Managed Care - March 2008 - (Page M3) INTRODUCTION The Inextricable Link of Mind and Body ALBERT TZEEL, MD, MHSA Vice President and Chief Medical Officer, Humana Wisconsin T he 2007 Medical Director Colloquy explored the ence to antidepressant therapy is associated with a reducinextricable link of mind and body. We examined tion in medical costs for treating these comorbid condinumerous challenges medical directors face in tions, ranging from 6 to 20 percent over the course of 1 managing populations with chronic deyear (Katon 2005). pression or other behavioral health condiAlthough more patients now are being tions and associated comorbidities. treated for depression than in years past Major depressive disorder (MDD) is a (Kessler 2003), they are not necessarily recommon chronic condition in the United ceiving the most effective treatment; treatStates, with a lifetime prevalence of 16.2 ment entails not just diagnosing the condipercent and a 12-month prevalence of 6.6 tion and prescribing a therapy, but also percent (Kessler 2003). This prevalence rate monitoring the patient’s progress and adextends to employed populations, such that justing or adding therapies as needed (Belin the typical U.S. workforce, 6 of every maker 2008). It is likely, then, that effective 100 employees will have MDD. Between treatment of depression in primary care absenteeism and presenteeism, each of — the setting in which most patients with those workers will lose 27 workdays per depression are seen — will provide multiALBERT TZEEL, MD, year (Kessler 2006). Across the U.S. workple benefits for payers and patients alike MHSA force, this degree of morbidity annually re(Wang 2006). sults in 225 million lost workdays valued at $37 billion This publication provides information and insights in salary-equivalent lost productivity. from a roster of experts that can help elevate the standard Depression is comorbid with numerous behavioral of care for patients with depression. and physical disorders, and understanding the link beReferences tween them is an important challenge that health care Belmaker RH, Agam G. Major depressive disorder. N Engl J Med. professionals must work together to address. Patients 2008;358:55–68. with MDD may have a concomitant anxiety disorder, imKaton W, Cantrell CR, Sokol MC, et al. Impact of antidepressant pulse control disorder, or substance abuse issues (Kessler drug adherence on comorbid medication use and resource 2003). Depression often is comorbid with such chronic utilization. Arch Intern Med. 2005;165:2497–2503. Kessler RC, Berglund P, Demler O, et al.; National Comorbidity physical conditions as diabetes, cancer, and rheumatoid Survey Replication. The epidemiology of major depressive arthritis, and is intertwined with cardiovascular diseases disorder: results from the National Comorbidity Survey such that it may contribute to their development, or Replication (NCS-R). JAMA. 2003;289:3095–3105. complicate recovery from them, or both. Moreover, deKessler RC, Akiskal HS, Ames M, et al. Prevalence and effects of pression has been associated with noncompliance with mood disorders on work performance in a nationally representative sample of U.S. workers. Am J Psychiatry. antihypertensive medications (Wang 2002). Conversely, 2006;163:1561–1568. patients who adhere to antidepressant drug therapy are Wang PS, Bohn RL, Knight E, et al. Noncompliance with antialso more likely to comply with treatment for any other hypertensive medications: the impact of depressive sympcomorbid chronic condition they may have, including ditoms and psychosocial factors. J Gen Intern Med. abetes, coronary artery disease, and dyslipidemia (Katon 2002;17:504–511. Wang PS, Patrick A, Avorn J, et al. The costs and benefits of en2005). The benefits to promoting adherence to a medicahanced depression care to employers. Arch Gen Psychiatry. tion regimen for depression has a cascade effect: Adher2006;63:1345–1353. SUPPLEMENT / 2007 MEDICAL DIRECTOR COLLOQUY 3
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.