How I can support depressed patients (Rachel Hall)

Half of patients with long-term conditions will suffer from depression. So it is no surprise that I come across patients on a daily basis who are suffering with the condition, whether or not it has been formally diagnosed.

Occasionally, I feel that it is appropriate to diagnose patients with depression myself, especially if a patient is particularly distressed since this often has a huge impact on their physical health. I certainly do not take this decision lightly — I weigh up the benefits of making a diagnosis and prescribing an antidepressant or referring a patient to another service (eg, counselling or cognitive behavioural therapy) against the risks of not doing so and asking him or her to book an appointment with a GP. I know that, in some cases, a patient will choose not to book another consultation, or that his or her ability to make this decision could be hindered by the way they are feeling or the availability of appointments. There is no right or wrong in this situation and you need to decide what to do on a case-by-case basis.

In 2008 I completed a clinical diploma module on mental health because I knew that I would be coming across many such cases, and it made me realise just how much I didn’t know about mental health problems. It highlighted the complexity of psychiatric conditions and the risk attached to the decisions we make as practitioners.

The patient health questionnaire-9 (PHQ-9) is a useful tool for screening patients who you suspect are suffering from depression. Although the tool has not been validated in general practice, it has been included as a Quality and Outcomes Framework indicator. Of course, these types of tools do not replace clinical judgement, but they can be useful to aid diagnosis and track a patient’s progress.

In some cases, I will discuss a particular patient with one of my GP colleagues, since they have more experience than me in dealing with people with depression.

As a practitioner, you need to make the decision whether or not you feel competent to prescribe — and diagnose — in any given situation. Certainly, I have seen first-hand what a difference it can make to patients when they realise that you can help them.

Rachel Hall is clinical pharmacist at the Old School Surgery, Bristol