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Depression is a disease like any other. The pharmacist's task is to keep depression patients educated about their disease and their medications, and to stress the importance of adherence to medication. But before that, depression screening may be Job 1.
Fact vs. stigma
Depression has been a touchy subject for people to talk about in this country. The disease has been stigmatized; our culture has labeled people with depression as weak or crazy. But depression is a disease like any other. Most of the time, it results from an imbalance of neurotransmitters in the brain that needs to be treated, usually with therapy and sometimes with medication.
Because of the history of stigma, many are afraid to talk about depression or to seek help. The pharmacist can reassure these patients that they are not alone and should not feel shame because they have this condition.
A natural adjunct to pharmacy practice
In addition to dispensing information about the disease and the medications to treat it, pharmacists can assist both patients and primary care physicians (PCP) by screening for the condition.
Pharmacists can incorporate screening into their daily practice whether the setting is hospital or retail pharmacy. For example, screening can be included in medication therapy management (MTM). Pharmacists can use a short questionnaire like the 3-item or 5-item screens, or the PHQ (Patient Health Questionnaire) 9. These questionnaires are good for screening people who may have depression, and they're easy to use.
Screening incorporated into MTM could be extremely beneficial. These patients usually have more than one chronic disease, which often leads to depression and reduced quality of life. After screening, the pharmacist can make appropriate recommendations, such as referrals to patients' PCPs.
Most retail pharmacies have private areas where pharmacists can talk to their patients. If the situation seems to call for it, the pharmacist could ask the patient for permission to explore whether the patient is at risk of depression. In hospitals, pharmacists have been trained to take a patient's complete history in the emergency room while the patient waits for treatment. This would be the perfect opportunity to screen for depression.
Challenges and opportunity
Pharmacists would need to overcome certain obstacles. A 2008 study (Scheerder, et al), queried 200 community pharmacists in Belgium about taking on a role in depression care. While response was positive, there was also some skepticism about ways and means. Respondents thought the biggest challenges were lack of training and a low level of cooperation from PCPs.
Training can be provided and cooperative arrangements can be forged. Depression screening seems a natural component of MTM. Similar studies conducted in the United States could prove very informative.
Jacquelyn S. Heisler is a registered pharmacist in Pennsylvania. On May 2 she received her PharmD degree from University of Florida. She can be reached by e-mail at firstname.lastname@example.org