Monaz: Hello, I'm Monaz Mehta, editor in the Cochrane Editorial and Methods department. The Cochrane Common Mental Disorders Group had published more than 180 reviews relevant to conditions such as anxiety and depression by the end of 2019. In December 2019, they added a review of whether pharmacist support can help people take their anti-depressants and we asked one of the authors, Jennifer Brown from the Centre for Reviews and Dissemination at the University of York in the UK, to tell us about the latest findings.

Jennifer: Many people who have depression are prescribed drugs, often called antidepressants, to help manage their condition, but it can take months for them to make a difference. It’s important, therefore, that people continue to take the drugs as prescribed, to give them the best chance of working. In most cases, their family doctor or GP supports them with this treatment to make sure they take the correct dose at the correct times and to watch out for side effects. However, in spite of this, some people struggle with their antidepressants and don’t take the drugs as prescribed, which can stop them from getting better or might even make their illness worse. 
We’ve investigated whether an alternative approach improves this problem. We were interested in the effect of people receiving support with their antidepressants from a pharmacist or a pharmacy-based team, rather than their GP or another primary care provider. This approach is being used successfully for physical health conditions such as monitoring blood pressure and is sometimes called “pharmacy-based management”. It’s promising because, in countries such as the UK, pharmacies are more easily accessible than GP practices, pharmacists and their teams are likely to have more time than GPs, and they have the necessary knowledge about the different drugs people might be prescribed. There is also some evidence that people form a closer relationship with their pharmacist than with their GP.
In our review, we compared pharmacy-based management with active control (for example, special information leaflets) or treatment as usual, which would be the “normal” care delivered by GPs or nurses.  The moderate quality evidence we found, from more than 2200 adults in 12 studies, shows that there is no reason to believe that there is a difference in the reduction of the symptoms of depression between pharmacy-based management and treatment as usual. We also found no evidence of a difference between the acceptability of these two approaches to participants, given the similar number who left the trials early in the pharmacy-based management and treatment as usual groups, but there is uncertainty about this because of the low quality evidence for this outcome. 
In summary, our review does not necessarily rule out a more active role for pharmacists in the treatment of people with depression. If additional support from pharmacists can reduce the time needed from GPs, without a detrimental effect on outcomes, this has important implications for cost-effectiveness. This would be important to assess in future research as we did not investigate this in our review. There is also a need for further research to establish which parts of the pharmacy-based management approach make it successful and why some models work better than others.

Monaz: If you would like to learn more about the different approaches that have been tested in the dozen studies in Jennifer’s reviews, it’s available online. Just go to Cochrane Library dot com and type in a search for 'pharmacy-based management for depression’ to find it'.