Detection and treatment of major depression in older medically ill hospitalized patients

While major depression is common among medically ill older inpatients, little is known about the frequency of detection or appropriate treatment in this population. In the present study, 171 consecutive men age seventy and over admitted to the medical and neurological services of a VA medical center were screened for major depression. The medical records of all patients identified with this disorder were reviewed for documentation of depression by housestaff 1) prior to our evaluation and 2) throughout the rest of the hospital stay. Relative and absolute contraindications to antidepressant therapy were also sought. Of patients identified with major depression, 20 percent (3/15) had depressive symptoms documented in their charts by housestaff prior to our evaluation. After housestaff were informed of the possibility of major depression, 27 percent (4/15) of these patients eventually received psychiatric consultations, and 13 percent (2/15) had antidepressants initiated. At the time of discharge only 13 percent (2/15) had followup plans documented in their medical record to provide ongoing therapy or any therapy for depression after discharge. While this low detection rate and less than adequate treatment may indicate a lack of sensitivity on the part of clinicians to depression in this population, the reluctance to use antidepressants may be partly explained by the observation that 87 percent (13/15) of depressed patients had relative or absolute contraindications to antidepressants.