Why anxiety disorders?
Anxiety disorders are the most common mental disorders in the general population. According to recent published estimates, about 1 in 3 people suffer from an anxiety disorder, which corresponds to more than 20 million people in Italy. And although the presence of an anxiety disorder is often underestimated as a "minor" disorder, studies indicate that it is the highest cause of disability in industrialized countries.
The real reason why anxiety disorders are so important has to do with the great suffering they cause. This suffering is particularly intense precisely because they affect people who are otherwise completely normal and aware and therefore feel the limitations and discomfort associated with the disorder very keenly
Anxiety disorders touch the core of one of the fundamental rights of every human being. The right to freedom. The freedom to move and be autonomous, the freedom to choose where to go, the freedom to meet other people, the freedom to seize the opportunities that life offers, the freedom to take risks and, finally, the freedom to decide and fight for one's own happiness.
What about the treatment of anxiety and panic disorders in Italy?
Although there are clear international guidelines that define "evidence-based" treatments, i.e. treatments that have been shown to be effective in controlled clinical trials, all too often in clinical practice drugs or combinations of drugs are used that have no real effectiveness, as well as psychotherapies for which there is insufficient scientific evidence to really treat anxiety disorders effectively. To date, so-called serotonin reuptake inhibitors and serotonin and noradrenaline reuptake inhibitors, as well as other drugs that act on other transmitters, have generally been favored for the treatment of anxiety disorders. One of the categories of medications that are all too often used inappropriately in the treatment of anxiety and panic disorders are the atypical and typical antipsychotics, which in the vast majority of cases are ineffective and have significant side effects. In addition, the use of mood stabilizers must also be carefully examined, as they are often prescribed without a valid clinical reason. With regard to psychotherapy, it is good to clarify that in the treatment of anxiety and panic disorders, the only psychotherapy that has been shown to be clearly effective is "classical" cognitive behavioral psychotherapy.
Finally, all too often, even when the right medication is chosen, the dosage is inadequate and so is the duration of therapy, or inadequate dosages are maintained over long periods of time. It is important to point out that the dosage of drug therapy must be gradually increased until the disappearance of the core symptoms of the anxiety disorders being treated is achieved. If no clear positive results are seen within 3 months of reaching the full dosage, a change of therapy should be considered. Similarly, it is not enough to be treated by a psychotherapist with the label "cognitive-behavioral", but he or she must also apply the scientifically validated protocols that find the main components in behavioral exposure and "homework".
Why is the treatment of anxiety disorders with proven drug therapies and psychotherapies no longer sufficient?
Apply the treatments that science has shown to be more effective than at least placebo, i.e. try to apply "evidence-based" therapy, which, in short, is not only based on a suggestive psychological effect, it is an essential first step in overcoming an anxiety disorder.
Treatment with "evidence-based" interventions guarantees improvement in most patients, but very often it alone does not allow a return to 100% well-being and, moreover, a significant percentage of people do not respond to "evidence-based" treatment". Almost all randomized and non-clinical trials of both pharmacological and psychotherapeutic therapies do not use a full return to well-being as a measure of successful treatment, but only a partial improvement. The aim of these studies is clinical improvement (better or less bad...) and not a 100% return to normality (feeling good!).
The use of proven "standard" therapies cannot guarantee a return to a state of complete well-being for every patient.
What could be the next step in the treatment of anxiety disorders?
If we are talking about "Back to the Future", to pick up the title of a famous movie from the eighties, then this might be the best way to increase the possibility of guaranteeing a return to a state of complete well-being for most patients while minimizing the side effects of drug and non-drug therapies.
With increasing experience, each doctor uses less and less manuals and more and more his personal clinical experience, which allows him to assess the patient based on the models he has refined over the years and to choose the most appropriate therapy for the patient beyond the guidelines. This approach guarantees quick decisions and the use of clinical wisdom developed over time, but it poses one of the greatest dangers to the health of every patient: the so-called "confirmation bias", i.e. the tendency of each of us to see what confirms our beliefs and not to see what contradicts them. In short, we are blind to the evidence that contradicts our beliefs and we become self-referential, especially if we are experts.
The antidote to this danger is to develop a personalized, tailored approach that draws inspiration from clinical experience but finds in science an impartial guarantor capable of preventing personal opinion and the tendency to see only what makes us feel expert, which can lead us down wrong diagnostic and therapeutic paths that patients will ultimately pay for.
Personalized medicine is the new approach that integrates and surpasses evidence-based medicine to consider each individual as a complex entity that cannot be reduced to a simple diagnosis, but starts from all the individual information (genetics, psychophysiology, neuropsychology, hematochemistry, traumatic experiences, but also spiritual aspects) that make it possible to create a tailor-made profile of the pathological condition that has affected "that" person. This allows a personalized choice of treatment that can integrate pharmacological, psychotherapeutic and other therapeutic interventions into the lifestyle in order to maximize the success of the therapy and minimize side effects and associated risks.
The therapy is therefore no longer a standard dress to which the patient must adapt, but a sartorially defined dress that adapts to the individual characteristics of each patient.
What does it mean to treat people suffering from an anxiety disorder with personalized medicine?
First of all, it means remembering that only the patient has experience of what they are experiencing. So you have to start from listening and, once a diagnostic hypothesis has been made, discuss with the patient whether this hypothesis is valid or not. If the patient does not fully agree with our feedback, we should still listen to them until there is complete agreement between the diagnostic hypothesis we have proposed and the patient's perception of having been fully understood. Once a diagnosis has been made, it is important to gather the information that will allow us to understand "that" patient and build their personal profile, starting from the diagnostic hypothesis to a series of individual aspects and personal experiences that are crucial for tailoring the most appropriate treatment for that person in order to maximize their well-being and minimize side effects.
For example, in the specific case of anxiety disorders, it is important to assess the symptom profile (e.g., respiratory, cardiovascular, balance, depersonalization), psychophysiological profile (e.g., cardiac variability, postural function, respiratory patterns), and blood chemistry testing profile (e.g., inflammatory indices, lipid indices, hyperventilation indices). In addition, brain imaging assessments and neuropsychological and personal attitude may also be useful. It is true that the soundness and reliability of a science of personalization of treatments in patients with anxiety disorders still has a long way to go before reaching clinical practice, but the elements that scientific research suggests allow us to start down this path now. Even 5% more clinical improvement and 5% fewer side effects can impact quality of life and make the difference between being chronically less bad, but still conditioned by an anxiety disorder, and feeling good when the conditioning that anxiety disorders impose is removed.
Why choose the Humanitas team expert in anxiety and panic disorders?
The team is led by Prof. Giampaolo Perna, one of the leading international experts in anxiety disorders, who has been dealing with anxiety disorders for over 30 years as a clinician, researcher and lecturer, as evidenced by his professional career:
1. In over 30 years of clinical experience in the diagnosis and treatment of anxiety disorders, he has never stopped seeing at least 30-40 patients a week in person and has directed anxiety disorder centers in prestigious institutions such as the San Raffaele Hospital in Milan and the Sisters Hospitaller in Milan and Como.
2. For several years, Giampaolo Perna has been ranked by the American rating agency Expertscape, which evaluates scientific research over the last 10 years, as the leading Italian and European scientific expert in panic disorders and one of the top three experts worldwide, as well as one of the top three Italian experts in anxiety disorders. In more than 30 years of scientific activity, he has published over 200 scientific articles and given more than 90 presentations at national and international conferences, mainly on anxiety disorders.
3. Giampaolo Perna is one of the worldwide references for personalized medicine. He has chaired the Personalized Psychiatry Section of the World Psychiatric Association (WPA) from 2015 and is co-editor of the international journal "Personalized Medicine in Psychiatry", published by Elsevier, the world's leading scientific publisher.
4. At the academic level, Giampaolo Perna has taught at 7 different national and international universities and is currently a professor at Humanitas University (Milan), University of Miami (USA) and Maatricht University (Netherlands).
Giampaolo Perna’s team includes psychiatrists and psychotherapists who use scientifically validated methods in the treatment of anxiety disorders and have been working with him for over a decade, developing a vast clinical and scientific experience.
What message of hope can we send to the millions of Italians who are still prisoners of anxiety?
Dear person suffering from an anxiety disorder, do not settle for feeling better, pretend to feel good. Science today has the tools to help you find the freedom that anxiety disorders have taken away from you. Trust science and those who offer scientifically proven therapies. You are not alone when you see the army of researchers dedicated to researching these disorders every day, publishing 20 new scientific studies every day.
