Antidepressants for seniors have doubled in two decades
- There’s been a major rise in the number of antidepressants being prescribed for older adults over the last two decades, without a similarly sharp increase in the number depressed
- In the first study group, 4.2% of the adults were taking antidepressants, but this jumped to 10.7% in the later study
- Among older adults living in care homes, the prevalence of depression was unchanged but the use of antidepressants rose from 7.4% to 29.2%
- Most of those prescribed antidepressants had not been diagnosed with depression
- Antidepressants are often ineffective for treating depression and pose risks to the elderly, including increasing the risk of falls, osteoporosis and fractures
Depression is common in older adults, occurring in 2% of those aged 55 years and older and rising with increasing age. Many more — from 10% to 15% — struggle with depressive symptoms, although they may not have been diagnosed with major depression.1
That being said, there’s been a major rise in the number of antidepressants being prescribed for older adults over the last two decades, without a similarly sharp increase in the number depressed, according to a study published in The British Journal of Psychiatry.2
The findings suggest seniors may be being overprescribed antidepressant drugs, which could have serious implications for their health, although the researchers weren’t willing to state this, noting instead, "we can't infer that older patients are prescribed antidepressants unnecessarily."3
Antidepressant Use More Than Doubles Among Seniors
In order to investigate whether the prevalence of depression and antidepressant drug use changed from 1990 to 2011 in people aged 65 and over, researchers used data from two English population-based cohort studies involving 15,397 people. The studies took place from 1991 to 1993 and between 2008 and 2011.
In the first study group, 4.2% of the adults were taking antidepressants, but this jumped to 10.7% in the later study. During this time, the prevalence of depression decreased, but only slightly, from 7.9% to 6.8%.4 Also noteworthy, among older adults living in care homes, the prevalence of depression was unchanged but the use of antidepressants rose from 7.4% to 29.2%.5
There were a few suggestions offered for why antidepressant prescribing rates increased so steeply without a similar increase in depression, including overdiagnosis or prescribing the drugs for conditions other than depression. However, most of those prescribed antidepressants had not been diagnosed with depression.
Lead study author Antony Arthur, Ph.D. of the University of East Anglia, Norwich, United Kingdom, told Medscape, "Sometimes treatment is given for mild depression which falls outside of our definition of depression ― much of the evidence for the effectiveness of antidepressants is for people with moderate or severe depression. Antidepressants are also used to treat other conditions, for example, neuropathic pain and sleep disorders."6
He added that opportunities to deprescribe antidepressants should not be overlooked.7 “Whatever the explanation, substantial increases in prescribing has not reduced the prevalence of depression in the over-65 population. The causes of depression in older people, the factors that perpetuate it, and the best ways to manage it remain poorly understood and merit more attention,” he stated.8
A separate study, published in World Psychiatry in 2017, reviewed data collected from 1990 to 2015 from Australia, Canada, England and the U.S. It similarly found that “the prevalence of mood and anxiety disorders and symptoms has not decreased, despite substantial increases in the provision of treatment, particularly antidepressants.”
Antidepressants Risky for the Elderly
Depression is a serious mental health condition that’s associated with many negative outcomes in older adults. Along with increasing personal suffering, depression is associated with an increased risk of cognitive decline, dementia, poor medical outcomes, suicide and high mortality.9
American Psychiatric Association guidelines suggest optimal treatment for depression should include antidepressant medication along with psychotherapy, but most elderly who are treated for depression (many go without treatment) receive antidepressant medications only.10 Yet, there are a number of risks that come with antidepressant usage.
For instance, antidepressant users have an increased risk of developing Type 2 diabetes,11 even after adjusting for other risk factors, like body mass index (BMI).12 Antidepressant use has also been linked to thicker arteries, which could contribute to the risk of heart disease and stroke.13
The drugs are also linked to dementia, with researchers noting “treatment with SSRIs, MAOIs, heterocyclic antidepressants and other antidepressants was associated with an increased risk of dementia,” and as the dose increased, so too did the risk.14
The drugs are also known to deplete various nutrients from your body, including coenzyme Q10 and vitamin B12 — in the case of tricyclic antidepressants — which are needed for proper mitochondrial function. SSRIs may deplete calcium, folate and other important nutrients from your body.15 There are also risks specific to older adults, which are not necessarily seen in younger adults.
According to research published in Expert Review of Neurotherapeutics, “One particular concern is that antidepressants increase the risk of falls, osteoporosis and fractures … antidepressants have side effects and risks, some of which can be observed acutely while others may be longer-term consequences.”16
For example, one 2015 study found that, compared to perimenopausal women treated with H2 antagonists or proton pump inhibitors (indigestion drugs), selective serotonin reuptake inhibitors (SSRIs, a class of antidepressants) raised bone fracture rates by 76% in the first year of use. After two years of treatment, the fracture rate was 73% higher.17,18
What’s more, between 1988 and 2010 39% of people aged 65 and over were taking at least five prescription medications each day19 — in 2019 as many as 43% may be taking eight or more, while 24% could be taking as many as 10 day,20 which can be contraindicated, raising new risks. In 2015 when the first study was published, researchers believed the increases were driven, in part, by rising use of antidepressant drugs.
Antidepressants Are Often Ineffective
Studies have repeatedly shown antidepressants work no better than placebo for mild to moderate depression,21 so seniors may be taking serious risks for a very small chance of benefit.
In yet another study that documented the overprescription of antidepressants in older adults, researchers found they were often prescribed in the absence of major depressive disorder (MDD), although they were not effective for such purposes. Researchers concluded:22
“Providers and the public increasingly recognize depression as a medical problem meriting treatment; however, they should be aware that antidepressants are not beneficial for depressive symptoms that do not meet the criteria for MDD, but their potential side effects and costs remain regardless of whether MDD is present.”
Even in severely depressed patients, the difference in efficacy between antidepressants and placebo has been described as “relatively small,”23 while Irving Kirsch, associate director of the Program in Placebo Studies at Harvard Medical School, has conducted several meta-analyses of antidepressants in comparison to placebo, concluding there’s virtually no difference in their effectiveness.
According to Kirsch, “The difference is so small, it’s not of any clinical importance.”24 In a 2014 article, he wrote:25
“Antidepressants are supposed to work by fixing a chemical imbalance, specifically, a lack of serotonin in the brain. Indeed, their supposed effectiveness is the primary evidence for the chemical imbalance theory.
But analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits are due to the placebo effect.
… Even the small statistical difference between antidepressants and placebos may be an enhanced placebo effect, due to the fact that most patients and doctors in clinical trials successfully break blind … Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future.”
Seniors Can Relieve Depression Via Exercise
The seriousness of depression cannot be overstated, and the need for effective treatment is a necessity. However, many seniors may be pinning their hopes of improving their mood and relieving depression on a pill solution that just doesn’t work. Importantly, there are other options available, with exercise being one of them.
In an 11-year study, people who engaged in regular leisure-time exercise for one hour a week were less likely to become depressed.26 A meta-analysis of 33 trials involving nearly 1,877 people also showed that strength training led to a significant reduction in depressive symptoms, and this held true regardless of the participant’s health status, improvements in strength or how much strength training they completed.27
According to the study’s lead author, Brett Gordon, a postgraduate researcher in the department of physical education and sports sciences at the University of Limerick in Ireland, the greatest improvements were seen among people with symptoms of mild to moderate depression, as opposed to those without depression, which suggests strength training may be most effective for people with greater depressive symptoms.28
Research has also looked into the effects of exercise and depression in seniors, particularly. In a study of older depressed adults, 80% experienced a significant reduction in depressive symptoms after taking up strength training for 10 weeks, such that researchers concluded, “PRT [progressive resistance training] is an effective antidepressant in depressed elders, while also improving strength, morale, and quality of life.”29
In yet another study of older adults with depression, those who took part in high-intensity strength training three days a week for eight weeks experienced a 50% reduction in depressive symptoms,30 whereas separate research showed strength training exercise reduced depressive symptoms in older Hispanic/Latino adults as well (endurance, balance and flexibility exercises were also beneficial for mood).31
The upside is that, unlike with antidepressants, which increase health risks, exercise provides additional health benefits to seniors. In my 2008 interview with Dr. James Gordon, an expert in using mind-body medicine to heal depression, he stated that physical exercise is at least as good as antidepressants for helping people who are depressed.
Seek Help if You’re Struggling With Depression
If you’re struggling with depression or depressive symptoms, seek help, from a counselor, a holistic psychiatrist or another natural health practitioner to start the journey toward healing. And, realize that antidepressants carry risks, including increasing the risk of suicide and violence,32 and are not the only available treatment.
In many cases, exercise, sleep and dietary changes can work wonders, especially when combined with nutritional and light therapy, along with energy psychology tools such as the Emotional Freedom Techniques (EFT). Supplements, including magnesium, omega-3 and B vitamins, along with vitamin D, can also be helpful in restoring optimal mental health.
If you’re in the throes of depression, it can be nearly impossible to commit to positive lifestyle changes, so please don’t suffer in silence. Get help from a health partner who can guide you out of crisis mode and into a mindset that allows you to make healthy changes.
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