“It’s not just about mood” Depression can consist of 227 different combinations of symptoms
Ron Campbell smiles a lot more than he used to. Although the retired RCMP officer from Edmonton still has some down days, many more of them are good, which wasn’t always the case. Not long ago when he woke up in the morning, he’d feel that there was nothing to look forward to.
For part of his career, Campbell worked as a hostage negotiator and a homicide investigator. He raced into crisis after crisis and witnessed many horrific scenes over the years. But it was the shooting death of a friend and colleague that proved to be a tipping point, triggering feelings of despair, guilt and thoughts of suicide. After nearly taking his own life, Campbell reached out for help.
“I’ve been in some crazy situations, but I’ve never been so scared as the time I walked into the psychologist’s office,” Campbell recalls. “It was the most difficult step I’ve ever made in my life.”
Doctors first diagnosed the retired officer with post-traumatic stress disorder (PTSD). A few years later, he was also found to have a major depressive disorder. Fortunately, Campbell had access to the RCMP’s employee health benefits plan, which paid for counselling and offered access to a range of treatments, including the latest innovative medicines.
Recent data shows that one in five Canadians will experience a mental health problem. Depression is the most common mental disorder and, according to the World Health Organization, is the leading cause of workplace disability. It’s a complex condition that affects people in different ways.
“Ten different people can walk into my office and have very different expressions of depression,” says Dr. Patrick Smith, CEO of the Canadian Mental Health Association. He says most older medications focus on mood because that’s how depression was first understood, but we now know that there are 227 combinations of symptoms. “It’s not just about mood,” Dr. Smith says. “Depression can affect many things, including sleep and appetite.” Newer medications focus on other symptoms along with mood and can come with fewer side effects.
Dr. Smith is currently working to raise awareness about what he sees as a dramatic inequity for Canadians living with depression. Patients with private health coverage have access to a wide range of prescription medicines, including the latest innovative therapies, but those who don’t have coverage through their employers or who can’t afford private drug coverage have far fewer options. Public drug programs, Dr. Smith points out, won’t reimburse patients for a long list of depression medications that have been deemed safe and effective for use.
“When it comes to depression specifically, there is a huge gap in the types of medications you have access to, whether you have [private employer] coverage or not,” he says. “I think most Canadians don’t understand that. People who are unemployed or already marginalized have the added challenge of not having access to the full range of medications that may be effective for them.”
Growing up in Ottawa, Brianne Moore experienced high levels of anxiety as a young girl and felt overwhelmed by feelings of sadness. As her condition worsened she became increasingly withdrawn. Moore engaged in self-harm in her early teens and tried to take her own life several times. Her erratic behaviour caused tensions in the family, and she spent time living in a youth shelter.
A diagnosis by doctors at the Royal Ottawa Mental Health Centre helped turn her life around. Moore learned she was living with borderline personality disorder, persistent depressive disorder, an eating disorder and generalized anxiety. She was prescribed medication to stabilize her symptoms, along with counselling. While she had more tools to manage her mental health, it wasn’t easy. At one point, when she was 17, Moore had to pay for her prescription medication out-of-pocket, making her an example of the 1.8% of Canadians who have no drug coverage or the 10% who don’t know they have coverage, according to a recent Conference Board of Canada analysis.
“There was a period when I was living on my own and paying for my own medication,” Moore says. “I would think, ‘Am I going to pay for my medications or am I going to pay to get myself dinner? What does my bank account look like?’”
While she now has drug coverage through Ontario’s extended drug benefit plan, Moore continues to empathize with Canadians who are falling through the drug coverage cracks. Indeed, according to various surveys, mental health medications are among the top medications that patients do not adhere to generally, for any reason, so cost barriers due to lack of or inadequate drug coverage would only exacerbate this.
Moore is fortunate that her particular depression medication is covered by her provincial drug plan. However, there continues to be patients that respond best to certain types of depression medications that aren’t covered by public drug plans. According to IQVIA claims data, in 2016 there were 55% more anti-depressants and mood stabilizer drugs (DINs) reimbursed in private plans in Ontario compared to public plans.
She says she’d like to see all Canadians who live with mental health disorders have the same access to medications, and the same opportunities to get better.
Similarly, thanks to his ability to access both therapy and innovative treatments for his PTSD and depression, Campbell says he finally feels happier and more in control. “For some of us, therapy isn’t enough,” he says. “It doesn’t fix the neurochemistry in our brains. The right medications can do that for us.” Doctors needed to tweak his medications several times to find the combination that worked best for him, and he is grateful. “I am absolutely convinced that without counselling and medication, I wouldn’t be here.”