Some individuals will research and learn every aspect of the disorder, including the medications they take, and will score as having high health literacy. Conversely there are those who are passive in the management and understanding of depression. The defining difference appears to be health literacy and motivation. In addition, it is not uncommon for an individual who “appears motivated and knowledgeable” to have difficulty managing treatments prescribed. Since motivation may ebb and flow with the depressed individual, the treatment team as well as the depressed individual may become frustrated, which further complicates the complexity of treatment. It is very important to discuss openly all aspects of care and repeat important information at every possible opportunity.
The next assessment tool in the CMAG is the Medication Knowledge Survey.72 This can be quite a challenging process for the individual with depression. He or she may be on many medications, especially if the individual has been diagnosed with Bipolar Disorder or generalized anxiety. They also may have to change medications until the “right” medication for them is found. As stated earlier, it is critical to allow time for the medication to become effective in relieving depression symptoms. Therefore, the individual must not stop the medication earlier than prescribed.
Another issue with medication knowledge is that the individual may have other medical disease processes that could complicate depression. If this is the case, it is imperative that the integrated care management professional assess knowledge of all medications. This is also a good time to consult with the pharmacist in order to understand side effects or potentially problematic drug interactions that could occur with the concurrent medications. The pharmacist would be a helpful partner in education.
In addition to the Medication Knowledge Survey, one question that may be important to ask is, “What are the times you find you may skip or forget to take your medication?” Any pills missed may signal a problem with medication adherence, but this question is less threatening and will likely illicit a truthful response from the patient instead of the information the individual thinks you want. When working with an individual with depression, this simple question may turn out to be critical, and it is a question that any individual will probably understand. It is also important to be aware of the reliability of the self- reporting. This may be particularly problematic if the assessment is being performed over the phone. Always be cognitive of this potential and speak with the treatment provider, who is face-to-face with the individual. For assessment purposes, suggest that the individual bring in all the medications they are currently taking. Pill counts, refill dates, and the individual’s knowledge may be assessed if this intervention is utilized.