New, structured approaches to depression treatment, which combine the most effective evidence-based therapies and integrate new, cutting-edge treatments, have been launched at CAMH as part of efforts to continue improving access and care for both adults and youth.
Depression is the most common mental illness, but at least 30 per cent of patients don’t respond to the initial treatment they receive.
“What we’re offering is a standardized, comprehensive treatment for depression, which we expect will lead to better outcomes for patients,” says Dr. Stefan Kloiber, Psychiatrist and Clinician Scientist in the Mood and Anxiety Division and the Campbell Institute for Mental Health Policy Research at CAMH. This new treatment approach, called an integrated care pathway (ICP), has six stages of care for adults.
What does it mean to “standardize” care? Patients with symptoms of depression will receive evidence-based, state-of-the-art treatment in a timely manner. In addition, symptoms are measured using questionnaires, and treatment decisions are based on these measurements, not only on clinical conversations.
Personalized and comprehensive
Although the ICP is highly structured, care is flexible and personalized, with different treatment options at each stage. To provide comprehensive care, there is a multidisciplinary team of physicians, psychologists, social workers and other health-care providers, and family engagement will also be part of the approach.
We would like this integrated care pathway to become a standard treatment model for all patients with depression.
Dr. Stefan Kloiber
The ICP drew from treatment guidelines and a wealth of past studies on treatment-sequencing and algorithm projects for depression, such as the STAR*D study, funded by the U.S. National Institutes of Mental Health. “We’ve made all aspects of this ICP evidence-based to offer best practice to our patients,” says Dr. Kloiber.
For any mental health treatment, achieving positive outcomes requires commitment from patients, a team of care providers and also their community. This is true of the ICP. Patients need to commit to weekly CBT group sessions, prescribed medications and regular psychiatrist visits.
“We would like this ICP to become a standard treatment model for all patients with depression,” says Dr. Kloiber. Another goal for 2018 is to collaborate with family health teams, and to that end, a full-day conference took place in April.
Over time, future plans include implementing biological markers into the treatment pathway, such as gene-based medication treatment, and to enhance monitoring of patients using wearable devices to track symptoms and sleep patterns.
Through Caribou, adolescents with depression are guided through a detailed plan that starts with family education. In an introductory session, young people and their families learn how proper sleep hygiene, exercise and diet can improve mood. Depending on needs and the overall functioning of the family, caregivers may also be offered eight additional weekly group sessions.
Youth participants are then offered 16 sessions of group CBT, and those with more severe depression may also be offered medication. As with the adult ICP, the pathway is also highly flexible and responsive to participants’ outcomes, based on measurements taken every four weeks.
“We’re going to check in with the adolescents to see whether this is working,” says Dr. Courtney. “Those check-ins will help determine whether we should we stick with our current treatment or consider changing it.”
As a pilot study for a multicentre, randomized controlled trial, Caribou is being compared to adolescent depression treatment as usual at Sunnybrook Health Sciences Centre.
All referrals to Caribou go through psychiatrists in the Mood and Anxiety Clinic within Child, Youth and Family Services at CAMH.
In the Summer 2018 Issue of CAMH Discovers Quarterly: