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Background Depression is a leading cause of disability with older people particularly susceptible to poor outcomes. Aims To investigate whether the prevalence of depression and antidepressant use have changed across two decades in the over-65s. Method The Cognitive Function and Ageing Studies (CFAS I and CFAS II) are two English population-based cohort studies of older people aged over 65 years with baseline measurements for each cohort conducted two decades apart (between 1990 and 1993 and between 2008 and 2011). Depression was assessed using the Geriatric Mental State (GMS) examination and diagnosed using the Automated Geriatric Examination for Computer-Assisted Taxonomy (AGECAT) algorithm. Results In CFAS I, 7635 people aged 65 or older were interviewed of whom 1457 were diagnostically assessed. In CFAS II, 7762 people were both interviewed and diagnostically assessed. Age standardised depression prevalence in CFAS II was 6.8% (95% CI 6.3-7.5), representing a non-significant decline from CFAS I (RR 0.82, 95% CI 0.64-1.07, p=0.14). At the time of CFAS II 10.7% of the population (95% CI 10.0%-11.5%) were taking antidepressant medication, more than twice that of CFAS I (RR 2.79, 95% CI 1.96-3.97 p<0.0001). Among care home residents, depression prevalence was unchanged, but the use of antidepressants increased from 7.4% (95% CI 3.8-13.8%) to 29.2% (95% CI 22.6-36.7%). Conclusions A substantial increase in the proportion of the population reporting taking antidepressant medication is seen across two decades for people aged 65 and over. However there was no evidence for a change in age-specific prevalence of depression.

Changing prevalence and treatment of depression among the over-65s over two decades:findings from the Cognitive Function and Ageing Studies