Challenges treating mood disorders

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

A: Aideen: Adherence to medication can be a challenge.

Doreen: Yes, particularly when the patient feels well. It’s important to explain to patients the rationale for treatment and continuing on treatment during remission and recovery.

Aideen: It’s during maintenance that many patients stop taking their medications. Another challenge we face is that there is also still a massive stigma about being on antidepressants in Ireland.

Q: How do you define remission in depression?

A: Aideen: I think it is when a patient returns back to usual life and useful function. Social and occupational function. Most people start to think they are okay and to feel better if they can return to work.

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

A: Aideen: Both are important. It is about integrated approaches – looking at genetic markers, taking account of the environment and in this we really need psychotherapies.

Doreen: Yes it’s about integrative and not reductive care, and collaborating in order to achieve patient recovery.

Q: What would you say is the potential for approaches such as biomarker-based screening or stratified medicine as predictors of pharmacological benefit?

A: Both: We don’t have any biomarkers to use in everyday practice as yet. It would be good to have biomarkers to identify slow metabolizers, but we can determine from clinical responses many of the patient’s characteristics.

Aideen: In many other fields of medicine, people link being able to quantify a response with being able to show that a treatment is working.

Doreen: Yet in some ways having measurable markers of response would change the patient-psychiatrist relationship in depression, away from one where chatting and talking predominate.

Q: What have been the most significant advances in the field of depression research lately?

A: Doreen: It’s hard to know – I think it is good that there has been a lot of re-evaluation of previous evidence, as well as attempts to link preclinical findings with clinical findings.

Aideen: Research that lows for a better understanding of the need for individualization of medication, based on genetics, the patient environment, the type or subtype of depression.

Q: Have you had any patients for whom you believe their cultural and/or social background has had a significant impact on their prognosis?

A: Aideen: Yes, social and cultural barriers can exist that mean patients drop out of treatment for their depression. But, these issues aren’t unique to psychiatry and people have a right to choose.