Screening, Detection and Management of Depression in Elderly Primary Care Attenders. II: II: Detection and Fitness for Treatment: a Case Record Study |
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Authors: | MULLAN, ELEANOR KATONA, PHILIPPA D'ATH, PENNY KATONA, CORNELIUS |
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Affiliation: | *Department of Psychiatry, University College London Medical School, Wolfson Building, Middlesex Hospital London WIN 8AA **Department of Psychiatry, Princess Alexandra Hospital Hamstel Road, Harlow, Essex Lower Clapton Health Centre Lower Clapton Road, London E5 |
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Abstract: | Case note data were obtained for 186 elderly primary care attenderswho also completed the 15 item Geriatric Depression Scale (GDS15).The presence or absence in the case notes of a current or pastdiagnosis of depression, of current treatment of depression,and of a number of clinical features of depression were noted.Case notes were also rated for the presence or absence of contraindicationsto the use of tricyclic antidepressants (TCAs) and to serotonin-specificreuptake inhibitors (SSRIs). Whereas 65 (35%) patients wererated as cases of depression on the GDS15, only28 (15%) had a current case note diagnosis of depression and37 (20%) had one or more current symptoms of depression recordedin the case notes. Patients rated by their GP as having oneor more current symptoms of depression scored higher on theGDS15 (P < 0.05) and were more likely to be categorized asa GDS case (P = 0.05). There was no significant relationshipbetween GDS caseness and a current case note diagnosis of depression.Seventy-three patients (39%) had a past history of depressionand 53 (28.5%) patients had previously been treated with antidepressants.The former was significantly associated with GDS caseness (P< 0.05). Twenty-four patients (13%) were currently on antidepressants,19 of them receiving adequate doses (equivalent to at least75 mg of amitriptyline). Current antidepressant treatment wasnot associated with GDS caseness. A significantlyhigher proportion of patients (both in the sample as a wholeand in the subgroup of GDS15 depression cases)had a medical condition or were taking a drug that mitigatedagainst the use of TCAs than was the case for SSRIs. |
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