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.