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By some estimates, as many as one-sixth of elderly Americans suffer from clinical depression. Elderly patients are more likely than younger ones to feel the stigma of depression, report fatigue and other somatic symptoms instead of psychological ones, and prefer treatment by their primary care physicians (PCPs). In fact, primary care prescribing of antidepressants for elderly patients increased markedly between 1985 and 1999, according to a study supported by the Agency for Healthcare Research and Quality (HS09566).
This was probably due to a combination of factors, says Stephen Crystal, Ph.D., of Rutgers University. These include: introduction of a new class of antidepressants in 1988—the selective serotonin reuptake inhibitors (SSRIs)—which have fewer side-effects than earlier antidepressants; increased recognition of depression by PCPs; and financial incentives leading to more reliance on antidepressants instead of more costly psychotherapy. Dr. Crystal and his colleagues used data from the National Ambulatory Medical Care Survey, a nationally representative annual survey of visits to physicians in office-based practices, to examine changes from 1985 to 1999 in diagnosis of depression and prescription of antidepressant medications during visits by elderly patients to PCPs, psychiatrists, and other specialists.
The majority of depression visits and visits where an antidepressant was prescribed were to PCPs in all time periods examined. Prescribing of antidepressants more than doubled between 1985 and 1998-1999 (from 2.4 percent of visits to 4.9 percent), with PCPs increasing their use of antidepressants from 3 percent to 6.3 percent of visits. Between 1993-1994 and 1997-1999, there was a significant increase in the rate at which SSRIs were prescribed during visits by elderly patients, with SSRIs accounting for over half (52 percent) of all antidepressants prescribed in 1997-1999.
More details are in "Trends in elderly patients' office visits for the treatment of depression according to physician specialty: 1985-1999," by Jeffrey S. Harman, Ph.D., Dr. Crystal, James Walkup, Ph.D., and Mark Olfson, M.D., M.P.H., in the July 2003 Journal of Behavioral Health Services & Research 30(3), pp. 332-341.
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