title: Do antidepressants reduce the burden imposed by depression on employers?
abstract: The ability to perform paid or unpaid work is integral to an individual's quality of life. Therefore, we performed a systematic literature review to examine the impact of depression and its treatment on occupational outcomes. This review found absenteeism from work to be markedly higher among depressed employees and productivity to be dramatically undermined by some symptoms of depression. Gaps in the published literature point to the need for future economic and clinical analyses to include work-related outcomes. Published studies showed that antidepressants can enhance work-related outcomes by alleviating affective symptoms. However, the pharmacological properties of antidepressants may produce differential effects that influence work-related outcomes in other ways. For example, TCAs, but not SSRIs, produce sedation and impair cognitive function in ways that could undermine work-related outcomes. Formal analyses are required to quantify whether the improved social functioning, motivation and vigilance that may be associated with some newer antidepressants translate into improved work-related outcomes. Although few published studies have directly quantified the cost benefit of managing depression and associated lost productivity, existing studies that directly assessed work-related outcomes have suggested that treating depression is cost effective. Gaps in the published literature imply that the impact of depression and antidepressants on occupational outcomes has been understudied. This reflects, in part, the fact that antidepressant studies lasting 4 or 6 weeks are unlikely to capture the impact of treatment on work-related measures. In addition, the current evidence base is fraught with other methodological limitations. The effect of depression on non-paid employment also requires further assessment. In conclusion, the efficacy of antidepressants on work-related outcomes should be measured in clinical trials that have an adequate design and a suitable follow-up period, and included in health technology assessments. Until such studies are available, the evidence base supporting the use of antidepressants will remain incomplete.
authors.affiliation: CATALYST Health Economics Consultants, Northwood, Middlesex HA6 1BN, UK.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Greener
authors.forename: Julian F
authors.initials: JF
authors.lastname: Guest
mesh_terms: D000041:Absenteeism; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D004526:Efficiency; D004651:Employment; D006801:Humans; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents
references.citation: Psychosom Med. 1999 Jan-Feb;61(1):6-17
references.pmid: 10024062
references.citation: Gen Hosp Psychiatry. 2000 May-Jun;22(3):153-62
references.pmid: 10880708
references.citation: Depress Anxiety. 2001;14(1):3-6
references.pmid: 11568977
references.citation: Br J Psychiatry. 2001 Jan;178(1):12-7
references.pmid: 11136204
references.citation: Prim Care. 1991 Jun;18(2):381-96
references.pmid: 1831558
references.citation: Psychiatr Serv. 1999 Sep;50(9):1209-13
references.pmid: 10478909
references.citation: Crisis. 2001;22(2):71-3
references.pmid: 11727897
references.citation: Disabil Rehabil. 2002 Apr 15;24(6):334-40
references.pmid: 12017467
references.citation: Am J Psychiatry. 1978 Nov;135(11):1368-70
references.pmid: 707638
references.citation: Empl Benefits J. 2002 Mar;27(1):16-21
references.pmid: 11859537
references.citation: J Clin Psychiatry. 2000;61 Suppl 6:24-8
references.pmid: 10775021
references.citation: J Am Med Womens Assoc (1972). 2004 Summer;59(3):198-206
references.pmid: 15354373
references.citation: J Psychosom Res. 2002 Oct;53(4):849-57
references.pmid: 12377293
references.citation: JAMA. 2003 Jun 18;289(23):3135-44
references.pmid: 12813119
references.citation: J Occup Environ Med. 2002 Apr;44(4):320-30
references.pmid: 11977418
references.citation: Occup Med (Lond). 1998 Feb;48(2):103-12
references.pmid: 9614769
references.citation: Benefits Q. 2001;17(2):37-48
references.pmid: 11372474
references.citation: Pharmacoeconomics. 1996 May;9(5):430-42
references.pmid: 10160255
references.citation: Psychiatr Serv. 1997 Jan;48(1):59-64
references.pmid: 9117501
references.citation: Acta Psychiatr Scand Suppl. 2000;403:17-25
references.pmid: 11019931
references.citation: J Psychosom Res. 2004 May;56(5):497-502
references.pmid: 15172205
references.citation: Am J Psychiatry. 1997 Oct;154(10):1417-23
references.pmid: 9326825
references.citation: Gen Hosp Psychiatry. 2003 Sep-Oct;25(5):303-10
references.pmid: 12972220
references.citation: Pharmacol Biochem Behav. 1996 Feb;53(2):265-9
references.pmid: 8808130
references.citation: Therapie. 1993 Mar-Apr;48(2):81-8
references.pmid: 8351692
references.citation: Postgrad Med J. 1994;70 Suppl 2:S14-22
references.pmid: 7716097
references.citation: Health Econ. 2002 Apr;11(3):221-31
references.pmid: 11921319
references.citation: J Clin Psychiatry. 1993 Nov;54(11):425-6
references.pmid: 8270585
references.citation: Int Clin Psychopharmacol. 1997 Jan;12(1):19-29
references.pmid: 9179630
references.citation: Eur J Epidemiol. 1997 Jan;13(1):87-93
references.pmid: 9062785
references.citation: Bus Health. 2000 Apr;18(4):48-52, 55
references.pmid: 10915292
references.citation: Soc Psychiatry Psychiatr Epidemiol. 1996 Jan;31(1):3-9
references.pmid: 8821918
references.citation: Arch Gen Psychiatry. 1992 Oct;49(10):761-8
references.pmid: 1417427
references.citation: Health Aff (Millwood). 1999 Sep-Oct;18(5):163-71
references.pmid: 10495604
references.citation: Int Clin Psychopharmacol. 1993 Winter;8(4):319-21
references.pmid: 8277155
references.citation: Med Care. 2002 Sep;40(9):752-60
references.pmid: 12218766
references.citation: Psychol Med. 1997 Jul;27(4):861-73
references.pmid: 9234464
references.citation: J Clin Psychiatry. 2002 Nov;63(11):963-71
references.pmid: 12444808
references.citation: JAMA. 1989 Aug 18;262(7):914-9
references.pmid: 2754791
references.citation: Psychopharmacol Bull. 2002 Summer;36 Suppl 2:103-11
references.pmid: 12490826
references.citation: Am J Psychiatry. 2001 May;158(5):731-4
references.pmid: 11329394
references.citation: J Clin Psychiatry. 1993 Nov;54(11):419-24
references.pmid: 8270584
references.citation: AAOHN J. 1999 Nov;47(11):526-37; quiz 538-9
references.pmid: 10865540
references.citation: J Clin Psychiatry. 2004;65 Suppl 16:27-32
references.pmid: 15575802
references.citation: Encephale. 1994 Sep-Oct;20(5):495-503
references.pmid: 7828512
references.citation: Am J Psychiatry. 1999 Jan;156(1):108-14
references.pmid: 9892305
references.citation: Behav Healthc Tomorrow. 2001 Dec;10(6):10-1
references.pmid: 11795227
references.citation: Arch Gen Psychiatry. 2001 Jan;58(1):55-61
references.pmid: 11146758
references.citation: Acta Psychiatr Scand. 2002 Mar;105(3):164-72
references.pmid: 11939969
references.citation: JAMA. 1990 Nov 21;264(19):2524-8
references.pmid: 2146410
references.citation: J Clin Psychiatry. 1993 Nov;54(11):405-18
references.pmid: 8270583