Influence of symptoms of anxiety on treatment of depression in later life in primary care: questionnaire survey.

13 West C. When the doctor is a " lady " : power, status and gender in physician-patient encounters. While studies of the prevalence of major depressive disorders in elderly people have produced rates of 1% to 2%, depression that is clinically significant has been shown to have a prevalence of at least 10% among older people and represents the most common mental disorder in later life. Most of these depressed older people, however, do not receive any treatment for their depression. 1 Prominent symptoms and syndromes of anxiety commonly accompany late life depression in the community 2 and may contribute to the low level of detection of the primary depressive disorder and to inappropriate treatment with benzodiazepines. As part of a naturalistic study of mental disorders among elderly people living in the community in Dublin 3 we studied the influence of concurrent anxiety symptoms on the likelihood of them receiving pharmacological treatment for depression. People aged 65 years and over on the practice lists of five urban general practices and not living in residential care were identified. We interviewed 1737 participants (82%) with the geriatric mental state and automated geriatric examination for computer assisted taxonomy instrument , which generates " cases " and " subcases " of mental disorder (subcase level representing symptoms not reaching the criteria for case level disorder).The level of depression among cases has been shown to correspond with what psychiatrists usually recognise as a depressive disorder and has been validated against the combined categories of major depression and dysthymia from the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III), with good agreement. 4 In addition to the primary diagnosis each subject is allocated a level of confidence on all (eight) diagnostic clusters and, therefore, the presence of symptoms or disorders comorbid with the principal diagnosis is recorded. Current use of psychotropic drugs was recorded by direct inspection of medications. There were 184 (11%) cases of depression among the elderly people. Of these, 84 (46%) were receiving a psychotropic drug, with a similar proportion of depressed men (22/53, 42%) and women (62/131, 47%). Sixty four (35%) depressed participants were taking a benzodiazepine and 34 (19%) were taking antidepressant medication. Of the 184 depressed people , 36 (20%) had a comorbid anxiety disorder (case level anxiety or phobia), 115 (63%) had concurrent anxiety symptoms (anxiety, phobic, or obsessional symptoms at subcase level), and 33 (18%) …