The World Health Organization has estimated that mental illness constitutes about 12% of

global disease burden, with one in four people directly affected during their lifetime.1 In Australia, this figure is 13%2 and in 2007, 45% of Australian adults reported experiencing a mental health disorder at some stage of their lives.3

‘Mental illness’ is a term used interchangeably with ‘mental health disorders’ and includes anxiety, mood or substance-use disorders, including with alcohol. This grouping pushes men ahead of women in national prevalence of mental illness, but when a 12-month timeframe is considered, women are more likely than men to have a mental illness (22% versus 18%).3

Depression—a mood disorder characterised by loss of enjoyment, energy and concentration for at least two weeks—is the most common mental illness. The WHO has projected that by 2020, depression will carry the second-highest global burden of disease after HIV/AIDS for all ages and both sexes, jumping up from fourth place in 2000.4

Depression is twice as prevalent as anxiety in Australia, affecting about 20% of people, with 6% experiencing a major (as opposed to minor: see Table One) depressive illness,5 where further symptoms (such as sudden loss of weight or appetite, insomnia/hypersomnia or suicidal thoughts) manifest.

changing aTTiTudesThe nature of depression is such that people who experience it sense they are isolated and have feelings of guilt and low self-worth, so it has traditionally been underreported. The premium that sociocultural values and media place on happiness, or at least coping with adversity, has also stigmatised and mythologised depression, making

people reluctant to complain. However, in recent years, a number

of public awareness campaigns; notable community figures admitting to depression; and concerted research efforts into epidemiology, causes, diagnosis, prevention and treatment is changing social attitudes towards depression. The proportion of people reporting a long-term mental or behavioural problem has increased from 5.9% in 1995 to 11.0% in 2004–5.6

In 2007, almost 12% of the population—or at least 1.1 million people—used mental health services in the previous 12 months, and more than half of these had a long-term mental illness.3

General practitioners are the most commonly consulted health professionals by mentally ill people,

at 25%; followed by psychologists (13%).3 However, a quarter of people with a 12-month-old disorder were taking medications for their condition, which suggests that pharmacy is already strongly involved in managing depression.

Pharmacy and menTal healTh Pharmacy’s involvement in mental health has traditionally been in the dispensing, monitoring and review of medications. This ranges from acute care in hospitals, usually for psychoses that may occur in conditions such as schizophrenia and under direction by a psychiatrist; to primary and secondary care of more common mood disorders or anxiety upon prescription by a GP or mental-health specialist; to

Professional

f e a t u r e | d e p r e s s i o n

the australian journal of pharmacy vol.91 june 2010

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Taking the lead on depression n A person with undiagnosed

depression can be difficult to identify by untrained pharmacists.

n Depressed patients have the biggest problems with medication compliance.

n With training in identification of the warning signs of depression and compliance, together with electronic prescribing, pharmacists have the potential to lead mental health reform.

Key points

WITH EXPERTS CALLING

FOR MENTAL HEALTH REFORM,

STEVEN CHONG REPORTS

ON THE CONTRIBUTION

PHARMACY IS MAKING IN

TACKLING AUSTRALIA’S MOST

PREVALENT MOOD DISORDER.