ASHP Midyear: Pharmacists Play Key Role in Addressing Depression in Women Through Medication Management

Kathleen Vest, PharmD, BCACP, CDCES, FCCP, professor of pharmacy practice at Drake University College of Pharmacy and Health Sciences, discusses the important role pharmacists can play in addressing depression, particularly in women. It discusses the higher prevalence of depression in women, which is attributed to factors like hormonal fluctuations, unique psychosocial pressures, and life transitions. She emphasizes the value of nonpharmacologic approaches, such as psychotherapy and lifestyle interventions like exercise, in managing depression symptoms. Pharmacists are identified as crucial partners in determining appropriate medication treatments, ensuring adherence, and monitoring patients for adverse effects.

Pharmacy Times: What are some of the unique factors that influence treatment decisions for women with depression compared to men?

Kathleen Vest: Well, first of all, we know that depression is twice as common in women than it is in men, and there are some evolving answers potentially to that question. So first, we believe that hormonal fluctuations and hormonal variability plays a role. We know it's not the complete end of the story, but we know that at various times during the menstrual cycle, for example, during menses, that these hormonal fluctuations can cause, potentially an increase in symptoms, and while we may have 2 patients experiencing the same type of hormonal fluctuations, some patients may have an underlying vulnerability, and that's what we're really still trying to explore other factors unique to women. Sometimes there are unique psychosocial factors, variability with roles that women may play in the home. They may be caretakers, parents, taking care of not only their children, but parents as well. So there are a lot of those different types of pressures that we see from that societal perspective, and then we have a lot of transitions in life in which major depressive disorder can increase. So times, for example, during menopause. During that time, we see things like vasomotor symptoms occurring, sleep changes, all of which can increase the onset of depression. So another thing to keep in mind is that symptoms may be different in men versus women. So symptoms that women may experience may be more general, like fatigue, sometimes body aches or headaches or things of that nature, low energy, whereas in men, we tend to see more aggressive behavior at times, and sleep problems like insomnia.

Pharmacy Times: How do hormonal fluctuations impact the course and severity of these disorders?

Kathleen Vest: So it's known that while we don't completely understand the role of estrogen and how it relates to neurotransmitters like serotonin and norepinephrine, we do know that it plays some role, and that hormonal fluctuations throughout various stages of life can increase potential for depression or depressive symptoms. We see that often when we look at premenstrual dysphoric disorder during the luteal phase of the menstrual cycle. We see this rise in estrogen and then a steady significant decrease that sometimes can precipitate mood symptoms. So we know that hormonal fluctuations do play a role that's still not widely understood at this time.

Pharmacy Times: How can pharmacotherapy and non-pharmacological interventions treatment approaches?

Kathleen Vest: So first and foremost, it's important to think about nonpharmacologic approaches to treating patients with depression. So psychotherapy, whenever possible, is an integral component in treating patients. Often, it's not accessible or affordable for a patient for many different reasons, but it can really help patients develop some of those coping mechanisms to help prevent worsening of depression and managing symptoms. We also have heard a term BDNF, or brain derived neurotropic factor, which is believed to be a protective factor within the brain, and sometimes stress can decrease some of that protective chemical. Sometimes we see increases in it to help protect us and help us with managing stress. But it's thought that things like exercise can actually promote or increase that chemical or stress management techniques, and also that sense of community and working with others can help with increasing that so nonpharmacologic treatments are very important. It's also important to think about treating with pharmacotherapy. So we have a lot of different medications available to treat some of these psychiatric illnesses, and as pharmacists, we can really help play a role with determining what's the most appropriate for the patient and helping them with managing potential side effects that they may experience.

Pharmacy Times: What is the role for pharmacists in managing treatment options for women with depression?

Kathleen Vest: Supporting the patient and listening is critical with helping a patient navigate depression. So it might be something like helping them access care, helping them access certain providers, and just being knowledgeable about the type of psychiatric care they may be able to acquire in your region or the town that you're practicing in, but also just assisting with nonpharmacologic recommendations and helping patients with improving their lifestyle, but but managing the med the medication therapy is critical. Teaching patients what they can expect with their treatments, letting them know that it will take up to 4 to 6 weeks to see benefit from their antidepressant, and helping to monitor them along the way, because sometimes they may even notice an increased in anxiety or other [advese] effects in that first couple of weeks. So really working with them to monitor and to try to help improve their outcomes is critical, and then helping ensure it's affordable and that they're able to tolerate the medication.

Pharmacy Times: How can pharmacists help ensure patients adhere to their medication, specifically during transition periods?

Kathleen Vest: So pharmacists can help with adherence to medications by first educating the patient and letting them know that these are medications that need to be taken chronically. Sometimes there could be worsening outcomes. If they're stopped abruptly, more [advese] effects can occur. And also, if somebody stops their antidepressant, that risk of recurrent depression is important to let them know about. During life transitions we do see sometimes in things like premenstrual dysphoric disorder, for example, where somebody might be on a low-dose antidepressant, and sometimes adjustment in therapy, like increasing the dose could be warranted. Then throughout other phases of life, we see, for example, in perimenopause and menopause, the benefit of using things like SSRIs and potentially even SNRIs to not only manage the mood related symptoms, but to also help with the hot flashes and other vasomotor symptoms that may be occurring.

Pharmacy Times: Is there anything else you would like to add?

Kathleen Vest: Pharmacists in any setting can make an impact on the care of patients suffering from depression, and it's also important as health care professionals to remember that we're taking care of patients, and that can be hard work, so making sure we're taking care of our own mental health is also critical so that we can help take care of others.