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1. Depression and Chronic Disease Public Health Detailers’ Training
NYC Department of Health and Mental Hygiene
Ann M. Sullivan, M.D.
Regional Director of Psychiatry for the Queens Health Network
New York City Health and Hospitals Corporation
2. Outline Recognition & Treatment
Primary Care
Challenges
Depression-Medical Comorbidities
3. Recognition and Treatment of Depression in U.S. Only 50% of adults with Major Depression receive any healthcare treatment at all for depression
Of the 50%, only 40% receive adequate treatment
Only 25-30% of adults receive adequate treatment for major depression
50% of patients stop anti-depressants within the first 3 months
4. Primary CareRecognition and Treatment of Depression 6-9% of patients in a Primary Care Practice have a treatable Depressive Disorder: Major Depression Disorder or Dysthymic Disorder
Most Primary Care Practices Diagnose only 2-3% of their patients as depressed
Among recognized and treated patients in Primary Care only 25% are adequately treated.
50% of patients with Major Depression, who do receive treatment, receive all their treatment in primary care.
5. Identified Challenges in the Care of Depression Practice:
“Pandora’s Box”
Detection and correct diagnosis (about 10% on benzodiazepines)
Primary care physicians frequently use medication only to treat depression
Antidepressants used at lower intensity in primary care
Almost 40% of patients stop antidepressant in first 30 days
Only 50% of those referred to specialty mental health practitioners complete more than one visit
Patients are not staying on antidepressants for continuation and maintenance phase
Difficulty accessing specialty care/consultation when needed
Patient:
Somatic presentation
Stigma
Co-morbidity – multiple problems – “too time consuming”
Cultural Variation
6. * R. Swift Depression-Medical Comorbidities*
7. DEPRESSION – MEDICAL COMORBIDITIES
8. Depression CARDIAC DISEASE
? Risk of hypertension, CVA, CAD
? Risk of death after MI
Mechanisms:
?Sympatho/Medullary activity
?Platelet aggregation
?coagulation
?Fibrinolysis
?Heart rate variability
DIABETES
?Non-adherence
? Hb1AC
? Retinopathy, Neuropathy, Nephropathy
?Microvascular complications