We know little about such data in European or some other regions in the world. I think it would be beneficial to clinical practice if some researchers conduct such a study in these regions.

You are right. We are conducting this type of study in Europe now. I hope that the results will be positive for patients, GPs and payers. U.S. evidence tell us that this type of coolaborative care should be establish within helath system.

Although I have not familiarized myself with the literature on this question, I have worked extensively with psychiatric clinical pharmacists on an inpatient psychiatric unit and have found their expertise and input to be extremely helpful in patient care.  I cannot imagine that the same would not be even more true for general practitioners prescribing psychotropics. 

Thanks Michael! I am glad to hear these news. In the last decade we are getting closer to the patients and physicians. I also working in inpatient unit at psychogeriatric unit and ambulatory next to the GPs. GPs deal with many diagnoses, which include also depression and other mood disorders and psychiatric clinical pharmacist with experience within psychiatric units (app. 5 years). This problem could help that patients with MDD would be treated more effective. I thinks it is very important that we are recognized by psychiatrists and that we are publishing scientific papers within important 'psychiatric' journals. If we can publish in for example Journal of Clinical Psychopharmacology, General Hospital Psychiatry and European Psychiatry. If we are recognized with these important issues, there should be a place for clinical pharmacy practice in each country. We are on 'the same boat' and in this point of view we should be next to the patients' beds and included in all processes, which are connected with pharmacotherapy. If you have time Michael, please read the following paper, which has been published in JCP by 2 clinical pharmacists (Ian and me).

https://www.researchgate.net/publication/306086180_Comment_on_An_Open_Trial_of_Lurasidone_as_an_Acute_and_Maintenance_Adjunctive_Treatment_for_Outpatients_With_Treatment-Resistant_Bipolar_Disorder

Article Comment on: An Open Trial of Lurasidone as an Acute and Main...

Matej, I heartily agree with your ideas and enjoyed reading your comments on Lurasidone. If you look at my publication list you will see that a number of my articles are co-written with a Pharm.D from my university in what has proven to be a very fruitful collaboration, clinically and from the standpoint of scholarly work.  Apropos of the initial question here then, I am convinced there is a convincing need for close collaboration of contiguous medical disciplines to optimize patient care.

Michael

Right Michael, I am again glad to hear these news. Yes, we should collaborate and clinical pharmacy practice is focused on health outcomes. This is the way to go, because there are many good practices. Especially, antipsychotic polypharmacy is one of the key question, where this collaboration should be adressed. Next to these important issues, there are many countries still in EU, where there are almost no discussion about inappropriate prescribing and collaborative care, which is scarce for the patients. As you Michael mentioned before, we are on the same boat and appropriate daily discussion about pharmacotherapy in accordance to evidence-based medicine is the best approach to deal with patients.

Matej

I agree that there is a need for collaborated work between psychiatrist and clinical pharmacist for managing MDD on daily basis. It is also important for a clinical pharmacist to make psychiatrist to be aware of our (Clinical Pharmacist) knowledge on clinical aspects of MDD, impact of depression symptoms on patient quality of life, patient awareness about disease and medication, and skills of pharmacist in improving medication adherence and managing drug related problems for long time during healthcare team work. Probably, such team work could greatly influence psychiatrist appreciation of the services of clinical pharmacist in psychiatry ward over a period of time.

A collaborative care model of treatment is the way to go. However, although we do not have this system adopted in many countries, this system is supported by evidence-based medicine (practice). For example, about 50 % of MDD patients are not treated appropriately and more than 50 % do not take their drugs regularly. With implication of this model these numbers are lowered. The health systems around should support this practice.

Matej

I agree with the fact mentioned by you. I like to mention few factors that affects the therapeutic outcome in MDD patients. They are related to physicians, culture, patients and therapeutic outcome.

Among physician related factors, the expertise to treat depressive patients is better with psychiatrist than the general practitioners who frequently work at outpatient clinics. This may lead to selection of antidepressants that are less specific to treat the patients suffering from severe depression. 

Psychiatric disorder is a social stigma in some countries due to influence of culture practiced in those communities since long time. This may lead to non-compliance to either prescribed drug treatment or suffering clinical condition itself.

The patients suffering from depression, after getting the treatment, always tries to figure out the ways out from those situations (mainly poor socio-economic) that made them depressed and may not willing to continue the treatment after their situations get solved. 

The patients depressive symptoms remit after 2-4 weeks of drug treatment. Such remission of symptoms makes them to discontinue to the treatment in spite of patient education and counselling done by psychiatrist as well as clinical pharmacist.

I agree that it is challenging area to be seen from multiple angles for better patient care, which is the motto of every healthcare system across the globe.

In my opinion, it is better to provide feasible healthcare, as a team, after learning from others experience in the same field. 

I agree, We are on the same boat as Michael sad in previous email. If we can even have more success in publishing and treating our patients even better. If there are support by evidence-based medicine there are no space for ignoring this type of service. In most EU countries there are few data about this topic, although there are many interest to impement psychiatric clinical pharmacy in many countries, however the barriers are exist in many countries, especially by owners and some prescribers. We should move up ... First, to conduct naturalistic trials to obtain "real life" data and after to try to collaborate. First step to recommend pharmacotherapy with MDD patients without bipolar depression/mania at first episode diagnosed by GPs and measure clinical outcomes and improvement (CGI-scale, Hamilton) and adherence. If we have the positive results there is a place to implement this type of service in health systems after final cost-effectiveness plus sensitive analysis is positive.

Please also see the following paper (in english): Memantine associated with parkisonism in a patient with Alzheimer's disease: A case study and the review of the literature, where also interventions made by clinical pharmacists have been described.

Regards,

Matej

Article Memantine associated with parkisonism in a patient with Alzh...