Mental Diseases: Understanding and Prevention

Q: How prevalent is depression in Mexico and to what extent is it on the rise?

A: The prevalence of depression and other mental diseases should be very similar in Mexico as in the rest of the world. I do not think the number of cases has increased. The question is whether more cases have been detected. There is a large number of people who will get some sort of mental disorder at some point in their life and the concern is whether or not doctors are diagnosing them.

The world is becoming more aware of mental health and within 10 years depression will be the most debilitating disease, more than diabetes or heart conditions. One reason is that depression strongly impacts productivity, firstly due to absenteeism from work but also because of a new concept called presentism whereby people go to work but do not perform. They sit at their desk, unable to make decisions or perform their work effectively.

Additionally, in the case of mental diseases, the economy not only loses the person who is mentally impaired but also the family member who leaves their job to take care of this person. The annual cost of mental illness in Europe is pegged at €798 billion. In Mexico awareness is improving and for the first time there is a working group in the legislative body looking at mental diseases.

Q: In 2016, the Table of Work-Related Diseases was updated to include stress and other mental afflictions. How does this impact awareness?

A: There is more and more information available on mental diseases and the government, health authorities and companies are realizing this is a big issue. We are hearing about it more now than a few years ago because it is something we cannot hide. Recently during a visit to Mexico by the Danish Minister of Health, data was presented regarding patients with depression. The results showed that patients were first treated for depression 10 years after they first showed symptoms. Those treated earlier were able to recover more easily while for others the disease became more complex. The Danish and Mexican authorities have agreed to work together and exchange perspectives on mental health issues. The Danish government is promoting grants for Danish researchers to conduct research in Mexico, generally in collaboration with Mexican researchers.

There are more people that at some point in their life suffer an episode of depression than any other mental disease. However, in Mexico there are many patients with Alzheimer’s, Parkinson’s and schizophrenia, which is a very difficult disease and patients are rarely understood.

Q: How does the demography of these diseases in Mexico compare to that of other Latin American countries?

A: Latin America is moving in the same direction. We are shifting from infectious disease to chronic diseases. Before, bacteria caused illnesses but now diabetes, cancer, depression and coronary diseases are more prevalent. Mexico is a young country and the main driver for growth is its large population. Therefore, it is important that all decision-makers in this country realize that the young population needs to be healthy to be productive.

Q: How can companies work with the public sector to prevent the young population becoming unhealthy?

A: First, we need to understand the issue before we fix it. For example, diabetes has been quite well researched and now the authorities are doing something about it. We have fallen behind in other areas and we need to calculate the impact of mental disease. I think getting data on how many people are absent from work due to depression would be quite interesting and would help to understand the magnitude of the impact these diseases have on the economy.

Q: What are the main risk factors for mental disease? How much do environmental factors influence this?

A: Urbanization and depression go hand in hand. As an economy develops, the population is weighed down with heavier workloads, we spend more time in traffic and we produce more pollution, all of which are stress factors that can lead to depression. There is a correlation between economic development and the development of depression. There are other risk factors for specific diseases.

Q: What percentage of sufferers are diagnosed and what percentage of those receive treatment?

A: In general, you see more diagnoses in places like Europe, the US and Canada, and less in Asia, Latin America and Africa. In Mexico, the likelihood of being diagnosed when going to a psychiatrist is extremely high and almost 100 percent of the patients that are diagnosed by a psychiatrist are treated, but few people go to a psychiatrist. The majority go to a general physician (GP) and so the process for diagnosis and treatment could be lengthier.

Visiting a psychiatrist is a big step for many people because mental disease sufferers are more prone to stigmatization. For example, schizophrenia is a difficult condition to talk about because it falls out of the common and many people think of depression as a weakness. Many do not recognize depression and tell sufferers to stay calm and go to work, but this is not the right way to deal with it. In the first two weeks, depression is just a feeling but after two or three weeks it becomes a biological problem. The neurotransmitters in the brain start working differently because the body is adapting to a condition.

Q: Which demographic suffers the most from depression?

A: There is a high prevalence of depression in older people but it is also common in the younger population aged late 20s to 50s. It is becoming more frequent in teenagers and this is troubling because young people should not be depressed yet suicide in the younger population is on the rise. 

Q: What programs are in place in Mexico to help with this?

A: There are some support programs for specific population segments with high suicide rates such as HIV patients, alcoholics and drug addicts. One of the main issues with depression is that a large number of the people who suffer from it commit suicide. If you think mental illness does not kill, it does.

Q: Which state of the art products has Lundbeck recently launched?

A: We launched an anti-depressant last year that is creating a completely new way to treat the disease. It is called Brintellix and it not only targets the feeling of depression but also the way we think when we are depressed. Depression not only affects a patient’s mood but also their cognitive abilities, which prevents them from being as productive as they could be.

Also, next year we will launch a product called Nuvigil for excessive sleepiness. It helps patients stay awake during the day and when it wears off they can go to sleep. It also works for people who want to regulate sleep patterns, such as shift workers. This new product will have a broader range of efficiency so patients will not only be awake but more alert. In 2018, we will market a product for schizophrenia. These will be our new products for the next three years. Lundbeck Mexico will be the central hub for Central America and the Andes so we are excited about the opportunities our industry has here.

Q: How do COFEPRIS’ regulations differ to those of the FDA or EMA?

A: COFEPRIS has done a fantastic job accelerating the processes and reducing bureaucracy. There are many differences from the other organizations. For instance in Europe you do not need to do local releases by repeating clinical testing.