Mental Health Conditions are on the Increase…and Shift Working Companies Should Take Notice
According to a report in the August 2009 issue of Archives of General Psychiatry, one of the JAMA/Archives journals, treatment for mental health conditions is becoming more common in the US. The article has several explanations for why this may be, including patient and medical providers having a broader understanding of the need for mental health treatment, recent significant outreach by nonprofit groups promoting mental health care, and the growing public acceptance of mental health treatments. A related outcome – antidepressants are now the most commonly prescribed class of medications in the US.
Adding to the costs of treating mental health conditions, a large study (Goetzel et al. 1998) found that overall health care expenditures are higher among depressed people (70% higher) and those under stress (46% higher), as compared with healthy people. Depression is a common condition, affecting nearly 15 million Americans a year, and one in six in a lifetime. Watch for sleep disturbances, changes in appetite, reduced enjoyment in previously pleasurable activities, feeling of worthlessness, reduced energy, problems concentrating, or thoughts of death. These symptoms need to be present almost all day nearly every day and they need to cause significant concern or difficulty in one’s life.
Some studies have found an increase in the prevalence of depression among shift workers vs. day-time workers, especially related to rotating three-shift workers and permanent night workers. Some studies also report that mental health problems also plague workers who rotate from shift work to days. Depression has been connected to disturbances of the circadian rhythms (‘biological rhythms’ with durations of approximately 24 hours). And, many of the drugs used to treat depression impact sleep. Lack of sleep causes fatigue, and tiredness can cause or exacerbate depression. It’s a vicious cycle that can be very difficult to get beyond.
The most common treatment for depression is counseling and drugs, with a combination of the two working best. Most treatment plans do not include a sleep disorder assessment, but they should, especially if the afflicted person is a shift worker. The intersection of mental health issues and sleep disorders is a broad one. Before treating depression with drugs, non-pharmaceutical solutions for sleep disorders should be ruled out. If the sleep disorder is sleep apnea, the treatment will most likely be use of a continuous positive airway pressure (CPAP) machine or surgery; the related depression may continue or go away after the sleep apnea is treated. If the diagnosed sleep disorder treatment is restless leg syndrome or insomnia for example, the drugs of choice for these ailments should be assessed along with the drugs used to treat any remaining depression so they are complementary and not working against each other.
Treating any remaining depression is not easy. Often it is necessary to try multiple drugs before finding the right one (only 60% of those treated are prescribed a drug that works on the first try). And, compounding the problem of finding the right drug is the fact that antidepressants take a very long time to work. Most people are used to speedy results from drugs, but it may take eight to twelve weeks to know if certain antidepressants are working or not. A large study funded by the National Institute of Mental Health (2006), found that 37% of patients went into remission after the first round of treatment, 31% after the second, 14% after the third, and 13% after the fourth. And, a third of patients in the study were still struggling with depression after four treatment cycles.
It’s worth trying and waiting for the right treatment. Not do patients feel better when properly treated but, depressions can and do recur, so it’s good to know what treatment works for the long term. One study found nearly a 50% recurrence rate.
Tags: depression, fatigue, Health Care, Human Capital, mental health, restless leg syndrome, shift work, sleep disorders, stress
