Doctors Eva Trillo and Blanca Fernandez-Abascal.
The Primary care It is the main door to the healthcare system in our country. Depression counseling maintains a high presence at this level of care, so training of these health professionals remains critical. We spoke with Eva Trillo, specialist in family and community medicinemedical coordinator of the health center Campo de Belchite (Zaragoza) and member of the board of directors of Semergen Aragón, and Blanca Fernandez-Abascalpsychiatrist at the Department of Mental Health López Albo I, of the Marqués de Valdecilla University Hospital (Santander), on the challenges in the therapeutic approach to depression in primary education, as a result of his participation in training course “Depression 360. Keys to depression in primary care”organized by The Butterflies Healthcare, with the sponsorship of Lundbeck and the scientific approval of Semergen.
Underdiagnosis of depression in primary care continues to be one of the major challenges to be addressed. As Eva Trillo explains, “Only 50% of patients with depression are diagnosed in our primary care consultations. This is due to various factors, such as the complexity of the clinical picture of depression, the lack of time with overcrowded schedules, the stigma that still haunts mental health or lack of training and awareness in this area”.
To advance and improve both the prevention and diagnosis and treatment of depression, the medical coordinator of the Campo de Belchite Health Center believes that more and better resources are needed, such as “better education and visibility of the disease, prevention from an early age, coordination between levels of care and, above all, time to dedicate to our patients. Obviously, all this requires financial investments and the participation of the administration”.
With an increasingly aging population and high prevalence rates of depression among older adults, elementary school professionals require special training to address pathology in this age group. “Depression manifests itself differently in each life cycle. Older adults tend to have more somatic symptoms. In addition, various pathologies associated with aging occur at these ages, making the diagnosis of depression difficult, delaying treatment and therefore worsening the prognosis and with the risk of chronicity. And this situation, in turn, will worsen the management and prognosis of their physical pathologies, entering into a very complex vicious cycle.details Trillo.
On the other hand, managing the disease from a gender perspective is another current need. For the family medicine specialist, “Women suffer more from depression than men due to multiple factors, such as genetic, hormonal, social or behavioral conditions., by the way. Every change within the life cycle implies a stressor that favors its occurrence: adolescence, pregnancy and childbirth, menopause and old age. So, it is interesting to pay attention to its management from the point of view of gender, as has already been done in other pathologies’.
Individual treatment with antidepressants
Faced with the need to that the computer specialist can choose the best treatment for each patient, Fernandez-Abascal emphasizes personalized treatment. According to him, “there is a wide range of antidepressants whose therapeutic efficacy is clearly established for all degrees of depressive disorder.so the choice of the same must be made individually”.
To do this, he recommends taking into account a number of factors, such as the predominant symptomatology, age, gender, presence of physical and mental co-morbidities, co-treatmentsthe side effects of the antidepressant, as well as the presence of a previous history of response to antidepressants in previous depressive episodes, both reported by the patient and by a close relative.
This is what the psychiatrist at the Marques de Valdecilla Hospital remembers “The goal of treating depression is not only to achieve a complete remission of symptoms, but also to restore the person’s functionality”. Therefore, when there is no treatment response or it is partial, some factors should be taken into account, such as “reviewing the patient’s diagnosis and confirming whether he really has depression, assessing whether there is any co-morbidity that we are not treating, assessing compliance with psychopharmacological treatment, since this is one of the most common reasons for lack of clinical response to antidepressantsexclude the intake of toxic substances and find out if there was any stressful event in life that acts as a factor maintaining depressive symptoms”, specifies the doctor.
Once these circumstances are ruled out, How to act from elementary school? “In case of complete lack of reaction, it is recommended to switch to another antidepressant until, if the response is partial and the latency period has expired, the dose can be optimized of the antidepressant we’re using, or change it, or even pair it with a booster drug,” explains Fernández-Abascal.
Adverse reactions affect adherence to antidepressant medication. According to this psychiatrist, “those that have the greatest impact on dropout are weight, sexual dysfunction, and sedation. However, other factors also influence poor patient adherence, such as mistaken beliefs about side effects or the belief that treatment is unnecessary. Good adherence is closely related to the possibility of achieving complete remission and therefore better functioning with a higher quality of life, in addition to preventing relapses”.
Coordination between primary care and mental health
According to Fernandez-Abascal, “Coordination of primary care with mental health is the foundation for success in the treatment of depression.” This will allow continuity of patient care and a multidisciplinary approach. Let’s not forget that primary care physicians have a longitudinal view of the patient, which puts them in a privileged position to identify any factor that may precipitate a depressive episode or contribute to a partial response to prescribed antidepressant treatment.
Finally, the psychiatrist insists on the criteria for referring a patient with depression from PC to mental health that go through “presence of autolytic risk, diagnosis of bipolar depression, presence of psychotic symptoms, and failure to respond to two antidepressants at appropriate dose and time.”
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