GPs are giving too many older people antidepressants when they are struggling with depression, and should prescribe talking therapies far more often, according to new research.
Family doctors too often avoid talking to patients over the age of 65 about depression and do not have the time to explore and treat the condition properly, the study found.
Almost one in 10 over-75s are thought to suffer from depression, while almost four in 10 (37.4%) exhibit some symptoms. However, the vast majority, 87%, are treated with medication, even though it often does not help, according to the findings.
Too often GPs dismiss talking therapies as a way of tackling depression in older people, partly because there are long waiting times to start treatment, according to the paper, which has been published in the British Journal of General Practice.
NHS Digital figures show that although 1.4 million people of all ages were referred for help to NHS Improving Access to Psychological Therapies (IAPT) in 2017/18, just 91,117 of them (6.3%) were aged over 65.
Similarly, while 1 million of all those referred started talking therapies treatment, only 74,503, or 7.4%, of those were over 65.
Even though evidence shows that talking therapies help older people with depression, they are twice as likely as younger people to be treated with antidepressants.
Those aged over 85 are five times less likely than 55 to 59-year-olds to receive psychological help. In some areas, as few as 3.5% of over-65s are recommended to see a therapist to undergo a course of cognitive behaviour therapy.
“There needs to be greater access to talking therapies. They are effective in older populations, but we know that GPs are less likely to refer those in their 80s to psychological therapies for depressive symptoms than those in their 50s and 60s,” said Rachael Frost, an academic at University College London and the lead author of the paper.
Older people may be reluctant to access NHS help because they fear they will be stigmatised, or that nothing can be done about their condition anyway, says the report. In addition, GPs often use their appointments to discuss the older person’s physical health, rather than their mental wellbeing, they found. Some fail to act on cues suggesting that over-65s want to talk about how they are feeling.
Their conclusions are based on a review of the evidence from 27 studies done in western countries, including eight from the UK, into how health professionals deal with patients over 65 who have depression.
Prof Helen Stokes-Lampard, the chair of the Royal College of GPs, said family doctors only prescribed antidepressants “after a full and frank discussion with the patient sitting in front of us, based on their individual circumstances, and if we genuinely believe they will help them.
“Regardless of a patient’s age, depression can be incredibly distressing and debilitating, and research has shown that for many adult patients, antidepressants can be effective drugs at alleviating its symptoms.”
Provision of talking therapies was “patchy”, she added.
Caroline Abrahams, the charity director of Age UK, said: “These figures once again show that older people are missing out on talking therapies and other effective treatments for mental health conditions, with medication too often being the prescribed approach.
“Depression and anxiety affects nearly three million people over 60, and older people mustn’t miss out on help and treatment because either they aren’t offered it or don’t know where to go for help. Talking therapies can benefit everyone, regardless of age.”
The Guardian Denis Campbell Health policy editor
Mon 11 Feb 2019 19.05 EST