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Pioneering Project Underway to Combat Depression


An innovative scheme is underway in the West of Scotland to combat depression. The new project, lead by a University of Glasgow researcher, adds structure to NHS care by integrating GP, patient and secondary care in the treatment of depression, and employs a novel electronic referral system that speeds up patient assessment.

Although the New Year is typically a time full of joy and optimistic hopes the future, many people experience seasonal ‘blues’. However, an ambitious project to improve the treatment of depression is now on track in Renfrewshire.

Dr Michael Smith, from the University of Glasgow, is the lead for the Scottish Executive’s ‘Doing well by people with depression initiative’ in Renfrewshire. The unique £450,000 initiative is one of is one of seven projects currently being rolled out by health boards across Scotland.

The scheme offers a comprehensive approach to treatment by integrating primary and secondary care and informed patient choice. A novel electronic referral system enables GP’s to forward information almost instantaneously to secondary care specialists. By integrating GP and hospital systems the treatment is administered more effectively and faster. The specialists can then administer the help that patients need, and offer self-help or follow up.

Often GP’s do not have the time or the specialist knowledge required to treat depression successfully, but the new system offers support provided by specialist psychiatric services.

It is the first UK NHS project to routinely use the PHQ (Personal Health Questionnaire), a validated screening instrument designed to assess the severity of depression. The questionnaire gives GP’s, patients and specialists a comprehensive assessment of what the patient requires.

The survey, which is completed by patients or their doctors, offers a quick checklist of the patient’s degree of depression, and this is passed on electronically to specialists who assess the best form of treatment. Scores of up to 15 (out of 27) on the PHQ are the equivalent of ‘mild’ depression or ‘adjustment disorder’, and people with these problems will be offered support with self-help approaches to resolving their problems. People scoring above 15 on the assessment are likely to have ‘clinical’ depression and would benefit from treatment with antidepressant medicines, as well as psychological therapies.

A recent survey of mental health in Scotland showed 22% of women and 14% of men will suffer from depression at some point in their life and that about one in four Scots have had experience of mental health problems at some time.
Dr Michael Smith, from the University of Glasgow, said: “Everyone knows that Scots have poor physical health compared to the rest of Europe, but few people realise that we have poor mental health too. This project is looking at alternative ways of diagnosing problems early and at providing improved NHS care.”

Some mental health problems such as stress, anxiety, or low mood do not need specialist help and are best managed through self-help, support from GPs and primary care teams, but some need to be referred onto psychiatric services- and this new system speeds up the process. It also involves patients in their own assessment. They can retain a copy of the PHQ so that they can continue their own evaluation, track changes and help manage their treatment.

Dr Smith added: “The under and over prescribing of drugs are both problems. Over the past decade the number of antidepressants prescribed has trebled in the UK, but research shows that medication does not work for mild depression. In cases of mild depression, over 80% of patients get better over a period of 6-8 weeks without any treatment. We make people more aware of the alternative types of treatment available, such as self-help therapies, and encourage them to look at the options available to them to help combat their illness.”

Anti-depressants can be a valuable form of treatment for many people affected by depression. But medicines work best when targeted and used in combination with other therapies. Patients with severe depression not only need to be prescribed medication, they also need adequate support to ensure that the drugs are taken properly, and the new project ensures that support is delivered. Often drugs are not taken properly by patients, as half of patients have stopped antidepressants by one month, and only about one fifth of people continue antidepressants treatment for the minimum treatment period of 6 months.

Jenny Murray | alfa
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