Bipolar Disorder Takes a Toll

A new study details the costs of manic depression in the workplace, but more information is needed to determine a thoughtful response SEPTEMBER 1, 2006
Top News
By Catherine Arnst

Bipolar disorder, sometimes known as manic depression, affects only about 1% of U.S. workers in a given year. Yet it costs the U.S. workplace $14.1 billion annually in lost productivity, according to a Harvard Medical School study. That’s almost half as much as the productivity losses attributed to major depression, even though the latter disease is six times as prevalent. The study determined that each U.S. worker with bipolar disorder averaged 65.5 lost workdays in a year, compared with 27.2 for those with depression.

It is not the manic episodes that are the problem, says Ronald Kessler, a co-author of the report and professor of health care policy at Harvard Medical. In fact, mild forms of mania in workers suffering from bipolar disorder are sometimes seen as a plus. “People with these subthreshold manias can really be very productive,” he says.

Depressive episodes cause the most damage. Kessler says that on any given day, about one-third of people in the workplace who are depressed are experiencing the downside of bipolar. In addition, these bipolar-generated depressive episodes are more severe and last longer than those of workers who suffer from depression alone.

TREATMENT. Bipolar disorder, which often runs in families, is characterized by alternating episodes of mania and major depression, and it usually develops in the teens or early 20s. The mania is characterized by elation, irritability, excitability, racing thought and speech, and hyperactivity, whereas depressive episodes are characterized by sadness, withdrawal, despair, and suicidal thoughts.

Bipolar disorder is treated with a combination of behavior therapy and a number of different drugs, among them the anti-psychotics Zyprexa from Eli Lilly (LLY ) and Risperdal from Janssen, a subsidiary of Johnson & Johnson (JNJ ) (see, 1/6/04, \”A Cloud Over Antidepressants\”).

The Harvard study, funded by the National Institutes of Health, is the first to distinguish the impact on the workplace of depressive episodes caused by bipolar disorder from those attributed to major depression. Published in the September issue of the American Journal of Psychiatry, the study is based on a year of data collected from 3,378 employees who responded to a national survey. The productivity losses were calculated by combining days absent from work with how people felt they were functioning on the job.

MISDIAGNOSIS. The researchers discovered that some 75% of the bipolar respondents had experienced depressive episodes over the past year, and 63% also reported manic episodes. But the depressive episodes were the most persistent, lasting anywhere from 134 to 164 days, compared with 98 days for major depression.

One problem facing employers, says Kessler, is that bipolar disorder is often misdiagnosed and treated as major depression. But the antidepressants used to treat depression can actually trigger a manic episode in bipolar patients.

Kessler suggested that workplace mental-health programs should first rule out bipolar disorder when treating a depressed employee. But he says further studies are needed to determine the best return on investment for employers offering evaluations and treatment programs.

Arnst is a senior writer for BusinessWeek based in New York
2000- 2006 by The McGraw-Hill Companies Inc.
The views and opinions expressed in these comments do not necessarily reflect the views or opinions of BusinessWeek or the McGraw-Hill Companies.

Most recent comments:

Nickname: Jake
Review: Does this guy Grackle have any idea what the bipolar meds cost? There is no way I could afford mine without my job benefits! And then that’s when I become especially mean, even my friends ask whether or not I’ve had them on a “bad” day.
Date reviewed: Sep 3, 2006 8:43 PM

Nickname: Missyk10
Review: First of all grackel you are the type of person who keeps bipolars in the closet because you are so ignorant. Oh geez, would you feel different if I had diabetes and refused my insulin or better yet took my insulin as prescribed by my doctor but still couldn’t get my blood sugars under control? Since I was diagnosed with bipolar after many, many years of being misdiagnosed with major depression it was like a weight had been lifted off of my shoulders. The average time to properly diagnose bipolar is 10 years. That’s right, 10 years of being improperly diagnosed and treated improperly and causing further problems with treatment only of anti depressants. The pull-yourself-up-by-your-own-bootstraps isn’t appropriate. And since it is a chemical imbalance within the brain should we just pop our brains out and fix it with a screwdriver? Gosh, I just hate ignorant people who won’t waste the time to educate themselves. To learn about bp go to
Date reviewed: Sep 3, 2006 12:13 PM

Nickname: Philip
Review: I could only feel that the medication of two companies is not enough to help those people who suffer bipolar disorder. That means that they need more companies to come out with more bipolar drugs. The two in the market are only good for preventing them from suffering from bipolar. Isn’t there is a way to kill this biploar totally?
Date reviewed: Sep 3, 2006 10:24 AM

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Nickname: Rose
Review: I wish people would realize that life is difficult in itself. Why complicate things for others? Live and let live.
Date reviewed: Sep 3, 2006 3:47 AM

Nickname: jayb
Review: Of course, everyone is entitled to their own comments… but I have to say that grackle’s comments really pis* me off. His/her comments make people who have this disorder sound like animals. Believe me, living with this (bipolar) is no choice. Also your comment about somehow finding a “Maybe if these manic depressive types had to go without a job and a paycheck (with no possibility of receiving Welfare benefits), they would somehow find the way to get past their disease by taking their medication and living within the parameters of the disorder” is pretty ignorant. There are plenty of people who never miss a dose of their medication(s) and suffer just as bad or worse as someone else who’s stopped their’s. I’m not trying to personally attack you or anything, I just really take offense to your comments.
Date reviewed: Sep 2, 2006 11:08 PM

Nickname: wendy
Review: The effects of the bipolar personality on co-workers can be very destructive and devastating. I wonder how many days are lost by those who have to contend with their depressed and emotionally distraught colleagues?
Date reviewed: Sep 2, 2006 12:26 PM

Nickname: steve
Review: As a person with this disorder I find that being self-employed is the way to go. It’s true that bipolar disorder affects those in the workplace but it also goes to show that there’s a lot of stress and others may not be bipolar but can have heart attacks; etc. We just react differently when stressed out. So maybe employers could be a little more sensitive. But I guess compassion isn’t always lucrative. I actually feel sorry for people stuck in the rat race. That’s kind of an illness in itself.
Date reviewed: Sep 2, 2006 3:23 AM

Nickname: Netsy
Review: I just had a conversation with my fiance who suffers from bipolar disorder. He told me that his boss called and wanted to check on him and see if he was okay since he knows he suffers from the condition and hasn’t reported to work in the last two days. As he is fairly new on this job, I have been worried about the effects of his condition on his job. I appreciated the call from his boss. From my perspective, I think the article did a wonderful job of describing the ups and downs and the positive and negative effects of the condition in the workplace. In a corporate environment where extreme productivity is rewarded let’s not forget that the employers do benefit from the up-swings on the condition. The least they can do is to be sympathetic to the down time. To the disrespectful reader who made the ridiculous comments about an employers right to “get rid of” unproductive employee- the employers right is to hire who he or she feels can adequately do the job.
Date reviewed: Sep 2, 2006 1:03 AM

Nickname: mom of 2
Review: In response to the person who seems somwhat heartless towards people with Bipolar Disorder, maybe you should walk in that person’s shoes. I have several family members who have been diagnosed with this horrible disorder and it is not something anyone likes to have to deal with. It is very hard to understand and control. You can be on an array of medication and still have “good” days and “bad” days. And the comment about maybe they should have to be without a job (paycheck) and not getting benefits is just ridiculous. Explain what that would prove. People suffer from obesity, which is also characterized as a disease. Taking their food and water away isn’t going to cure them. People with Bipolar Disorder, along with their medical professionals, deal with it the best way they know how. Have a little compassion.
Date reviewed: Sep 1, 2006 11:20 PM

Nickname: grackle
Review: I’m sick and tired of hearing about people with “bipolar disorder,” the way the disorder pre-disposes them to not take their medication, and now, the way employers have to tolerate their mood swings and absence in the work place. The employers should have the right to get rid of an employee who is absent too much, or who causes disruption in the work place. Maybe if these manic depressive types had to go without a job and a paycheck (with no possibility of receiving Welfare benefits), they would somehow find the way to get past their disease by taking their medication and living within the parameters of the disorder. It is amazing what a growling stomach can do to force someone to take responsibility for himself!
Date reviewed: Sep 1, 2006 7:39 PM

Nickname: sahrah louise
Review: as a bipolar II sufferer, I can attest to the facts in this article. Thanks for putting this out there–there is so misinformation and stigma, it’s nice to see good reporting on the topic.
Date reviewed: Sep 1, 2006 6:19 PM
Nickname: Vangie
Review: I have a special kid and I have made some few readings and I found out that some forms of behaviour problem is caused by some hidden yeast infection usually in the gut brought by stress…personally I’m on a psychiatric drug and made some food and lifestyle changes and after a while took nystatin for two weeks…and now I can tolerate coffee not like before where I get so restless…
Date reviewed: Sep 1, 2006 6:42 AM

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