The 2020 mood disorders clinical practice guidelines: Translating evidence into practice with both style and substance

The editorial by Marx et al. (2021) echoes the recommendations by the mood disorders clinical practice guidelines (CPGs) concerning lifestyle interventions (Malhi et al., 2021). The CPGs place lifestyle changes firmly as the cornerstone of management and as the foundation of the Actions that must be considered at the outset of treatment (Malhi et al., 2020a, 2020b). These, along with psychological interventions, provide the base upon which a framework for pharmacotherapy and Alternatives can be constructed. The editorial highlights the gap between evidence and clinical practice and notes the difficulties in translation.

Following presentations of the guidelines by the CPG mood disorders committee in the form of webinars and podcasts, clinicians have highlighted the difficulties of engaging patients in lifestyle change. Many have commented that diet and regular exercise pose challenges for everyone, including themselves, let alone individuals who may be suffering from lack of motivation and drive because of mental illness. Furthermore, because of illness, and sometimes the effects of medication, instituting sleep hygiene and avoiding weight gain can be particularly problematic. We agree. And we fully accept that these are extremely difficult changes to implement and that they are indeed ambitious goals – for all of us. At the same time, it is important to recognise that these are essential remedies and that they are fundamental to achieving the restoration of health and as such cannot be ignored.

It is important to note that one of the principal aims of the guidelines is to put these considerations front and centre, in any conversation that takes place with patients with mood disorders, and to ensure that whenever planning management, clinicians are reminded to give due consideration to lifestyle changes.

Of course, like many other aspects of management, there is no guarantee that a satisfactory outcome can be achieved with respect to instituting lifestyle change, but this does not mean that this should not be an integral part of the advice that we offer. Surely, as clinicians, it is our duty to present the best available information and to provide guidance that is ultimately in the best interest of our patients.

Drawing on parallels in psychological treatment to enact behavioural change requires an active, engaged patient, a robust and collaborative client–therapist relationship, and sensitivity to the broader social and economic context in which treatment is offered. Thus, change rests on assumptions, models and strategies that are not only transdiagnostic, but (usefully, we believe) highlight what is shared between people with and without diagnosable mood disorders. The key message is that, although difficult – change is possible.

Hence, we strongly endorse the recommendations and suggestions made by Marx and colleagues as to how to address the ‘evidence-translation gap’, and in particular, the need to enhance clinician training in lifestyle-based mental health care. We therefore appreciate the points made in the editorial, and in particular the comments of the authors in which they describe the ‘recent 2020 Royal Australian and New Zealand College of Psychiatrists (RANZCP) clinical practice guidelines for mood disorders …’ as ‘a significant milestone’ and ‘a key step in translating the evidence into clinical practice’. It would seem that our recommendations have the necessary substance – all we now need is for you to implement them using your style.