SCREENING, DETECTION AND MANAGEMENT OF DEPRESSION IN ELDERLY PRIMARY-CARE ATTENDERS .2. DETECTION AND FITNESS FOR TREATMENT - A CASE RECORDSTUDY

Case note data were obtained for 186 elderly primary care attenders wh o also completed the 15 item Geriatric Depression Scale (GDS15). The p resence or absence in the case notes of a current or past diagnosis of depression, of current treatment of depression, and of a number of cl inical features of depression were noted. Case notes were also rated f or the presence or absence of contraindications to the use of tricycli c antidepressants (TCAs) and to serotonin-specific reuptake inhibitors (SSRIs). Whereas 65 (35%) patients were rated as 'cases' of depressio n on the GDS15, only 28 (15%) had a current case note diagnosis of dep ression and 37 (20%) had one or more current symptoms of depression re corded in the case notes. Patients rated by their GP as having one or more current symptoms of depression scored higher on the GDS15 (P < 0. 05) and were more likely to be categorized as a GDS case (P = 0.05). T here was no significant relationship between GDS caseness and a curren t case note diagnosis of depression. Seventy-three patients (39%) had a past history of depression and 53 (28.5%) patients had previously be en treated with antidepressants. The former was significantly associat ed with GDS caseness (P < 0.05). Twenty-four patients (13%) were curre ntly on antidepressants, 19 of them receiving adequate doses (equivale nt to at least 75 mg of amitriptyline). Current antidepressant treatme nt was not associated with GDS 'caseness'. A significantly higher prop ortion of patients (both in the sample as a whole and in the subgroup of GDS15 depression 'cases') had a medical condition or were taking a drug that mitigated against the use of TCAs than was the case for SSRI s.