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The stark reality of living with depression in Europe

An urgent call for change

Over the past decade we have seen the prevalence and burden of mental health conditions, including depression, continue to grow¹. Now, with the world facing such unprecedented times, levels of loneliness, anxiety, depression and self-harm or suicidal behavior have become a pervasive concern, due to increased social isolation and loss of major support networks².

The World Health Organization recognized depression as the leading cause of disability worldwide³, with mental health disorders representing a greater economic cost to society than cancer of diabetes. And the cost is expected to increase exponentially over the next 15 years⁴. There is therefore an urgent need for policy action to ensure that people living with this devastating condition receive the understanding, support and access to treatments that they need.

Two of Europe’s leading psychiatrists, Professor Eduard Vieta* and Dr. Daniel Souery†, discuss what they think should be done to motivate sustainable change for Europe’s mental health services.

Current treatment pathways are not working effectively enough

We’re seeing the burden of mental health conditions — and particularly depression — continuing to rise to become the leading cause of disease burden by 2030⁵. With people’s lifestyles becoming increasingly demanding this is unlikely to change, leading to more people with mental health conditions seeking medical help. However, the current infrastructure and lack of capacity within European health care systems means that far too few patients get access to the right care, at the right time.

That’s why some experts suggest that the current approach requires change. “Most primary care is delivered in a format that isn’t helpful for people with mental health conditions,” explains Professor Vieta.

Indeed, the average patient consultation lasts just five minutes or less⁶ and, although some European countries have increased the amount of time spent per patient in primary care, this alone isn’t enough.

“As a psychiatrist, I can’t effectively diagnose or help a patient with depression in just 10 minutes, other than to prescribe them medication,” explains Professor Vieta. “Medication is of course important but not at the expense of a face-to-face consultation with a health care professional.”

In mental health, arguably more so than with physical health conditions, there is no ‘one size fits all’ approach that can work across the range and severities of conditions that exist⁷. Not everyone with a mental health problem needs to see a psychiatrist but those who do encounter barriers, including long waiting times⁸.

Professor Vieta says: “There is no doubt that patients with moderate-to-severe depression require specialist care. For this reason, I believe we need to take a two-pronged approach. Firstly, enhance specialist care and, secondly, reinforce support resources within the community.”

Moving care into the community has a key role to play in ensuring the right people can access the right care, as Dr. Souery explains: “For someone living with depression, knowing that at some point they may have to be hospitalized and withdrawn from their life makes them less likely to seek the help that they need. So, we have to make a transition from hospital to outpatient care.”

Public health systems certainly have a role to play in helping to manage the burden that mental health presents to society. Dr. Souery says: “Educating people, including social workers, teachers, friends and relatives, to an adequate level would not only significantly reduce the stigma associated with mental health conditions, but it would also help to reduce important risk factors, such as loneliness. This in turn could help to reduce the number of people who are entering the health care system.”

Clinical practice is not keeping up with innovations in neuroscience

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There have been impressive advances in neuroscience over the past three decades, which began with the first functional neuroimaging studies⁹. The results of these studies have revolutionized the way we understand the biological and neurological basis of psychiatric disorders, psychological distress and, subsequently, our understanding of their treatment⁹. However, despite these breakthroughs, the speed at which they have been translated to clinical practice has been anything but rapid, taking up to 17 years in some cases¹⁰.

Our experts agree. “Many of us are still relying on what we discovered over 40 years ago about neurotransmitters and the classical antidepressants like SSRIs,” says Dr. Souery. “We should be exploring how to integrate genetic advances to develop personalized treatment plans or using machine learning to help predict treatment response. After all, the future is tomorrow.”

Dr. Souery also believes we should be providing integrated and more comprehensive care for patients. “As caregivers, it is our responsibility to utilize all of the recent knowledge from within the neuroscience field, but we must also start to think more holistically by applying the latest advancements from sociology and education to the way we practice.”

Such innovations do not necessarily have to be incredibly hi-tech or expensive. Both experts believe that health care professionals really shouldn’t miss out on social media and other digital platforms. “Nowadays, people can access excellent care programs online which can have a great benefit. As a field, we need to be less reluctant in using these tools and instead be encouraging governments to invest more time and money in them.”

Barriers to accessing new psychiatric treatments hinder progress

Mental illness is one of society’s greatest public health problems and there is a vast unmet need among people of all ages¹¹. Accessing effective treatments remains an issue, as demonstrated by the example of Major Depressive Disorder (MDD), where three out of four people do not receive adequate treatment²,¹². Barriers against new psychiatric treatments during the regulatory approval and the reimbursement process may be partly to blame, according to Professor Vieta. “We see that new oncology therapies, for example, are approved fairly quickly so that patients gain access to them faster. On the contrary, treatments for depression take far longer to be approved and there is disproportionate discussion around the cost of the treatment. My hospital is far more likely to pay €2 million per month for cancer treatments than €200,000 for treatments for depression. But there is no getting away from the fact that medication is very important. We need the best treatments to be approved and we need to reduce the barriers to getting them approved.”

“We are not advancing at the right speed,” agrees Dr. Souery. “We are still looking at depression, and treatments for depression, the old-fashioned way. The regulatory authorities are too focused on the cost of the treatment alone, instead of invested in increasing education and awareness, which is crucial.”

Let’s empower policy leaders to take action

We have heard from the experts and it is clear that there are some important areas that require policy attention. Now is the time for us to work together to change attitudes toward mental health. To enable real change, we need to encourage conversations that motivate policy leaders to take action while educating the broader public about what it is like to live with a mental health condition.
Breaking Depression, a pan-European disease awareness campaign initiated by Janssen, with support from GAMIAN-Europe (Global Alliance of Mental Illness Advocacy Networks-Europe), sets out to help start more conversations about depression in general and MDD specifically.

Visit www.breakingdepression.eu to find out more and pledge your support. Together, we can break the silence, break the stigma and work together to ensure we’re ultimately Breaking Depression.

If you’re worried about your own mental health, or someone else’s, you can find more information and support from one of GAMIAN-Europe’s network organizations:

www.gamian.eu/wp-content/uploads/GAMIAN-Europe-Mental-Health-Support.pdf

In an emergency situation, get help immediately by calling the emergency services or your local mental health helpline.

This article was created on the initiative of and with financial and content-related support of Janssen Pharmaceutica NV.

 

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References:

1. World Health Organization (WHO). World Health Report. Available at: http://www.who.int/whr/2001/media_centre/press_release/en/(Last accessed March 2020).
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3. World Health Organization (WHO). Depression. Available at: https://www.who.int/mental_health/management/depression/wfmh_paper_depression_wmhd_2012.pdf  (Last accessed March 2020).
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8. Barbato A, et al. Access to Mental Health Care in Europe. Available at: https://ec.europa.eu/health/sites/health/files/mental_health/docs/ev_20161006_co02_en.pdf (Last accessed March 2020).
9. Miles A. Evaluation in Clinical Practice 2018;24(4):788–790.
10. Morris Z, et al. Royal Society of Medicine 2011;104(12):510–520.
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*Professor Eduard Vieta is a Professor of Psychiatry at the University of Barcelona and head of the world-leading Bipolar and Depressive Disorders Program in Barcelona.

†Dr. Daniel Souery is a psychiatrist and director of Psy Pluriel, a multidisciplinary psychiatric center specializing in the management of psychiatric disorders, clinical research and education.

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