Crisis in treatment of Depression and Bipolar disorder

The increasing rate of Depression in patients is becoming a huge crisis in South Africa and World wide

More than 17 million people in South Africa are dealing with depression, substance abuse, anxiety, bipolar disorder and schizophrenia-illnesses that round out the top five mental health diagnoses, according to the Mental Health Federation of South Africa. Furthermore,

A recent study showed that Depression cost the South African economy more than R232 milliard a year due to lost of productivity. Loss of productivity is caused by absence from work or attending work while unwell. That is 5,7% of the total South African annual economy.

London School of Economic and Political Science. (E-news 10/10/2017 at 19h00)

The incidence of patients with depression is increasing at an alarming rate as the following paragraphs clearly show.

The suicide rate for children aged 10-14 years old has more than doubled over the last fifteen years (3)

According to SADAG (South African Depression and Anxiety Group)

23 people commit suicide every day countrywide and a further 230 attempt to.

That is more suicides than America and the UK. (3)

The country have approximately 8 000 suicides a year. Around one million suicides were recorded each year globally.(3)

According to the WHO (World Health Organization) suicide is the 2nd leading cause of death among 15-29 year olds, with 1 person committing suicide every 40 seconds. For every person that dies by suicide, between 10-20 people attempt it.(3)

  • 1 in 4 SA teens have attempted suicide.

  • 1 in 3 hospital admissions for suicide involve youth.

“Depression and bipolar disorders form part of the top 15 diagnosis codes used, and contribute to some of the highest psychiatric benefits used during the 2013 service period,” (4)

Profmed’s member profiles in 2013, compared with last year, showed a 50% increase in those diagnosed with severe depressive episodes without psychotic symptoms.

There was also a 75% increase in Profmed members suffering from a severe depressive episode with psychotic symptoms for the same period.(4)

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Bad “Patient compliance” and the alarming effects

75% of people will not get the mental health treatment they need.

Others continue on ineffective doses and medications due to clinical inertia and a lack of appropriate treatment intensification, in patients who are not improving with initial treatments. As a result, as few as 20 – 40 % of patients started on depression treatment in primary care show substantial clinical improvements. (2)

This high percentage of patients not showing substantial clinical improvement, indicates that about 60% of patients do not reach “remission” or “recovery.”

This may be one of the reasons why many people suffering from depression will not go to a clinician for help, because the population out there view treatment for depression as ineffective and a waste of money, since so many of their family and friends have been taking medication for years without any significant improvement.

Therefore adherence cannot be expected per se but needs special efforts on behalf of prescribers and public health initiatives.(1)

This article is based on the result of the research and planing of:

Dr Hans (JGM) Dreyer, Pastoral Counselor in Private practice in Pretoria.

Research Litterature available on request.

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