The Ministry of Health has updated the standard for depression treatment: therapy will become year-round.

      The Ministry of Health of Russia has published a draft of the updated standard for medical care for adults with recurrent depressive disorder. The document will replace the 2022 order and will for the first time cover not only diagnosis and treatment during the acute period but also outpatient monitoring throughout all 365 days — three mandatory psychiatrist visits in addition to 13 follow-up appointments, reports the newspaper "Kommersant."

      The new standard has been developed in accordance with the clinical recommendations of the Russian Society of Psychiatrists, updated in 2024. A key change is the expansion of therapeutic coverage. Previously, psychotherapy sessions under compulsory medical insurance could be accessed by only 25% of patients, but now they will become mandatory for everyone. The number of reimbursed sessions will increase from 10 to 14. Additionally, the list of non-drug methods for complex cases has been expanded to include plasmapheresis, laser therapy, and biofeedback training.

      The medication strategy has also been revised: outdated antipsychotics have been excluded, while the frequency of prescribing modern antipsychotics has increased — aripiprazole nearly tripled, quetiapine doubled. The standard also includes laboratory safety monitoring of treatment directly during therapy.

      The chief freelance psychiatrist of the Ministry of Health, Svetlana Shport, explained to the publication that the approach has been revised in light of modern scientific trends, with a shift in focus from drug therapy to psychotherapeutic interventions.

      However, practicing doctors evaluate the initiative with caution. Associate Professor of Psychiatry at RUDN University Roman Suleymanov described the new provisions as a "methodologically impeccable biopsychosocial approach," but warned that the theory risks colliding with reality in regional psychoneurological dispensaries. According to him, the positions of medical psychologists and psychotherapists there have been vacant for years, and one district psychiatrist is forced to work across several areas. Three mandatory visits to the doctor per year, in the expert's opinion, will ultimately paralyze queues in provincial dispensaries.

      Particular concern is raised about the technological and financial aspects. Laser therapy, plasmapheresis, and biofeedback training are at the level of large metropolitan institutions, while most district hospitals can only dream of such equipment. At the same time, the cost of modern drugs included in the standard is significantly higher than that of classical ones: while a package of amitriptyline costs about 200 rubles, modern vortioxetine costs almost 4,000.

      Psychiatrist Suleymanov points out a systemic problem: by raising rates for psychiatry, compulsory medical insurance funds are forced to either cut spending on cardiology and oncology or deliberately underfund the new standards. In his opinion, the developers of the progressive document did not take into account the budget deficits of the regions, resulting in chief doctors and practicing psychiatrists risking becoming hostages of the situation.