Important topics of the standard of care
There are several topics in the standard of care that are considered as
important elements of good clinical care for patients with depression
and were not (or differently) addressed in the multidisciplinary
guideline depression. These topics are a combination of scientific
evidence, practice based knowledge and patients preferences.
Recovery, participation and re-integration should be addressed
from the start of treatment. Personal well-being, coping with depression
and quality of life are essential elements for patients. Empowerment,
self-management skills and self-direction are steps that help to
overcome depression. To reach personal recovery, re-integration in
(volunteer) work and/or social activities is crucial. Some limitations
in functioning may persist after treatment of depression and finding the
balance between capacity and stress is an important challenge. Support
in daily and weekly structuring might be necessary and methods from
rehabilitation practices can be helpful for this purpose. Peer support
can be helpful to reach recovery and options to contact experiential
experts should be promoted. Mental health professionals and experiential
experts should work together to promote peer support facilities in each
region.
Support for the social network. Supporting family and relatives
of patient can enhance and consolidate the effects of treatment.
Psycho-education, emotional support, teaching coping styles and
practical tips are elements of support for the network.
Matched care is the preferred option to organize treatment for
depression. Treatment options for depression are numerous and matching
treatment to patients preferences and characteristics is crucial for
treatment success. Matched care means generalist and accessible care if
possible and specialized and intensive care if needed. Matching to
specific interventions or a specific professional is preferred, taking
nature, severity and course of depression into account.
Restricted use of antidepressants is warranted. There is a
growing awareness of the high usage of antidepressants in the
population. Professionals and patients recognize the importance to
reduce the prescribing of antidepressants. Before antidepressants are
prescribed professional and client should consider non-pharmaceutical
options with strict agreements on monitoring and evaluation of the
treatment plan. It is important to take note that the efficacy of
antidepressants is limited compared to placebo in non-severe depression
and effects of antidepressants do not endure after cessation of the
treatment. Side effects of antidepressants are problematic and
discontinuation of treatment can result in withdrawal symptoms.
Treatment for persistent depression . Preferred treatment for
persistent depression is a combination of biological treatment and
evidence based psychotherapy. Knowledge from practice and patients
preferences indicate that more sessions of psychotherapy might be needed
than is stipulated in the protocols and also that psycho-analytic
psychotherapy is an optional intervention, even though the scientific
evidence is weak.
Relapse prevention . Patients with depression express an urgent
need to address relapse prevention. Important themes for patients are
the accessibility of care in case of an emergent relapse and the option
to contact a professional even when treatment has ended. A relapse
prevention plan is mandatory for every patient who terminates treatment.
Food and nutritional supplements. Especially patients
representatives supported the update of the evidence on the effects of
food and nutritional supplements in the treatment of depression. The
evidence for vitamin supplements, zinc-supplements, medicinal herbs
(excluding St Johns worth), reed ginseng and tryptophan is weak and/or
contradictory. Only omega-3 polyunsurated fatty acids are found to be
effective in the treatment of depression in adults.
Arts therapies Professionals and patients representatives highly
appreciate arts therapy (music therapy, creative therapy, dance therapy
etc) for depression. Therefore it is stated that arts therapy can be
part of every treatment plan as an adjunct to the evidence based
treatment interventions. The indication for these interventions is the
result of a shared decision making process.