“The under treatment of anxiety and depression is a health care crisis of major proportion,” says Mary Guardino, Chairman of GAMIAN (The Global Alliance of Mental Illness Advocacy Networks). “These illnesses severely impair not only the lives of the individuals with the symptoms but their families as well. It is absolutely essential that we address this very serious problem urgently.”
Founded in 1997, GAMIAN unites worldwide mental health advocacy associations including the South African Depression and Anxiety Support Group, in a global effort to dispel stigmas associated with mental illness, create awareness of treatment options and to further research in key areas such as depression and anxiety. Membership is open to mental illness advocacy associations, healthcare professionals, representatives of government agencies, consumers and other concerned individuals who are committed to the mission and goals of GAMIAN.
The World Health Organisation (WHO) reports that in the next century, the major causes of disability adjusted life years (DALY) in the economically developed countries will be the neuropsychiatric disorders. In 1990, the cost of anxiety and depression in the United States was more than $90 billion, with 75% of that cost due to absenteeism and reduced productivity in the work force as well as suicides.
Conducted via mail questionnaire to patient advocacy groups in Argentina, Austria, Belgium, Great Britain, France, Italy, South Africa, Sweden, Switzerland and the US, this first-of-its-kind survey was designed to determine the experiences of people seeking treatment for depression, anxiety and other common psychiatric disorders. Although response rates differed substantially between countries – from a low of 17.5% in France to a high of 84% in the US – the results were surprisingly similar with respect to patients’ experiences in seeking and sustaining treatment.
South African patients comprised over 400 of the respondents out of the total 3500 patients from 10 different countries who participated in the international survey by GAMIAN.
The survey was funded by an unrestricted educational grant from Bristol-Myers Squibb Company, the manufacturer of Nefazadone, an antidepressant, and Busiprone, an anxiolytic.
Despite the explosion of new therapies and greater public attention to depression and other psychiatric disorders, the vast majority of people worldwide still delay seeking initial treatment for a number of years, according to the results. Almost 35% of sufferers world-wide are only properly diagnosed after consultation with four or more doctors, with many waiting for up to four years to seek treatment for their conditions.
Other very significant information from the South African respondents indicated that sexual side-effects to medication are particularly common in South Africa, and are a major factor influencing treatment drop-out. A startling 81% of respondents reported sex performance problems as a major side effect of medication, compared to the global average of only 45.2%. Loss of sex drive recorded similar responses, with South Africa scoring the highest for decreased sex drive and impaired sexual performance side-effect profiles. Other major side-effects most commonly reported by South Africans included sleep disturbances and irritability.
The survey results showed that treatment with only pharmacotherapy is associated with fewer dropouts that treatment based exclusively on talk therapy. However, treatment modalities that combine medication and talk therapy produce the lowest drop-out rates. Dr. Kessler indicates that interactions between doctors and patients can help reduce the adverse impact of side effects on dropout. He emphasised that open communication between physician and patient regarding the success of therapy and the response rate of treatment is crucial to ensure that patient expectations of improvement are realistic. He also explained the importance of a careful evaluation of medication to minimise or avoid side effects.
Local expert Dr. Annemarie Potgieter believes that further research into side-effect profiles is necessary. “Researchers need to specifically focus on developing medication with fewer side effects and a shorter treatment duration than provided by medication currently available”, says Dr. Potgieter. In terms of the need to provide further education about mental illness, destigmatisation of the diseases forms a major component of the motivation behind intensive education programmes conducted by the Depression & Anxiety Support Group. According to Kevin Bolon, a Johannesburg Psychologist, “South African medical professionals need to be informed about being more understanding and knowledgeable when dealing with mental illness”. He further believes that the label “neurotic” is attached to patients far too easily. However, the results of the study should encourage all those who suffer from or work to treat depression, to work together in order to ultimately overcome these diseases. Charl Els, prominent Bloemfontein Psychiatrist, echoes this sentiment and believes that the high regard for medication indicated by South African patients in the survey to be a very positive sign.