Do antidepressants reduce the burden imposed by depression on employers?
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.
Greener
Mark J
MJ
CATALYST Health Economics Consultants, Northwood, Middlesex HA6 1BN, UK.
Guest
Julian F
JF
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
D000928:Antidepressive Agents
Psychosom Med. 1999 Jan-Feb;61(1):6-17
10024062
Gen Hosp Psychiatry. 2000 May-Jun;22(3):153-62
10880708
Depress Anxiety. 2001;14(1):3-6
11568977
Br J Psychiatry. 2001 Jan;178(1):12-7
11136204
Prim Care. 1991 Jun;18(2):381-96
1831558
Psychiatr Serv. 1999 Sep;50(9):1209-13
10478909
Crisis. 2001;22(2):71-3
11727897
Disabil Rehabil. 2002 Apr 15;24(6):334-40
12017467
Am J Psychiatry. 1978 Nov;135(11):1368-70
707638
Empl Benefits J. 2002 Mar;27(1):16-21
11859537
J Clin Psychiatry. 2000;61 Suppl 6:24-8
10775021
J Am Med Womens Assoc (1972). 2004 Summer;59(3):198-206
15354373
J Psychosom Res. 2002 Oct;53(4):849-57
12377293
JAMA. 2003 Jun 18;289(23):3135-44
12813119
J Occup Environ Med. 2002 Apr;44(4):320-30
11977418
Occup Med (Lond). 1998 Feb;48(2):103-12
9614769
Benefits Q. 2001;17(2):37-48
11372474
Pharmacoeconomics. 1996 May;9(5):430-42
10160255
Psychiatr Serv. 1997 Jan;48(1):59-64
9117501
Acta Psychiatr Scand Suppl. 2000;403:17-25
11019931
J Psychosom Res. 2004 May;56(5):497-502
15172205
Am J Psychiatry. 1997 Oct;154(10):1417-23
9326825
Gen Hosp Psychiatry. 2003 Sep-Oct;25(5):303-10
12972220
Pharmacol Biochem Behav. 1996 Feb;53(2):265-9
8808130
Therapie. 1993 Mar-Apr;48(2):81-8
8351692
Postgrad Med J. 1994;70 Suppl 2:S14-22
7716097
Health Econ. 2002 Apr;11(3):221-31
11921319
J Clin Psychiatry. 1993 Nov;54(11):425-6
8270585
Int Clin Psychopharmacol. 1997 Jan;12(1):19-29
9179630
Eur J Epidemiol. 1997 Jan;13(1):87-93
9062785
Bus Health. 2000 Apr;18(4):48-52, 55
10915292
Soc Psychiatry Psychiatr Epidemiol. 1996 Jan;31(1):3-9
8821918
Arch Gen Psychiatry. 1992 Oct;49(10):761-8
1417427
Health Aff (Millwood). 1999 Sep-Oct;18(5):163-71
10495604
Int Clin Psychopharmacol. 1993 Winter;8(4):319-21
8277155
Med Care. 2002 Sep;40(9):752-60
12218766
Psychol Med. 1997 Jul;27(4):861-73
9234464
J Clin Psychiatry. 2002 Nov;63(11):963-71
12444808
JAMA. 1989 Aug 18;262(7):914-9
2754791
Psychopharmacol Bull. 2002 Summer;36 Suppl 2:103-11
12490826
Am J Psychiatry. 2001 May;158(5):731-4
11329394
J Clin Psychiatry. 1993 Nov;54(11):419-24
8270584
AAOHN J. 1999 Nov;47(11):526-37; quiz 538-9
10865540
J Clin Psychiatry. 2004;65 Suppl 16:27-32
15575802
Encephale. 1994 Sep-Oct;20(5):495-503
7828512
Am J Psychiatry. 1999 Jan;156(1):108-14
9892305
Behav Healthc Tomorrow. 2001 Dec;10(6):10-1
11795227
Arch Gen Psychiatry. 2001 Jan;58(1):55-61
11146758
Acta Psychiatr Scand. 2002 Mar;105(3):164-72
11939969
JAMA. 1990 Nov 21;264(19):2524-8
2146410
J Clin Psychiatry. 1993 Nov;54(11):405-18
8270583