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Study Shows Depression Can be Treated Cheaply in Developing Countries - 2003-06-17

No matter who you are or where you live, there is a good chance that you will suffer depression at some point in your life. A significant minority of people are frequently depressed and for them, where they live does matter because modern treatment might not be available, such as in developing countries. But a study in Uganda offers hope that people in poor areas can be successfully treated at less expense than in the industrial world.

The World Health Organization says that nearly six percent of men and almost 10 percent of women will be depressed in any 12-month period. They might feel sad, be sleepless, or unable to function well in daily life.

The percentages are higher if one measures occurrences of depression over a lifetime. In the United States, for example, 16 percent of the adult population will have major depression at some time in their life, according to a new study published in the Journal of the American Medical Association. The author of that study, Kathleen Merikangas of the U.S. government's National Institute of Mental Health, says depression is much more common globally than you might think.

"Major depression is now the number one, the leading cause of disability in the general population across the world. It has now surpassed heart disease, which was the leading cause of disability as recently as 1996," she said,

Previous U.S. research has shown that the prevalence of depression grows with each generation. Once thought to be a problem among only the middle-aged and elderly, it is reaching down into younger and younger age groups worldwide.

As depression has spread, so has therapy. Several chemical antidepressants have shown effectiveness in relieving the disorder. Psychotherapy, a form of counseling, is also effective. In fact, a combination of drugs and psychotherapy is often prescribed.

But developing countries are at a disadvantage because antidepressant medications, like drugs for so many other conditions, are generally unavailable.

"Drugs are too expensive. Also the drugs you would use to treat depression have a lot of side effects, and it's relatively easy to overdose on them," explains Paul Bolton of the Johns Hopkins University School of Public Health in Baltimore, Maryland. "The other problem with drugs is that unlike treating infectious diseases, these are drugs you have to take for months to years."

But without antidepressants, is talk therapy good enough by itself in developing nations? An unprecedented study Mr. Bolton led in Uganda suggests that it is. As described in the Journal of the American Medical Association, his team scored 225 rural Ugandan men and women on a standard scale of depression before and after they went through weekly group psychotherapy sessions for four months. Before the intervention, 86 percent of the patients met the criteria for major depression. Afterwards, only seven percent did.

Mr. Bolton says the results are significant. "This is something that looks from these initial results to be very promising. We don't know yet, though, what it was about this intervention that worked," he said. "We used a particular group therapy, but it may be that it was actually the meeting in groups and talking about these issues that was the important part. But what we feel that this study has demonstrated is that it is possible with minimal resources to address these issues in a way that's quite effective."

Wherever depression occurs, its economic consequences are high. Another study in the same journal shows that in the United States, depression costs employers an enormous amount in lost productivity, $44 billion annually. The loss is because of either absenteeism or, more commonly, poor performance on the job. The lead author of the study, Walter Stewart of Geisinger Health Systems in Danville, Pennsylvania, says lost productivity due to depression is more than three times as expensive as that among workers without depression.

"While depression is not the most common illness among working populations, it is probably the most costly in terms of lost productive time. Most of that cost is invisible. Most of it is occurring while individuals are at work," he said.

The World Health Organization says most studies of the economic costs of depression have been conducted in industrial nations, but it notes that the cost of depression as a proportion of the overall economy is probably high in other regions, too.

Walter Stewart says the use of treatment for depression in the U.S. workplace appears to be relatively low. He points out that therapy may prove cost effective for employers.