The treatment of depression in older people needs an integrated approach with pharmacological and psychosocial
approaches working together. Within secondary mental health services there are patients with severe depression
who are often at a significant risk. There is evidence to suggest the older antidepressants are over prescribed to the elderly
in primary care and there are gaps in the assessment information recorded. This study aimed to identify if the same issues
were present in secondary care.
This study was a retrospective case note survey of 181 patients aged 65 and over referred to a secondary mental health
service with depression. Eligible patient’s case notes were surveyed in pairs and data was recorded on data collection
forms using electronic records and paper case notes to ensure the data was comprehensive.
Older people treated for their current episode of depression are seven times more likely to receive the newer classes of
antidepressants (SSRI, SNRI and NASSA) than in their previous depressive episodes (odds ratio 7.27 95% CI: 3.78 -
13.98; p<0.001). NICE recommends SSRIs as they are less likely to be discontinued due to side effects. However, for all
antidepressants prescribed there was no information recorded about side effects for 75%, or treatment response for 37%.
Other significant missing information included severity and duration of depression, exercise, alcohol, smoking, nonpharmacological
interventions and BMI. Comprehensive assessment and clear recording are needed. Further research
could repeat this survey in other services to see how far the results can be generalised.