Age-related depression: Why are more and more senior citizens taking antidepressants?

Veröffentlicht am: October 15, 2024

General practitioner

Today, twice as many senior citizens take antidepressants than 20 years ago. This article explains the causes and side effects of this trend.

THE ARTICLE AT A GLANCE

Over the last two decades, there has been a sharp increase in the number of antidepressants prescribed for senior citizens, although the number of cases of depression has not increased to the same extent.
In an initial study, 4.2 percent of adults took antidepressants. This figure rose to 10.7 percent in a follow-up study.
The percentage of senior citizens suffering from depression and living in care homes remained unchanged. However, the use of antidepressants increased from 7.4 to 29.2 percent.
Most antidepressants were not prescribed because of a diagnosis of depression.
Antidepressants are often ineffective in treating depression and pose a risk to older people. They increase the risk of falls, osteoporosis and bone fractures.

Depression often occurs in senior citizens. Around two percent of 55-year-olds suffer from it. The disease affects more and more people as they get older. In addition, between ten and 15 percent of people in this age group struggle with depressive symptoms, even if they may not be diagnosed with severe depression.

Apart from this, there has been a sharp increase in the number of antidepressants prescribed for senior citizens over the last two decades, but without a similar increase in the number of cases of depression. These are the findings of a study published in "The British Journal of Psychiatry".

The results suggest that older people may be over-prescribed antidepressants, which could have serious consequences for their health. However, the researchers did not go so far as to conclude "that older patients are actually being prescribed antidepressants unnecessarily."

Why has the use of antidepressants in the elderly more than doubled?

Researchers analyzed data from two English cohort studies of 15,397 people to determine whether the incidence of depression and the use of antidepressants changed from 1990 to 2011 in people aged 65 and over. The studies were conducted from 1991 to 1993 and from 2008 to 2011.

In the first study, 4.2 percent of adults took antidepressants. This figure rose to 10.7 percent in the follow-up study. During this period, the number of cases of depression fell slightly from 7.9 to 6.8 percent. It is interesting to note that the percentage of seniors suffering from depression and living in nursing homes remained unchanged, but the use of antidepressants increased from 7.4 to 29.2 percent.

There have been several explanations as to why the prescription rate for antidepressants has risen so sharply without a similar increase in depression. These included overdiagnosis or prescribing antidepressants for conditions other than depression. The results showed that most antidepressants were not prescribed for diagnosed depression.

Lead study author Antony Arthur, Ph.D. of the University of East Anglia in Norwich in the UK, told Medscape: "Sometimes antidepressants are given to treat mild depression, which is outside our definition of depression. A large body of evidence supports the effectiveness of antidepressants for people with moderate or severe depression. Antidepressants are also used to treat other conditions, such as neuropathic pain and sleep disorders."

He added that opportunities to discontinue antidepressants should not be overlooked. "Regardless of why antidepressants are prescribed, increased use has not led to a decrease in depression in the 65+ age group. We still know very little about the causes of depression in older people, factors that contribute to its maintenance and ways of coping with it. These questions deserve more attention."

Another study was published in the journal "World Psychiatry" in 2017. Scientists reviewed data from Australia, Canada, England and the USA from 1990 to 2015 and also came to the conclusion that "the incidence of mood and anxiety disorders and related symptoms has not decreased despite a significant expansion in treatment provision and, in particular, the increased use of antidepressants."

Numerous side effects of antidepressants in seniors

Depression is a serious mental illness that is associated with many negative consequences for seniors. In addition to the increased personal suffering experienced by those affected, depression is suspected of increasing the risk of cognitive decline, dementia, poor performance on medical tests, suicide and premature death.

The American Psychiatric Association guidelines suggest that optimal treatment for depression should include antidepressants in addition to psychotherapy. However, most people in this age group who receive treatment for depression (many choose not to) only receive antidepressants. There are a number of risks associated with taking these drugs.

For example, the risk of developing type 2 diabetes increases. This applies even when the data is adjusted for other risk factors such as body mass index (BMI). The use of antidepressants was also linked to a thickening of the arteries, which could increase the risk of heart disease and strokes.

The drugs are also associated with dementia. The researchers found that "treatment with SSRIs, MAOIs, heterocyclic and other antidepressants is associated with an increased risk of dementia." The risk also increases with increasing dose.

The drugs also deprive the body of various nutrients. Tricyclic antidepressants, for example, deprive the body of coenzyme Q10 and vitamin B12, which are needed for the mitochondria to work properly. SSRIs can deprive the body of calcium, folic acid and other important nutrients. Certain risks apply exclusively to older adults and do not necessarily occur in younger adults.

According to a study published in the journal "Expert Review of Neurotherapeutics", "there are particular concerns that antidepressants increase the risk of falls, osteoporosis and fractures... Antidepressants are associated with side effects and risks, some of which may be observed immediately, while others may take longer to become apparent."

For example, a 2015 study of perimenopausal women found that the bone fracture rate increased by 76 percent in the first year of taking selective serotonin reuptake inhibitors (SSRIs) compared to women treated with H2 antagonists or proton pump inhibitors (drugs for digestive disorders). After two years of treatment, the fracture rate was 73 percent higher.

In addition, between 1988 and 2010, 39% of people in the 65+ age group took at least five prescription drugs a day. For 2019, the researchers assume that 43% are even taking eight or more medications, with 24% of seniors even taking up to ten medications per day. This can lead to numerous contraindications, which entail new risks. In 2015, when the first study was published, the scientists were convinced that the increase was at least partly caused by the increasing use of antidepressants.

Antidepressants are often ineffective

Studies have repeatedly shown that antidepressants work no better than placebo for mild to moderate depression. This means that older people may be taking serious risks and, in turn, have very little chance of the drugs providing any benefit.

In another study documenting the overprescription of antidepressants in older adults, researchers found that they were often prescribed without the presence of major depressive disorder (MDD), even though they are not intended for such purposes and accordingly do not work. The researchers concluded:

"Doctors, therapists and the general public increasingly see depression as a medical problem that needs to be treated. However, everyone should be aware that antidepressants are not beneficial for depressive symptoms that do not meet the criteria for MDD, but the potential side effects and costs remain - regardless of whether MDD is actually present."

Even in patients with severe depression, the difference in efficacy between antidepressants and placebo was described as "relatively small". Irving Kirsch, Associate Director for Placebo Studies at Harvard Medical School, conducted several meta-analyses comparing the use of antidepressants with placebo. He came to the conclusion that there was practically no difference in their effectiveness.

Kirsch reported: "The difference is so small that it is not clinically relevant." In an article from 2014, he wrote:

"The effect of antidepressants is based on the fact that they are supposed to eliminate a chemical imbalance in the brain, caused in particular by a lack of serotonin. In fact, their supposed effectiveness is seen as primary evidence for the chemical imbalance theory.

However, analyses of published data and unpublished information that pharmaceutical companies like to keep under wraps show that most (if not all) of the benefits of these drugs are due to the placebo effect.

.... Even the small statistical difference that exists between antidepressants and placebo could be an amplified placebo effect, as most patients and doctors successfully blind themselves in clinical trials.... Instead of curing depression, popular antidepressants may create a kind of biological vulnerability that makes these people more likely to develop depression in the future..."

Seniors can alleviate depression with physical exercise

Depression is always a serious illness that absolutely requires effective treatment. Many seniors place their hopes of improving their mood and alleviating their depression on medication, which simply does not work. It is important to realize that other treatment options exist. Physical exercise is one of them.

An 11-year study showed that subjects who regularly exercised once a week for an hour in their free time were less likely to suffer from depression. A meta-analysis of 33 studies with 1,877 test subjects also showed that strength training led to a significant reduction in depressive symptoms, regardless of the participant's state of health, their individual training progress or the frequency of the strength training sessions.

According to Brett Gordon, lead author of the study and a PhD student at the Department of Exercise and Sport Science at the University of Limerick in Ireland, the greatest improvements were observed in people who had symptoms of mild to moderate depression - as opposed to people without depression. This suggests that strength training may be most effective for people with more severe depressive symptoms.

The researchers also investigated the effects of exercise, particularly on seniors with depression. In a study of seniors suffering from depression, 80 percent experienced a significant reduction in their depressive symptoms after ten weeks of strength training. This observation led the researchers to conclude that "Progressive resistance training is an effective antidepressant for seniors with depression while improving strength, morale and quality of life."

In another study - also with seniors with depression - those who performed high-intensity strength training three days a week over an eight-week period enjoyed a 50 percent reduction in their depressive symptoms. Separate studies showed that strength training also reduced depressive symptoms in seniors of Hispanic/Latino descent. (Endurance, balance and flexibility exercises also had a positive effect on mood).

Another advantage of physical activity as opposed to taking antidepressants is that exercise offers further health benefits, whereas medication puts people's health at additional risk. In 2008, we conducted an interview with Dr. James Gordon, an expert in mind-body medicine, which aims to bring people's bodies and souls into harmony. On curing depression, he said that physical exercise works at least as well as antidepressants.

Seek professional help if you suffer from depression

If you suffer from depression or are struggling with depressive symptoms, seek help, for example from a life counselor, psychiatrist or other alternative practitioner. Don't take your symptoms for granted, but take the first steps towards a better life. You should also be aware that antidepressants carry risks. These include an increased risk of committing suicide or acts of violence. These medications are by no means the only treatment method available.

In many cases, exercise, sleep and dietary changes can work wonders, especially when combined with nutritional and light therapy and energy psychology methods such as Emotional Freedom Techniques (EFT). Nutritional supplements, including magnesium, omega-3 and B vitamins, along with vitamin D, can also help restore optimal mental health.

If you are deeply trapped in depression, it is almost impossible to persuade yourself to make positive changes to your lifestyle. Please do not suffer in secret. Seek professional help that can guide you out of your crisis mode and into a mindset that allows you to make healthy changes.

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