XXVI CINP CONGRESS. mood disorders: The application. Gerhard Heinze M.D.

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1 XXVI CINP CONGRESS CINP Task Force: Antidepressants and mood disorders: The application The impact of antidepressants and the treatment of depression in Latin America Gerhard Heinze M.D.

1 Colombia 71.7 Ecuador 74.2 Perú 69.9 Bolivia 63.9 Chile 77.9 Panamá 74.

2 Life expectancy in years,, 2005 Canadá 79.8 IDH High Medium México 74.9 Nicaragua 70.8 Honduras 68.6 Belice 75.6 Guatemala 69 El Salvador 70.7 Costa rica 78.1 Colombia 71.7 Ecuador 74.2 Perú 69.9 Bolivia 63.9 Chile 77.9 Panamá 74.7 Venezuela 72.8 Guyana 63.6 Surinam 69.1 Uruguay 75.3 Argentina 74.3 Brasil 71 Paraguay 70.8 PNUD, 2007/2008

7% life time prevalence of depression 5.5 % life time prevalence of anxiety 1.

3 450 Million of people suffer currently from neurological and psychiatric disorders. 33% of the global burden of disease. 4 of the 10 more disability diseases are mental disorders. 8.7% life time prevalence of depression 5.5 % life time prevalence of anxiety 1.4 % life time prevalence of bipolar disorder 40% of the people diagnosed with depressive disorders, ask for some kind of help. WHO 2002; ISM 2002; Saraceno et al 2005

4 Magnitude of Poverty % Brazil Mexico Chile Colombia Latin Am. CEPAL,2007

5 Main causes of DALYS by sex in Mexico, 2005 Women Depression 6.5 Diabetes mellitus 6.3 Perinatal period diseases 5.3 Congenital abnormalities 4.3 Isquemic heart diseases 2.8 Osteoarthritis 2.3 Cataracts 2.2 Cerebrovascular disease 2.2 Demency & Alzheimer s disease 2.1 Asthma 2.0 Infectious intestinal diseases 2.0 Chronic obstructive pulmonary disease 2.0 Cirrhosis & other chronic liver diseases 2.0 Severe low respiratory tract infections 1.9 Motorcar traffic accidents 1.7 Total (millions) 6.9 % Men % Perinatal period diseases 5.9 Cirrhosis & other chronic liver diseases 5.1 Alcohol consumption 4.8 Assaults (homicides) 4.6 Motorcar traffic accidents) 4.6 Diabetes mellitus 4.5 Congenital abnormalities 4.0 Isquemic heart diseases 3.5 Depression 2.6 Motorcar accident-injured pedestrian 2.2 Severe low respiratory tract infections 1.9 Infectious intestinal diseases 1.9 Asthma 1.8 Cerebrovascular disease 1.7 Chronic obstructive pulmonary disease 1.5 Total (millions) 8.4 Lozano, 2006

6 Relation between severity of mental disorders and poverty in Latin America Any 12 month Disorder Severe Disorder Mood OR OR OR Income Low Middle High * *Significant at 0.05 Medina-Mora Mora et al., 2005

7 International Comparison Anxiety Depression Impulse Substances Any diagnosis Colombia Mexico US % Germany * 9.1 Spain * 9.2 Japan China * Only alcohol WHO 2000, JAMA, 2004

8 % Prevalence of lifetime and 12 month DSM IV major depressive disorders among Hispanics in the US, Mexicans and Colombians Borges et al, in press

9 Association between WMH-CIDI/DSM CIDI/DSM-IV IV disorder and treatment (last 12 months) Spain France Belgium US Netherlands Germany Colombia Mexico Ucrania Lebanon Severe disorders 0% 10% 20% 30% 40% 50% 60% 70% Percentage under treatment

10 Total Prescriptions of antidepressants (%) in Latin America Chile 2.91% Argentina 2.76% Mexico 1.36% Colombia 1.31% Peru 1.28% Ecuador 0.63% Central America 0.62% Venezuela 0.41%

11 Years without treatment Medina-Mora Mora 2003 (Not published)

12 Who prescribes antidepressants in different countries (1) MEG: General Practitioner; MIN Internist; ; NEU Neurologist; ; PSQ Psychiatrist

13 Who prescribes antidepressants in different countries (2) MEG: General Practitioner; MIN Internist; NEU Neurologist; PSQ Psychiatrist

14 Prescriptions of Antidepressants in Mexico YEAR GROWTH % % % Percentage of Prescriptions of SSRI Antidepressants = 51%

15 Discussion 1. Poverty increases the risk of emotional mood disorders. It is needed a proper detection and an early treatment to reduce the burden of depressive illness. 2. Delay in the utilization of mental health services in Latin America is a key factor: years for mood disorders and more than 25 years for anxiety disorders.

16 Discussion 3. Lifetime prevalence and 12-month major depressive disorders are similar in Latin American countries, but much higher in Hispanics born in US. 4. The number of prescriptions of antidepressants in Latin America are higher in Chile and Argentina probably due to their better cultural level 5. Only 20-25% patients with severe mental health disorders are under treatment (Colombia, Mexico) vs. 60% in European countries (Spain, France, Belgium)

Special Topic. The ten leading causes of death in countries of the Americas

Special Topic. The ten leading causes of death in countries of the Americas The ten leading causes of death in countries of the Americas Table 1: Country specific information on the ten leading causes of death in broad age groups, by sex, for the latest two or three data years