993, a survey was conducted in 46 of the 47 nursing homes in a hea lth district of Sydney. Medication cards and notes of all residents (N = 2414) were studied. Subjects who were willing and able to answer qu estions were interviewed by research assistants (senior nurses). Using the Mini-Mental State Examination and Mental Status Questionnaire, ab out 80% were found to be cognitively impaired. Of 874 subjects assesse d with the Geriatric Depression Scale (GDS), 30.4% scored in the clear ly depressed range (14 or more) of whom 27.4% were taking antidepressa nts. From a subsample of 26 with GDS scores of 14+, the psychiatrist c oncluded that only one-third would fulfil DSM-III-R criteria for major depression, with or without dementia. The dosages of antidepressants used in these nursing homes were relatively low. Of residents taking a tricyclic or mianserin, 48% were taking less than 30 mg daily, even t hough in 72% of cases their doctors stated the primary reason they wer e having this medication was to treat or prevent recurrence of depress ion. Opinions and evidence concerning the efficacy of such low dosage are conflicting. There is a need for further research, including corre lation of efficacy with blood levels of antidepressants.