Pharmacotherapy for Depression in Long-Term Care: A Real-World EHR Study

ObjectivesTo evaluate rates of treatment for depression and identify resident- and facility-level predictors of pharmacotherapy among long-term care (LTC) residents in the United States. DesignRetrospective, observational study. Setting and ParticipantsElectronic health record data from 1,675,873 LTC residents in the PointClickCare Life Sciences database (January-April 2025) were reviewed and 358,425 skilled nursing facility residents with a documented depression diagnosis were identified. MethodsResidents were classified as treated/untreated based on having a medication order for pharmacological depression treatment within medication classes recommended by the American Psychological Association. Descriptive analyses incorporated demographic and clinical characteristics, and multivariable logistic regression estimated odds of treatment. ResultsOverall, 81.7% of residents diagnosed with depression had [≥]1 pharmacological depression treatment order. Selective serotonin reuptake inhibitors (59.8%) and miscellaneous antidepressants (42.3%) were the most frequently used classes. Treatment rates were similar across depression diagnoses. Higher odds of receiving treatment were observed among residents also diagnosed with vascular dementia and those with hyperlipidemia medication orders. Lower odds were noted among residents who were Black or African American, had diabetes or hyperlipidemia diagnoses, or resided in facilities located in areas with poor socioeconomic status. Conclusions and ImplicationsMost residents with depression had at least one recommended pharmacologic therapy, although important disparities remain. Racial differences, comorbid conditions, and facility context continue to influence treatment access. These findings support the need for improved screening practices, greater attention to equity in prescribing, and strengthened clinical resources in socially vulnerable settings to enhance the quality of depression care in LTC facilities. Brief SummaryDepression is common in long-term care (LTC) and is associated with poor functional and clinical outcomes, however recent treatment patterns are not well understood. Using electronic health record data from 1,675,873 U.S. LTC residents between January and April 2025, 358,425 skilled nursing facility residents were identified with a documented depression diagnosis. The use of antidepressant medication was assessed based on medication order history and was aligned with American Psychological Association recommendations. Overall, 81.7% had at least one pharmacologic treatment order for depression; selective serotonin reuptake inhibitors (59.8%) and miscellaneous antidepressants (42.3%) were most frequently used. After adjusting for covariates, lower odds of treatment were observed among Black or African American residents and among residents in facilities located in more socioeconomically vulnerable areas. These findings highlight persistent inequities in depression pharmacotherapy in LTC and support efforts to strengthen depression assessment and ensure equitable access to evidence-informed treatment across facilities.