Home' Australian Pharmacist : September 2011 Contents Vol. 30 -- September #09, 2011
Continuing Professional Development
The articles in this series are independently researched and compiled by PSA commissioned authors and peer reviewed.
The principles of mental health first
aid centre around assessing and
assisting with any crises (in particular
suicide), listening to the person in a
non-judgemental way, giving support
and information especially highlighting
the fact that they are not alone,
encourage appropriate professional
health and other supports. Having a
good support network is one of the
most beneficial protective factors for
depression and should be encouraged
whenever depression is suspected.10
Significant stigma about mental
health issues exists. It is important to
reassure people who may be suffering
from depression that they are not
alone and to seek help and support
from family and friends. People who
have a chronic illness may find it
difficult to make the effort to spend
time with family and friends, but this
is an important factor in reducing
social isolation and risk of depression.5
People who have co-existing
depression and chronic illness find
it more difficult to manage their
condition than those who have
either depression or a chronic illness
alone.5 There may be a tendency in
the health care system to focus on
the treatment of the chronic illness
before treating the mental illness.
The aim for people with co-morbid
depression and chronic illness is to
treat the depression and minimise
the effects of the chronic illness to
improve the person's quality of life.
Both depression and the chronic
illness need to be addressed together
with an integrated approach to
promote the best health outcomes.1
Psychological based therapies
for depression such as cognitive
behavioural therapy and relaxation
therapy have been shown to be
an effective option for people with
depression and a range of co-existing
chronic illnesses. They can be
considered as part of an integrated
management approach which may also
Mary has now presented with a
prescription for Zoloft. She has really
been struggling to come to terms with
the worsening of her diabetes. Her
GP has recognised the problem and
is now treating her for depression.
The focus for Mary now needs to be
on maintaining a holistic approach to
her care, focusing not only on either
her physical health or her mental
health but integrating treatment of
both. In order to delay the progression
of either her chronic illnesses or her
depression, both aspects will need to
be adequately treated and considered.
The GP has also referred Mary to
a clinical psychologist for cognitive
In addition, discussion with Mary
about existing appropriate support
networks could be helpful. Support
networks for Mary could include
her family and friends. Investigation
into local support groups for people
experiencing similar medical
conditions may also be an option.
Pharmacists can have an important
role to play in health promotion for
chronic illness and depression to
identify 'at-risk' individuals who may
benefit from education and referral to
their GP and to provide support and
education to those people who have
co-morbid depression and chronic
illness about the management of their
1. Clarke DM, Currie KC. Depression, anxiety and their
relationship with chronic diseases: a review of the
epidemiology, risk and treatment evidence. MJA
2. Pfaff JJ, Draper BM, Pirkis JE, Stocks NP, Snowdon
JA, Sim MG et al. Medical morbidity and severity
of depression in a large primary care sample of
older Australians: the DEPS-GP project. MJA
3. Kelly BJ, Turner J. Depression in advanced physical
illness: diagnostic and treatment issues. MJA
4. Evans DL, Charney DS, Lewis L, Golden RN,
Gorman JM, Ranga Rama Krishnan K, et al. Mood
disorders in the medically ill: Scientific review and
recommendations. Biol Psych 2005;58:175--89.
5. beyondblue: the national depression initiative. Chronic
physical illness and depression. Fact sheet 23. [online].
[accessed 20 Jul 2011]. At: www.beyondblue.org.au/
6. Queensland Health. Chronic disease guidelines 3rd
ed. Section 2: Health promotion. [online]. [accessed
23 Jul 2011]. At: www.health.qld.gov.au/cdg/docs/
7. Teychenne M, Ball K, Salmon J. Physical activity and
likelihood of depression in adults: A review. Prev Med
8. beyondblue: the national depression initiative. Healthy
eating for people with depression, anxiety and related
disorders. Fact sheet 30 [online]. [accessed 21 Jul
2011]. At: www.beyondblue.org.au/index.aspx?link_
9. Firipis M. Essential CPE: Depression in older adults.
Canberra: Pharmaceutical Society of Australia; 2010.
10. Mental health first aid. Mental health first aid training
and research program. [online] [accessed 23 July
2011]. At: www.mhfa.com.au/cms/wp-content/
1. Which of the following
symptoms of depression is
MOST indicative of depression
in someone with a chronic
a) Lack of energy.
b) Inability to experience pleasure
from pleasurable activities.
c) Difficulty sleeping.
d) Reduced appetite.
2. Factors of chronic medical
conditions which may
INCREASE risk of depression
a) Lack of exercise.
b) Feelings of guilt.
c) Functional improvement.
d) Treatment regimens.
3. Which of the following are
APPROPRIATE strategies to
include in a health promotion
activity on chronic medical
conditions and depression?
a) Cognitive behavioural therapy.
b) Recommend getting more sleep.
c) Support and education.
d) Increasing food intake.
A score of 3 out of 4 attracts 0.75 CPD credits.
4. Chronic illnesses which have
been associated with an
increased risk of depression
c) Urinary Tract Infections.
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