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Changing prevalence and treatment of depression in people aged over 65

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A recently published paper (Arthur A., et al, British Journal of Psychiatry Oct 7:1-6. doi: 10.1192/bjp.2019.193. [Epub ahead of print]) reports findings from the Cognitive Function and Ageing Study (CFAS), which is a population-based study of over 15,000 people aged 65 plus. The study has two parts, CFAS I and CFASII, which were conducted 20 years apart on different groups of people. The study is led and co-ordinated from the University of Cambridge, and Nottingham University has been one of its centres for both stages. The current local investigator for Nottingham is Prof Tom Dening of the Division of Psychiatry and Applied Psychology. CFAS has been influential in providing high quality estimates of disorders such as dementia and depression, and these data have often been used for national and international policy purposes.

CFASII was conducted using the same methods as CFASI, which enables comparisons to made about changes in the frequency of disorders and also the treatments being used across a 20-year period. Recent CFAS papers have reported a decrease in the prevalence and incidence of dementia during this period, most probably due to improved general health in the more recent population.

Our paper looked at depression, to see if there were any changes either in its frequency (prevalence) or in the use of antidepressants to treat it. The main finding was that there was not a sizeable change in the numbers of people with depression even though over twice as many people were being prescribed antidepressants. This is an important result, although it raises more questions than it answers. For example, it might mean that depression would be even more common in the current cohort if there were fewer people taking antidepressants. However, it might also mean that people are being prescribed antidepressants and are not really benefitting from them. This causes concern as we have also recently, in a separate study, published research showing that drugs with anticholinergic properties (which include many antidepressants) are associated with an increased risk of developing dementia, so it is important that prescribing should be done carefully. Perhaps the message is that we should look more carefully at responses to depression other than medication such as psychological treatments and improving social resources for older people.

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