Management of depression in the elderly by general practitioners: I. Use of antidepressants

Depression is a common problem in the elderly but studies have suggested that it is often inadequately treated by general practitioners (GPs). This study aims to investigate how GPs manage depression in the elderly. A national questionnaire study on the management of depression in the elderly was carried out. Case vignettes were used to investigate how GPs manage depression and what influenced their decision making process. Each case vignette had a factor complicating the use of the older tricyclics. The questionnaire was completed by 407 out of 667 GPs (61%). Many GPs chose the newer antidepressants but a substantial proportion preferred the older tricyclics. Many GPs selected subtherapeutic doses, particularly of the older tricyclics. Few GPs said they maintained patients on antidepressants for more than 3 months after recovery and only 1 in 12 continued antidepressants for over 6 months. If these results reflect GPs practice there is a danger that many patients will be inadequately treated and also at risk of relapse because of their antidepressants being stopped too soon after recovery.