Science & Research

Improving care

Winnipeg researchers hope to better identify and treat chronic disease patients who also suffer from depression and anxiety

Improving care
Drs. Ruth Ann Marrie and Charles Bernstein are seeking participants for their study.
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Winnipeg Health Region
Wave, September / October 2015

When Barbara Toews was 55 years old, she suddenly lost the vision in her left eye. Then her entire left side began to go numb.

Toews, now 68, remembers that time as being one of the most frightening of her life.

"I had no idea what was wrong. That period in time was very scary," she says. "The uncertainty and fear of the unknown really affected my mental state."

She was soon diagnosed with multiple sclerosis (MS), a chronic immune-mediated inflammatory disease where the insulation lining nerve fibres (myelin) in the brain and spinal cord are damaged.

The diagnosis, along with the death of her brother, plunged her into a depression.

"MS is a weird disease. You don't know what's going on and what's going to happen. You don't know how it's going to affect your life, which is really hard to deal with mentally," says Toews.

Depression and anxiety are more common in people with chronic illnesses than they are in the general population. In Toews's case, she knew to seek help for her depression, but many with chronic illnesses do not.

Since depression and anxiety can worsen the outcomes and symptoms of immune-mediated inflammatory diseases, it's important that patients who have these conditions and are struggling with mental health issues are identified and treated quickly.

As a result, Toews has volunteered to be part of a study underway at Health Sciences Centre Winnipeg that is designed to help do just that.

Led by Dr. Ruth Ann Marrie, Director of the Multiple Sclerosis Clinic at Health Sciences Centre Winnipeg, the study is looking at the effects of depression and anxiety on those with MS and other immune-mediated inflammatory diseases.

The ultimate goal of the study is to develop tools that primary-care providers  and specialists can use to identify chronic disease patients who are also suffering from depression and anxiety, and to assist them in managing the depression and anxiety. By doing so, it is hoped health-care providers can be in a better position to treat the patient for all the health issues they are facing - not just the chronic disease in question. 

"The hope is that we'll be able to manage the care of these patients properly from the beginning, instead of trying different things and seeing what works," says Marrie, who is the principal researcher on the project, entitled Defining the Burden and Managing the Effects of Psychiatric Comorbidity in Chronic Immune-inflammatory Disease.

Currently, her research team, which includes 17 investigators, has enlisted 375 participants in the study, which will continue for another four years. But the study needs more participants. Eventually, the team hopes to have 1,050 people enrolled in the study, which means they are currently looking for more people to participate in the project.

Specifically, she hopes the project can enlist 250 participants with inflammatory bowel disease (IBD), 250 with rheumatoid arthritis (RA), 250 with MS, 150 with depression but no chronic inflammatory illness, and 150 with anxiety but no chronic inflammatory illness. Each participant will be monitored for three years, and is required to undergo an interview, cognitive tests, have blood drawn, and fill out a series of questionnaires.

"It adds up to a substantial commitment of time and involves sharing sensitive information with us, but this study will assess the impact of depression and anxiety on important issues such as pain, fatigue and quality of life, whether you have a chronic inflammatory illness or not," Marrie says, underscoring the importance of the work.

Among other things, Marrie and her team want to find out how often depression and anxiety occur in Manitoba, the impact on the health-care system, what can be done about it, and how to better identify people who are struggling with these conditions.

"Hopefully we enroll enough people that we can dig in and find some of these answers," she says. "We need to get at the big picture, and look at all aspects of a person."

People who participate in drug studies for mental illness are usually required to be in good physical condition, which has left a lot of questions concerning the effect of mental health issues on those with chronic diseases unanswered.

"Our understanding of depression is limited," says Dr. Alex Singer, a co-investigator in the study and a family physician. "Most of the research has been done on people who don't have a lot of other things going on. We lack understanding of complex patients." 

One of the challenges of treating patients with chronic illnesses for depression and anxiety is that any new medication may interfere with their current treatment, or affect the way they respond.

"I've had these questions in the real world with my patients, and there's not a great amount of literature or resources I can turn to," Singer says. "As a family doctor, I hope the final outcome of this project will be some salient resources and tools."

Dr. Charles Bernstein, co-principal investigator and Director of the IBD Clinical and Research Centre, says health-care providers often shy away from topics like mental well-being when seeing patients with chronic diseases.

"Most specialists shy away from asking about mental health because of the challenges of dealing with the answers, but they're critical. It's as important to look at their depression as it is to look at their (disease)," he says.

"Depression and anxiety really have an impact on how well people do with their medications and how these diseases unfold. These conditions can trigger the inflammation of your disease."

The Canadian Institute of Health Research is funding the study. Crohn's and Colitis Canada and the University of Manitoba provided matching grants.

While the funding period will end in 2019, Bernstein hopes several different research questions will come from the study, which will allow the team to apply for additional grants.

"We really need more access to clinical health psychologists. There's a dearth of practitioners to treat all the people who need it," he says. "One of our main goals is to give primary-care providers the tools to feel more confident when treating people with these conditions."

As for Toews, she visited her family physician, who prescribed a low-dose anti-depressant and a sleeping pill. As soon as the treatment took effect, Toews noticed a significant difference in her health and well-being.

"The change was pretty clear," she says. "My energy level and mood improved. I was more interested in being social and felt better about myself."

Holli Moncrieff is a Winnipeg writer.

Wave: March / April 2015

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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