Number of depressed over-65s unchanged but antidepressant use soars

The proportion of people aged over 65 on antidepressants has more than doubled in two decades -- according to new research led by the University of East Anglia.

Despite a rise in antidepressant use, there was little change in the number of older people diagnosed with depression.

The findings are based on the Cognitive Function and Ageing Studies, conducted at two time points -- between 1991 and 1993, and between 2008 and 2011.

Researchers interviewed more than 15,000 over 65s in England and Wales to see whether the prevalence of depression and antidepressant use is changing.

Lead author Prof Antony Arthur, from UEA's School of Health Sciences, said: "Depression is a leading cause of poor quality of life worldwide and we know that older people may be less likely than other age groups to go to their GP with symptoms of depression.

"Until now, little was known about how the relationship between the prevalence of depression and antidepressant use among older people has changed over time. The Cognitive Function and Ageing Studies led by the University of Cambridge have the ability to exam changes in the health needs of older people across generations based on random sampling and diagnostic methods held constant over time.

"We asked participants about their health, daily activities, use of health and social care services, and the medications they were taking.

"We used a standardised interview process to ascertain the presence or absence of symptoms of depression and then applied diagnostic criteria to see whether the participant was considered to have 'case level' depression, a level of depression more severe than that characterised by minor mood symptoms, such as loss of energy, interest or enjoyment."

The study's lead investigator Prof Carol Brayne, director of the Cambridge Institute of Public Health, said: "Our research has previously shown a dramatic age-for-age drop in dementia occurrence across generations. This new work reveals that depression has not shown the same reduction even in the presence of dramatically increased prescribing, itself not without concern given potential adverse effects we have also shown that are associated with polypharmacy."

Key findings

  • The proportion of older people receiving anti-depressant medication more than doubled over two decades -- from 4.2 per cent in the early nineties to 10.7 per cent 20 years later.
  • The estimated prevalence of depression among over 65s in the early 1990s was 7.9 per cent, compared to 6.8 per cent 20 years later.
  • Depression and antidepressant use was more common in women than men at both time points.
  • Depression was associated with living in a more deprived area.
  • The proportion of over 65s living in care homes declined, but prevalence of depression in care homes remained unchanged -- affecting around one in ten residents.
  • Across both time periods, most people with case-level depression were not on antidepressants, while most of those on antidepressants did not have depression.

    Prof Arthur said: "Depression affects one in 15 people aged over 65, and its impact is felt by the individual, their families and friends.

"Between two comparable samples interviewed 20 years apart (1990-93 and 2008-11) we found little change in the prevalence of depression, but the proportion of participants taking antidepressants rose from 4 per cent to almost 11 per cent. This could be due to improved recognition and treatment of depression, overprescribing, or use of antidepressants for other conditions.

"Whatever the explanation, substantial increases in prescribing has not reduced the prevalence of depression in the over-65 population. The causes of depression in older people, the factors that perpetuate it, and the best ways to manage it remain poorly understood and merit more attention."

The research was led by the University of East Anglia in collaboration with the University of Cambridge, the University of Newcastle and the University of Nottingham.

'Changing prevalence and treatment of depression among the over-65s over two decades: findings from the Cognitive Function and Ageing Studies' is published in the British Journal of Psychiatry.


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Materials provided by University of East Anglia. Note: Content may be edited for style and length.

Depression, anxiety may take same toll on health as smoking and obesity

An annual physical typically involves a weight check and questions about unhealthy habits like smoking, but a new study from UC San Francisco suggests health care providers may be overlooking a critical question: Are you depressed or anxious?

Anxiety and depression may be leading predictors of conditions ranging from heart disease and high blood pressure to arthritis, headaches, back pain and stomach upset, having similar effects as long-established risk factors like smoking and obesity, according to the new research.

In the study, first author Andrea Niles, PhD, and senior author Aoife O'Donovan, PhD, of the UCSF Department of Psychiatry and the San Francisco VA Medical Center, looked at the health data of more than 15,000 older adults over a four-year period.

They found that 16 percent (2,225) suffered from high levels of anxiety and depression, 31 percent (4,737) were obese and 14 percent (2,125) were current smokers, according to their study published in the journal Health Psychology on Dec. 17, 2018.

Participants with high levels of anxiety and depression were found to face 65 percent increased odds for a heart condition, 64 percent for stroke, 50 percent for high blood pressure and 87 for arthritis, compared to those without anxiety and depression.

"These increased odds are similar to those of participants who are smokers or are obese," said O'Donovan, who, with Niles, also is affiliated with UCSF Weill Institute for Neurosciences. "However, for arthritis, high anxiety and depression seem to confer higher risks than smoking and obesity."

Cancer an Exception to Conditions Impacted by Depression and Anxiety

Unlike the other conditions investigated, the authors found that high levels of depression and anxiety were not associated with cancer incidence. This confirms results from previous studies, but contradicts a prevailing idea shared by many patients.

"Our findings are in line with a lot of other studies showing that psychological distress is not a strong predictor of many types of cancer," O'Donovan said. "On top of highlighting that mental health matters for a whole host of medical illnesses, it is important that we promote these null findings. We need to stop attributing cancer diagnoses to histories of stress, depression and anxiety."

Niles and O'Donovan discovered that symptoms such as headache, stomach upset, back pain and shortness of breath increased exponentially in association with high stress and depression. Odds for headache, for example, were 161 percent higher in this group, compared with no increase among the participants who were obese and smokers.

Treating Mental Health Can Cut Health Care Costs

"Anxiety and depression symptoms are strongly linked to poor physical health, yet these conditions continue to receive limited attention in primary care settings, compared to smoking and obesity," Niles said. "To our knowledge this is the first study that directly compared anxiety and depression to obesity and smoking as prospective risk factors for disease onset in long-term studies."

The results of the study underscore the "long-term costs of untreated depression and anxiety," said O'Donovan. "They serve as a reminder that treating mental health conditions can save money for health systems."

The two authors evaluated health data from a government study of 15,418 retirees, whose average age was 68. Depression and anxiety symptoms were assessed using data from participant interviews. Participants were questioned about their current smoking status, while weight was self-reported or measured during in-person visits. Medical diagnoses and somatic symptoms were reported by participants.

Depression strongly linked to higher long-term risk of early death for both women, men

Despite increased awareness about mental illness, depression remains strongly linked to a higher risk of early death -- and this risk has increased for women in recent years -- according to results from the 60-year Stirling County Study published in CMAJ (Canadian Medical Association Journal).

"There is less stigma associated with depression, better treatments are available, but depression's link to mortality still persists," said Dr. Stephen Gilman of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, part of the National Institutes of Health in Bethesda, Maryland. "At first, the association was limited to men, but in later years it was seen for women as well."

The Stirling County Study, begun in 1952 in Atlantic Canada, is well-known internationally as one of the first community-based studies on mental illness. A researcher from the original study, Dr. Jane Murphy with Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, is a coauthor on this latest research study.

An international team of researchers looked at 60 years of mental health data on 3410 adults during 3 periods (1952-1967, 1968-1990 and 1991-2011) from a region in Atlantic Canada and linked the data to deaths in the Canadian Mortality Database. They found that the link between depression and an increased risk of death was observed in all decades of the study among men, whereas it emerged among women beginning in the 1990s. The risk of death associated with depression appeared strongest in the years following a depressive episode, leading the authors to speculate that this risk could be reversed by achieving remission of depression.

The mean age of participants at enrolment in the study was about 49 years. "The lifespan for young adults with depression at age 25 was markedly shorter over the 60-year period, ranging from 10 to 12 fewer years of life in the first group, 4 to 7 years in the second group and 7 to 18 fewer years of life in the 1992 group," says Dr. Ian Colman, Canada Research Chair in the School of Epidemiology, University of Ottawa, Ottawa, Ontario. "Most disturbing is the 50% increase in the risk of death for women with depression between 1992 and 2011."

Though depression has also been linked with poorer diet, lack of exercise, smoking and alcohol consumption -- all factors that can result in chronic health conditions -- these did not explain the increased risk of death associated with depression in this study.

Societal change may help explain the emergent risk of death for women with depression.

"During the last 20 years of the study in which women's risk of death increased significantly, roles have changed dramatically both at home and in the workplace, and many women shoulder multiple responsibilities and expectations," says Dr. Colman.

The authors suggest that family physicians should monitor patients for mood disturbances, especially recurrent episodes of depression, so that they may offer treatment and support.

Limitations include a long interval between participant interviews which prevented determining the exact timing of depression and the participants' experiences of recurrent episodes of depression between interviews.

Brain architecture alters to compensate for depression

A study led by Ravi Bansal, PhD, and Bradley S. Peterson, MD, of The Saban Research Institute of Children's Hospital Los Angeles, has found structural differences in the cerebral cortex of patients with depression and that these differences normalize with appropriate medication. The study, published in Molecular Psychiatry on March 7, is the first to report within the context of a randomized, controlled trial, the presence of structural changes in the cerebral cortex during medication treatment for depression and the first to provide in vivo evidence for the presence of anatomical neuroplasticity in human brain.

"Our findings suggest that thickening of the cerebral cortex is a compensatory, neuroplastic response that helps to reduce the severity of depressive symptoms," said Peterson, director of the Institute of the Developing Mind at CHLA and professor of pediatrics and psychiatry at the Keck School of Medicine of the University of Southern California. "Patients off medication have a thickened cortex, and the thicker it is, the fewer the symptoms they have. Treatment with medication then reduces the severity of symptoms, which in turn reduces the need for biological compensation in the brain -- so that their cortex becomes thinner, reaching thickness values similar to those in healthy volunteers."

The investigators acquired anatomical brain scans at baseline and again at the end of the 10-week study period for 41 patients with chronic depression, while 39 healthy volunteers were scanned once. This study was conducted with adult patients treated at Columbia University, when Peterson and Bansal were faculty members.

Patients were randomized to receive active medication duloxetine, a selective serotonin and norepinephrine reuptake inhibitor, or placebo. During the trial, patients receiving medication experienced significant improvement of symptoms compared with patients receiving placebo. In medication-treated patients, cortical thickness declined toward values found in healthy volunteers while placebo-treated patients showed a slight thickening of the cortex. According to Bansal, a researcher at CHLA and professor of pediatrics at the Keck School of Medicine of USC, this finding suggests that placebo-treated patients continue to require compensation for their ongoing symptoms.

"Although this study was conducted in adults, the methodology developed -- pairing a randomized controlled trial with MRI scanning -- can be applied to many other populations in both children and adults," said Bansal. "Also, our observations of neuroplasticity suggest new biological targets for treatment of persons with neuropsychiatric disorders."


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