An examination of the attitudes and practice of general practitioners in the diagnosis and treatment of depression in older people

Ian Rothera, Rob Jones, Catherine Gordon
International Journal of Geriatric Psychiatry 2002, 17 (4): 354-8

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.

METHOD: 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.

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