Screening, Detection and Management of Depression in Elderly Primary Care Attenders. II: II: Detection and Fitness for Treatment: a Case Record Study

摘要

Case note data were obtained for 186 elderly primary care attenders who also completed the 15 item Geriatric Depression Scale (GDS15). The presence or absence in the case notes of a current or past diagnosis of depression, of current treatment of depression, and of a number of clinical features of depression were noted. Case notes were also rated for the presence or absence of contraindications to the use of tricyclic antidepressants (TCAs) and to serotonin-specific reuptake inhibitors (SSRIs). Whereas 65 (35) patients were rated as‘cases’of depression on the GDS15, only 28 (15) had a current case note diagnosis of depression and 37 (20) had one or more current symptoms of depression recorded in the case notes. Patients rated by their GP as having one or more current symptoms of depression scored higher on the GDS15 (P<0.05) and were more likely to be categorized as a GDS case (P=0.05). There was no significant relationship between GDS caseness and a current case note diagnosis of depression. Seventy-three patients (39) had a past history of depression and 53 (28.5) patients had previously been treated with antidepressants. The former was significantly associated with GDS caseness (P<0.05). Twenty-four patients (13) were currently on antidepressants, 19 of them receiving adequate doses (equivalent to at least 75 mg of amitriptyline). Current antidepressant treatment was not associated with GDS‘caseness’. A significantly higher proportion of patients (both in the sample as a whole and in the subgroup of GDS15 depression‘cases’) had a medical condition or were taking a drug that mitigated against the use of TCAs than was the cas