The good news about depression - includes related article on economic costs of clinical depression in the workplace, diagnosis

The good news about depression

Workers can be easily cured if employers recognize symptoms early and encourage treatment.

Clinical depression is more than just a bad case of the blues. It's an illness that strikes one out of every 20 Americans a month and is often severe enough to warrant medical attention. When left untreated, it can become chronic, debilitating--and sometimes even fatal.

Depression, is costing companies at least $10 billion annually in lost productivity alone, according to a 1986 study by several noted psychiatrists. Increased absenteeism and higher accident rates further siphon away company funds.

But all the news about depression isn't negative. According to the National Institute of Mental Health, most individuals, if correctly diagnosed and treated, recover fully. Indeed, 80 to 90 percent of people with clinical depression can be helped within a few weeks through psychoterapy, drugs, or a combination of the two.

Employers' role

In all cases, the earlier the intervention, the better and less costly the treatment. Therefore, it's critical that "employers know and care about depression," contends Chris Bisgard, M.D., medical director of Pacific Bell, San Francisco. "Of all mental health problems, depression is the most easily recognized and treated. It's up to employers to make sure people are receiving the help they need."

But that's not happening, say a number of mental health professionals. Employers generally are doing less than they should to help depressed employees, argues Alan Stoudemire, M.D., professor of psychiatry at Emory University, Atlanta. "There's a general tendency to deny that depression exists, even when it happens to top employees. Employers don't want to get involved. One way to avoid the problem is to ignore it."

For many employers there is still a stigma about mental illness, Stoudemire observes. Others are confused by the conflicting advice from psychiatrists, psychologists, and physicians about diagnosis and treatment.

Still other employers question the severity and significance of depression. Pat Nazemetz, director of benefits for Xerox, Stamford, Conn., asks: "What constitutes depression? The checklist of symptoms is pretty vanilla; they can apply to just about anyone. The only people who don't have some of these symptoms at one time or another are embalmed."

David Kupfer, M.D., professor and chairman of psychiatry at the University of Pittsburgh School of Medicine, disagrees. "Depression is easily recognized and is a serious health threat," he says. "I see depression as the same as diabetes, hypertension, and many other physical ailments. It can be chronic; it's influenced by both biological and lifestyle factors, and it can trigger major health problems."

Most employers and managers fail to see how high the stakes are, says Pacific Bell's Bisgard. "Ask any manager what is a worse problem: substance abuse or depression? The answer is always substance abuse, although depression is a far more significant and prevalent problem. If the statistics are right, then nearly 7 percent of the estimated 37,000 women who work at Pacific Bell are depressed. That far outnumbers the people who are substance abusers."

Company strategies

A handful of employers, however, are taking steps to learn more about depression and how it's affecting their workforce. Wells Fargo in San Francisco is looking at the number of self-reported depression cases, where individuals sought help--from family, friends, the company's EAP, or elsewhere --and corporate barriers preventing people from seeking professional attention.

Bryan Lawton, vice president and director of employee assistance programs at Wells Fargo, says these steps are only the beginning. "We need to get a firm grip on what depression is costing us and how many people are affected. Then we need to think about creative solutions beyond treatment.

"If companies are concerned about depression, it may help to formalize support networks within the work site," he says. "For many people, their primary support comes from co-workers. Employers must remember this. They could, for example, have ongoing bereavement groups, run by the EAP, for employees who recently suffered a loss."

Pacific Bell in San Francisco already is running support groups for employees with AIDS and for those who know someone with the disease. At Pacific Bell, AIDS is the leading cause of death among active employees.

To bring information about depression into their work places, other employers are taking part in a recently launched federal program. Sponsored by the National Institute of Mental Health, the D/ART program--which stands for Depression, Awareness, Recognition, and Treatment--is designed to teach the public, employers, physicians, and mental health professionals about depression: its symptoms, diagnosis, and treatments. Television, radio, and print public service announcements are just some of the materials being used.

Among the companies participating in the project are Allegheny Ludlum in Pittsburgh and Boeing in Seattle. Allegheny Ludlum is reprinting 10,000 NIMH pamphlets about depression and will pass them out to all employees and retirees. Boeing is distributing pamphlets to its employees and writing about the D/ART project in its company newspaper.

The Washington Business Group on Health in Washington, D.C. is coordinating other work site efforts. Long-term goals include training employee assistance counselors about depression and encouraging increased benefit coverage for mental health disorders.

Getting proper care

"Often I hear employers saying that if their employees know more about depression, they'll increase their use of mental health benefits," says Pacific Bell's Bisgard. "But educating people about depression doesn't mean that health care costs will go up. Yes, your mental health costs probably will increase, but this will be offset by a decrease in the use of medical services and an increase in productivity."

Nearly all mental health benefit packages cover treatment for depression so most employers won't need to expand coverage. But as with all mental health cases, employers must be sure people are receiving the proper care for their depression.

Says Xerox's Nazemetz: "Whether that involves a third-party intervention, managed care firm, or some other method, it's in the best interest of the company and employees to look at treatments. At least some providers within the psychiatric community will go overboard with diagnoses, especially with something as ambiguous as depression.

"Checks need to be in place, and the mental health profession must be held accountable," she says. "But this issue boils down to one thing: If people are truly in trouble and medical intervention would help, they should get it."

Most people will recover from mild depression on their own, generally with the help of a good support network--friends, family, co-workers. But acute cases require professional treatment.

Antidepressant drugs are used with the more serious and recurrent forms of depression. These medications help to bring mood, appetite, energy levels, sleep patterns, and concentration back to normal. People with recurrent bipolar depression generally need ongoing treatment with different types of medications, of which lithium is the most well known.

Psychotherapy, especially short-term cognitive behavior therapy, works best with milder forms of depression. This treatment generally goes on for a few months and sometimes is combined with drug therapy. In the most severe cases, controversial shock therapy, medically known as electroconvulsive treatment, also can help.

Depression can recur. About 40 percent of people with clinical depression will have more than one episode. However, treatment can help prevent recurrences or at least diminish the severity and length of episodes.

"Of all mental illnesses, depression can be most effectively and quickly treated," says Stoudemire of Emory University. "Treatment often requires no more than five to six visits to a therapist."

Barriers to care

Some psychiatrists estimate that as many as 15 percent of middle managers suffer from depression serious enough to hurt their job performance. Fearful about being pegged as weak, most, however, won't admit they are depressed.

"It doesn't look very macho to talk about depression," observes Lawton of Wells Fargo. "It raises concern about a person's abilities. Management would prefer not to address the issue. There's a real stigma attached to depression. Because most people feel down at one time or another, there's a tendency to downplay or just plain ignore these feelings."

Even when people acknowledge a problem, they often seek help not for their depression but for physical ailments: headaches, stomach problems, fatigue, insomnia, back pain. "People are more likely to say they're feeling sick than to say they're depressed," Lawton adds.

That's true, says Stoudemire. "On any given day, 15 to 30 percent of visits to physicians are related to psychological problems. More than half of people who are depressed first seek help from their private physician."

Often these people are inappropriately diagnosed and treated by doctors who may not recognize depression as readily as mental health professionals do, says Kupfer of the University of Pittsburgh. Many people are told to keep a stiff upper lip or are prescribed the wrong medications.

Without the correct treatment, many people will take longer to recover from their depression and to return to work in peak form. For employers, this inappropriate care jacks up the cost of health care and of lost productivity.

"People may make four, five or even more trips to their physicians before they're correctly diagnosed --if they ever are," says Pacific Bell's Bisgard. "Companies are paying huge bills for the wrong treatment and prolonged absenteeism."

"Employers need to put the word out to managers about depression just as we told them about substance abuse," Bisgard maintains. By recognizing depression as a serious health problem and helping those who suffer from it, "Employers will save money today and in the years to come," he says.

COPYRIGHT 1989 A Thomson Healthcare Company
COPYRIGHT 2004 Gale Group