Psychotherapy first of all, then drugs if necessary, but also Mindfulness and physical activity. These are the tools to combat depression included in the new guidelines of NICE, the English body that evaluates the appropriateness of therapy. Therapies to be chosen by talking to the doctor, reserving drugs for cases where they are really needed, and carefully monitoring their suspension to avoid side effects. “For now it is a proposal on which for a few weeks a consultation with associations of doctors and patients or even individual citizens will be open, even if it is not a particularly controversial text”, he explains Carmine Pariante, psychiatrist and lecturer at Kings College London.
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After ratification, the new guidelines, proposed 12 years after the previous version, will serve to guide not only specialists but above all general practitioners: “Compared to before, the spectrum of psychological or psychosocial therapies is broadening: in addition to cognitive therapy behavioral, the effectiveness of which has been confirmed for years, there are psychodynamic psychotherapy and above all mindfulness meditation, which can also be a valid aid for ‘stress management’, explains Pariante.
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Note the recognition of physical activity as a valid intervention for cases of mild and moderate depression: “We have solid confirmation on the biological benefits of running, gym and other forms of physical activity”, Pariante underlines. “We think of the anti-inflammatory effect and the increase in brain plasticity, but also the production of endocannabinoids that positively influence mood”. Without forgetting that many physical activities offer the possibility of socializing or spending time in the midst of nature, “adding further psychological benefits”.
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In any case, the NICE experts underline, the choice of therapy must arise from a decision shared by doctor and patient. “We must realize that the treatment with which to deal with depression must be chosen on the basis of the patient: there is a range of therapies with proven efficacy”, explains the president of the NICE committee. Nav Kapur of the University of Manchester.
“The indication for doctors is to talk to their patients, explaining that there are different therapeutic options, to be used also in combination”, continues Pariante. The new version of the guidelines also confirms the tendency to avoid the use of drugs in the less severe or sub-threshold forms, “that is, in those in which only two or three of the symptoms that characterize depression occur”, explains Pariante.
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In addition to mood disorders, depression can cause sleep disturbances, loss of hope for the future, difficulty concentrating and paying attention, excessive guilt and low self-esteem, fatigue, loss of sexual desire and more. “The most serious cases”, emphasizes the psychiatrist, “are those in which the symptoms are more numerous and above all they heavily interfere in working life or in relationships”. And when the choice falls on the drug, which must be taken for several months even after the depression has improved, NICE warns not to abruptly stop the therapies. “The suspension must be gradual over the course of a few weeks, slowing the speed if the symptoms become problematic,” Pariante recalls. An indication that applies to all types of antidepressant drugs, and which should serve to combat the unfortunately widespread practice of abruptly suspending therapies.
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“The main message of the new guidelines is to understand the importance of psychotherapy, alone or in combination with drugs, to fight depression” concludes Pariante. “Taking into account that in Great Britain, unlike what happens in Italy, these therapies are relatively accessible through the national health service”.
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