Underrecognition and undertreatment of depression: what is the pharmacist's culpability?

Gaps in pharmaceutical care for patients with mental health issues: A cross-sectional study

Background

Mental health issues such as depression and anxiety are often underdiagnosed and undertreated. Medications are a primary method of managing mental health problems, and pharmacists therefore have a vital role in supporting patients and providing them with information about the safety and efficacy of mental health medications. However, the potential role of pharmacists in managing mental health issues in Jordan has not been well established.

Aim

This study aimed to assess Jordanian pharmacists’ attitudes and actual practices related to the provision of mental health services.

Method

This was an exploratory cross-sectional study that used a self-report questionnaire among a convenience sample of 347 pharmacists in Amman, the capital of Jordan.

Results

The participating pharmacists had positive attitudes towards providing care for patients with mental health problems. However, their actual practices did not resonate with their enthusiasm, particularly in terms of the long-term follow-up of disease symptoms and medication side effects and adherence. The participating pharmacists showed an eagerness to collaborate with their colleagues, but their level of actual cooperation was lower than desired. The most reported barrier to providing care for patients with mental health problems was the lack of education on mental health issues (71.5%), followed by the lack of privacy in pharmacy settings (53.9%).

Conclusion

To be effectively involved in the provision of care to mental health patients, pharmacists should receive adequate education/training related to mental health issues, and pharmacies should be redesigned to provide private areas for patient counseling.

Community pharmacy services for antidepressant users

Objective

To evaluate the communication and barriers to communication between community-based pharmacists and antidepressant users.

Method

A survey package designed to evaluate the communication between pharmacists and antidepressant users was distributed to 50 community pharmacies. Each package included one pharmacist survey and 10 sealed antidepressant user surveys to be distributed by the pharmacy staff. The survey addressed the components of communication, level of satisfaction and barriers to effective communication.

Setting

Urban and rural community pharmacies in the Canadian Maritime provinces of Nova Scotia and New Brunswick.

Key findings

Overall, pharmacists rated the value of their communication more highly than did antidepressant users, although the difference was not statistically significant. When beginning treatment, between one-half and two-thirds of antidepressant users recalled pharmacists inquiring about past use of the antidepressant and discussing information provided by the physician, time to onset of benefits and potential side effects. The purpose of the antidepressant, target symptoms, usual duration of therapy and risk of relapse with premature discontinuation were addressed less often according to antidepressant users, and monitoring of compliance was not a common activity. Antidepressant users estimated that initial communication with the pharmacist generally lasted less than five minutes, and often less than two minutes. However, pharmacists appeared to resolve misconceptions and concerns about antidepressant use efficiently. According to pharmacists, the major barrier to effective communication was a lack of privacy.

Conclusion

Although compliance with antidepressants is low and treatment outcomes are sub-optimal, pharmacists are not using their opportunities to minimise this problem through effective communication and follow-up. Pharmacists, pharmacy administrators and regulators need to re-assess their contribution to this problem and how they can lead to its resolution in the patient's best interest.

Attitudes of Pharmacists Toward Mental Illness and Providing Pharmaceutical Care to the Mentally III

BACKGROUND:

Few studies have examined the attitudes of pharmacists toward mental illness.

OBJECTIVE:

To study the attitudes of Alabama pharmacists toward both mental illness and the providing of pharmaceutical care to mentally ill patients.

METHODS:

The survey used in this project was composed of 3 sections. Section 1 collected demographic information, section 2 asked 11 Likert-type questions concerning attitudes toward mental illness, and section 3 asked about attitudes toward providing pharmaceutical care to mentally ill patients. The surveys were distributed to pharmacists attending 3 school-sponsored continuing education programs.

RESULTS:

One hundred eighty-seven pharmacists participated in the survey. The vast majority (>90%) of participants disagreed or strongly disagreed with statements that mentally ill patients are easily recognizable, unintelligent, and do not care how they look. Approximately 30–50% of participants expressed being “more” or “much more” confident, comfortable, interested, and likely to perform pharmaceutical care activities for mentally ill patients relative to medically ill patients, while only approximately 5–20% of participants expressed being “less” or “much less” so. Several demographic factors, including gender, age, and years in practice, were associated with attitudes toward providing pharmaceutical care to mentally ill patients.

CONCLUSIONS:

Pharmacists expressed generally positive attitudes toward both mental illness and the providing of pharmaceutical care to mentally ill patients.

Collaborative care model to improve outcomes in major depression

OBJECTIVE

To develop a pharmacist intervention to improve depression care and outcomes within a primary care setting.

METHODS

Pragmatic, randomized trial of a clinical pharmacist collaborative care intervention versus usual care in a busy, academic family practice clinic.

RESULTS

Seventy-four patients diagnosed with a new episode of major depression and started on antidepressant medications were randomized to enhanced care (EC) or usual care (UC) groups. EC consists of a clinical pharmacist collaborating with primary care providers (PCPs) to facilitate education, initiation, and titration of acute-phase antidepressant treatment to monitor treatment adherence and to prevent relapse. Control patients receive UC by their PCP. The main end point is reduction of depression symptoms over time as measured by the Hopkins Symptom Checklist (SCL-20). Other outcomes include the Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV) criteria for major depression, health-related quality of life measured by the Medical Outcomes Study Short Form 12 (SF-12), medication adherence, patient satisfaction, and healthcare utilization. The main end point and the cost of treating major depression will be used to estimate the cost-effectiveness of the collaborative care model.

CONCLUSIONS

The study is a unique, ongoing trial that may have important implications for the treatment of depression in primary care settings as well as new roles for clinical pharmacists.

The influence of ethnicity and antidepressant pharmacogenetics in the treatment of depression

Antidepressant disposition can be influenced by a variety of CYP isozymes and their effects in the treatment of depression are reviewed. The CYP isozymes 2D6, 3A4, 1A2 and 2C are discussed in regard to antidepressant drug pharmacokinetics, clinical relevance and variability in activity for each isozyme. Polymorphism has been identified with CYP 2D6 and 2C19. Disposition of antidepressants which are substrates of these two isozymes can also be influenced and contributes towards the wide interpatient and interethnic variability found with these drugs. Antidepressants (especially SSRIs) can be CYP isozyme inhibitors and produce significant drug-drug interactions.