Prof. Dr. Victor Amorim Rodrigues, a psychiatrist, psychotherapist, and clinical director of The Clinic of Change, was interviewed by Jornal Médico. The conversation covered the current state of mental health in Portugal, the growing role of neuromodulation and ketamine-assisted psychotherapy in the treatment of treatment-resistant depression, and the potential of precision medicine in personalized therapy.
Portugal's Diagnosis
The starting point is the national reality. Amorim Rodrigues notes that about 8% of the Portuguese population exhibits symptoms of depression, that Portugal ranks above the European average in the prevalence of mental disorders, and that the use of antidepressants has grown significantly over the past decade. He acknowledges that mental health has gained visibility and that there is now greater awareness and less stigma—but he warns that this progress has not always been accompanied by a diversification of therapeutic approaches, especially for patients with more complex or treatment-resistant forms of the illness.
TMS and ketamine-assisted psychotherapy: expanding the therapeutic arsenal
According to the clinical director of The Clinic of Change, Transcranial Magnetic Stimulation (TMS) and ketamine-assisted psychotherapy do not replace conventional treatments—they complement them. TMS acts directly on the neural circuits involved in mood regulation without resorting to systemic therapy, offering a favorable tolerability profile and avoiding the adverse effects often associated with antidepressants, such as weight gain or sexual dysfunction. The treatment is performed on an outpatient basis, without anesthesia, and patients can immediately resume their normal activities.
As for ketamine-assisted psychotherapy, Amorim Rodrigues is clear about what distinguishes it from purely pharmacological approaches: “Pharmacological intervention does not, in and of itself, constitute treatment. The clinical benefit results from the integration of the substance’s administration, psychotherapeutic preparation, monitoring during the session, and the follow-up work conducted afterward.”At The Clinic of Change, an observational study involving 98 patients enrolled in this program recorded average reductions of nine points on the PHQ-9 scale for depressive symptoms, eight points on the GAD-7 for anxiety, and eight points on the WSAS, which assesses functional impairment.
When should you consider these alternatives?
When asked about the right time to transition to these approaches, Amorim Rodrigues rejects the idea that they should be viewed as a last resort. Rather, they should be part of an evidence-based clinical algorithm, allowing each patient to have access to the most appropriate option at the right time. “True innovation lies precisely in offering more personalized medicine, moving away from one-size-fits-all models that do not always address the enormous heterogeneity of mental disorders, ” he says.
Combating Stigma Through Transparency
Regarding the stigma that still surrounds these interventions, the psychiatrist is blunt: the answer lies in transparency. Patients have the right to clearly understand what the treatments entail, what their goals are, what the clinical indications are, and what results they can realistically expect. He also clarifies that these are not “quick fixes” or “miracle” treatments—they are structured therapeutic programs carried out by multidisciplinary teams and subject to rigorous selection and monitoring criteria.
The Future of Mental Health in Portugal
Looking ahead, Amorim Rodrigues identifies four priorities: the development of well-defined national clinical protocols; investment in the training of healthcare professionals; greater involvement by Portugal in international clinical research networks; and an open, rigorous scientific debate, free from ideological biases, on the part of scientific societies and professional associations. His conclusion sums up his vision: “We must be prudent, but not resistant to change on principle. Prudence requires critical evaluation, monitoring, and scientific rigor; it does not require resistance to change.”
The full article can be read in the online edition of Jornal Médico.
