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Australian Journal of Pharmacy : October 2005
depression Dr Russell told the AJP there is a group of disorders which fall into the category of minor mood disturbances (dys- thymias). He said these often present in people who are unhappy and not travelling well, but without the full range of symptoms, signs and features seen in a major depres- sion. However, Dr Russell does not believe older people are necessarily at greater risk of developing depression than younger people. ‘Older people who are essentially healthy, don’t have financial problems and maintain good family relationships and friendship networks cope well, so there is no real reason why they should be at greater risk from suffering depres- sion than anyone at a younger age.’ He said where the elderly are likely to be at greatest risk is from vascular disor- ders, which happen more frequently in this age group. ‘The brain deteriorates at a faster rate if there has been a history of vascular dis- ease, hypertension or late onset diabetes that are seen more commonly in older people. ‘These diseases can result in changes in the brain that not so much cause depres- sion, per se, but if the patient does become depressed they do not respond so well to treatment as those with a younger, healthier brain. ‘Vascular depression is not necessarily exemplified by low mood or crying, but is generally more a picture of apathy and slowing down. There is a loss of what we call ‘executive function’—planning and organisation of everyday life. Judgement can become impaired and the condition is not readily recognised as depression but more of a burn-out, [or] running out of steam. ‘It is not the ageing process itself at fault. Ageing does not produce depres- sion any more than it produces demen- tia. It is the disease process which is important. Diseases like Alzheimer’s, cerebral vascular disease, metabolic syn- drome and diabetes are more likely to occur because the body is wearing out. Depression goes along with that rather than the fact of being old,’ Dr Russell said. He went on to say the most important aspect of treatment for this group is man- agement of vascular risk factors such as blood pressure, cholesterol and weight Call for ‘best practice’ protocol P HARMACIST Mark Coles from Secret Harbour in Western Australia would like to see the Pharmaceutical Society of Australia produce a brochure for elderly customers describing the common symptoms of depression that can occur in elderly people. ‘A simple, easy to read, one page sheet about depression symptoms that could be discreetly placed in the patient’s bag with prescriptions or other pharmacy purchases [would be appropriate] for those patients the pharmacist believes may need an impetus to get them talking to their GP if they think they may have symptoms of depression. ‘People are used to having pamphlets in with their purchases, and this could be a non-threatening way of providing the patient with information.’ Mr Coles said while there was information available on depression, it would be useful to have information available in an inexpensive, standardised format on a single sheet that could be readily provided to patients by all pharmacists. Although there are counselling opportunities in community pharmacy practice, broaching the subject may be difficult in the pharmacy environment if a depression issue is suspected. ‘Pharmacists do not have the training or expertise to diagnose depression, but may regularly see patients who they consider may benefit being assessed by their GP. ‘I do come across patients who may be suffering from depression when undertaking home medicine reviews, in the home setting, where the patient is often more open in discussing their feelings and moods. In this environment, it is much easier to openly encourage the patient to discuss their concerns with their GP, and even to seek the patient’s permission to include these concerns when writing to the GP. ‘We have a private consulting room in our pharmacy. Private consulting rooms provide the most suitable environment in a pharmacy for the patient to feel at ease in discussing symptoms of depression. The pharmacist is then in a position to encourage the patient to speak to their GP.’ Mr Coles believed there could be a benefit in the PSA providing pharmacists with a ‘best practice’ protocol in how to broach the delicate 806 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 OCTOBER 2005 subject of depression with patients that is acceptable to the GP, the pharmacy profession and the patient. Male patients, he said, find it especially difficult to discuss health issues like depression, given that there still appears to be a certain level of stigma attached to the disease. ‘It is much easier to speak with female patients for obvious reasons—they take better care of their health, are more aware of their health and more willing to talk about it.’ As well as lecturing pharmacy students on HMR and clinical case studies, Mr Coles has for the past five years provided education to GPs on prescribing via the National Prescribing Service (NPS) and Divisions of General Practice. ‘Pharmacy and GP relationships are improving but as a general rule there is very little interaction between pharmacists and GPs in regard to pharmacists providing ongoing support to patients with depression. Patients could only benefit if there were a more collaborative approach that would have GPs recommending depressed patients discuss their medications, and medication problems with pharmacists.’