Addressing the Worldwide Scourge of Depression

by Timothy Conway, PhD, 2008


At this webpage, we at Rare Leadership Solutions want to inform you about a widespread, dire affliction —and help you alleviate it in your workplace: depressive illness.

Depression is a severe, usually prolonged form of illness interfering with the ability to physically and mentally function, and it leads to significant rates of absenteeism, lost productivity, reduced quality of work, employee turnover, and on-the-job accidents. According to the World Health Organization (WHO), depression is projected to become by the year 2020 the leading cause of disability in the world, and the second leading contributor to the global "burden of disease."

A diagnosis of major depressive disorder is made if an individual has five or more of the following symptoms during the same two-week period. Symptoms may vary from person to person but usually include, according to the NIMH (National Institute of Mental Health):

• Persistent sad, anxious or "empty" feelings
• Feelings of hopelessness and/or pessimism
• Feelings of guilt, worthlessness and/or helplessness
• Irritability, restlessness
• Loss of interest in activities or hobbies once pleasurable, including sex
• Fatigue and decreased energy
• Difficulty concentrating, remembering details and making decisions
• Insomnia, early–morning wakefulness, or excessive sleeping
• Overeating, or appetite loss
• Repeated thoughts of suicide, suicide attempts
• Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment (NOTE: this can also fit the profile of FMS, Fibromyalgia Syndrome, a disease now thought to afflict some 6 million Americans alone, 85% of them women, mostly Caucasian women.)

The NIMH further clarifies the several forms of depressive disorders. The most common are major depressive disorder and dysthymic disorder.

1. Major depressive disorder, also called major depression, shows a combination of symptoms listed above, interfering with a person's ability to work, sleep, study, eat, and enjoy once–pleasurable activities. Major depression is truly disabling and prevents a person from functioning normally. An episode of major depression may occur only once in a person's lifetime, but more often it recurs throughout a person's life, perhaps starting in early childhood.

2. Dysthymic disorder, also called dysthymia, is characterized by long–term (two years or longer) but less severe symptoms that may not disable a person but can prevent one from functioning normally or feeling well. People with dysthymia may also experience one or more episodes of major depression during their lifetimes.

Some forms of depressive disorder exhibit slightly different characteristics than those described above, or may develop under unique circumstances. However, not all scientists agree on how to characterize and define these forms of depression. They include:

3. Psychotic depression, when a severe depressive illness is accompanied by a psychosis, such as a break with reality, hallucinations, and delusions.

4. Postpartum depression, diagnosed when a new mother develops a major depressive episode within one month after delivery. An estimated 10-15% of women experience postpartum depression after giving birth.

5. Seasonal affective disorder (SAD), characterized by the onset of a depressive illness during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer.

6. Bipolar disorder, or manic-depressive illness, not as common as major depression or dysthymia, and characterized by cycling mood changes—from extreme highs or mania period (known as dysthenic bipolar disorder when the mania is agitated, not euphoric) down to extreme lows or depression.

Co-Morbidity of Depression with Other Illnesses

The NIMH further informs that depression often co–exists with other illnesses. "Such illnesses may precede the depression, cause it, and/or be a consequence of it." Other mental illnesses often accompanying depression include the anxiety disorders: post–traumatic stress disorder (PTSD), obsessive–compulsive disorder (OCD), panic disorder, social phobia and generalized anxiety disorder, often accompany depression. [Note: PTSD is experienced as stress, anxiety, haunting memories, flashbacks and nightmares for years or decades after a terrifying event or ordeal, e.g., a violent assault, rape, natural disaster, accident, military combat, or terrorist incident. Research indicates that more than 40% of people with PTSD also had depression at one-month and four-month intervals after the traumatic event, and often much longer intervals.]

Abuse or dependency on alcohol and/or other substances also often co–occurs with depression. Studies show a pervasive co–existence of mood disorders and substance abuse in the U.S. population.

Depression also often co–exists with other serious physical illnesses such as heart disease, stroke, cancer, hiv/aids, diabetes, and Parkinson's disease. People with depression in addition to another serious medical illness tend to have more severe symptoms of both depression and the medical illness, more difficulty adapting to their medical condition, and more medical costs than those who do not have co–existing depression. Research further shows that treating the depression can also help improve the outcome of treating the co–occurring illness.

Causes of Depression?

As to the underlying reasons for depressive illnesses, the NIMH states:

"There is no single known cause of depression. Rather, it likely results from a combination of genetic, biochemical, environmental, and psychological factors. Research indicates that depressive illnesses are disorders of the brain. Brain-imaging technologies, such as magnetic resonance imaging (MRI), have shown that the brains of people who have depression look different than those of people without depression. The parts of the brain responsible for regulating mood, thinking, sleep, appetite and behavior appear to function abnormally. In addition, important neurotransmitters–chemicals that brain cells use to communicate–appear to be out of balance. But these images do not reveal why the depression has occurred. Some types of depression tend to run in families, suggesting a genetic link. However, depression can occur in people without family histories of depression as well."

It is reported elsewhere in the mental health literature that depression can also be caused by stress, trauma, certain medications, abuse of recreational drugs (cocaine, methamphetamine, MDMA), or physical illnesses such as a heart attack, stroke, or cancer. Certain personality traits and family history can also contribute to depression.

Prevalence of Major Depression:

• In any one-year period, some 10% of the U.S. population, or an estimated 24 million American adults, suffer from a depressive illness.
• One of every 4 women and one in 10 men can expect to be diagnosed with some form of depression during their lifetime. This gender difference may be due to the fact that men are less likely to admit depression and doctors less likely to diagnose it.
• Women are almost twice as likely as men to be diagnosed with depression and reasons may include hormonal changes women go through during menstruation, pregnancy, and menopause. Doctors are also more likely to diagnose depression in women.
• Men often experience depression differently than women and may have different ways of coping with the symptoms. Men are more likely to acknowledge having fatigue, irritability, loss of interest in once–pleasurable activities, and sleep disturbances, whereas women are more likely to admit to feelings of sadness, worthlessness and/or excessive guilt

The effects of workplace depression are devastating....

According to results of the Depressive Disorders Study (DDS), completed by the American Productivity Audit in 2002, workers with depression cost employers more than three times the amount associated with lost productivity from all other illness combined.

Several years ago the Journal of the American Medical Association (June 18, 2003) reported “lost productive time (LPT)” costs in the USA alone of $44 billion per year due to workplace depressive illness.

This silent epidemic of depressive illness is growing worse and, according to many experts, will decimate the productive workforce and a viable economy in the USA and elsewhere unless we prudently act now to minimize what has been termed a “clear and present danger” by international mental-health experts.

It is instructive here to see that our Canadian neighbors, with the help of their former Minister of Finance and Ambassador to the U.S., Michael Wilson, have already established a national association comprised of their largest corporations to address this problem (see Their research, frequently cited by the Canadian Mental Health Association, indicates that by the year 2020, depressive illness, if left untreated, will escalate and destroy their economy.

The extensive Global Burden of Disease study, conducted by the World Bank, World Health Organization, and Harvard University School of Public Health and completed in 1996, identified mental illness—specifically depressive illness—as the leading source of human disability. Depressive illness cuts across all cultural, economic and national boundaries. Its harmful effects in the workplace and family life will, if allowed to grow unchecked, soon amplify to such a degree that, according to experts, a viable United States economy will cease to exist.

Depressive illness is thus a business and workplace disability issue with drastic implications for productivity, performance and profits.

Consider some more stunning facts drawn from the major study done by Harvard-World Bank-WHO, along with other studies:

1. Workplace depressive illness is driving up disability rates more than ever within the North American labor force and is a significant business cost and deterrent to productivity.

2. Depressive illness is the leading source of disability worldwide; it is growing faster in the global population than cardiovascular disorders, yet, grievously, it remains poorly researched, detected or treated.

3. The modern global economy is an economy especially based on the mental performance of the "Knowledge Worker." Herein mental health in the labor force factors much like physical health factored in the manufacturing economy.

4. Depressive illness is medically linked to other mental diseases—chiefly anxiety disorders—and myriad physical disorders like heart disease, cancer and diabetes. Yet this information is rarely disseminated nor deployed in defense of employee, executive and workplace health.

5. Depressive illness and ischemic heart disease are estimated to become the leading causes of productive work years lost in the global economy by the year 2020, affecting 20-25% of the working population.

The benefits to business of early treatment of depression can be huge. The National Institute of Mental Health concludes that more 80% of those who get treatment for depression show improvement. The Canadian Mental Health Association reports that, for each employee who gets access to treatment, employers save between $5,000 and $10,000 per year in the cost of medications, sick leave, and wage replacement. Newer, less costly strategies that complement or even replace standard SSRI and SNRI antidepressant drugs can increase these savings by even more.

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At Rare Leadership Solutions, we have three major objectives here concerning this epidemic of depression:

1. To increase understanding among executives, managers, employees, their families, business leaders, opinion leaders, legislators, and health care providers regarding workplace depressive illness, its links to other chronic diseases, and its causes: chiefly, chemical imbalances in the brain and mal-illumination — inadequate levels of biologically beneficial lighting. (Mal-illumination is a condition afflicting the Western world like malnutrition afflicts the Third World.)

2. To help you eliminate sources of workplace stress contributing to or aggravating depressive illness in the workforce.

3. To pre-empt this escalating health crisis and reduce the disabling, even deadly effects of depressive illness through prevention, early detection and effective treatment.

For treatment, we help you understand not only the pros and cons of well-known pharmaceutical medications (SSRI and SNRI drugs, MAO inhibitors) and psychotherapeutic approaches (cognitive therapy, etc.), we go much further to inform you about proven new/old treatments far less widely known and far less costly—especially light therapy for mal-illumination and circadian rhythm problems (click on link to read an informative essay on light therapy).

Light therapy is now strongly recommended by the NIMH and other mental health associations as a "treatment of choice" for major depressive illness, not just SAD (Seasonal Affective Disorder).

Significantly, light therapy is also now being urged for treating many physical diseases, too— including osteoporosis, diabetes, cancers, arthritis— due to Vitamin D deficiency. (Well known to experts but not to the general public, Vitamin D deficiency is another major health epidemic in the U.S. that is wreaking havoc for business in terms of absenteeism, lost productivity, and medical insurance costs.)

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All of us can work together to address the severe problem of workplace depressive illness. We no longer have the luxury of waiting to see the full-scale disaster that is predicted by medical science but is therapeutically quite preventable.

Let Rare Leadership Solutions help you achieve radiant good health for you and your organizational team. This is not just about employees. A Wall Street Journal “In the Lead” column by Carol Hymowitz, “More CEOs Seek Therapy” (June 22, 2004), reveals that CEOs are breaking through the stigma of mental illness to complain of debilitating mental illness—chiefly depression (triggered in part by the extraordinary job pressures and lonely isolation at the top)—and to get treatment to become more healthy and effective.

We are happy to provide you low-cost consultations (customized to fit your time schedule) on how to improve both the health of your team and your corporate bottom line. A wealth of expertise is available to help you to make the easy changes to ward off the scourge of workplace depressive illness with its related physical and mental diseases and hefty financial costs.

Feel free to call or email anytime about how your corporate team can be empowered to function at its highest, healthiest level.

Wishing you all the very best...

Timothy Conway, Ph.D.
Director, Rare Leadership Solutions
Phone: 805-564-2125
Email: conwayt324 @ (no spaces)