Treatment goals and challenges in depression - a New Zealand doctor’s perspective

Dr Fontillas-Luis and her team adopt a biopsychosocial approach in treating depression. From the biological perspective, antidepressants are used to treat the depressive symptoms, including mood, sleep and appetite. The social approach involves encouraging patients to engage with their community mental health team. Occupational goals are pursued too, such as better function and involvement within their community. Some patients arrive at the clinic with severe depression. In these cases, to protect the patients, in-patient admission would be considered.

Dr Fontillas-Luis noted that the treatment guidelines in New Zealand are very similar to those followed in Europe. At an ECNP symposium the day before, she had noted similarities between the approaches presented by a few of the speakers and those applied within the social healthcare system in which she works.

Family support can help with adherence

Dr Fontillas-Luis described how the treatment priorities of patients can differ from those of physicians. Physicians want their patients to take their medication regularly and to engage with clinicians. But for patients, once they start to feel better, they no longer want to take their medication. They complain about side effects and can’t weigh the risks and benefits of sticking to their treatment plan. Family support can help with adherence, but it is difficult if patients are isolated. Patients with chronic, long-term illness may have burned their bridges with family and friends. She commented that stressful city life may cause people to become more isolated than in rural communities. However, engagement with a community mental health team may be more difficult if patients live very far away.