April 2019

Depression Medication Shared Decision-making Aid

In the U.S., the incidence of depression is on the rise. Depression is the leading cause of suicide and complicates the successful treatment of medical comorbidities¹. According to the National Alliance on Mental Illness (NAMI), about 67 percent of people living with depression are prescribed medication as their primary form of treatment². Antidepressants are the second most commonly prescribed drugs in the U.S., according to a study published in 2013 in the American Journal of Clinical Hypnosis³. Most often, it is the primary care provider (PCP) that initially diagnoses and begins treatment of depression.

Antidepressant medications can be an effective treatment to manage the symptoms of depression, along with appropriate behavioral health therapies, but they only work if the patient adheres to the prescribed medication treatment plan and remains consistent with the medication for adequate time to achieve therapeutic control of symptoms.

Our aim at Blue Cross and Blue Shield of Texas (BCBSTX) is to ensure our members receive the best care and highest quality treatment for their conditions, leading to optimal health outcomes. Therefore, when patients are diagnosed with major depression, it is important for providers to encourage the patient to stay on the medication throughout the initiation phase, which lasts 12 weeks, and the continuation and management phase, lasting 6 months to receive the full effect of the medication, and also follow up with the patient.

There are numerous factors that influence patient adherence to the prescribed antidepressant medication. Some of these factors include understanding why the medication is important, whether there are adverse side effects, and how conveniently the medication routine fits their life. Including the patient and their caregiver in a shared decision-making process of determining which medication to prescribe may help ensure adherence to the medication by allowing them to say what is important to them in the selection of medication and what potential side effects would not be tolerable.

The Mayo Clinic Shared Decision Making National Resource Center offers shared decision-making tools to support providers in their efforts to increase patient’s knowledge of available depression medication treatments and/or lifestyle changes, improve patient’s engagement and participation in decision making, and supports optimal outcomes and quality of life. The decision-making aids at the following website provides an online, interactive shared decision-making resource as well as paper-based shared decision aids and instructional videos for use of the tools.

Browse the resources at: shareddecisions.mayoclinic.org and shareddecisions.mayoclinic.org/decision-aid-information.

Best Practice Summary:

1. Assess your patients’ mental health and medications at every appointment by utilizing screening tools and/or the referenced shared decision-making tools.
2. Take time to explain uses and schedules for medications while assessing the continued need for medications.
3. Educate your patients on the importance of medication continuation while making them aware of potential side effects and benefits.
4. Leverage shared decision-making resources and the additional resources below to assist in the assessment, care coordination and screening of your patients.

Additional Resources (provided by Magellan Healthcare^®):

• Behavioral Health Toolkit: Resources for coordinating a patient's behavioral health needs.
• Clinical Practice Guidelines: Magellan's clinical practice guidelines and supporting resources for providers.
• Screening Tools: Helpful self-assessments and screening tools you can use with your patients.

Reference and review BCBSTX’s Preventive Care Guidelines and Clinical Practice Guidelines, and the THSteps for Providers website for more information on this and other important topics for treating your patients.

References:
¹Caruso, Kevin. "Suicide Causes." Suicide prevention, awareness, and support, www.suicide.org/suicide-causes.html.
²National Alliance of Mental Illness. Depression, August 2017, www.nami.org/Learn-More/Mental-Health-Conditions/Depression/Overview.
³Irving Kirsch & Carol B. Low (2013) Suggestion in the Treatment of Depression, American Journal of Clinical Hypnosis, 55:3, 221-229, pdfs.semanticscholar.org/0c83/a909eb520fbc3239523cce26883cc5ec9138.pdf.

Blue Cross and Blue Shield of Texas (BCBSTX) contracts with Magellan Behavioral Health, Inc. (“Magellan”), an independent company, to administer BCBSTX’s managed mental health program.