Iria Grande, psychiatrist in the hospital’s depressive and bipolar disorder ward; and Jose Martinez-Raga, head of the psychiatry department at Dr. Peset University Hospital.
the pandemic of Covid-19 put on the table the importance of mental health, while bringing with it an increase in depressive symptoms among the Spanish population. Although attempts have been made to provide mental health services with experience tools to improve the detection of pathologies such as depressionthe reality is that resources remain insufficient.
As Iria Grande recalls, “The average number of psychiatrists in Europe is 18 per 100,000 inhabitants, while in Spain we continue with one of the lowest levels, with a maximum of 11 psychiatrists per 100,000 inhabitants.. Only Poland and Bulgaria are behind us. ” The proportion of psychologists is also very low, 6 per 100,000 population compared to 38 for the European average, and nursing for mental health is almost a testament even today, so there is enough room for improvement in this regard, as psychiatrists Iria Grande and Martinez-Raga showed.
“The pandemic, on the other hand, served for raising public awareness of mental health issuesbut it also means that we are witnessing a greater demand for everyday problems that are not depression and in many cases are not adjustment problems, and this is the great challenge that primary care faces in these areas. moments. ” , confirmed Martinez-Raga.
This emotional discomfort, Grande explains, “This can have a big impact on everyday life and be a cause of mental illnessbut we must also keep in mind that adverse situations are a part of life and that some moments cause suffering. ”
Although mental health in general and depression in particular have become more visible since the pandemic, experts agree that we are still a long way from breaking down the major barriers that exist. As Martinez-Raga said, “there is still a lot of work to be done at the public level. We need to learn that the brain is another organ that is especially important, but another that is “inflamed”, in which chemical changes are produced that affect biology and genetics, as in any other pathology. The reference to the biopsychosocial model is lost a little where the biological part is particularly stigmatized and there is too much emphasis on the social part ”.
Mental health problems are the main reason for consultation in primary care -one in every five patients- and are relevant at the hospital level. “About 30% of emergency department visits are related to mental health. However, in the last two decades at the level of treatment there has been less revolutionary progress than in other specialties, and the administration needs to promote access to innovation by approving and funding new therapeutic opportunities to make them accessible to patients, ”defended the head of the psychiatry department at Dr. Peset University Hospital in Valencia.
In this sense, the degree of response from the first treatment with antidepressants is between 30-40%, therefore healthcare professionals must have all possible optionsto meet the needs of each patient, as each is different and has its own clinical characteristics and personal and social characteristics, they conclude.
Functional recovery, therapeutic goal in depression
The majority of patients with depression recover, however about 30% can see that the pathology is becoming chronic. In this sense, it is important to note that the concept of chronicity in mental illness is different from that used in internal medicine or primary care. “We are not talking about diabetes or hypertension, which in most cases are present all the time. In depression, the performance is often cyclical. “, explained Martinez-Raga. Thus, a depressive episode can reach complete remission, in most cases, however who has suffered it has a 50% risk of having a second episode, and when he has had two, the risk of a third increases to 70%, he said. Therefore, part of the therapeutic work is to help prevent and reduce the impact of these possible relapses.
Functional recovery is high, with the existing means: medical and psychosocial approaches. Grande also stressed the importance of a multidisciplinary team working with depressed patients, from psychiatrists to psychologists, through nurses and social workers and educators. He also wanted to highlight these last two profiles, given the role they play in the case of those who have lost functionality, from helping with bureaucratic procedures to looking for social devices so as not to lose this integration into society.
Martinez-Raga insists on the idea that functionality goes beyond clinical remission. The patient, in addition to being clinically well, should feel well. Other aspects come into play here, such as cognitive symptoms – difficulty concentrating, paying attention, remembering and planning – that take longer to subside.
“Functionality is what we all want, not to stop doing our daily activities, to have full social and labor integration ”concluded the psychiatrist from the Hospital Clinic.
Antidepressants, effective and safe
Just as in other diseases it is assumed that drugs are needed for as long as they are needed, in brain diseases this situation still does not happen as a result of stigma.
“Antidepressants work, according to a recent study conducted in 2018. Psychiatrists know that they are effective and safe,” That is why we prescribe them, but the stigma around them still remains and there is the paradox that they generate rejection among the population, something that does not happen with benzodiazepines, which create addiction and dependence. There is a lack of training in this regard, so that people lose their fear of antidepressant treatment, “Grande insisted.
In cases of depression that require antidepressant treatment, “what we are looking for is what we think can work best for each patient, based on scientific evidence. In case of vortioxetine -a drug of choice for Canadian guidelines for the treatment of cognitive symptoms of depression-its multimodal profile has access to different neurotransmission systems involved in different symptoms“Said Martinez-Raga.
Another important aspect that Grande emphasizes when choosing an antidepressant is its tolerance profile and the lower presence of adverse effects. In this sense, “Vortioxetine, in addition to antidepressant efficacy and improving cognitive symptoms, also has a lower rate of side effects, which helps with adherence.
Both specialists are for involving the patient in decision making. Without this, therapeutic failure is almost certain. They insist that it is necessary to help patients understand why medicines are needed and how they will help them.
Looking to the future, Grande strives to reach “Make the suit tailored to the patient, customize the treatment“The same idea that Martinez-Raga is talking about, “Precision psychiatry. “Genetics is beginning to penetrate when it comes to labeling treatments, this is the future and where there will be one of the great revolutions, I hope in the next decade,” he concluded.
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