April 29, 2016 - Briget has been battling depression since she was a teenager. When she migrated to Canada eight years ago from Germany, Briget spent the first six years trying to navigate a strangely disconnected health care system for help not only with her spiralling depression, but also the issue of increasing weight gain --an unexpected side effect of her antidepressants.
“I changed psychiatrists and family doctors, and I saw so many specialists over the years….but we couldn’t find the right medication to treat my depression,” says Briget. “When I finally found a medication that worked to help my depression, I started to gain a lot of weight. I asked my psychiatrist for help, but he didn’t understand. He simply asked, “Wouldn’t you rather be happy?”
Briget (on the right) is currently a client of the new MPA Brain-Heart Initiative, led by Dr. Valerie Taylor, Chief of General and Health Systems Psychiatry at CAMH.
Briget shakes her head in wonder. “How can you be happy when you are gaining so much weight? I gained 20 pounds from the anti-depressant I was taking. And if I stopped taking the medication, I wouldn’t feel like getting out of bed, much less going to work. It was frustrating that no one understood how I felt.”
Through proactive research, Briget discovered the work of Dr. Valerie Taylor, Chief of General and Health Systems Psychiatry at the Centre for Addiction and Mental Health (CAMH) and a leading expert in the metabolic side effects of psychiatric medications. Dr. Taylor is also leading the new Medical Psychiatry Alliance (MPA) Brain-Heart Service at CAMH, a pilot program that is integrating primary care and specialized resources in the community in order to identify and manage weight-change and other medical issues of patients living with severe mental illness. In helping patients manage weight- and related issues, the new service aims to help patients better adhere to their psychiatric medication and care plans.
Once the new pilot program is evaluated and found to be successful, the plan is to roll it out more widely across CAMH and in the community within primary care, so that patients referred through the MPA Brain-Heart Service will have fast, seamless access to community resources. One of the community partners for this pilot program is the Wharton Medical Clinic, with services at seven GTA locations, which will identify metabolic issues early and develop a patient-centred treatment plan. CAMH patients with additional medical issues will also have access to hospital-based outpatient services through a new partnership with Women’s College Hospital.
“When we look at obesity being an epidemic in Canada, those rates are higher still in people with mental illness,” says Dr. Taylor. “It’s a complicated relationship and not all healthcare providers are comfortable with this area. The new pilot service launching under the mandate of the MPA aims to build capacity and increase awareness of these issues not only within the walls of CAMH, but beyond in the community, like within primary care.”
Dr. Taylor recently referred Briget to the Wharton Medical Clinic, where she receives ongoing support to achieve her best weight, and be preventative against the potential metabolic effects of her antidepressant.
The global health challenge of adult and child obesity disproportionately affects people who suffer from serious mental illness – life expectancy can be 10-15 years shorter for patients with a diagnosis of depression, bipolar disorder or schizophrenia.
“If you have to tell an 18-year-old: you have depression and bi-polar disorder and we can help you, but these medications we are going to give you are also going to cause you to gain weight, chances are high that she may not comply,” says Dr. Taylor. “In this situation, the healthcare provider needs to take the issue of weight gain seriously, and address all of these issues – the physical and the mental – together. The healthcare provider needs to understand all the metabolic effects of the medications they are prescribing...and prescribe appropriately.”
Through the MPA Brain-Heart Service, Dr. Taylor is also leading a series of teaching workshops for health care providers at CAMH in order to build awareness of the metabolic issues that accompany psychiatric medications, as well as resources available to their patients, such as the partnership with the Wharton Medical Clinic.
“Obesity is not just something that you get…like a cold which is done in three weeks,” says Briget. “It’s a chronic illness, just like depression. And now, for the first time, my health care team is paying attention. No one is telling me, ‘it’s all in your head’.”