Donovan Maust, an assistant professor of psychiatry at the University of Michigan, is the geriatric psychiatrist who led the study, the first to compare overall outpatient mental health treatment in adults over age 65 with that of patients between ages of 18 and 64. It was funded by AFAR, the John A. Hartford Foundation, the Atlantic Philanthropies, and the Beeson Career Development Award Program.
As Maust explained, "We need to pay special attention to polypharmacy, or multiple drugs taken at once, when prescribing psychotropic drugs in this population, because so many older adults are already on multiple medications." Maust believes that the issue of medication use is especially troubling for older adults, because the side effects or adverse effects of taking multiple drugs could shift the risk/benefit balance. As he says, "While it's still true that we have patients who are not getting treated for mental health concerns, these data suggest that we also need to be mindful of the possibility of overtreatment, especially given the changing balance of risk and benefit as patients age."
While certain or instance, anti-anxiety benzodiazepine drugs such as Valium, Xanax, Klonopin, and Ativan (and their generic counterparts) may be relatively safe for younger adults, they carry a higher risk of car accidents, falls, fractures and muddled thinking for older patients. When antidepressants interact with blood thinners and painkillers, they can raise blood pressure.
The study used information from more than 100,000 outpatient visits to outpatient physicians between 2007 and 2010 collected by the National Ambulatory Medical Care Survey, a national survey administered by the National Center for Health Statistics of the Centers for Disease Control and Prevention. Maust and his colleagues analyzed four types of visits: ones where "patients received a mental health diagnosis; saw a psychiatrist; received psychotherapy; and/or received a prescription or renewal of a psychotropic medication." They then determined the number of visits per potential outpatients in the community and found that visits concerning antidepressant and anti-anxiety drug use among older adults happened at nearly twice the frequency of such visits by younger adults. Conversely, older adults see psychiatrists at about half the rate of younger adults.
According to Maust, "In many cases, especially for milder depression and anxiety, the safer treatment for older adults who are already taking multiple medications for other conditions might be more therapy-oriented, but very few older adults receive this sort of care."
According to BC Medical Journal, depression is the most common mental health problem in the elderly. It is associated with a significant burden of illness that affects patients, their families, and communities and takes an economic toll as well. Prevalence studies suggest that 14 to 20 percent of the elderly experience depressive symptoms, with higher rates among the elderly in the hospital and even higher rates in long-term care facilities. Awareness of factors that cause depression can help to identify patients in need of screening with tools such as the Geriatric Depression Scale. After diagnosis, patients require regular follow-up and active medication management to maximize treatment and remission outcomes. Selection of an antidepressant medication should be based on minimizing side effects profile and drug-drug interaction. If there is no improvement, add-on treatments, including other drugs and psychotherapy, may be considered (http://www.bcmj.org/articles/geriatric-depression-use-antidepressants-elderly).