Healthcare Perception of Major Depressive Disorder

Greg Mattingly, MD: Welcome to this Patient Care Online^® presentation titled “Navigating the New Era of Major Depressive Disorder Treatment: Expert Opinions on RapidActing Therapies.” I’m Dr Greg Mattingly, an associate clinical professor at Washington University and president of the Midwest Research Group in St. Charles, Missouri. Today it’s my pleasure to be joined by Jeremy Schreiber, a psychiatric mental health nurse practitioner and founder and CEO of Enlighten Health Care, LLC in Wheeling, West Virginia. Our discussion today will focus on treatment options for major depressive disorder, or MDD. We’re going to begin by exploring the current healthcare perception of the condition, focusing on how to navigate the expanding treatment landscape of treatment options, and provide insight into current treatment practices and approaches. Regrettably, over the past decade the prevalence of major depression has continued to escalate, leading to a worsening of disability across our country. This trend highlights the urgent need for a shift in our current treatment models. As practitioners we must question how we can reshape this field by embracing the emerging treatment options that are either available now or on the very future horizon. Jeremy, why don’t we start by talking a little bit about the perception of major depression within the overall healthcare community. In your approach, what are the clinical and practical implications of this condition when we think about a chronic disease state model versus thinking about episodes of the course of an illness? So chronic disease state, chronic treatment versus episodic treatment. How does that change the way we view the condition?

Jeremy Schreiber, MSN, PMHNP-BC: I think that’s a very interesting question, Greg, because historically, I always have thought about depression as more of a chronic condition. And it may be because the patients that I’ve had seen have had more chronicity to their illness. However, I’ve seen a fair degree of patients who have also responded readily to medications. If we look at the literature, we know that some patients who develop major depressive disorder go on to experience remission and readily and without much treatment. We also know that a lot of patients aren’t even kind of captured, so to speak, in terms of the suffering that these patients experience. So I think, when looking at my historical training to kind of the way I view things now, I think that it’s actually both. I think we can have kind of more chronicity to the illness, and we should be looking at depression as an episodic condition as well. I think that when we look at depression as an episodic condition, it lets us focus on getting our patients to remission or having resolution of their symptoms occur very rapidly, which is something that we should be striving for, especially since we realize that the longer patients are depressed, the harder it is to get these patients to remission.

Greg Mattingly, MD: I 100% agree with you, Jeremy. I think the trap we can all fall into is we start thinking of depression a lot like we think of chronic pain, where the goal isn’t restoring wellness, the goal is to decrease the suffering somewhat. I want to turn down the level of your pain. I’m not going to get rid of it, but I just want to turn it down somewhat. Throughout the years we’ve kind of developed that same approach to depression. Instead of getting your remission, I’ll turn down the level of your symptoms, but I’m not really restoring wellness.

Jeremy Schreiber, MSN, PMHNP-BC: Yeah. I think you’re exactly right. If we look at the research as well, the American Psychiatric Association says that residual symptoms are predictors of worse outcomes and things of that nature. So the goal really should be to strive for remission in our patients not, as you said, totreat it like we treat chronic pain just to minimize the suffering. We want to ameliorate it.

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