Critical of the National Board of Health and Welfare

Rolf Holmqvist, professor of clinical psychology, is one of 17 researchers who are critical to guidelines for the treatment of depression and anxiety.

In an opinion piece in DN Debatt (14/1) 17 Nordic researchers in psychotherapy criticise the new national guidelines that the National Board of Health and Welfare has put forward for the care of those with depression or anxiety syndrome. The Swedish guidelines now differ significantly from those in neighbouring countries. The researchers, including Rolf Holmqvist, claim that the guidelines are based in certain cases on erroneous interpretations of current research.

Rolf HolmqvistIn what ways are the new guidelines unsatisfactory?
The main problem is that the new guidelines are based on a limited and biased interpretation of research in the field. It’s remarkable that all of the neighbouring countries have a view of the available research that differs from that now put forward in Sweden. Their recommendations are quite similar and far more open.

The guidelines from the National Board of Health and Welfare recommend solely biological treatments (antidepressive drugs and ECT) for the treatment of severe depression. The use of psychotherapy to treat these conditions is not described at all. This contrasts with the Danish guidelines, which recommend strongly that these patients be offered both psychotherapy and drug treatment.

Is it traditional for Swedish doctors to suggest only drug treatments?
No, not at all. A biased interpretation of the research results has led to rigid guidelines. Of course, it’s possible to say that a certain treatment has stronger support from research than other treatments, but the proposed guidelines are based in certain cases on clearly erroneous interpretations of the research. For example, the guidelines advise against treatment in cases where the research results are weak, even if the clinical evidence is strong. An example of this is family therapy for young people. It must be remembered that a psychiatric diagnosis cannot be compared to an evidence-based medical diagnosis. It is more a case of a collection of different symptoms. Some severely depressed patients will benefit greatly from counselling, while others will not. Each patient is unique, with unique needs. In addition, a patient’s preferences for type of treatment will play an important role in how successful it is.

In addition, the 17 researchers who have signed the opinion piece point to deficiencies in the research on which the recommendations for the treatment of anxiety syndrome, post-traumatic stress syndrome, social phobias and depression in young people are based. The researchers also criticise the National Board of Health and Welfare for a failure to discuss randomised studies of psychological treatments.

What should be done differently?
We want the guidelines to be reviewed and reformulated with the aid of researchers with a broader perspective in the field. The reformulation must take place with the aid of researchers who are familiar with modern psychotherapy research, and who preferably come from outside Sweden.

Text: Susanna Lönnqvist

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