"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," says Donovan Maust. (Credit: Nikita Gavrilovs/Flickr)

anxiety

Are too many seniors taking antidepressants?

Older Americans receive prescriptions for mental health medications at more than twice the rate that younger adults do, a new study finds.

The worry of previous decades—that America’s seniors weren’t receiving attention for mental health issues—may now need to shift, says Donovan Maust, the geriatric psychiatrist who led the analysis.

“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,” says Maust, an assistant professor of psychiatry at the University of Michigan.

The issue of medication use is particularly concerning for older adults, because the risk/benefit balance can shift as they become more likely to experience side effects or other adverse events.

“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,” adds Maust.

Dangerous side effects

For instance, anti-anxiety benzodiazepine drugs such as Valium, Xanax, Klonopin, and Ativan (and their generic counterparts) may be relatively safe for younger adults, but carry a higher risk of car accidents, falls, fractures, and worsening of thinking ability or memory for older patients.

Antidepressants can interact with blood thinners and painkillers and can raise blood pressure, all of which are more likely to be problems for older adults, who are generally on more medications than their younger counterparts.

The new findings, published in the Journal of the American Geriatrics Society, come from the first study to compare overall outpatient mental health treatment in adults over age 65 with that of patients between ages of 18 and 64.

Maust and colleagues started with information from over 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.

See a psychiatrist?

They examined 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 (including antidepressants, anxiety-calming drugs called anxiolytics, mood stabilizers, antipsychotics, or stimulant drugs).

They converted their results to a population-based visit rate, which helps consider the number of visits out of the eligible pool of potential outpatients in the community.

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In this light, for example, visits related to antidepressant and anti-anxiety drug use among older adults (63 and 62 visits per 100 people per year, respectively) occurred at nearly double the rates of such visits by younger adults (36 and 29 visits per year per 100 people, respectively).

In contrast, older adults see psychiatrists at about half the rate of younger adults (6.3 versus 12 visits per year per 100 people).

“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,” says Maust.

AFAR, the John A. Hartford Foundation, the Atlantic Philanthropies, and the Beeson Career Development Award Program supported the research.

Source: University of Michigan

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