COG IN THE MACHINE

Depression Isn’t Just a Health Crisis, It’s an Economic Disaster

Depression costs the U.S. $44 billion in lost wages every year, but it’s still not enough to change the perception of the disease.

03.10.15 9:25 AM ET

Depression is a master of procrastination.

The disease, which the World Health Organization (WHO) estimates afflicts 350 million people worldwide, can reduce productivity in individuals by as much as one-third. It’s an issue that researchers from Tufts Medical School this week determined costs the U.S. a whopping $44 billion per year in lost wages.

With these statistics in mind, lead author Dr. Debra Lerner set out to explore solutions to what has slowly become America’s own efficiency vacuum. Her team of researchers studied 380 individuals, aged 45 and up, from 23 organizations—splitting them into groups of two. The first received telephone-based therapy that was specifically tailored to work issues. The other received just basic counseling.

The intervention, eight sessions over the course of four months, proved extremely effective. The first group, who received work-specific therapy, saw a 51 percent decrease in mean depression symptom severity, coupled with a 44 percent drop in unproductive hours and a 53 percent drop in absenteeism. The control group’s numbers were far lower, with a 26 percent decrease in depression, and 13 percent for both unproductive hours and absence days.

The main goal of the work-related therapy was to help individuals recognize that unhappiness at work may be less about work and more about their health. “Many people haven’t made that connection,” says Lerner. “They think problems at work are simply problems at work, and everything else is just their depression.”

Once they were able to accept that problems at work were stemming from their own depression, not just unhappy workplaces, their perspective and productivity changed. Accepting the disease as a disease seems to be one of the biggest obstacles in finding relief from it.

Today, depression is one of the most prevalent and far-reaching diseases in the world—and one of the most ignored. According to the CDC, of the 350 million people reportedly suffering from it worldwide, less than half have access to treatment. Without adequate care, particularly in developing countries, the disease leads to at least 1 million suicides per year.

The lack of attention depression garners is no doubt colored by the assumption that happiness is a choice—implying that the opposite must be too. The truth reveals a lack of choice that’s unsettling. Depression, as swaths of scientific researchers have shown, is no more a choice than any other illness.

Dr. Heidi Ledford addresses the discrepancy in the way depression is viewed in an article titled “If Depression Were Cancer.” “If the extent of human suffering were used to decide which diseases deserve the most medical attention, then depression would be near the top of the list,” she writes.

For years the scientific community has raised flags about the increasing dangers of this epidemic. A 1997 paper in The Lancet predicted that unipolar major depression would be the No. 2 leading cause of disability-adjusted life years (DALYs) by 2020. It’s an idea echoed by WHO in 2010, and many in the psychiatric field since.

But some in the field worry that reports and predictions like these only serve to make the problem worse. Dr. Gary Greenberg, author and 30-year veteran of the psychotherapy world, says these studies employ diagnostic criteria that—while useful for more quantitative things like blood pressure—aren’t necessarily a clear marker for mental illness.

“I think what you’re looking at there is research artifact,” he says. “That’s what happens when you start asking those questions.” The Diagnostic and Statistical Manual (DSM) uses nine criteria for diagnosing depression, some of which are vague in nature, like “fatigue” or “change in sleep.”

Anyone that has watched a commercial for antidepressants and heard the lines “Are you tired? Angry?” understands how easy it could be to qualify for this condition.

But by studying how many people are affected by this disease, and how the brain functions during this time of stress, Greenberg argues that science is leaving out one of the most important pieces of the puzzle: why. “I don’t want to underplay it,” he says of the numbers. “It must be an indication that life is getting harder for many people. Depression diagnosis is one of the greatest exports of the last century, but its highly possible we help to export the problems that cause it.”

Research into depression is almost exclusively dedicated to this systematic consideration of what is going on in the brain, not what factors led to it—a fact that is in part due to the difficult nature of examining risk factors. “It’s much easier to look at a person’s state of mind than to figure out whether the problem is poverty or misogyny,” Greenberg says.

While WHO’s intention in releasing information about the growing severity of depression in the U.S. is to increase awareness, the result is a significant boost in psychiatry—a move that is both proactive and stunting.

“People start to think about mood states,” says Greenberg—who worries that the knowledge promotes more drug regimens than personal exploration that may take a deeper look at the problems. “Suddenly psychiatry isn’t a luxury anymore—it’s a necessity.”