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Professor Pierre Blier shares insights about treatmenting depression

Professor Pierre Blier

Professor Pierre Blier talks about challenges facing clinicians in the treatment of depression and why it isn't realistic to treat with one agent.

Q: What are the most significant challenges facing clinicians today when treating mood disorders?

 

A: The high degree of treatment resistance. Despite prescribing an antidepressant, most patients have an incomplete response to therapy. Depression is a heterogeneous disease and it is frivolous to think that one agent with one mode of action can manage this heterogeneous disease. I often combine treatments to help achieve response.

 

Q: How would you define remission?

 

Wellness is not just the absence of symptoms.

A: Absence of symptoms, a sense of well-being and an ability to function. Wellness is not just the absence of symptoms.

 

Q: What type of tools do you use regularly in your daily practice?

 

A: I use the standard DSM IV and DSM 5.0 when diagnosing patients with unipolar disease and in our waiting room we ask patients to complete the validated 16-item QIDS self-rating score at every visit. It takes just 5 minutes for the patient to complete and the items are rated 1-4. This means at a consultation I can jump to the items where the patient has scored 4s and 3s and concentrate on looking to address those aspects of disease.

 

Q: What’s your opinion on combining psychiatric and psychotherapeautic approaches to care?

 

A: It is fine to combine these approaches but the reality is that at my hospital, to get a patient even into group psychotherapy involves a 2-3 month waiting list and it can take 9-12 months for a patient to start individual psychotherapy.

The costs of such sessions in the private sector in Canada is around $160-220 per hour and patients often need between 4-6 sessions. So getting access to psychotherapy is the issue.

Also, if the patient is severely ill, staying on a psychotherapy programme can be very challenging. I’m not against psychotherapy, but I do appreciate that there is often a significant response to drug therapy.

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

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