Challenges, Goals, and Strategies for the Management of Depression

Major depressive disorder is a complex, chronic, and recurrent illness that can affect other medical conditions. It is projected that 16.2 million Americans live with depression, with an estimated economic burden of $210.5 billion, including indirect workplace costs.

Untreated or undertreated depression can increase functional impairment, decrease quality of life, create a barrier between patients and providers, induce physical symptoms, and provoke a negative effect on other illnesses. Chronic conditions that can influence mental health include diabetes, cardiovascular diseases, kidney disease, Parkinson’s disease, HIV, chronic obstructive pulmonary disease, and stroke.

There is a shortage of psychiatrists nationwide, and managed care organizations face many challenges in providing effective care for these patients, according to Jessica L. Ho, PharmD, BCPS, BCPP, a clinical pharmacy specialist at Kaiser Permanente of the Mid-Atlantic States in Virginia, who discussed this condition from a managed care perspective at the AMCP Annual Meeting 2018.

Current goals for the management of depression include achieving response and remission, reducing recurrence, optimizing treatment strategies, improving antidepressant adherence, and addressing medical and psychiatric needs. Strategies that can improve access to care include focusing on screening in primary care, educating primary care providers, developing treatment guidelines, referring patients to mental health specialties, using technology such as telepsychiatry, and integrating mental health specialists into the primary care sphere.

Collaborative care is important to managing depression and should include a treatment plan and protocol, practice reorganization, systematic attention, and targeted outcomes. Collaborative care has documented effectiveness and is associated with lower overall healthcare costs than usual care.

A psychiatric pharmacist is another component of optimal depression care. This role can identify and correct medication-related problems, as well as optimize medications, minimize adverse events and drug–drug interactions, provide patient education, and reduce costs.

The benefits of implementing a psychiatric pharmacist include higher rates of antidepressant use, higher medication adherence rates, greater improvement in depression scores, higher patient satisfaction, fewer primary care visits, and overall cost savings.

Presentation F6: Holistic Management of Depression – The View from an Integrated Health Care System. AMCP Annual Meeting 2018.