Q: What are the most significant challenges facing clinicians today when treating mood disorders?

A: The high degree of treatment resistance. Despite prescribing an antidepressant, most patients have an incomplete response to therapy. Depression is a heterogeneous disease and it is frivolous to think that one agent with one mode of action can manage this heterogeneous disease. I often combine treatments to help achieve response.

Q: How would you define remission?

Wellness is not just the absence of symptoms.

A: Absence of symptoms, a sense of well-being and an ability to function. Wellness is not just the absence of symptoms.

Q: What type of tools do you use regularly in your daily practice?

A: I use the standard DSM IV and DSM 5.0 when diagnosing patients with unipolar disease and in our waiting room we ask patients to complete the validated 16-item QIDS self-rating score at every visit. It takes just 5 minutes for the patient to complete and the items are rated 1-4. This means at a consultation I can jump to the items where the patient has scored 4s and 3s and concentrate on looking to address those aspects of disease.

Q: What’s your opinion on combining psychiatric and psychotherapeautic approaches to care?

A: It is fine to combine these approaches but the reality is that at my hospital, to get a patient even into group psychotherapy involves a 2-3 month waiting list and it can take 9-12 months for a patient to start individual psychotherapy.

The costs of such sessions in the private sector in Canada is around $160-220 per hour and patients often need between 4-6 sessions. So getting access to psychotherapy is the issue.

Also, if the patient is severely ill, staying on a psychotherapy programme can be very challenging. I’m not against psychotherapy, but I do appreciate that there is often a significant response to drug therapy.