Hypericum en el manejo de la depresión y ansiedad en el primer nivel de atención. Opinión de expertos

Abstract

Introduction. Depression and anxiety are the most frequent and disabling mental disorders worldwide. Primary care provides most of the attention to mental health, and the highest proportion of psychopharmaceuticals are prescribed there. It is necessary that personnel from primary care purposely ask the patients about their state of mind and that they also suitably manage depression. Primary healthcare providers must be trained to treat mild and moderate depression using psychopharmaceuticals, including phytopharmaceuticals such as Hypericum. Likewise, they should recognize severe depression and refer the patient to a specialist in due course. An interdisciplinary group of experts gathered to assess the use of Hypericum extract to manage depression and anxiety in primary care and make recommendations. To draw up the recommendations, the group not only turned to their clinical expertise but also searched for published evidence. Recommendations. Hypericum is recommended in patients with mild to moderate depression, with or without anxiety symptoms, and treated in primary care as a first therapeutic option. It is recommended that the cases with mild to moderate and severe depression, comorbidities with other psychiatric disorders, or difficulty to control be promptly refered to the psychiatrist. Likewise, it is recommended to purposely explore the presence of depression, use scales, and have an optimal physician-patient relationship. The recommendations about dosage and duration of treatment with Hypericum are also included because, at standardized extracts, Hypericum is an effective antidepressant recommended in several international guidelines. Conclusions. Timely detection of depression is crucial in primary care. The use of Hypericum as a first-line treatment has enough clinical support, and it is an optimal tool for primary care providers to manage depression with or without anxiety.