Abstract
Management of multi-drug Resistance Tuberculosis (MDR-TB) therapy (a prolonged therapy, i.e. for 18-24 months) is complicated owing to treatment interruption. This study aimed to describe the incidence and prevalence of depression among individuals receiving MDR-TB therapy, and to detail the management approach by assessing effect of pharmacist directed education on therapy adherence and to identify pharmaceutical issues of MDR-TB patients. A randomized controlled trial was carried out at Nishter Hospital, Multan, Pakistan during the year 2014. About 70 MDR-TB patients (n = 35 in supported group and n = 35 in non-supported group) randomly participated in current observational controlled intervention trial. Patients in non-supported group received routine medical out-door patient department (OPD) check up and patients of supported group, in addition to standard medical check-up, also received socio-economic help and educational intervention from pharmacist to increase treatment adherence by managing depression. Depression scores were rated on Beck depression inventory (BDI) scale. Patients having scores of 0-9 were labeled as normal, 10-18 for mild depression, 19-29 for moderate depression, and 30-63 for severe depression. Statistically significant difference was observed in scores of depression among patients of supported and non-supported group after ten months study. The prevalence of baseline depression in supported group patients was 8.57% mild depression, 54.29% moderate depression and 37.14% severe depression. Moderate to severe depression was observed more in elderly patients, uneducated patients and in those with low socio-economic status, in patients with previous category 11 TB, in those patients having high dose of cycloserine. Most individuals in supported group experienced improvement of depression symptoms during the course of MDR-TB therapy. After ten months, 11.43% patients had moderate depression, 45.71% patients having mild depression, and 42.86% patients having no depression symptoms. Moreover in non-supported group depression persisted at moderate to severe level. Management of depressive complications is possible without compromising MDR-TB treatment. The adherence to treatment may be improved when a pharmacist provides patient education on medication use and provide support on patient's pharmaceutical issues along with socio-economic help to maintain patient's quality of life level.