Episode 10: Bridging the Gap in Depression Care

Andie Cartwright

Hey everyone, welcome back to Better Living Through Data! I’m Andie Cartwright, joined by Anthony Pero, and today—this is one I’ve wanted to spotlight for ages—we’re digging into depression care in long-term care settings. Anthony, you and I have both seen how these issues get almost swept under the rug, right?

Anthony Pero

Yeah, absolutely. You know, it’s a big disconnect. People assume older adults in LTC are just inherently “sad” because of their circumstances, which isn’t just unfair—it’s flat out wrong. According to a 2025 PCC Life Sciences study, the prevalence of depression in LTC is significantly higher than in community-dwelling older adults. The real kicker? There are huge treatment gaps, even when someone does get a diagnosis.

Andie Cartwright

Right? And it isn’t just about getting diagnosed. In our study we found that only about 82% of LTC residents who are diagnosed with depression actually get any guideline-directed depression medication. That leaves almost one in five with no proper treatment at all. I was thinking back to my time in marketing for senior mental health programs—there’s this stubborn stigma, especially in older generations. Even if there’s awareness, people just... don’t talk about it. Families might worry about “medicating” Mom or Dad or, worse, see depression as a normal part of aging. It’s not.

Anthony Pero

And let’s not forget, there’s also a tendency to substitute antipsychotic meds for actual antidepressants—especially in severe cases. I’m not saying clinical teams don’t care, but with the workload and complexity in LTC, following the textbook just doesn’t always happen.Andie, you mentioned that program—what barriers did you see the most?

Andie Cartwright

Stigma was the big one. A lot of residents or families felt embarrassed by a diagnosis or didn’t want to talk about “mental health.” And then there’s just a lack of trust—like folks thinking antidepressants are too risky, or they’ll zombify people. But in reality? We know untreated depression can make every other health condition and the whole quality of life way worse.

Anthony Pero

Exactly. And as we’ve seen in past episodes—especially when we talked about medication access and data gaps for seniors—there’s this recurring theme: People aren’t getting what the clinical guidelines actually recommend, and the reasons aren’t always clinical. Sometimes they’re… systemic, or honestly, just human.

Anthony Pero

Let’s get into the numbers. The latest study leveraged PointClickCare’s enormous EHR dataset—over eighteen million individuals, but for depression, they zeroed in on about 358,000 residents with a diagnosis during just a four-month window. That’s massive. Now, in terms of treatment, SSRI use was nearly 49%, and SNRIs about 18%. That pattern’s basically a mirror image of what you see in the general community.

Andie Cartwright

Yeah, so on the surface it might seem like “Hey, good, LTC isn’t lagging behind,” but then you dig into the logistic regression and it’s more nuanced. Residents with diabetes or hyperlipidemia had about 20% lower odds of receiving guideline-directed depression treatment. And for Black or African American residents, it was even starker—30% lower odds. That is not a small difference, and it just jumps off the page.

Anthony Pero

It really does. And from the payer-provider side, we’ve tried—sometimes with limited success—to design interventions that take these comorbidities and disparities into account. It’s tricky. The data’s there, but actually tailoring action based on comorbidity and demographic complexity? The real world is messy. Like, trying to close this treatment gap isn’t just about one prescription pad; you need trust, sustained outreach, and honestly, the right incentives for providers. Where was I going with this... Oh, right, tailoring is hard, but the data shows we can’t ignore it.

Andie Cartwright

I think you nailed it. This isn’t a matter of one-off education or tossing more SSRIs into a med pass. The real-world EHR data spells out the need to look at who’s not getting care and why. It always amazes me how you can see these invisible walls—like, the numbers don’t lie, right? We can’t just pretend everyone’s starting from the same playing field in LTC.

Anthony Pero

And that’s not news just for clinicians, but for everyone building policies or creating new programs. If your intervention isn’t factoring in comorbidities, race, and all these social variables, I mean... are you really improving care? Or just moving chess pieces around on a board that’s already uneven?

Andie Cartwright

Let’s talk about the bigger picture. The data says loud and clear: care can’t be one-size-fits-all, especially not in depression where comorbidities, race, and social vulnerability can totally change the story. We need to ask, “Who’s missing out and why?” Even with prescribers trying their best, some groups just don’t get the same level of care.

Anthony Pero

It’s a wake-up call for clinical guidelines, too. Regulators and professional societies often base their guidance on “ideal” trial settings. But these real-world findings scream for personalized pathways—especially when the odds are so skewed against some subgroups.

Andie Cartwright

This is where real-world EHR studies become super valuable. They’re showing us disparities that randomized trials never could. Take the Social Vulnerability Index, for instance. Residents who scored high—meaning more social barriers and less support—were less likely to receive guideline-based depression meds, even after adjusting for other factors.

Anthony Pero

Exactly. It circles back to trust, like you said earlier. If folks don’t see depression care as something for “people like them”—or if the outreach isn’t meeting them where they are—then no amount of policy fixes will stick. We’re seeing more efforts to embed outreach specialists from similar backgrounds, or to build program pilots that focus on relational trust instead of just prescription metrics. It’s early, but the data says we’ve gotta keep pushing that direction.

Andie Cartwright

And it fits with everything we’ve been learning episode after episode, honestly. Change happens when you combine evidence with empathy—and keep analyzing where things fall short. I think that’s a pretty good note to end on for now. We always want to hear what folks in the field are seeing, so if you’ve got feedback or a story to share, reach out! Anthony, this was a good one.

Anthony Pero

Always great, Andie. Thanks everyone for joining us again—can’t wait for our next conversation. Take care and goodbye!

Andie Cartwright

Same here—thanks for listening to Better Living Through Data. Talk to you soon!