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An estimated one in seven adults in the U.S. suffers from depression, an often under-diagnosed illness that, if left untreated, can also worsen chronic conditions and medical illnesses.
“The prevalence of depression in this country is so great, and yet there is a stigma associated it with that may prevent people from seeking treatment,” said David Silbersweig, MD, chair of BW/F Psychiatry and the Institute for Neurosciences. “We know that untreated depression can lead to other health issues for patients, and therefore can also burden the health care system, bringing increased costs. New insights into the neurobiology of depression and cognitive behavioral treatments are providing tremendous hope for patients suffering with this condition.”
The BW/F Depression Center is working to improve and streamline care delivery for patients with depression, and to eliminate the stigma surrounding the illness through education. The Depression Center also provides an infrastructure that promotes collaboration among those conducting research on mood disorders at BW/F and throughout the National Network of Depression Centers (NNDC).
“BWH is a charter member of the NNDC, which brings together the energy of many individuals at 21 academic medical centers throughout North America,” said Jane Erb, MD, program director for the Depression Center. “This allows for many mutual benefits in our efforts to understand and better care for individuals with depression.”
The BW/F center was recently approved to launch a national taskforce with other NNDC members to promote the study of the impact of depression on other major medical disorders as well as its treatment.
“This is a BW/F-led national taskforce that will allow for a more nuanced understanding of the intersection of depression in major medical and neurologic illness and ultimately allow for better care of patients with depression and a co-morbidity, such as diabetes or heart disease,” Erb said. “Right now, most clinical trials exclude subjects with major medical and neurologic illness.”
Across BW/F, the Depression Center team is also partnering with primary care physicians, specialists and other members of the care team to enhance the care of patients with depression and mood disorders.
“We are embedding ourselves in patient-centered medical homes and specialty services to work directly with care providers to identify and better treat patients,” Silbersweig said. “We are also working collaboratively to develop and test novel diagnostic and therapeutic strategies.” The clinical team ensures that patients are carefully screened and have an opportunity to learn about and discuss different treatment options.
“Medications aren’t the only answer, and most often, they shouldn’t be the first step in treating depression,” Erb said. “There are many evidence-based psychotherapies and other approaches we can use, in addition to addressing the basics of healthy diet, restorative sleep and promoting exercise and meaningful work.”
Primary care clinics screen for and treat some types of depression, and refer more complex cases to Psychiatry. Some of these complex patients may be part of the center’s new care management pilot. “For patients who are complex, at risk for harming themselves or who keep derailing from their treatment, we are piloting a model where a clinical social worker is front and center in keeping patients on track,” said Emily Benedetto, LCSW, program manager for the Depression Center.
In this model, the social worker motivates the patient to come in for appointments and otherwise adhere to the treatment plan through phone calls to ensure everything is going well. “Patients are at high risk to drop out of treatment for a variety of reasons, sometimes simply due to their depressed state,” Benedetto said. “If a social worker calls them, they can talk about it and intervene right then and there before the patient derails.”
The pilot already has seen positive results.
“It’s becoming evident that by constructing a coordinated team approach, you can help individuals in ways you wouldn’t have otherwise been able to,” said Erb.