Depression: An Increased Need for Screenings in Primary Care Settings

Depression is found to be one of the leading causes of disability for people in the United States that are 15 and older. Depression is also commonly seen in primary care settings, and is very common in older adults and in women that are pregnant or that just gave birth. In pregnant and post-partum women in particular, it is a large concern because it not only affects the mother, but the child as well. The USPSTF has found that screening adults for depression has greatly improved the identification of adults suffering from depression that came into the primary care setting. Some common screening techniques to use are the Patient Health Questionnaire, the Geriatric Depression Scale in older adults, and the Edinburgh Postnatal Depression Scale in pregnant or postpartum women. After screening, appropriate and common treatments of depression include antidepressants or psychotherapy, either alone or combined. The study also found that treating adults with depression that was identified through screening has lead to decreased morbidity in these patients, and the USPSTF recommends screening for the general adult population, which is all patients over the age of 18, with particular emphasis on pregnant and postpartum women.

JAMA. 2016;315(4):380-387

I chose this article because depression is becoming more and more prevalent in our country. We see this firsthand in the pharmacy with all of the depression and anxiety medications that we dispense, and have even seen proof in our Professions of Pharmacy class with the depression medications that have made it to the Top Drugs list. However, with all of the depression and associated medications that we do see, it is scary to me to hear that there are still so many cases of depression that go un-diagnosed. I believe that having greater screenings for patients that are known to be more prone to depression is important because it will prevent their illness from spiraling out of control while no one knows it is happening. I do not believe that medications should be used in every instance of depression or anxiety, and think that therapy is also a valid option to try, but whatever a patient needs is what they should receive because the primary goal of all health care professionals is to help patient get better, and the first step to that is knowing that there is a problem present.

Guidelines for the Zika virus in pregnant women

According to the CDC, the Zika virus is transmitted through a certain type of mosquito that also transmits other viruses that have been found in the United States. Although the Zika virus has not yet been identified in the United States, there have been infections reported throughout the world in people returning from travel to an area that has seen this virus, which could result in disease transfer from human to human rather than from mosquito and human. This increases the risk of the virus entering the United States.

Pregnant women are not thought to be more at risk for this disease or to have more serious symptoms. However, there is currently an outbreak of this virus in Brazil, and there has been an increase in infants born with microcephaly, which is a disease characterized by abnormal brain growth and an underdeveloped head size. Because of this, there are studies underway to see if the Zika virus is the cause, but until then, the CDC is recommending that all pregnant women hold off on traveling to areas that have a Zika virus outbreak, and if they do travel to this area, to wear long sleeved shirts and use insect repellants. There is no vaccine to prevent this infection and there is currently no cure, just the recommendation of rest, fluids and acetaminophen for fever and pain. In addition, if a woman has been tested positive for this virus, she should receive regular ultrasounds to monitor the growth of her baby and talk with a fetal medicine specialist.

MMWR Morb Mortal Wkly Rep. 2016;65(Early Release):1-4.

I thought this article was very interesting because it was proactive, discussing emerging health risks in other areas of the world before they hit the United States. I believe looking at health information from other areas of the world, especially those neighboring the U.S., and initiating studies based on that information should be done more often to help prevent large outbreaks that can turn into epidemics, which were seen with Ebola and the West Nile Virus. In addition, working on preventative measures, such as vaccines, as early as possible is one step that can be made to help prepare for potential disease outbreaks, because it is better to be over prepared than to be working against an epidemic.