Addressing poverty, conflict, and abuse have the potential to prevent and alleviate poor mental health, but such a broad stance fails to highlight effective treatments for depression and other common disabling mental disorders. In contrast, the Wellcome Trust is focusing on the active ingredients of interventions (ie, aspects that drive clinical effect, are conceptually well defined, and link to specific hypothesised mechanisms of action) to improve mental health.
Although the Wellcome Trust stance is oriented towards research, this model should be applied to clinical practice and policy to improve lives without delay.
Health and social care professionals, and those working in charities, should use depression-informed conversations with those who they suspect to have psychosocial difficulties.
Second, using ingredients known to be active against depression. This element begins with psychoeducation about symptoms and causes of depression and the vicious cycle of uncomfortable feelings, unhelpful thoughts, and unhelpful behaviours. Techniques derived from behavioural activation and problem-solving therapy are brief yet effective.,
A person experiencing depression should be encouraged to select and schedule meaningful activities that will probably give them pleasure or a sense of achievement, and to face fears to counter avoidance. Problem solving requires the person to narrate problems faced (which are often linked to social determinants of their depression), define a specific problem they wish to work on, weigh up the pros and cons of solutions they have generated themselves, and be invited back to discuss how they got on. These approaches should be underpinned by the common elements in social healing: empathy, consensus over treatment goals and how to achieve them, positive regard, expectations, and hope.
Self-care materials describing, for example, how to cope with stress and to be kinder to oneself, are available for free online (eg, eMHPrac, Good Thinking, and MoodGym websites). However, these require digital resources and are available in only a small number of languages.
It is important to ensure the person understands their condition and how treatment works, and to help them identify and reduce their barriers to adherence.
Those with severe symptom levels should have combination therapy from the outset.
It is ethical to give non-judgemental clear information about antidepressants, their benefits and harms, and how they might later be discontinued. However, in most government settings across the world, treatment components are split between clinicians working in different locations with diverse conceptual models about management. This fragmented system undermines communication and coordination of treatment.
We all need to be depression aware and to practise these techniques. Crucial to the scale-up will be understanding the barriers to and enablers of access. Historically opposing factions of psychological therapists and psychopharmacologists need to co-operate in training and supervising non-specialists, and issuing joint policy. Influencers who have experienced depression, like athletes and musicians, could help reduce stigma by being specific about their type of mental health problem. Greater demand for, and better access to, selfcare and delivery of the best combination of treatments in primary care will give people with depression the best chance of getting well quickly, allowing them to take part in the post-pandemic recovery.
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Article Info
Publication History
Published: December 08, 2021
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Crown Copyright © 2021 Published by Elsevier Ltd. All rights reserved.
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https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00436-3/fulltext
