With mental illness the leading cause of disability in Canada, early detection and treatment offer the best and perhaps only chance of a full recovery.

That was a key message from Dr. Jeffrey Habert, assistant professor at the University of Toronto’s department of family and community medicine, during a session at Benefits Canada’s 2017 Mental Health Summit in Toronto on Nov. 7. “This isn’t an illness that should wait. The longer you take to treat, the less chance there is of a remission,” he warned.

Read: The role of technology in improving access to timely care

In addition, he noted the link between delays in the effective treatment of major depressive disorders and higher rates of relapse. “And with every subsequent relapse, the chances of recovery get dimmer. That’s why it’s important to treat patients fully with their first episode.”

It’s also important to assess the efficacy of treatment plans early on, according to Habert. “Ineffective or poorly tolerated treatment may delay recovery and heighten the risk of residual symptoms.”

Habert also stressed the importance of measurement in diagnosing and treating mental disorders. “Measurement-based care is the centrepiece of early optimized treatment. You would never diagnose diabetes without a sugar test or hypertension without measuring blood pressure. But for depression, we don’t measure anything.”

“This is an illness we see as much or more than the rest, but only a minority of physicians ― primary care practitioners, psychologists and mental-health workers ― use measurement-based care,” he added.

Read: Early detection, treatment key to addressing mental disorders

Like diabetes or hypertension, there are no standard physical parameters that determine the level of a mental disorder. But there are patient health questionnaires for screening, diagnosing, monitoring and measuring the severity of depression. Insurers, Habert suggested, should strongly advocate for the use of those questionnaires.

For his patients, Habert also uses the Sheehan disability scale, which measures functional impairment in social, occupational and family interactions.

Measurement, he noted, is important because symptoms can improve before function does. For example, patients might say they’re feeling less sad, but unless physicians measure their functional recovery, they won’t know if they’re reconnecting with friends or family, playing hockey or taking the kids to the park again. “And the problem with not reaching full functional recovery is that you won’t be effective at work. Plus, there’s always the looming possibility of a relapse,” said Habert.

Proper adherence to medication is also a big part of the recovery. “But almost 60 per cent of the patients stop antidepressants after six months due to severe side-effects,” said Habert. “As a result, treatment failure rate hovers between 40 per cent to 60 per cent. And that poses a big problem because, after one episode, the probability of a second episode increases by 50 per cent and a third episode by 90 per cent.”

Read: How to bridge the insurer, physician divide in disability management

Drug substitution could also dampen the efficacy of mental-health treatment, according to Habert, who recommended a careful risk-benefit assessment before switching patients who are responding well to a particular drug. “Bioequivalence does not always translate to therapeutic equivalence,” he said.

“So rather than save money, unplanned substitutions could render the treatment less effective, worsen the side-effects and lead to higher health-care costs,” he added.

When patients who have been stable on antidepressants suddenly take a turn, Habert said he asks them to check with the pharmacist whether the brand had changed. “You’d be surprised how often that is the case. Adherence is tough to begin with. Our job is to find ways to make it easier, not the other way around.”

Read more stories from the 2017 Mental Health Summit

Copyright © 2018 Transcontinental Media G.P. Originally published on benefitscanada.com

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