An examination of the attitudes and practice of general practitioners in the diagnosis and treatment of depression in older people.
BACKGROUND
Most depression in older people is managed in primary care settings but can be difficult to diagnose and is often under-treated. This study examined the attitudes and practice of general practitioners in the treatment of late-life depression using antidepressant medication.


METHODS
Three hundred and thirty general practitioners in 116 general practices within the Nottingham Health Authority were surveyed. Their responses to a series of attitude statements and clinical vignettes regarding antidepressant prescribing were assessed.


RESULTS
Analysis of vignettes showed newer antidepressants to be prescribed much more frequently than older antidepressants, with a substantial increase in the use of SSRIs compared to the results of previous research. Older general practitioners and those who had been in practice for longer were more likely to prescribe tricyclic antidepressants. They were also more likely to identify a need for extra training in treating old age depression, as were those GPs without previous psychiatric training. However, most GPs were confident in treating depression in the elderly although younger GPs were the most confident.


CONCLUSIONS
Selective Serotonin Re-Uptake Inhibitors are the preferred drugs in treating certain problematic cases of late-life depression. These results suggest there may be a greater propensity for GPs to prescribe SSRIs although further research is needed to clarify whether this finding can be generalised beyond this study. Most general practitioners felt confident in treating late-life depression, but older doctors, those who had been practising for longer and those without previous psychiatric training, may benefit most from further training.
Rothera
Ian
I
Section of Old Age Psychiatry, Division of Psychiatry, Queen's Medical Centre, Nottingham, UK. ian.rothera@nottingham.ac.uk
Jones
Rob
R
Gordon
Catherine
C
D000367:Age Factors; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D003866:Depressive Disorder / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D004739:England; D005194:Family Practice; D016330:Frail Elderly; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D007022:Hypotension / Q000150:complications; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D000092864:Suicide Prevention
D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors