Enhancing Healthcare Team Outcomes
While antidepressants are beneficial in treating depression and its other indications, many patients fail to receive adequate treatment. To effectively manage depression, a clinician must employ an interprofessional team-centered approach to effectively detect and diagnose the depression, provide patient education, use evidence-based pharmacotherapy, provide close-follow up for compliance, identify side effects, and determine treatment effectiveness.[59] Studies show multiple factors contribute to patient compliance with antidepressant medications. Generally, concerns about drug side effects were predictive of adherence.[60]
Patient comorbidities can also contribute to compliance with antidepressant medications. Particularly, conditions that impact one’s cognitive status can lead to non-compliance.[61] Alcohol or substance abuse, cardiovascular disease, metabolic disorders, young age, low-income residents, and old-generation antidepressant medication usage were predictive of lower adherence, particularly in the acute phase.[62]
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Identifying and addressing these concerns is pivotal in the management of depression and the prescription of antidepressant medications. Several randomized controlled trials support the collaborative care approach in treating depression. Suggestions are that the program includes a depression care manager, psychiatric consultant, prescribing physician, and the patient. The depression care manager will manage the antidepressants, provide education, and coordinate referrals if necessary. The psychiatric consultant will be responsible for improving treatment strategies in patients who are not meeting expectations.[63] Patients may be receiving more than one antidepressant medication at a time. Hence it is essential to identify all the drugs involved in poisoning for the emergency physicians and triage nurses.
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Other healthcare team members who must contribute to antidepressant care include the pharmacist and the nursing staff. Psychiatric specialty nurses are best equipped to recognize treatment failure, counsel patients on the medication, monitor adverse events, and assess compliance. Pharmacists can verify agent selection and dosing and perform medication reconciliation for drug interactions. Both pharmacists and nurses need open access to the prescriber in case of concern.
In overdose of antidepressants, emergency department physicians should rapidly stabilize the patient ensuring adequate airway, breathing, and circulation. Cardiac arrhythmias, serotonin syndrome, and seizures require ICU care under the supervision of a critical care physician. Medical toxicologists should be consulted for severe poisoning. Deliberate overdose requires consultation with a psychiatrist. As illustrated above, clinicians (MDs, DOs, NPs, PAs), specialists, pharmacists, nurses, and other healthcare providers are involved in taking care of the patient receiving antidepressant therapy. All interprofessional team members functioning as one unit can maximize efficacy and minimize adverse reactions, translating to optimal patient outcomes. [Level 5]
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