Return to PJ Online Home Page
The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR26

Pharmacists' roles in the treatment of depression in primary care

By S. Garfield, F. J. Smith and S-A. Francis

Introduction Depression is a widespread chronic illness which the United Kingdom Government has recognised as a priority area. Mental health is one of the four key areas in the recently published White Paper, "Saving lives: our healthier nation".1 The national service framework for mental health has reported that most of the 4,000 suicides committed each year are attributed to depression and has recommended that assessment and management protocols are implemented throughout primary care.2
In terms of medication for the treatment of depression, previous research has shown that compliance at the end of three months is between 48 and 56 per cent,3,4 whereas the minimum recommended treatment course is six months. It is being increasingly recognised that patients may want more involvement in making decisions about their therapy.5
This research aims to obtain information about the concerns and needs of those suffering from depression that will inform the development of the role of the pharmacist in supporting individuals in this process.

Method Preliminary fieldwork involved meeting with local self-help groups of national organisations for people with depression. Exploratory discussions were carried out with the groups and individuals were interviewed using mostly open questions.
Recruitment of participants for the main study is currently being undertaken. Participants who are beginning courses of antidepressant medication are identified through general practice surgeries. A semi-structured interview, based on the combination of a qualitative interview and three quantitative validated instruments, is administered on two occasions: one month and four months after the first prescription for antidepressant medication.
Sixty participants will be interviewed at the conclusion of the study. The sample will include people who have continued with their medication, people who have discontinued their medication, and those who did not commence taking their medication.

Focal points

  • Depression is a widespread chronic illness that the UK government has identified as a priority area
  • Three months after starting drug therapy, compliance with antidepressant medication is known to be about 50 per cent
  • Qualitative interviews were carried out with patients receiving a new prescription for antidepressant medication
  • Preliminary analysis identified important issues such as the timing and access of information, information concerning adverse effects and length of course of treatment and information about complementary medicine
  • Pharmacists are in a prime position to address the information needs of people beginning courses of antidepressant medication

Results and discussion To date, 28 participants have been recruited to the study, with 26 having completed a first interview and nine a follow-up interview. Preliminary analysis of the qualitative interviews has identified several factors that are of importance to pharmacists when counselling patients beginning courses of antidepressants.
A first prescription for antidepressant medication can be a traumatic experience for some people, with the prescribing of medication perceived as labelling the condition. Provision of information concerning medication at the time of diagnosis in the doctor's surgery was not always absorbed by patients and therefore, pharmacists have an important opportunity to reinforce information.
Some participants in this study identified that the decision to take medication, was separate to the decision to have it dispensed. This confirms the importance of counselling at the supply stage.
Depression can cause some people to have short attention spans and therefore repeated opportunities for the provision of information could be advantageous. As an accessible health professional, the pharmacist can play a valuable role in providing information between appointments at the doctor's surgeries.
With regards to the type of information required, the patients' expectations of length of treatment at the start of therapy may be important for future decisions. Information requirements concerning adverse effects was variable; however, the importance of the side effect for patient decision-making will depend on the effect which it has on patient functioning.
A preference was also expressed by some participants for complementary medicines, as these were perceived as more natural and less stigma was attached to taking this type of medication. With the recent publicity associated with the use of St John's wort, future interviews may further highlight the need for information concerning the use of this drug and interactions associated with it.

Conclusion Several factors have been identified as important to patients beginning courses of antidepressants and will be further addressed in future interviews. Detailed analysis will access which are important in distinguishing those who continue with their medication and those who discontinue. In light of this information, pharmacists' roles in improving concordance will be considered further.

School of Pharmacy, University of London, 29-39 Brunswick Square, London WN1N 1AX

References

1. Department of Health. Saving lives: our healthier nation. London: The Stationery Office, 1999.
2. Department of Health. National service framework for mental health: modern standards and service models. London: The Stationery Office, 1999.
3. Maddox JC, Levi M, Thompson C. The compliance with antidepressants in general practice. J Psychopharmacol 1994;8:48-53.
4. Lin EHB, Von Korff M, Katon WJ, BushT, Simon GE, Robinson P. The role of the primary care physician in patients' adherence to antidepressant therapy. Medical Care 1995;33:67-74.
5. Royal Pharmaceutical Society and Merck Sharp & Dohme. From compliance to concordance: achieving shared goals in medicine-taking. London: The Society and MSD, 1997.