Countries like Brazil fail to diagnose and treat 70% of depression cases

Depression affects 5% of the adult population, it is considered one of the most disabling diseases, but half of the cases are still neglected in developed countries. In low- or middle-income countries, such as Brazil, the lack of diagnosis and treatment affects more than 70% of people with the problem.

The data are included in a report by the World Psychiatric Association on Depression and the scientific journal The Lancet, which will be released at an international seminar on Wednesday (16).

Prepared by 25 researchers from 11 countries and from different disciplines —from public health to neuroscience—, the document draws attention to the negligence with which countries have been dealing with the serious global crisis of depression and calls for the engagement of the whole society in confronting it. .

Among the proposals is the training of other non-medical professionals, people in the community and young people who have already had depression and are willing to help others who go through the same problem.

With social isolation, bereavement, hardship and limited access to health care brought on by the Covid-19 pandemic, people’s mental health has deteriorated further and, according to the report, there is a “tsunami” of unmet needs. in that area.

Psychiatrist Christian Kieling, professor at the Federal University of Rio Grande do Sul and co-editor of the report, says that the goal was to concentrate in the document all the knowledge accumulated so far about depression, the barriers and the ways to face it.

“There’s a lot that we still don’t know about depression and that we need to invest in research to advance, but there’s a lot that we already know how to prevent and treat depression. Unfortunately, most of the planet doesn’t have access.”

The researchers support a personalized approach to depression that recognizes the chronology and intensity of symptoms. And they recommend interventions tailored to the individual’s specific needs, disease severity, and available resources.

Strategies range from self-help and lifestyle changes to psychological therapies, antidepressants and more intensive treatments such as electroconvulsive therapy (ECT) for severe and refractory forms of the disease.

“There are even strategies for social interaction and social interaction for the elderly. Today, we clearly see the association between loneliness and depression in the elderly”, says Kieling.

The report mentions therapeutic interventions in the community, such as the Friendship Bank, a project developed by psychiatrist Dixon Chibanda, from Zimbabwe, in which grandmothers are trained in therapeutic techniques with scientific evidence.

They adapt knowledge to the reality of the communities where they live. For example, terminology such as “depression” and “suicidal ideation” are not used. It is necessary to speak the language of patients through cultural concepts with which they identify. In the Shona culture (Bantu-speaking peoples who inhabit Zimbabwe), therapy would be something to “open the mind, strengthen and enliven the spirit”.

According to Christian Kieling, there is very robust evidence on the effectiveness of this concept of collaborative care. “If I train people, under the supervision of the UBS family doctor, involving other community members, such as schools, social services, religious groups, with the patient at the center, it is possible to offer care as effective or more than that offered by the specialist.”

The engagement of people who have been through episodes of depression in the care of others who are now facing the problem is another strategy that has proven to be successful. In Australia, for example, young people who have experienced depression help others.

“Young people often do not seek formal help from the health system. Young people who are thinking about suicide will not wake up at 5 am to get in line at the health center and get a form to be seen. for the family, nor will he speak to the school. But suddenly he will speak to his best friend, his best friend”, says Kieling, specialized in children and teenagers.

The document also warns that strategies that reduce exposure to adverse childhood experiences (such as violence, neglect and trauma) are needed to reduce the prevalence of depression in adulthood.

There are also risk factors associated with depression that can be prevented by public policies, such as smoking, alcohol consumption, physical inactivity, domestic violence, grief and financial crisis. Underprivileged groups from a socioeconomic point of view, who experience situations of discrimination based on race or gender, and women are also more susceptible to the disease.

“Prevention is the most neglected aspect of depression. This is in part because most interventions are outside the health sector,” says Lakshmi Vijayakumar of the Center for Suicide Prevention and Voluntary Health Services in Chennai (India), co-author of the report.

“Given the lasting effects of teenage depression, from difficulties in school and future relationships to the risk of substance abuse, self-harm and suicide, investing in depression prevention is excellent value for money.”

Christian Kieling, from UFRGS, also reinforces the need to prevent the chronicity of depression. “We know that many people will have a depressive episode and never have another one. But there are a number of individuals who can have new episodes.”

In these cases, there is evidence in the literature showing that psychotherapy, with or without medication, has better results than treatment with medication alone.

According to the report, at worst, depression can lead to suicide. Studies indicate that about half of the people who kill themselves in low- and middle-income countries suffer from mental illness, of which depression is the most common cause—in high-income countries, the rate is as high as 80%.

Fighting the stigma that still surrounds the disease is another challenge. One of the strategies has been to “empower” people living with depression, bringing them to a more active position in the debate. “We learned that excessive biologization can bring a certain fatalism, like I have a genetic predisposition and there’s nothing I can do.”

The researchers also emphasize that the current system of classifying people with symptoms of depression into just two categories (clinical depression or not) is too simplistic.

“Two individuals do not share exact life history and makeup, which ultimately leads to a unique experience of depression and different needs for help, support and treatment,” explains Vikram Patel of Harvard Medical School and co-author of the report.

The document also reinforces that depression has an enormous social and economic cost that is still poorly recognized. Even before the Covid-19 pandemic, the global economic productivity loss linked to the depression was about $1 trillion a year.

“There is no other health condition that is as common, as costly, as universal, or as treatable as depression, but receives little attention and resources in policy,” says Kieling.

The report “Lancet-Word Psychiatric Association Commission: time for united action on depression” will be released this Wednesday (16) during an international seminar.