Integrated Care and Treatment-Resistant Depression


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Insight regarding proper timing to initiate electroconvulsive therapy to help manage depression.

Steven Levine, MD: We’ve covered a lot of ground here today. I want to thank everyone for this rich and informative discussion. Before we conclude, I’d love to get final thoughts from each of you. Perhaps we can start with you, Angelos.

Angelos Halaris, MD, PhD, APA, ACNP, CINP: Thank you. This was a great idea and a great panel. It’s too bad we didn’t have 6 hours or longer to get more in depth about these very apt questions and issues you raised, Steve. I’d like to conclude by saying we need to help the public, including our patients and colleagues, raise their level of awareness of depressive illness in general, and the state of the art about what we can do. I’m not going to use the word pandemic because it has a different connotation, but it’s a very widespread problem worldwide.

Thanks to the [COVID-19] pandemic, the latest statistics as reported by the AMA [American Medical Association] a couple of days ago showed that of those who have been infected with COVID-19, about a third of them go on to develop clinical depression, anxiety, possibly substance abuse, suicidality, and even neurological sequelae. We have a serious situation here, and it behooves us to make the public and our colleagues—psychiatric and more so nonpsychiatric colleagues—aware that we have a real problem. There are a lot of things we can do. We’ve got to work as a team. We have to be cooperative and open-minded. Doing anything we can to help our patients be safe, get better, and have a life offers the best gratification of my entire career.

Steven Levine, MD: That’s an important message, Angelos. Hopefully this discussion we’re having today that will be shared with our colleagues will go some distance toward accomplishing that. Thank you. Lisa, do you have final thoughts?

Lisa Harding, MD: Yes. Somewhat riffing off of what Angelos said, before the COVID-19 pandemic, the WHO [World Health Organization] said that in 2020, depression would be the leading cause of disability. That was before the pandemic ever happened. It’s 2021; no new data are out there, but each of us can hazard a guess as to where major depressive disorder lies. The overarching message for me is of love and patient-centered care. We’re living in times where there’s heightened sensitivity to everything. There’s a lot of talk in the community about who should be delivering care and what kind of care. But at the end of the day, each of us has made a commitment to mankind to help end suffering. If we keep that first, we’ll all make the world a better place.

Steven Levine, MD: Those are beautiful sentiments, Lisa. Thank you. Patricia?

Patricia Ares-Romero, MD, FASAM: I definitely agree with what my colleagues have said here on the panel. We really need to look at integrative care. Because depression is going to be so much more prominent in the next 5 to 10 years, we need to look and be able to identify patients who are suffering from depression and start treatment earlier. One of the biggest issues is that treatment is withheld and not started earlier. That’s why we’re seeing so many patients who later are resistant to medication as well. Refer early, educate yourself, and please don’t be scared of the new treatments we have: racemic ketamine, esketamine, and all the other things coming down the pike that we are very excited about. Don’t be afraid. Educate yourself. Know that there are other treatment options for your patients, and they deserve to be considered if they’re the right patient.

Transcript Edited for Clarity

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