This March, Veradigm is recognizing mental health and addiction to raise awareness and help the millions of patients affected each year. Major depressive disorder (MDD) is a relatively common and serious illness that interferes with daily life and may last for weeks to months at a time. It has been estimated that the lifetime prevalence is around 10-15% in the United States (U.S.) with 7.6% of that population suffering from moderate to severe depressive symptoms. Surprisingly, depression is one of the top three causes of global morbidity and is a direct cause of mortality.1
Depression is far more complex than patients just experiencing “sadness”. Have you ever lost interest or pleasure in activities that you used to thoroughly enjoy and also been in a depressed mood? This is often considered the classic signs of major depressive disorder, others include fatigue, sleep disturbances such as insomnia, changes in appetite and psychomotor activity, decreased concentration, and suicidal thoughts or behaviors.1 Pharmacists and other clinicians often use diagnostic criteria to count symptoms occurring over a specific amount of time to determine the extent of the illness (mild, moderate, or severe). The DSM-5 is an example of criteria tool used by clinicians to diagnose depression. An individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either depressed mood or loss of interest or pleasure.2
Electronic health records (EHRs) can play a vital role in identifying the cause of major depressive disorder through the analysis of patient data. Although the exact etiology of depression is unknown and is most likely multifactorial and complex, validated screening instruments and patient responses to appropriate questions can lead to diagnosis along with the prescribing of a care plan. Age, income level, medical conditions, and medications have all been shown to considerably affect the diagnosis and treatment of depression. The three most important factors when evaluating patients are biological (often thought of as family history), psychological (previous and ongoing life events), and social and environmental (living situations).1
Clinicians are urged to perform routine screening on all patients 12 years and older for the identification of major depressive disorder. The Patient Health Questionnaire (PHQ-2) is a quick and accurate tool for initial assessment, along with the PHQ-9. After assessing patient progress, initial treatment for depression may include Cognitive Behavioral Therapy (CBT) and/or pharmacotherapy depending on patient preference and depression severity. If drug therapy is warranted, there are multiple therapeutic classes that are indicated in the treatment guidelines. Most common medications include: Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs), Tricyclic Antidepressants (TCAs), and Monoamine Oxidase Inhibitors (MAOIs).
Lack of adherence is a common challenge in treating major depressive disorder. This could be due to patient out of pocket cost, complex dosing schedule, tolerability issues, side effects, inadequate psychosocial support, and lack of symptom improvement. Some key considerations when starting therapy is to advise patients that it takes four to six weeks typically to see the full effect of antidepressants but can take up to eight weeks to see a response. An acceptable response to a prescribed care plan is usually defined as a 50% reduction in symptoms.
To help address medication adherence, Veradigm’s EHR has integrated an e-Prescribing platform which provides patient support such as cash offers and e-coupons. When a provider prescribes a medication, they are notified of the lowest price available for that medication at local pharmacies. Some medications also have e-coupons that can be printed and given to the patient before they leave the office giving patients options for lower cost prescriptions which can help address medication abandonment and improve adherence.
2bPrecise, a member of the Allscripts family of organizations, is working with healthcare providers to introduce pharmacogenomics testing (PGx) into their clinical workflows. The goal being to help them treat major depressive disorder patients sooner and more effectively. PGx tests reveal how well – or poorly – an individual patient metabolizes specific medications. With this insight the provider can be sure to prescribe the most effective treatment immediately upon diagnosis, rather than undertaking the traditional trial-and-error approach that delays positive response.
Murfreesboro Medical Clinic and SurgiCenter, a 2bPrecise client in Tennessee, recently initiated testing among a pilot group of patients who experienced a less-than-satisfactory result after being prescribed anti-anxiety or anti-depression medications. Of those tested, 87% required a medication change and, after the change, most reported an improvement in how they were feeling.
Veradigm is dedicated to continuing work on finding more efficient and safe ways to improve patient care. Remember that exercise is a critical component to help manage symptoms of mental illness along with other methods such as Electroconvulsive Therapy (ECT) and CBT. I try to stay active through various activities including running, basketball, rock climbing, and weightlifting and encourage others to find a physical activity they love. I recently completed my first half marathon distance race on the same trail as our annual Allscripts sponsored race called Tobacco Road Marathon.
1Cauffield, J. (2015). ACCP Updates in Therapeutics: Pharmacotherapy Preparatory Review and Recertification Course (Volume 1): General Psychiatry. Lenexa, Kansas: American College of Clinical Pharmacy.