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Am J Psychiatry 1997; 154:1369-1375
Copyright © 1997 by American Psychiatric Association
Use of antidepressants by nonpsychiatrists in the treatment of medically ill hospitalized depressed elderly patients
HG Koenig, LK George and KG Meador
Department of Psychiatry, Duke University Medical Center, NC 27710, USA.
OBJECTIVE: The purpose of this study was to examine antidepressant use by
nonpsychiatrists in the treatment of depressed elderly medical inpatients.
METHOD: Patients aged 60 or older who were admitted to medical services at
Duke Hospital were evaluated by a geropsychiatrist who used a structured
psychiatric interview to identify major or minor depressive disorder.
Medical records of depressed patients were reviewed for use of
antidepressants and benzodiazepines before admission, during
hospitalization, and on discharge. After discharge, depressed patients were
contacted four times by telephone at 12-week intervals to inquire about
medication use (median follow-up time = 45 weeks). RESULTS: Of 153
depressed patients, 40.5% received antidepressants at some time during
their hospital stay or follow-up period, 25.5% received only
benzodiazepines, and 34.0% received neither. The most commonly prescribed
antidepressant was amitriptyline (45.2% of treated patients), administered
at an average maximum dose of 49 mg/day. Only 15 of 114 untreated depressed
patients started antidepressant therapy during hospitalization (nine with
amitriptyline). Of 91 depressed patients who did not receive
antidepressants either before admission or during hospitalization, only 11%
received any antidepressant therapy during the median 11-month follow-up;
again, half were treated with amitriptyline at doses of 10- 30 mg/day.
Intensity of antidepressant therapy was predicted by severity of depressive
symptoms, history of psychiatric problems, and higher income. CONCLUSIONS:
A relatively low proportion of depressed older medical inpatients receive
treatment with antidepressants. Patients treated with antidepressants often
receive potentially dangerous tertiary tricyclics at inadequate doses.
Unless depression is identified and treated during medical hospitalization,
it is unlikely to be treated adequately after discharge.
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