Psychiatry
Major Depressive Disorder
Restoring High-Functioning Workers to Baseline Productivity After Episodes of Depression
Overview
Traditionally, the focus has been on symptoms of major depressive disorder (MDD) and reducing depressive symptom severity, with much less focus on cognition and the impact of depression on other spheres, such as work productivity and performance. Thus, patients traditionally have been defined as having shown improvement in response to therapy based on symptom rating scales like the Hamilton Rating Scale for Depression (HRSD) or the Montgomery-Åsberg Depression Rating Scale (MADRS). However, such patients are not necessarily fully recovered. Significant factors driving disability in working patients with MDD include cognitive impairment, which may persist despite resolution of the emotional aspects of the depressive episode.
Expert Commentary
Charles Debattista, MD
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“A big factor driving disability in patients with MDD (and even partial disability, in the population that we work with) is cognitive impairment, which may certainly outlive the emotional aspects of the depressive episode.”
In this practice, we see many people who used to be high-functioning workers (eg, Silicon Valley executives) who have had 1 or more episodes of depression, and with treatment they may achieve significant improvements in their depressive symptoms, allowing for a return to work – but not at the same level of functioning as before.
So, we have CEOs who cannot function any longer as CEOs after experiencing a significant period of depression, or in some instances, multiple recurrences.
We know that depression is one of the leading causes of long-term disability in the developed world, and if anything, those rates seem to be increasing. If one can’t think, regardless of whether one is the CEO of a major company or stacking boxes in a warehouse, it becomes very difficult to work.
A big factor driving disability in patients with MDD (and even partial disability, in the population that we work with) is cognitive impairment, which may certainly outlive the emotional aspects of the depressive episode. This can also be true for a person who returns to the workplace after responding to therapy but who does not perform at the same level as in the past.
In addition to the cognitive deficits, fatigue is probably the other driver for a lot of people who end up being disabled. It can be very hard to work if you can’t get out of bed. So, I think those 2 factors may be particularly critical in driving disability in our more severely depressed patients.
References
Jha MK, Minhajuddin A, Greer TL, et al. Early improvement in work productivity predicts future clinical course in depressed outpatients: findings from the CO-MED Trial. Am J Psychiatry. 2016;173(12):1196-1204.
Jha MK, Minhajuddin A, Greer TL, et al. Early improvement in psychosocial function predicts longer-term symptomatic remission in depressed patients. Aleksic B, ed. PLoS ONE. 2016;11(12):e0167901.
McIntyre RS, Soczynska JZ, Woldeyohannes HO, et al. The impact of cognitive impairment on perceived workforce performance: results from the International Mood Disorders Collaborative Project. Compr Psychiatry. 2015;56:279-282.
Trivedi MH, Morris DW, Wisniewski SR, et al. Increase in work productivity of depressed individuals with improvement in depressive symptom severity. Am J Psychiatry. 2013;170(6):633-641.
