The utilization of antidepressants in community-dwelling and institutionalized elderly - Results form a representative survey in Germany

Given its widespread occurrence and consequences, old-age depression has to be regarded as a major public health problem. Drug treatment has been prov en effective in the majority of elderly individuals suffering from depressi on. This study presents pharmacoepidemiological data regarding the use of p rescribed antidepressants and those purchased over the counter in the elder ly. Furthermore, it links the data to simultaneously assessed depressive sy mptomatology. A representative survey on the utilization of prescription an d over-the-counter antidepressant drugs and depressive symptomatology in co mmunity-dwelling (n = 1193) and institutionalized elderly individuals (n = 470) aged 75 and over was conducted in an urban region of Germany. Antidepr essant use was found to be remarkably low (synthetic antidepressants: 2.2% of community dwelling individuals, 3.6% of institutionalized individuals; p hytopharmaca containing hypericum perforatum: 4.2% of community dwelling in dividuals, 2.8% of institutionalized individuals). Two-thirds of the indivi duals treated with synthetic antidepressants received tri- and tetracyclic drugs, which were given at lower dosages than recommended for depression tr eatment. Selective serotonin reuptake inhibitors (SSRIs) were introduced in community-dwelling individuals only; none of the individuals cared for in residential and nursing homes received SSRIs. Only a minority of individual s with depressive symptoms were treated with antidepressants. The data sugg ests underutilization of antidepressants in the elderly, in which instituti onalized elderly seem especially disadvantaged. The results call for increa sed efforts to discuss mental health issues in the public and to share scie ntific knowledge about symptoms, course and treatment options for depressio n. Furthermore, geron-to-psychiatric competence of medical professionals, e specially GPs, has to be systematically developed.