Can Pharmacists Have an Impact on the Treatment of Mental Health Issues?

According to the National Alliance on Mental Illness (NAMI), 1 in 5 adults in the United States experience mental illness annually. Additionally, 1 in 20 adults experience serious mental illness issues, and 17% of pediatric patients between 6 and 17 years of age have a mental health disorder.¹ Since mental health issues are still often associated with stigmas, and many individuals do not seek help for their mental health issues for various reasons, the number of Americans suffering from mental health issues is probably even higher. 

Various education and public awareness initiatives have aimed to expand awareness about the multiple resources available for people with mental health issues. Health care providers, especially pharmacists, can act as patient identifiers, educators, and advocates for the millions of individuals with and/or at risk for mental health issues. Many physicians and nurse practitioners now routinely screen their patients for depression during office visits. Despite these efforts, there is an urgent need to continue to remind patients they are not alone and direct them to the valuable resources available, especially since many patients are unaware of them.

Pharmacists are well poised to assist patients suffering from mental health issues and can be instrumental in encouraging patients to seek further medical evaluation when warranted. Due to having frequent encounters with patients, pharmacists can also identify patients who may have treatment-resistant depression or are noncompliant with therapies. Pharmacists can make recommendations as needed, including measures to improve treatment compliance and ensure that patients initiating therapy understand it may take a few weeks to experience therapeutic benefits.

Noncompliance is often a challenge in treating people with mental health issues, and factors that contribute to noncompliance are often complex and multifaceted. A recent systematic review revealed that noncompliance to psychotropic medication for the treatment of schizophrenia, major depressive disorders, and bipolar disorders was 56%, 50%, and 44%, respectively. Factors that contributed to noncompliance included individual patient behaviors, absence of social support, clinical or treatment- and illness-related adverse effects, and health system factors.² 

A study published in Pharmacy Practice³ indicated that pharmacists are integral members of the multidisciplinary care team treating patients with mental health issues. The authors said critical roles for pharmacists include optimizing drug therapies via clinical recommendations, educating patients, providing patient support, and working in conjunction with other health care providers to improve clinical outcomes. 

Additionally, a prospective study⁴ was conducted to explore the impact of pharmacists implementing depression screening using the Patient Health Questionnaire (PHQ). During the study period, pharmacists screened 3726 patients for depression. Results showed that 67 (1.8%) patients screened positive on the PHQ-2. Among patients who completed the PHQ-9, approximately one-quarter of participants who met the criteria for consideration of diagnosis were referred to their physician. Additionally, 5 patients exhibited suicidal thoughts and were immediately referred for treatment. At the time of follow-up, an estimated 60% of patients with a positive PHQ-9 initiated or modified treatment. The authors concluded that employing the PHQ screening tools enabled pharmacists to identify patients with depression swiftly, and the PHQ can be implemented effectively in the community pharmacy setting.

Another study⁵ highlighted the pivotal roles of pharmacists working collaboratively with other professionals at US Veterans Affairs hospitals. The authors said health care systems should continue to explore the valuable role of the pharmacist since increased services by these providers can improve clinical outcomes and overall patient care, and optimize the use of medications for treating various mental health disorders.

Pharmacists can also be instrumental in making clinical recommendations tailored to patient need and educating prescribers and patients about long-acting therapies, including injectables and novel treatments, that may improve patient compliance. For example, in February 2023, the US Food and Drug Administration (FDA) approved the New Drug Application for zuranolone, a 14-day, rapid-acting, once-daily oral neuroactive steroid (NAS) GABA-A receptor positive allosteric modulator, for the treatment of major depressive disorder and postpartum depression in adults.⁶ The application has been granted priority review, and the FDA has assigned a Prescription Drug User Fee Act (PDUFA) action date of August 5, 2023.

Conclusion

Mental health issues affect individuals across all age groups. To identify and address them, it is critical that patients feel comfortable seeking help, receive empathy and support, and understand the significance of routine health care and compliance with therapies. 

According to the National Community Pharmacists Association (NCPA), pharmacists and pharmacy team members practicing in community/retail settings are more likely to encounter a patient having a mental health episode than a situation requiring basic life support or CPR.Therefore, the NCPA offers a Mental Health First Aid Training course which is an 8-hour, in-person program created to train health care providers on recognizing, understanding, and responding to signs of mental illnesses and substance use disorders.

Lastly, in addition to providing quality care to patients living with mental health issues, it is also essential that pharmacists and other health care providers implement measures into their daily routines to take care of themselves and be proactive about their physical and mental health.

References:

1. Mental health by the numbers. National Alliance on Mental Illness. Updated June 2022. Accessed April 11, 2023. https://www.nami.org/mhstats 
2. Semahegn A, Torpey K, Manu A, Assefa N, Tesfaye G, Ankomah A. Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: a systematic review and meta-analysis. Syst Rev. 2018;7(1):10. doi:10.1186/s13643-020-1274-3 
3. El-Den S, Collins JC, Chen TF, O’Reilly CL. Pharmacists' roles in mental healthcare: Past, present and future. Pharm Pract (Granada). 2021;19(3):2545. doi:10.18549/PharmPract.2021.3.2545
4. Rosser S, Frede S, Conrad WF, Heaton PC. Development, implementation, and evaluation of a pharmacist-conducted screening program for depression. J Am Pharm Assoc. 2013;53(1):22-29. doi:10.1331/JAPhA.2013.11176
5. Romney M, Robinson RF, Boyle J. Mental health pharmacists: increasing necessary mental health service delivery. Fed Pract. 2022;39(3):106-108. doi:10.12788/fp.0237 
6. Biogen and Sage Therapeutics announce FDA accepts filing of new drug application and grants priority review of zuranolone in the treatment of major depressive disorder and postpartum depression. News release. Biogen; February 6, 2023. Accessed April 11, 2023. https://investors.biogen.com/news-releases/news-release-details/biogen-and-sage-therapeutics-announce-fda-accepts-filing-new