![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by dj on July 18, 2000, at 20:25:19
May 18, 2000
Use Both Drugs and Therapy, Advises Study on Depression
By ERICA GOODE, NY Times
When it comes to treating depression, those who espouse drugs as the most effective therapy and those who champion psychotherapy have often been at war. But a new study indicates that at least for patients with chronic depression, a combination of antidepressants and psychotherapy works significantly better than either treatment alone.The study, appearing in today's issue of The New England Journal of Medicine, is the largest to compare drugs and psychotherapy for chronic depression.
After 12 weeks of treatment, the response among the patients given only an antidepressant and the patients who received 16 to 20 sessions of psychotherapy was about the same: 55 percent in the drug group and 52 percent in the psychotherapy group showed improvement.
But the response rates jumped sharply for the subjects given both the drug and psychotherapy, with 85 percent showing significant improvement in their symptoms. A total of 519 patients, at 12 academic medical centers across the country, completed the course of treatment for the study.
As in other studies, patients taking the antidepressant improved more quickly during the first few weeks of treatment than those receiving psychotherapy. But by the 12th and final week, the researchers found, patients in the psychotherapy group had caught up.
The study's lead investigator, Dr. Martin B. Keller, chairman of psychiatry at Brown University Medical School, said about 5 percent of Americans suffered from chronic depression, a condition that can persist for years. On average, patients in the study reported having suffered from some form of depression for more than two decades.
The study was financed by Bristol-Myers Squibb, which makes Serzone, the antidepressant used in the research. All but one of the 12 principal authors of the study have consulted for, received honorariums from or had other financial dealings with the company, and with other companies that make antidepressants.
Serzone was used, Dr. Keller said, because it appears less likely than some other drugs to produce sexual dysfunction as a side effect, and because it aids sleep, an advantage for depressed patients who often have trouble sleeping. Cognitive behavioral analysis, the form of psychotherapy used in the study, was developed by Dr. James P. McCullough, a psychologist at Virginia Commonwealth University who was a co-author in this research.
The method, the journal's report said, "teaches patients to focus on the consequences of their behavior" and uses a "social problem-solving" approach to interpersonal relationships.
Dr. Robert J. DeRubeis, an associate professor of psychology at the University of Pennsylvania, said the new study was significant, both because it showed the two treatments to be equivalent in effectiveness and because it demonstrated the additional benefits of combining them.
But Dr. DeRubeis added that many people were likely to receive one form of treatment or the other, not both, for various reasons, including cost considerations, restrictions on insurance coverage, drug side effects and personal preference.
Still, other researchers said the fact that patients receiving both drugs and psychotherapy were also more likely to have a complete remission of their symptoms should encourage managed care companies to foot the bill for combined treatment. Studies indicate that the more thoroughly a patient recovers from depression, the less likely a relapse.
Posted by ksvt on July 20, 2000, at 7:32:59
In reply to Use Both Drugs and Therapy, Advises Study on Depre, posted by dj on July 18, 2000, at 20:25:19
> May 18, 2000
>
> Use Both Drugs and Therapy, Advises Study on Depression
>
> By ERICA GOODE, NY Times
>
> When it comes to treating depression, those who espouse drugs as the most effective therapy and those who champion psychotherapy have often been at war. But a new study indicates that at least for patients with chronic depression, a combination of antidepressants and psychotherapy works significantly better than either treatment alone.
>
> The study, appearing in today's issue of The New England Journal of Medicine, is the largest to compare drugs and psychotherapy for chronic depression.
>
> After 12 weeks of treatment, the response among the patients given only an antidepressant and the patients who received 16 to 20 sessions of psychotherapy was about the same: 55 percent in the drug group and 52 percent in the psychotherapy group showed improvement.
>
> But the response rates jumped sharply for the subjects given both the drug and psychotherapy, with 85 percent showing significant improvement in their symptoms. A total of 519 patients, at 12 academic medical centers across the country, completed the course of treatment for the study.
>
> As in other studies, patients taking the antidepressant improved more quickly during the first few weeks of treatment than those receiving psychotherapy. But by the 12th and final week, the researchers found, patients in the psychotherapy group had caught up.
>
> The study's lead investigator, Dr. Martin B. Keller, chairman of psychiatry at Brown University Medical School, said about 5 percent of Americans suffered from chronic depression, a condition that can persist for years. On average, patients in the study reported having suffered from some form of depression for more than two decades.
>
> The study was financed by Bristol-Myers Squibb, which makes Serzone, the antidepressant used in the research. All but one of the 12 principal authors of the study have consulted for, received honorariums from or had other financial dealings with the company, and with other companies that make antidepressants.
>
> Serzone was used, Dr. Keller said, because it appears less likely than some other drugs to produce sexual dysfunction as a side effect, and because it aids sleep, an advantage for depressed patients who often have trouble sleeping. Cognitive behavioral analysis, the form of psychotherapy used in the study, was developed by Dr. James P. McCullough, a psychologist at Virginia Commonwealth University who was a co-author in this research.
>
> The method, the journal's report said, "teaches patients to focus on the consequences of their behavior" and uses a "social problem-solving" approach to interpersonal relationships.
>
> Dr. Robert J. DeRubeis, an associate professor of psychology at the University of Pennsylvania, said the new study was significant, both because it showed the two treatments to be equivalent in effectiveness and because it demonstrated the additional benefits of combining them.
>
> But Dr. DeRubeis added that many people were likely to receive one form of treatment or the other, not both, for various reasons, including cost considerations, restrictions on insurance coverage, drug side effects and personal preference.
>
> Still, other researchers said the fact that patients receiving both drugs and psychotherapy were also more likely to have a complete remission of their symptoms should encourage managed care companies to foot the bill for combined treatment. Studies indicate that the more thoroughly a patient recovers from depression, the less likely a relapse.dj - I tried to post something on this the other day but it never showed up. The one thing this article doesn't address if the length of psychotherapy, which is a real issue for insurance companies and HMOs. If you suffer from chronic recurrent depression, you're probably on the drugs for life plan, as it has been explained to me, to lessen the frequency and duration of subsequent episodes. I clearly do better with both drugs and therapy, maybe in part because I've never felt that I was fully responsive to drug therapies, but while I've sort of resigned myself to drugs as a pretty permanent part of my landscape, I also worry that I can't really visualize an end to therapy. I'm sure some insurance company would love to use me as an example of why they don't like footing the bill for therapy. I think it helps me function better but I'm not convinced it's bringing me closer to a lasting remission.
Posted by dj on July 20, 2000, at 12:13:07
In reply to Re: Use Both Drugs and Therapy, Advises Study on Depre, posted by ksvt on July 20, 2000, at 7:32:59
> ...I clearly do better with both drugs and therapy, maybe in part because I've never felt that I was fully responsive to drug therapies, but while I've sort of resigned myself to drugs as a pretty permanent part of my landscape, I also worry that I can't really visualize an end to therapy. I'm sure some insurance company would love to use me as an example of why they don't like footing the bill for therapy. I think it helps me function better but I'm not convinced >it's bringing me closer to a lasting remission.
kvst,
I empathize with your dilemna. One advantage of sorts we Canadians have is that many, but not all, counselling resources are funded by our medicare system. What is offered locally can vary from health region to health region, however. So some offer a more integrated approach (which I believe is the key, based on my own experiences, conversations and readings).
In my area funding covers psychiatrists and not psychologists (though in nearby areas this varies) and as I believe the medical model and mindset is insufficient I was very cautious in choosing to connect with a psychiatrist until after careful research I was referred to one (a couple of years ago) who focuses on short-term interventions (approx. 12 sessions - my preference then and now)
After having to endure a waiting list at a critical juncture we met for video-taped sessions which Dr. A. would review after the fact, I believe. He pointed out contradictory behaviour patterns he observed at times and his manner was I believe more direct and immediate than perhaps some of his traditonal peers. He also encouraged me to do the therapy without ADs. However as I was hitting the wall around that time, I reluctantly decided to go for ADs, also which I chose to do on a short term basis because of their negative impacts overweighing the positive after a time.
I eventually wound up my 12 or so sessions with Dr. A. and left feeling better, still somewhat out of sync. but having experienced some progress. In addition to my sessions with him, which I did a few more of at another time before he left to teach at an eastern univ., I also briefly enrolled in an outpatients program at a mental health unit in a nearby health region based on feedback from a friend. In a later written critique of this program I described it as a "factory model". Though it did have some good elements it was very much a paternalistic command and control model on many levels.
I left that when accepted into the initial mind-body research program put on by the Tzu-Chi Institute for Complimentary and Alternative Medicine (http://www.tzu-chi.bc.ca/)which was somewhat similar to the program described by Dr. Jon Kabat-Zin in his very, good book "Full Catastrophe Living". This program was also very much informed by the philsophies of Dr. Andrew Weil ("Spontaneous Healing", "8 Weeks to Optimumn Health, etc.) whose works I was introduced to by the co-ordinating physician and whose ideas I have come to deeply respect (both Weils and the physician, the former who you can find out more about at http://www.drweil.com/).
The facilitator for the mind-body research program trained at PD Seminars (http://www.pdseminars.com) where I had met some of them when participating in their intial "Disengaging Depression" workshop, which was also very much a respectful, integrative, educative, learner-centred approach. It took place over 5 concentrated days in a wonderful resort setting, whereas the mind-body program took place over 12 weeks in one-day sessions which included a range of folks and ages with a range of ailments including cancers, AIDs, various palsies, drug addictions, etc...
All of these and many other experiences and learnings (many of which I have noted on this board) have contributed to, aided and abetted my healing to the point where I've become pretty adapt at identifying the sources of my dis-ease(s) and dealing with them in a systematic fashion before things get dangerous for me and my health gets severely out of whack.
Yoga is an aid, as I've noted elsewhere, hot baths, deep relaxation, careful attention to what I eat and doing regular exercise, paying careful attention to what goes into and out of my mouth and mind and how it impacts me and others. My experiences here on PB have contributed to those learnings as well and continue to...
My point being that depression is a multi-faceted challenge that can take a lot of careful and compassionate attention to deal with, amidst the many distractions and potential stressors we all face. The challenge is to remain focused on what works and build on that, using what ever useful resources you can tap into, given your specific circumstances. For me to a large degree it was about finding meaning, purpose, joy and compassion amidst all of this morass, which surrounds, astounds and deeply dismays me at times.
It's an ongoing challenge but one that I've learned that I'm up to as I am sure that you are too!! As one of my many wall posters sometimes reminds me when I'm paying attention to it: "It makes all the difference whether one sees darkness through the light or brightness through the shadows." Here's wishing you and everyone here lots of brightness!!!
Namaste!
dj
Posted by ksvt on July 21, 2000, at 7:30:30
In reply to Re: Use Both Drugs and Therapy, - ksvt, posted by dj on July 20, 2000, at 12:13:07
> > ...I clearly do better with both drugs and therapy, maybe in part because I've never felt that I was fully responsive to drug therapies, but while I've sort of resigned myself to drugs as a pretty permanent part of my landscape, I also worry that I can't really visualize an end to therapy. I'm sure some insurance company would love to use me as an example of why they don't like footing the bill for therapy. I think it helps me function better but I'm not convinced >it's bringing me closer to a lasting remission.
>
> kvst,
>
> I empathize with your dilemna. One advantage of sorts we Canadians have is that many, but not all, counselling resources are funded by our medicare system. What is offered locally can vary from health region to health region, however. So some offer a more integrated approach (which I believe is the key, based on my own experiences, conversations and readings).
>
> In my area funding covers psychiatrists and not psychologists (though in nearby areas this varies) and as I believe the medical model and mindset is insufficient I was very cautious in choosing to connect with a psychiatrist until after careful research I was referred to one (a couple of years ago) who focuses on short-term interventions (approx. 12 sessions - my preference then and now)
>
> After having to endure a waiting list at a critical juncture we met for video-taped sessions which Dr. A. would review after the fact, I believe. He pointed out contradictory behaviour patterns he observed at times and his manner was I believe more direct and immediate than perhaps some of his traditonal peers. He also encouraged me to do the therapy without ADs. However as I was hitting the wall around that time, I reluctantly decided to go for ADs, also which I chose to do on a short term basis because of their negative impacts overweighing the positive after a time.
>
> I eventually wound up my 12 or so sessions with Dr. A. and left feeling better, still somewhat out of sync. but having experienced some progress. In addition to my sessions with him, which I did a few more of at another time before he left to teach at an eastern univ., I also briefly enrolled in an outpatients program at a mental health unit in a nearby health region based on feedback from a friend. In a later written critique of this program I described it as a "factory model". Though it did have some good elements it was very much a paternalistic command and control model on many levels.
>
> I left that when accepted into the initial mind-body research program put on by the Tzu-Chi Institute for Complimentary and Alternative Medicine (http://www.tzu-chi.bc.ca/)which was somewhat similar to the program described by Dr. Jon Kabat-Zin in his very, good book "Full Catastrophe Living". This program was also very much informed by the philsophies of Dr. Andrew Weil ("Spontaneous Healing", "8 Weeks to Optimumn Health, etc.) whose works I was introduced to by the co-ordinating physician and whose ideas I have come to deeply respect (both Weils and the physician, the former who you can find out more about at http://www.drweil.com/).
>
> The facilitator for the mind-body research program trained at PD Seminars (http://www.pdseminars.com) where I had met some of them when participating in their intial "Disengaging Depression" workshop, which was also very much a respectful, integrative, educative, learner-centred approach. It took place over 5 concentrated days in a wonderful resort setting, whereas the mind-body program took place over 12 weeks in one-day sessions which included a range of folks and ages with a range of ailments including cancers, AIDs, various palsies, drug addictions, etc...
>
> All of these and many other experiences and learnings (many of which I have noted on this board) have contributed to, aided and abetted my healing to the point where I've become pretty adapt at identifying the sources of my dis-ease(s) and dealing with them in a systematic fashion before things get dangerous for me and my health gets severely out of whack.
>
> Yoga is an aid, as I've noted elsewhere, hot baths, deep relaxation, careful attention to what I eat and doing regular exercise, paying careful attention to what goes into and out of my mouth and mind and how it impacts me and others. My experiences here on PB have contributed to those learnings as well and continue to...
>
> My point being that depression is a multi-faceted challenge that can take a lot of careful and compassionate attention to deal with, amidst the many distractions and potential stressors we all face. The challenge is to remain focused on what works and build on that, using what ever useful resources you can tap into, given your specific circumstances. For me to a large degree it was about finding meaning, purpose, joy and compassion amidst all of this morass, which surrounds, astounds and deeply dismays me at times.
>
> It's an ongoing challenge but one that I've learned that I'm up to as I am sure that you are too!! As one of my many wall posters sometimes reminds me when I'm paying attention to it: "It makes all the difference whether one sees darkness through the light or brightness through the shadows." Here's wishing you and everyone here lots of brightness!!!
>
> Namaste!
>
> djdj - thanks for the response. I'm rather in awe that you would allow yourself to be videotaped. I assume you didn't have to watch the tapes. I struggle with the issue of how much of what I go through is triggered by biological factors, and how much by psychological. I have this theory, that does me no justice, that I ought to be able to control my depressions much better than I do, and that since I don't very well, it represents a real lack of will on my part. Its as if depression is this huge weight you carry around, and while it is exhausting to bear, if you expended more energy, you could lift it off. It doesn't help that I have so few factors existing in my life which would explain the frequency and severity of my depressed states. You can spend very little time on this board to be reminded how tough some folks' struggles have been and what horrible things they have had to endure. It's quite humbling. Anyway, I admire the energy you have obviously devoted to dealing with your own struggles, and appreciate the words of encouragement.
Posted by dj on July 21, 2000, at 11:08:54
In reply to Re: Use Both Drugs and Therapy, - ksvt, posted by ksvt on July 21, 2000, at 7:30:30
> dj - thanks for the response. I'm rather in awe that you would allow yourself to be videotaped. I assume you didn't have to watch >the tapes.I didn't watch those tapes, though I did sign an agreement about their usage. It's a valuable tool, I believe, for perhaps helping a counsellor pick up on things they may have missed.
I have been video and audio-taped in group dynamic exercises and have learned from re-listening and re-viewing those. I commend the possibility to you and others. Interesting to hear or see yourself, via those media.
>I struggle with the issue of how much of what I go through is triggered by biological factors, and how much by psychological. I have this theory, that does me no justice, that I ought to be able to control my depressions much better than I do, and that since I don't very well, it
> represents a real lack of will on my part.It's tough teasing out the distinctions and what environmental triggers may be. The book "Undoing Depression" (http://www.undoingdepression.com) is a good resource on this issue.
I've quoted the following elsewhere on PB and I believe it to be a profoundly important context to consider:
"…as the evidence in this chapter makes abundantly clear, depression is a genetic disorder of being vulnerable to a stressful environment."
Robert M. Sapolosky, Why Zebras Don’t Get Ulcers: An Updated Guide to Stress, Stress-Related Diseases, and Coping, 1998
A friend who has struggled with depression, as well, commented that he considered it the best definition of depression he has read anyplace. And he's a pretty thorough guy. The following article in one of Canada's newspapers today also reinforces this view.Worker stress costing economy billions, panel warns
LOST PRODUCTIVITY
An estimated 10% of the work force is suffering from depression,which often goes undiagnosed and untreated, a report by the Business and Economic Roundtable on Mental Health says.
VIRGINIA GALT
Workplace Reporter, Globe and Mail
Friday, July 21, 2000Toronto -- E-mail overload, cutthroat office politics and longer work weeks are pushing some employees over the edge, costing the Canadian economy billions of dollars in lost productivity, a panel of business leaders warned yesterday.
The Business and Economic Roundtable on Mental Health said in a report that, at any given time, an estimated 10 per cent of the work force is suffering from depression, "a pervasive and treacherous illness" that often goes undiagnosed and untreated.
Employees are generally afraid to report mental health problems for fear of being stigmatized, the panel said, and employee assistance plans are underused because of "widespread employee fears of breakdowns in confidentiality."
Change has to come from the top, said former federal finance minister Michael Wilson, chairman of the mental health roundtable and newly appointed chief executive officer of RT Capital Management Inc.
He said he knows of one high-profile CEO who boasts that he does not suffer from stress -- he causes it.
Mr. Wilson's reasons for volunteering to serve on the roundtable, formed two years ago, are deeply personal. His 29-year-old son, Cameron, a successful businessman who suffered from debilitating depression, committed suicide in 1995.
But quite apart from the personal heartache, there are practical business reasons for improving the overall mental health of Canadians, he said at a news conference in Toronto.
"We live in an information economy, it's a brain-based economy, and a healthy mind is very important to the successful operation . . . of the economy," Mr. Wilson said.
Another roundtable member, Colum Bastable, CEO of Royal LePage Ltd., said employers who do not treat their workers well risk losing them to illness or to the competition.
Problems with increased workload can often be eased by clearer communication about priorities, he said. "It's not rocket science."
In a climate of increased competitive pressures, the onus is on employers to create a culture where staff can seek confidential help with health problems, Mr. Bastable said.
Bill Wilkerson, president of the roundtable and senior counsel with communications firm GPC Canada, said stress-related disorders cost the economy more than strikes, plant shutdowns or product defects.
"Depression is by far the leading cause of disability today. . . . We are also seeing people today working harder and longer, but not more productively," said Mr. Wilkerson, former CEO of insurer Liberty Health.
The roundtable is a volunteer organization of senior business executives and health professionals concerned about mental health issues, Mr. Wilkerson said. It does not receive government funding, but is associated with public institutions such as Hamilton's McMaster University. GPC Canada has donated office space and aims to give widespread distribution to the panel's first report, the result of 18 months of preparation and research by Mr. Wilson, Mr. Bastable, Mr. Wilkerson and psychiatrist Russell Joffe, dean of health sciences at McMaster.
With yesterday's report, the roundtable embarked on a public information campaign aimed at educating CEOs about the impact of stress on their workers. The panel outlined some of the steps employers can take to ease the pressure.
Early detection and referrals to treatment are key, Mr. Wilkerson said. If an employee complains that he or she is overworked, the boss should not respond by saying "join the club."
Increased volumes of E-mail, voice mail, and longer office hours are contributing heavily to stress levels, he said.
Employers should install filtering devices on e-mail and voice mail systems to cut down on junk mail, said Mr. Wilkerson, who knows of people who delay going to work in the morning because "they don't want to see that blinking light."
The roundtable report said a principal cause of stress among employees is a "prolonged sense . . . of constant catchup, interruption and distraction.
"Over time, such stress can trigger mental distress, which may further evolve to a medical condition among some. Individuals experience stress when they are forced to spend hours upon hours digging through electronic messages -- some trivial and some relevant to their work -- which build up overnight, during the day or even through the lunch break," the report said.
"E-mail, in this form, contributes to the 24-hour workday."
The roundtable report also singles out "destructive office politics" as a major cause of stress.
McMaster's Dr. Joffe said stress and depression -- "a disabling and deadly disease" -- are related. Depressed employees are less able to remember and concentrate, the quality of their work is affected, and they become pessimistic and without hope.
The economic costs of ignoring the disorder are high, the roundtable said in its report.
"Depression costs the [Canadian and U.S.] economy $60-billion [U.S.] a year; more than half of that in lost productivity."
TOP 10 SOURCES OF WORKPLACE STRESS
1. Too much or too little to do. The feeling of not contributing and lacking control.2. Lack of two-way communication up and down.
3. Being unappreciated.
4. Inconsistent performance management processes. Employees get raises but no reviews, or get positive evaluation but are laid off afterward.
5. Career and job ambiguity. Things happen without the employee knowing why.
6. Unclear company direction and policies.
7. Mistrust. Vicious office politics disrupts positive behaviour.
8. Doubt. Employees are not sure what is happening, where things are headed.
9. Random interruptions.
10. The treadmill syndrome: Too much to do at once, requiring the 24-hour work day.
Source: Business and Economic Roundtable on Mental Health
Posted by ksvt on July 21, 2000, at 23:23:20
In reply to Thanks, ksvt and more on stress, depression links, posted by dj on July 21, 2000, at 11:08:54
>
> > dj - thanks for the response. I'm rather in awe that you would allow yourself to be videotaped. I assume you didn't have to watch >the tapes.
>
> I didn't watch those tapes, though I did sign an agreement about their usage. It's a valuable tool, I believe, for perhaps helping a counsellor pick up on things they may have missed.
>
> I have been video and audio-taped in group dynamic exercises and have learned from re-listening and re-viewing those. I commend the possibility to you and others. Interesting to hear or see yourself, via those media.
>
> >I struggle with the issue of how much of what I go through is triggered by biological factors, and how much by psychological. I have this theory, that does me no justice, that I ought to be able to control my depressions much better than I do, and that since I don't very well, it
> > represents a real lack of will on my part.
>
> It's tough teasing out the distinctions and what environmental triggers may be. The book "Undoing Depression" (http://www.undoingdepression.com) is a good resource on this issue.
>
> I've quoted the following elsewhere on PB and I believe it to be a profoundly important context to consider:
>
> "…as the evidence in this chapter makes abundantly clear, depression is a genetic disorder of being vulnerable to a stressful environment."
>
> Robert M. Sapolosky, Why Zebras Don’t Get Ulcers: An Updated Guide to Stress, Stress-Related Diseases, and Coping, 1998
>
> A friend who has struggled with depression, as well, commented that he considered it the best definition of depression he has read anyplace. And he's a pretty thorough guy. The following article in one of Canada's newspapers today also reinforces this view.
>
> Worker stress costing economy billions, panel warns
>
> LOST PRODUCTIVITY
>
> An estimated 10% of the work force is suffering from depression,which often goes undiagnosed and untreated, a report by the Business and Economic Roundtable on Mental Health says.
>
> VIRGINIA GALT
> Workplace Reporter, Globe and Mail
> Friday, July 21, 2000
>
> Toronto -- E-mail overload, cutthroat office politics and longer work weeks are pushing some employees over the edge, costing the Canadian economy billions of dollars in lost productivity, a panel of business leaders warned yesterday.
>
> The Business and Economic Roundtable on Mental Health said in a report that, at any given time, an estimated 10 per cent of the work force is suffering from depression, "a pervasive and treacherous illness" that often goes undiagnosed and untreated.
>
> Employees are generally afraid to report mental health problems for fear of being stigmatized, the panel said, and employee assistance plans are underused because of "widespread employee fears of breakdowns in confidentiality."
>
> Change has to come from the top, said former federal finance minister Michael Wilson, chairman of the mental health roundtable and newly appointed chief executive officer of RT Capital Management Inc.
>
> He said he knows of one high-profile CEO who boasts that he does not suffer from stress -- he causes it.
>
> Mr. Wilson's reasons for volunteering to serve on the roundtable, formed two years ago, are deeply personal. His 29-year-old son, Cameron, a successful businessman who suffered from debilitating depression, committed suicide in 1995.
>
> But quite apart from the personal heartache, there are practical business reasons for improving the overall mental health of Canadians, he said at a news conference in Toronto.
>
> "We live in an information economy, it's a brain-based economy, and a healthy mind is very important to the successful operation . . . of the economy," Mr. Wilson said.
>
> Another roundtable member, Colum Bastable, CEO of Royal LePage Ltd., said employers who do not treat their workers well risk losing them to illness or to the competition.
>
> Problems with increased workload can often be eased by clearer communication about priorities, he said. "It's not rocket science."
>
> In a climate of increased competitive pressures, the onus is on employers to create a culture where staff can seek confidential help with health problems, Mr. Bastable said.
>
> Bill Wilkerson, president of the roundtable and senior counsel with communications firm GPC Canada, said stress-related disorders cost the economy more than strikes, plant shutdowns or product defects.
>
> "Depression is by far the leading cause of disability today. . . . We are also seeing people today working harder and longer, but not more productively," said Mr. Wilkerson, former CEO of insurer Liberty Health.
>
> The roundtable is a volunteer organization of senior business executives and health professionals concerned about mental health issues, Mr. Wilkerson said. It does not receive government funding, but is associated with public institutions such as Hamilton's McMaster University. GPC Canada has donated office space and aims to give widespread distribution to the panel's first report, the result of 18 months of preparation and research by Mr. Wilson, Mr. Bastable, Mr. Wilkerson and psychiatrist Russell Joffe, dean of health sciences at McMaster.
>
> With yesterday's report, the roundtable embarked on a public information campaign aimed at educating CEOs about the impact of stress on their workers. The panel outlined some of the steps employers can take to ease the pressure.
>
> Early detection and referrals to treatment are key, Mr. Wilkerson said. If an employee complains that he or she is overworked, the boss should not respond by saying "join the club."
>
> Increased volumes of E-mail, voice mail, and longer office hours are contributing heavily to stress levels, he said.
>
> Employers should install filtering devices on e-mail and voice mail systems to cut down on junk mail, said Mr. Wilkerson, who knows of people who delay going to work in the morning because "they don't want to see that blinking light."
>
> The roundtable report said a principal cause of stress among employees is a "prolonged sense . . . of constant catchup, interruption and distraction.
>
> "Over time, such stress can trigger mental distress, which may further evolve to a medical condition among some. Individuals experience stress when they are forced to spend hours upon hours digging through electronic messages -- some trivial and some relevant to their work -- which build up overnight, during the day or even through the lunch break," the report said.
>
> "E-mail, in this form, contributes to the 24-hour workday."
>
> The roundtable report also singles out "destructive office politics" as a major cause of stress.
>
> McMaster's Dr. Joffe said stress and depression -- "a disabling and deadly disease" -- are related. Depressed employees are less able to remember and concentrate, the quality of their work is affected, and they become pessimistic and without hope.
>
> The economic costs of ignoring the disorder are high, the roundtable said in its report.
>
> "Depression costs the [Canadian and U.S.] economy $60-billion [U.S.] a year; more than half of that in lost productivity."
>
> TOP 10 SOURCES OF WORKPLACE STRESS
> 1. Too much or too little to do. The feeling of not contributing and lacking control.
>
> 2. Lack of two-way communication up and down.
>
> 3. Being unappreciated.
>
> 4. Inconsistent performance management processes. Employees get raises but no reviews, or get positive evaluation but are laid off afterward.
>
> 5. Career and job ambiguity. Things happen without the employee knowing why.
>
> 6. Unclear company direction and policies.
>
> 7. Mistrust. Vicious office politics disrupts positive behaviour.
>
> 8. Doubt. Employees are not sure what is happening, where things are headed.
>
> 9. Random interruptions.
>
> 10. The treadmill syndrome: Too much to do at once, requiring the 24-hour work day.
> Source: Business and Economic Roundtable on Mental Health
>
>
>dj - thanks for the definition. It pretty much fits in with what my therapist was saying to me not too long ago about not kicking myself for the fact that the stressors that trigger depressions in me might not be at all bothersome to other people. It makes sense, but is still hard to swallow. If the symptoms hang around long enough, you start feeling that this is a life you have chosen for yourself. In response to the article you sent, I find it to be an interesting phenomenon that advances that are supposed to make our lives so much easier, in fact make our lives more stressful. I don't use email alot in my work (although I am using it more and more), but fax machines abound. I rarely "mail" anything now, and most of the letters I receive are faxed to me. It's sometimes hard to recall how I ever got by before fax machines, but on the other hand, fax machines and computers have created an expectation of speed that is frequently crushing. You have to be so much more responsive and there seems to be a deadline to everything you do.Lastly, I read Undoing Depression last summer and was pretty bowled over with its relevance to me. I just think Dr. O'Connor does a really good job of describing depressed people and how they think and how they react. At the time, I didn't feel I could implement some of what he suggested, but just just reading the book made me feel considerably less isolated. Maybe it's time for me to give it another read. Ciao
Posted by dj on July 22, 2000, at 7:47:12
In reply to Re: Thanks, ksvt and more on stress, depression links, posted by ksvt on July 21, 2000, at 23:23:20
>dj - thanks for the definition. It pretty much fits in with what my therapist was saying to me not too long ago about not kicking myself for the fact that the stressors that trigger depressions in me might not be at all bothersome to other people. It makes sense, but is still hard to swallow. If the symptoms hang around long enough, you start feeling that this is a life you have >chosen for yourself.
In some cosmic, karmic sense perhaps. It is difficult to see the forest for the trees at times, particularly when in the midst of the symptoms of depression - helplessness and hopelessness being key ones. And it takes time, effort, compasssionate support (from self and others) and faith to work one's way through the thickets of one's own afflictions and realize which one's you can influence, how and how subtle the distinctions can be at times.
I know that when I'm feeling off, as I was yesterday for awhile (though to a much lesser degree than I have in the past) that this too will pass and there are things that I can do to help speed up that passage. For instance a combo. of heat, fatigue, a spazzed back and feeling generally run down convinced me that it would be futile to work on a some lengthy writing that I am working my way through, much more slowly than I would prefer. And I was sent a computer virus on top of all that.
I felt somewhat discouaged at times, yesterday but underneath that was a faith that this too will pass, and I can speed up and influence the progress as I can and did, rather than feeling overwhelmed by all these things in combination. So, I spent the time I needed to dealing with these factors one by one. I also went to the movie "Chicken Run" as I find Matinee Therapy a boost. And it was a pure delight to see kids dancing in the aisles with their parents when the movie wrapped.
That final scene was the most touching one of all and provided me some joy and perspective to move on to what I needed to do next, which was clean up the virus. And so on and so forth...Today I feel better but still a bit tired and am working on moving through all of that...
>I just think Dr. O'Connor does a really good job of describing depressed people and how they think and how they react. At the time, I didn't feel I could implement some of what he suggested, but just just reading the book made me feel considerably less isolated. Maybe it's time for >me to give it another read. Ciao
I've read and re-read the book and portions of it many times and it helps we and has helped me with my perspective when it has been skewed by my perception of my cirucumstances. That and finding good folks and counsellors to help me keep my balance and finding a core faith that there is some sort of meaning in all of this, and that my challenge is to take it and make it a worthwhile story for all concerned, rather than not.
Sante!
dj
P.S. - How do you eat an elephant??
One mouthful at a time!!!
Posted by Nibor on July 22, 2000, at 16:27:00
In reply to Re: Thanks, ksvt and more on stress, depression links, posted by ksvt on July 21, 2000, at 23:23:20
> Lastly, I read Undoing Depression last summer and was pretty bowled over with its relevance to me. I just think Dr. O'Connor does a really good job of describing depressed people and how they think and how they react. At the time, I didn't feel I could implement some of what he suggested, but just just reading the book made me feel considerably less isolated. Maybe it's time for me to give it another read. CiaoIt's good to know UD has been helpful. I think I wrote before that I work on the website at http://www.undoingdepression.com and am currently working on an extensive update. But we do have a Guestbook set up finally; we call it "I Have Something to Say," because we hope readers will use it as a place to contribute their thoughts. Dr. O'Connor's next book, Active Treatment of Depression, will be coming out at the end of the year. Many suggestions from people who emailed him through the website have been implemented there.
Be Well,
Nibor
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