J. Snowdon et al., USE OF ANTIDEPRESSANTS, AND THE PREVALENCE OF DEPRESSION AND COGNITIVE IMPAIRMENT IN SYDNEY NURSING-HOMES, International journal of geriatric psychiatry, 11(7), 1996, pp. 599-606
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.