Treatment of Depression in Correctional Institutions
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1
University of Toronto, Forensic Psychiatry, Canada
Problems mental disorder in correctional institution’s is higher than that of the general population. It is estimated that 9–20 percent of inmates in these institutions have serious mental illness. The prevalence of major depressive disorder is estimated at 12% females and 10% for males; this is as high as 50% if we count those with significant depressive symptoms. The treatment of mental disorder and prisons is a constitutional right in the USA.
The first issue is screening admissions to correctional institutions in order to provide a timely access to mental health. This is not infrequently interrupted or delayed due to court appearances, lockdowns, and interruptions in programming due to various incidents. Many correctional institutions limit the use of controlled medications such as benzodiazepines and psychostimulants. It is not uncommon for patients to be transferred from one institution to another due to a number of reasons, and continuity of care may be difficult to achieve.
In addition to the above-noted problems administering the right treatment to the right patient is not without its obstacles in these settings. Abuse and diversion of medications is alarmingly common. Various techniques are used including, “cheeking”, “palming” in order to divert the medication to another inmate, sometimes because the patient is being bullied for the medication, or sometimes because he can trade medication for something of equivalent value. Other difficulties involved the timing of medication, such as nighttime medications being given at 1730 hours, frequency of institutional lockdowns, and restriction of medications due to cost.
Even though the patient is incarcerated it is incumbent upon the mental health worker to obtain informed consent for medications in the usual manner. For subthreshold depressive symptoms most guidelines recommend cognitive behavioral therapy or interpersonal therapy. We would recommend a first-line antidepressant such as an SSRI or SnRI for mild and moderate depression, as well as patient education. Comorbidity is frequent in this population. Substance use and withdrawals complicate a diagnosis and should be taken into consideration. Comorbidity such as ADHD symptoms are commonand the use of bupropion, venlafaxine, or duloxetine may be considered as they have helpful effects on both disorders. Concomitant insomnia is also common and therefore mirtazapine should be considered.
Second line treatment may include a switch to bupropion or venlafaxine, or augmentation strategies such as the use of lithium carbonate, additional mirtazapine, or the addition of a second-generation antipsychotic. Regular follow-up should be attempted, but may be difficult to achieve. Treatment guidelines suggest continuation of treatment for 2 years before tapering, with careful monitoring.
References
American Psychiatric Association (APA): Practice guideline for the treatment of patients with major depressive disorder, Third Edition. Available at: https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf. Accessed January 26, 2016
Bond DJ, Hadjipavlou G, Lam RW, et al: The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force recommendations for the management of patients with mood disorders and comorbid attention-deficit/hyperactivity disorder. Ann Clin Psychiatry 24(1):23-37, 2012
Cameron IM, Reid IC, MacGillivray SA: Efficacy and tolerability of antidepressants for sub-threshold depression and for mild major depressive disorder. J Affect Disord 166:48-58, 2014
Cassau JS, Goodwin DE: The phenomenology and course of depressive syndromes in pre-trial detention. Int J Law Psychiatry 35(3):231-5, 2012
Elger BS: Management of sleep complaints in correctional settings, in: Oxford Textbook of Correctional Psychiatry. Edited by Trestman RL, Appelbaum KL, Metzner JL. New York: Oxford University Press, 2015, pp. 85-9
Lam RW, Kennedy SH, Grigoriadis S, et al: Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. III. Pharmacotherapy. J Affect Disord 117 Suppl 1:S26-43, 2009
National Institute for Health and Care Excellence (NICE): Depression in adults: recognition and management. Available at: https://www.nice.org.uk/guidance/cg90/chapter/1-Guidance. Accessed July 14, 2016
Quaglio G, Schifano F, Lugoboni F: Venlafaxine dependence in a patient with a history of alcohol and amineptine misuse. Addiction 103(9):1572-4, 2008
Tamburello AC: Prescribed medication abuse: limitless creativity, in: Oxford Textbook of Correctional Psychiatry. Edited by Trestman RL, Appelbaum KL, Metzner JL. New York: Oxford University Press, 2015, pp. 165-9
Keywords:
Depression,
corrections,
Guidelines.,
Antidepressants,
Treatment
Conference:
ISAD LONDON 2017: Perspectives on Mood and Anxiety Disorders: Looking to the future, London, United Kingdom, 6 Jul - 7 Jul, 2017.
Presentation Type:
Poster
Topic:
Pharmacological / Somatic treatments
Citation:
Glancy
G
(2019). Treatment of Depression in Correctional Institutions.
Front. Psychiatry.
Conference Abstract:
ISAD LONDON 2017: Perspectives on Mood and Anxiety Disorders: Looking to the future.
doi: 10.3389/conf.fpsyt.2017.48.00025
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Received:
26 May 2017;
Published Online:
25 Jan 2019.
*
Correspondence:
Prof. Graham Glancy, University of Toronto, Forensic Psychiatry, Toronto, Ontario, M5S2T9, Canada, graham.glancy@utoronto.ca