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The (un)happy pills that profit from prolonging depression

Profit from "happy pills" skews the treatment of depression

Common unhappiness occasionally mutates as, almost imperceptibly, mild melancholy descends into malignant misery. Childhood experiences, marital problems and painful insights conspire to steal a person's fragile sense of psychological well-being.

Like an ill-omened planetary alignment, the convergence of genetic predisposition, early-life trauma and present-day drama can lead to what is commonly referred to as a nervous breakdown. Or, as those in psychiatry might describe such an event, a mild-to-moderate mental health problem.

The most common form of everyday unhappiness is known as major depressive disorder (MDD). This condition (the world's fourth most common cause of disability) is particularly responsive to psychological therapies, especially cognitive therapy. Such therapies generally lead to rapid improvements and, more importantly, make relapse far less likely.

However, despite a clear understanding of these treatments, most people experiencing depressive disorders in the UAE do not receive psychological therapies. And the UAE is not alone: the majority of MDD patients in the UK do not receive psychological therapies either.

A 2007 article in the leading medical journal The Lancet described the situation as "a silent scandal". Why is the most effective treatment, for the most common mental health problem, not in widespread use?

The problem is threefold. The first, and perhaps the most obvious issue, is that not many people are trained to deliver psychological therapies. According to WHO data, globally the average number of psychologists per 100,000 people is 6.43.

Even more disconcerting, WHO data for the Eastern Mediterranean region (which includes the UAE), suggests that on average there is less than one full-time psychologist for every 100,000 people.

But psychological therapy doesn't necessarily need to come from a clinical psychologist. Britain has recently encouraged other health-care professionals to develop the skills required to deliver psychological therapies.

But in spite of these efforts, all too often psychological treatments have the phrase "unmet need" scrawled in the medical notes.

Another barrier, however, is the stigma that some people still attach to mental health problems. One student in my psychology class suggested that any Emirati woman with a psychiatric history would find her marriage prospects greatly diminished, no matter how mild or short-lived her problems were. For some, this would be a very good reason not to seek help, or at least not the kind of help that leaves a paper trail.

Finally, and for me most problematic of all, is the under-regulated pharmaceutical industry and its overzealous product promotion.

It's important to appreciate that the pharmaceutical industry is the most profitable industry on the planet. At the turn of the century, the top-10 pharmaceutical giants - all Fortune 500 companies - were making an 18.5 per cent return on sales. Compare that to commercial banking with its 13.5 per cent.

In 2002, the total profit of the top-10 drugs companies was greater than that of the other 490 Fortune 500 companies combined. As my old psychology professor once quipped: " There is gold in them there pills."

But hyper-profitability is not the problem. The real issue is the relationship between the pharmaceutical industry and psychiatry. The industry influences both prescriptions and research agendas. Some psychiatrists receive huge secondary incomes from drug companies, usually in the guise of research contracts or consultancy fees.

At one UK clinic where I worked, psychiatrists were receiving 2,000 (Dh12,000) for each patient they recruited into a drug trail unbeknown to patients. Such payments add to the drug company's "loyalty incentives", whereby they sponsor international conferences, then pay for attendance and business-class airfare.

To improve access to psychological therapies in the UAE, more trained professionals are needed. There is also a need to tackle the stigma of mental health problems.

Finally, it is essential that the relationship between health-care professionals and the pharmaceutical industry is well regulated with the patient's best interests at heart.

Justin Thomas is an assistant professor of psychology at Zayed University

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