Mental Strength: Managing and Treating Depression

Everyone gets the blues or feels sad from time to time. However, if a person experiences these emotions intensely or for two weeks or longer, it may signal clinical depression, a condition that requires treatment.

Clinical depression affects the total person—body, feelings, thoughts, and behaviors—and comes in various forms. Some people have a single bout of depression; others suffer recurrent episodes. Still others experience the severe mood swings of bipolar disorder—sometimes called manic-depressive illness—with moods alternating between depressive lows and manic highs.

According to the Gallup-Healthways Well-Being Index, workers in the U.S. who, at some point in their lives, have been diagnosed with depression miss an estimated 68 million additional days of work each year than their counterparts who have not been depressed—resulting in an estimated cost of more than $23 billion in lost productivity annually to U.S. employers.

Depression is not only an issue of work impairment. Fourteen million people in our country know the ravages of clinical depression, with four million of them receiving little benefit from treatment with antidepressant medications. The key is to recognize the symptoms of depression early and to receive appropriate treatment.

Many companies are helping employees with depression by providing training on depressive illnesses for supervisors, employee assistance, and occupational health personnel. Employers are also making appropriate treatment available through employee assistance programs and through company-sponsored health benefits. Such efforts are contributing to significant reductions in lost time and job-related accidents as well as marked increases in productivity.

Today, there is a non-invasive, outpatient treatment called transcranial magnetic stimulation (TMS) that stimulates the nerve cells in the brain.

The procedure, which does not require anesthesia, was approved by the U.S. Food and Drug Administration in 2008.

Research unrelated to TMS has shown that people who suffer from depression have underactive areas in specific parts of their brains.
TMS stimulates that region of the brain with targeted electromagnetic pulsations. Theoretically, these pulses stimulate metabolism and increase the brain’s neurotransmitters, thereby helping alleviate depression.

In order to meet criteria for TMS, patients must have a diagnosis of major depressive disorder, be 18 years of age or older and have failed at least one trial with an antidepressant of adequate dose and duration.

The outpatient procedure begins with a one to two hour initial mapping of the area to be stimulated. Subsequent treatments are approximately
35 minutes, five days a week for six weeks. Patients can return to normal activity immediately after each session. TMS is a safe procedure with minimal to no side effects. The most common side effect of TMS is a mild headache, which is usually limited to the first few days of treatment.

TMS is not meant to take the place of medication or therapy. It is an additional modality to treat depression. According to one TMS patient who had suffered from depression for years, “Worthlessness and hopelessness were the norm.” Today, he has his life back.

While employers and supervisors cannot diagnose depression, they can note changes in work performance and listen to employee concerns. If your company does not have an employee assistance program, ask a counselor for suggestions on how best to approach an employee who they suspect is experiencing work problems that may be related to depression.

For more information about TMS treatment for depression at Centra Medical Group Piedmont Psychiatric Center, call (434) 200-5999.

By Michael Judd, MD
Board-certified Psychiatrist | Medical Director, Centra Medical Group Piedmont Psychiatric Center