Should antidepressants be the first course of treatment for mild to moderate depression?

Not necessarily, said Peter Gove, innovation leader for health management at Green Shield Canada, during the 2017 Healthy Outcomes conference in June.

“Everyone experiences sadness from time to time. It’s normal,” he said. “Sadness is often a temporary reaction to difficult life events. It’s not illness.”

Yet according to a 2014 editorial in the BMJ, the definition of what constitutes depression has widened so much in recent years that it captures just about everyone, he said. “As a result, we’re over-medicating people like crazy,” said Gove.

Read: The promises and perils of personalized medicine and antidepressants

When Green Shield Canada looked at its drug data, it found only 15 per cent of employees on antidepressants were receiving the correct treatment. The other 85 per cent either received too low a dosage or didn’t stay on the medication because of side-effects or other issues. “We concluded many people probably did not need, or want, medication,” said Gove.

Gove explained that while medication does help people with severe depression, they’re usually too unwell to work. In the workplace, it’s mild or moderate depression that’s having an enormous impact on productivity, drug plans and disability claims. But if most employees experiencing depressive symptoms are receiving unnecessary or ineffective medication, what’s the solution?

“We need to get them psychotherapy,” said Gove. “That’s challenging, because good, evidence-based psychotherapy is not that available in our health-care system today. Yet psychotherapy results in better outcomes and prevents relapses.”

According to Gove, one of the most effective approaches for treating depression is cognitive behavioural therapy. It helps people understand their thought patterns and challenges them to change their behaviour. However, it can be costly. But there’s a new approach that’s both effective and more affordable: low-intensity cognitive behavioural therapy.

Read: Healthy Outcomes: Setting the standard for mental health

“This involves brief, very structured interventions delivered by paraprofessionals, rather than psychologists or social workers,” said Gove. “The employee then works with this coach over the phone using manuals. The outcomes are terrific, and it’s cost-effective.”

Gove presented some other ways organizations can support employees struggling with depression. They include:

  • Regular check-ins between employees and their managers;
  • More flexible work schedules;
  • Support with workloads;
  • Quiet places for timeouts;
  • Reducing cognitive demands;
  • Peer support programs; and
  • Support through employee assistance programs.

“We need to realize that depression is a thought disorder. People are not thinking well,” said Gove.

“As a result, they often don’t recognize they have an illness and so don’t ask for help. But identifying people who may be at risk for, or experiencing, mild depression and getting them appropriate help not only helps keep them at work but can change the course of their illness.”

Read more coverage from the 2017 Healthy Outcomes conference

Copyright © 2019 Transcontinental Media G.P. Originally published on

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