Your New Role in the Battle Against Depression
Pharmacists have a role for those who are fighting depression
One of the obstacles to screening in a community setting is reimbursement. However, Galdo, who is also an Assistant Professor and Residency Director at Samford University in Birmingham, AL, hopes to show that when proper reimbursement is in place, pharmacists can be a valuable resource for identifying undiagnosed depression. He is conducting a grant-funded research project at 10 independent pharmacies to compare screening rates in pharmacies that receive reimbursement for their services with those that don’t. As part of the study, five of the pharmacies will receive $15 in reimbursement for the screenings they complete.
“The goal of this grant is to impact patient care first and foremost. But it is also to show that it is something that a pharmacist can get reimbursed for,” he says.
However, community pharmacists who offer the screenings should have a plan in place about what to do if a customer responds affirmatively to showing signs of depression. Depending on a patient’s test score, the next steps could include referral to a mental health provider, contacting the primary care physician, calling an emergency hotline, or even calling 911.
The community setting isn’t the only outlet where pharmacists can offer the screenings. Kylee Funk, PharmD, BCPS, a Clinical Pharmacist and Assistant Professor in the Department of Pharmaceutical Care and Health Systems at the University of Minnesota College of Pharmacy in Minneapolis, MN, says she offered depression screenings for all patients with diabetes at one of her previous jobs. She then worked closely with physicians to help identify the best antidepressant medications for the patients who were diagnosed with depression.
As medication experts, pharmacists are already armed with the knowledge they need to advise physicians and other members of the care team about what antidepressant medication may be best for an individual patient, as well as the best strategies to taper or titrate off a medication and possible drug interactions to consider.
“There are so many medications for depression that act in different ways and that have different side effects. There are just so many considerations, including the patient’s co-existing medical conditions, medication history, and personal preferences, that go into that selection of a best treatment option for them,” Funk says.
More clinical teams are including pharmacists for their medication expertise and patient counseling abilities.
Clinical pharmacists can also help patients more successfully transition between care settings. For example, Carla Cobb, PharmD, BCPP, a psychiatric pharmacist at RiverStone Health in Billings, MT, works closely with patients recently released from inpatient treatment facilities.
She spends half a day each week working in conjunction with a behavioral health provider to meet with these patients in hour-long appointments. The behavioral health provider does a social history and assesses any current symptoms, while Cobb does a comprehensive medication assessment that includes the patient’s medication history, current medications, and hospitalization records. She also evaluates the effectiveness of their current drug regimen.
In addition to being a screening tool, the PHQ-9 can also be used to evaluate the effectiveness of a particular medication. For instance, if a patient still scores high while taking an antidepressant, he or she may need to make a change. That may mean switching to a different SSRI, switching to a different class of antidepressant, or adding an augmenting agent. “If you are not getting a new response, then you need to do something different,” Cobb says.
Experts say one of the best things pharmacists can do is listen to their patients and not ignore negative side effects or the personal preferences or feelings of an individual patient.
Bostwick, who is also an Associate Chair of the Department of Clinical Pharmacy at the University of Michigan College of Pharmacy in Ann Arbor, MI, regularly evaluates how her patients at the clinic are doing by following up with them one to two weeks after any medication change has been made. During these check-ins, she assesses whether patients are following their plans, how they are tolerating the medications and whether they are experiencing any side effects.
“With the stigma associated with psychiatric illnesses, I think it’s really valuable that patients just know that there’s someone on their side,” she says.