Insufficient Diagnosis and Treatment of Older Patients With Depression

Elderly woman, wheelchair, old, patient
Elderly woman, wheelchair, old, patient
Participants were visited in person and researchers were able to determine that antidepressants were underused in a large population aged 55-85 years.

Older adults often do not receive proper diagnosis or treatment, according to a study published in the International Journal of Geriatric Psychiatry.

Researchers investigated pharmacological and psychological depression treatment, as well as prescribed antidepressants and their dosages, for older adults in a community dwelling. Data came from the 3rd follow-up of the ESTHER study, a German population-based cohort study. Physicians completed home visits to collect geriatric assessments, depression evaluations, prescribed pharmacology substances, doses of antidepressants, and psychological treatments.

Of the 3117 participants, 1637 were women and the mean age was 69.6 years old. Of the 163 patients who met the criteria for depression, 38.6% had not been diagnosed, 22.7% were prescribed antidepressants, 4.9% reported psychological treatment, and 38.7% received some type of mental health care. Antidepressants were underutilized in 77.3% of the cases, and women were more frequently prescribed antidepressants when compared with men (66.1% vs 33.9%; P <.001). Tricyclic and tetracyclic antidepressants were prescribed most frequently (41.3%), but also had the highest underdose percentage (47.1%). Selective serotonin/noradrenaline reuptake inhibitors and herbal drugs were prescribed least frequently (8.7%, both), and alpha2‐adrenoceptor antagonists were the least underdosed (10.6%). The use of antidepressants without a clinical indication, or overuse, was found in 41.7% of the cases.

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Future studies should analyze how dosages and treatments change over time, including

• how this impacts the definition of underdose and overuse;
• what other medical conditions might warrant the use of antidepressants; and
• how to effectively collect data on depression diagnosis and symptoms when underreporting could occur.

Underdiagnosis and improper treatment of older adults with depression is common, yet there is also a high proportion of antidepressant overuse. Researchers concluded that “the attentiveness of practitioners and patients regarding depression symptoms and treatment in elderly persons should be enhanced. Furthermore, it is recommended to continuously monitor depression symptoms during treatment and to discontinue medication when patients do not meet the criteria for depression anymore.”


Boehlen FH, Freigofas J, Herzog W, et al. Evidence for underuse and overuse of antidepressants in older adults: Results of a large population‐based study [published online January 8, 2019]. Int J Geriatr Psychiatry. doi: 10.1002/gps.5047