Comparison of depression treatment among different age groups in primary care setting

The aim of this study was to explore the association between age and care of patients with depression in primary care setting. A comparison was made among the groups of elderly patients, middle aged patients and younger patients with diagnosis of depressive episode (F32).

Patients (17.290) from ten GP offices in the city of Zagreb formed the representative sample for this study according to the estimated depression prevalence in Europe of 5%. A group of 231 (60%) patients with diagnosis Depressive episode (F32), out of 383 patients with Depression diagnosis according to ICD-10, were reviewed and extracted from GPs' standardized medical files. They were divided in three age groups: <45 years (n=58), 45-65 years (n=97) and >65 years (n=76). Data were tracked longitudinally and obtained retrospectively for one-year period from 1st January to 31th December 2009. Pharmacotherapy was classified according to the Anatomical Therapeutic Chemical (ATC) classification index.

The youngest and the oldest age group mainly used only one drug in their therapy (47% vs 64%), but middle age group almost equally used one or two drugs (42 vs 45%). About 50% of all patients used SSRIs. Benzodiazepines were used most frequently in middle and in the oldest age group (71% vs 60%). The most frequent combinations of antidepressants in the youngest age group were SSRIs and combination of SSRIs and benzodiazepines; in middle age group it was combination of SSRIs and benzodiazepines and benzodiazepines; and in the oldest benzodiazepines, and SSRIs. Benzodiazepines were used mainly discontinuously in oppose to significant continuous usage in middle age group (P 0.043). In the oldest age groupe, depression diagnose was mostly given by GP and the most frequent therapy was combination of pharmacotherapy and GP's support. Unaided clinical assessment of depression outcome by GP did not differ significantly between age groups although some differences existed.

Number and sort of antidepressants as well as sort of physician: GP or psychiatrist differed between age groups of depressed patients. Further investigation of specifical depression treatment compared with outcome measures should give answer whether those differences are justified.