Personalised approach lacking in debate about medications in psychiatry

Turbulence in the media around the use of medications in psychiatry.

On Saturday, December 17th an interview with Dick Bijl, physician and epidemiologist, entitled ‘Antidepressants useless and harmful’ appeared in Trouw. This to the Dutch translation of the recently published book by the Danish internist professor Gotzche ‘Deadly psychiatry and systematic denial’. In Medical Contact a written response was given by doctors and psychiatrists. They describe examples of people with severe depression who have benefited from the use of antidepressants.

medicatie

Earlier this year, a broadcast of Zembla was dedicated to the possible side effects of antidepressants, among other things the increasing risk of suicide among young people. A possibility of side effects with the use of antidepressants has been known for many years. Lareb reports on her website that aggression can be a side effect in modern antidepressants. Also, weight gain and heart arrhythmias are possible as a side effect. Moreover certain medications should not be used in combination with antidepressants.

In the Netherlands more than 1 million people use anti-depressants. 800,000 people each year suffer from depression. In US 1 out of 6 adult used anti-depressivum in 2013 of which 80 % used the medication for a longer period. In the Netherlands in recent years, the number of users increases by about 3% / year. This is a worrying development. The NHG depression which is currently being revised will pay more attention to “not start”, side effects and reducing.

Personalised medicine/Precision medicine

Through scientific research in recent years there is a growing understanding that everyone is unique and therefore sometimes can respond unexpectedly to a proposed drug or therapy. Each person has a unique history, genetic code, microbiome, and is living in a different social context that influences the diet and lifestyle. All these factors together influence the biochemical processes in our body (Clemente et al. Cell. 2012. The impact of the gut microbiota on human health; an integrative view). So a given dose of a drug can work very well for one person while barely or not working for another person or giving side effects. Randomized Controlled Clinical Trials, the scientific studies as the gold standard for testing the efficacy of new drugs to date might not present the best insights for every person.

Professor Nicholas J Schork published in Nature: Personalised Medicine: Time for one person trials a plea to enter Precision Medicine as a gold norm. The key to Precision Medicine is to scan in continuous interaction between patient and doctor what can be and is possible. A recovery is fragile and requires constant tuning between doctor and patient. Recovery is about the right intervention at the right time.. In these one person trials the patient’s and their environment’s involvement is many times larger. The doctor acts as coach. Together they decide what is the right intervention.

Although this seems more expensive initially, the greater effectiveness and often shorter time for recovery can save costs as presented by the Bernhoven hospital with their project less care can result in better care. The patient can take more responsibility in which subsequent relapse can be prevented.

Personalised integrative care alternative for anti-depressants

COBALA Good Care Feels Better was established to assist people from their unique background and personality to recovery from illness or prevent disease. We work with Personalised Integrative Care in which the premise is that we consider each person as unique. People not bearing anti-depressants, not using because they use other drugs that should not be used together or wanting to reduce/finish medication can contact COBALA.

The past year we have guided people with anxiety, insomnia and / or depression with this question, successfully to recovery. Sometimes medications were not necessary, could be reduced and sometimes better tolerated. We work with a multidisciplinary approach, individual coaching to increase the personal resilience with a focus on personalised nutrition and lifestyle.


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