September 2019

The phrase ‘treat the person, not the disease’ has become a bit of a cliché in recent years. It rolls off the tongue easily, but putting that mantra into practice can be fraught with difficulties.

How many people do you see every day in your pharmacy, who come to you with a physical illness, in whom you suspect a mental health comorbidity? What do you do about it? Even taking into account study literature, mental health comorbidities in patients with physiological illness is probably more prevalent than we think. And of course, this has a knock-on effect on medications compliance.

A 2016 study in The Lancet found that depression is twice as common in people with diabetes relative to the general population and is associated with a rise in debilitating complications. Work is ongoing to learn more about the bidirectional relationship between diabetes and major depressive disorders, particularly in the type 2 variety. Rates of anxiety disorders are also elevated in these people, independent of the incidence of depression. Another 2014 study in Psycho-oncology found that patients in the community with active cancer and cancer survivors have a relatively higher rate of common mental disorders than the general population and have a higher treatment gap, primarily for affective and anxiety disorders.

Even in non-life threatening conditions such as arthritis, there is a demonstrable connection. To its credit, the Arthritis Foundation raises awareness of this risk in its patient information. The list of illnesses that put a patient’s mental health at risk is exhaustive. A 2019 study in Inflammatory Bowel Disease points to a higher incidence of anxiety disorders, bipolar disorder and schizophrenia in a significant cohort of IBD patients. These elevated rates were similar in both coeliac and Crohn’s disease. Even in the old foe of migraine, more than half of these patients meet criteria for at least one anxiety disorder, and they are also vulnerable to depression and bipolar spectrum disorder. All this seems pretty obvious, but the potential solutions are not. Perhaps greater collaboration between pharmacy representatives and their counterparts in mental healthcare is called for? In addition, how you raise the subject with a patient that they may have a psychological problem cannot be easy and perhaps more emphasis could be placed on this by the colleges. Either way, if we are to embrace the concept of holistic treatment and ‘treating the person, not just the disease’ as a mantra, this aspect of patient care in the pharmacy may need closer attention.