OBJECTIVE: To discuss the impact of major disease states, including depression, 
in the loss of productivity in the workplace and how integration of health care 
can decrease cost to employers.
SUMMARY: The majority of costs associated with depressive illness can be traced 
to lost productivity, and the employer, therefore, bears most of the economic 
burden. Efforts to improve employee health and productivity have been hampered 
by the compartmentalization of medical costs, pharmacy costs, behavioral health 
costs, and productivity measures. This situation can be rectified by "busting" 
these silos and promoting a reintegration of prospective costs and parties. 
Health risk assessments enable employers to identify illnesses that are suitable 
targets for integrated health and productivity management programs. In the case 
of depression, employers can act proactively to identify employees at risk, 
working to minimize risk factors such as stress before these individuals become 
heavy utilizers of company resources. For employees who are currently depressed, 
recent research evidence has demonstrated that pharmacotherapy can have a 
dramatic and positive effect on lost productivity, absenteeism, and 
presenteeism. The selection of antidepressants and subsequent follow-up must be 
improved, however, if the benefits of pharmacotherapy are to be optimized.
CONCLUSION: Understanding the linkage of disease management and productivity in 
the workplace can result in dramatic decreases in absenteeism and presenteeism 
and increased cost savings to the employers.