MARCH 2017 - Evidence builds that early optimized treatment for major depressive disorder holds the greatest potential for patients to make a full recovery. Yet this method turns the traditional “start low, go slow” approach on its head. What role can community pharmacists play?
In a 2016 review article in The Primary Care Companion for CNS Disorders, physician researchers across Canada analysed findings from 30 antidepressant studies and found that an improvement of symptoms within two to three weeks of initiating therapy predicts improvement at four to 52 weeks.1 Conversely, patients who remain on ineffective or poorly tolerated treatment for more than four weeks are at higher risk of delayed or incomplete recovery. “By intercepting and optimally treating depression earlier, there is the potential to reduce, sometimes by many years, the substantial morbidity, mortality and functional impairment associated with this illness,” states the article.
Clinical guidelines from the Canadian Network for Mood and Anxiety Treatments similarly state that adjustments to antidepressants could be made earlier, within one to four weeks of starting treatment. Yet the traditional start low, go slow approach often sees patients try the lowest effective dose for six to eight weeks before adjustments are made.
Pharmacists can support early optimized treatment (EOT) by raising awareness among local family physicians. And for physicians whose workloads may make it difficult to schedule more frequent appointments with patients, pharmacists can pitch by doing callbacks or follow-up medication reviews one week after the initial dispensing of therapy (which can also be reduced to a trial supply of seven to 10 days), suggests John Papastergiou, associate-owner of two Shoppers Drug Mart pharmacies in Toronto, who is helping to spread the word about EOT at a roundtable discussion on mental health hosted by Benefits Canada magazine on March 30.
“Pharmacists can really run with this, working with physicians. In some provinces scope of practice allows us to change dosages right away,” says Papastergiou. To determine whether treatment changes are required, pharmacists and physicians would use a validated assessment tool, such as the Sheehan Disability Scale, he adds.
1 Habert J, Katzman MA, Oluboka OJ, et al. Functional Recovery in Major Depressive Disorder: Focus on Early Optimized Treatment. Prim Care Companion CNS Disord 2016;18(5). Accessible at http://www.psychiatrist.com/PCC/article/Pages/2016/v18n05/15r01926.aspx