Caring for patients with chronic conditions

March 15, 2010

Efforts to improve treatment of all physical conditions and patients' self-care are futile if comorbid depression is not controlled first.

"I don't care about preventing heart disease because I don't want to be here in 10 years if I keep feeling like this." "I don't have enough energy to exercise." "I try to make nutritious food choices, but all I want is comfort food when I am down."

It is not uncommon for me to hear these types of statements from some of the participants enrolled in my employer's disease-management program for depression.

In my new role, I soon realized that my efforts to help improve the self-care and treatment of all the disease states of each patient, although well intended, were futile if comorbid depression were not controlled first. I had not ignored their depression, but I had not been giving it the full attention it required. In an effort to provide comprehensive care, I had been trying to manage all their conditions simultaneously. Once I fully realized the potential impact of the depression on their other conditions, I changed my approach to caring for these patients.

I noticed a shift in my practice when I began to concentrate on what mattered to the patient at that moment. When depressive symptoms were identified, we spent most of the visit discussing what the patient wanted to talk about, such as how to improve mood, energy, sleep, and motivation. The other issues, if they were not urgent, could wait.

I recall that after starting an SSRI, one patient with diabetes exclaimed, "I'm back!" She was now ready to address other health concerns. Another patient with hypertension and dyslipidemia announced, after switching antidepressants, that he had started going to the gym on his own. Owing to the chronic and remitting nature of depression, not all my patient stories are successes, but I now know where to focus my efforts.

Pharmacists in various ambulatory care settings are in an excellent position to screen for possible depressive symptoms, refer patients to their primary care providers for follow-up, provide education to patients about depression, and monitor antidepressant treatment response, tolerability, and adherence. My experiences in caring for patients with depression illustrate that focusing on depression first may enhance the care of the whole patient more effectively than would an attempt to care for the whole patient at once.

What has your experience been when treating patients with depression? To share your thoughts with fellow pharmacists, send your comments to drugtopics@advanstar.com
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Charlene Williams, PharmD, BCPS, CDE, is a director of pharmacy residency with Mission Hospitals Health Education Center in Asheville, N.C. She can be reached at charlierx2@hotmail.com
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The opinions expressed by guest editorial writers are their own and do not necessarily represent the views of Drug Topics' staff or the staff of Advanstar Communications.