By Carolyn Jackson, MD
Senior Medical Director
Howard, 49, a business owner, has applied for disability
insurance with a 90-day elimination period (EP). Four years
Depression is one of the most common mental health
ago, he went through a very emotionally traumatic separation
disorders in the United States. According to the National
and divorce after 12 years of marriage and experienced
Institute of Mental Health, up to 6.7% of the United States
multiple recurrent brief episodes of depression. His primary
population may have major depression at any one time.
care physician gave him a diagnosis of Depression, Not
Women are 70% more likely to experience depression during
Otherwise Specified (NOS), and prescribed Zoloft to help
their lifetime than men.1 In addition to a depressed mood,
him through this difficult period in his life. He discontinued
depressive symptoms can also include a loss of interest or
the Zoloft over three years ago and has not had any further
pleasure in most or all activities (anhedonia), irritability,
insomnia or hypersomnia, change in appetite or weight,
Diane, 36, a dentist, has applied for disability insurance
somatic complaints like muscle aches, headache or abdominal
with a 90-day EP. Seven years ago she began experiencing
pain, fatigue and decreased energy and problems with memory
symptoms of depressed mood, sleep disturbances, decreased
or concentration. In severe cases, there may be recurrent
appetite, poor concentration and a lack of interest in work and
thoughts about death or suicide or even a suicide attempt.
social activities. After a visit to her physician, she was given a diagnosis of major depression. Initially, for the first year, she
was under the care of a psychiatrist, placed on Prozac and she also attended some counseling sessions. She responded very quickly to this combination therapy. For the past six years, she has been solely under the care of her primary care physician
Questions to ask your clients who have a
with a current diagnosis of mild depression and has remained
history of depression:
on the same dose of Prozac that was originally prescribed.
1) When were you first diagnosed with depression?
2) Have you had a prior episode of depression or any other
Howard had a limited period of depression that responded well to a short course of Zoloft to help him through a difficult
3) Were you ever hospitalized due to a psychiatric illness?
emotional period in his life. Since he has been symptom-
free and off Zoloft for three years, he can be considered for a
4) Are you currently being treated by a psychiatrist? In
standard disability insurance policy.
Diane has a history of major depression that requires long
5) What medication(s) are you currently taking? When was it
term antidepressant therapy. Since she has been stable and
prescribed and when was it last adjusted?
asymptomatic for the past 6 years on one antidepressant medication, she can be considered for a disability insurance
6) Have you ever lost time from work due to your illness?
policy with a Mental and Nervous Rider.
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Depression Dark Cloud — Bright Outcome
Understanding Depression (cont’d)The diagnosis of depression is largely based on the patient’s history and mental status examination. People with depressive illnesses do not all experience the same severity, frequency, and duration of symptoms. Depressive diagnoses include Major Depressive Disorder, Dythymic Disorder and Depressive Disorder, NOS. All depressions are characterized by a combination of symptoms that interfere with a person’s ability to work, sleep, study, eat and enjoy once-pleasurable activities. Some people may experience only a single episode within their lifetime, but more often a person may have multiple episodes. Even minor depressive symptoms that persist, if left untreated, can progress to a major depressive episode.
Depression is a treatable illness that responds to a variety of therapeutic interventions. Usually, the earlier that treatment can begin, the more effective it is. Once diagnosed, a person with depression can be treated in several ways, most often with pharmacotherapy (oral medications) and/or psychotherapy (counseling, cognitive or behavioral therapy, interpersonal therapy, etc.). Antidepressants are often the first line of therapy. The choice of antidepressant is likely to be less important than treating patients with medications that they can tolerate and with doses sufficient to achieve symptom remission. Commonly used antidepressants are Prozac, Zoloft, Lexapro, Paxil, Effexor and Cymbalta. An initial therapeutic response typically occurs within two to six weeks of antidepressant therapy. Therapy should be modified if the response to an initial medication is inadequate or incomplete.
The prognosis for depressive disorders is often highly variable, which is probably a result of the fact that depressive disorders represent a number of different illnesses that differ in their etiology, clinical presentation, and treatment response. Patients may experience a single major depressive episode, follow a highly recurrent course with full resolution of symptoms between episodes, or spend much of their lives struggling with persistent, fluctuating symptoms. Depressive episodes can range in intensity from states that produce limited or no physical or cognitive impairment and are little noticed by others to severe disease that can result in a significant impact on daily activities, personal relationships, work capacity and overall quality of life.
For more information about depression or MetLife’s revised underwriting guidelines,
contact a member of your underwriting team.
1 National Institute of Mental Health. Available at http://www.nimh.nih.gov/statistics/1mdd_adult.shtml.
Disability income insurance is issued by Metropolitan Life Insurance Company, New York, NY. June 2013
Metropolitan life insurance company
200 Park Avenue
New York, NY 10166
BDUW23396 L0613329940 2013 METLIFE, INC. PEANUTS 2013 Peanuts Worldwide
For Producer Use Only. Not for Public Distribution.
Richtlinien subkutane spezifische Immuntherapie Die spezifische Immuntherapie (syn. De-, Hyposensibilisierung) soll nur nach allergologi-scher Abklärung beim Spezialisten erfolgen (Limitation für die Erstattung der Impfextrak-te durch die Krankenversicherung). Die Erfolgsrate ist stark abhängig von multiplen Fak-toren, die alle berücksichtigt werden müssen (Krankheitsdauer, relevantes/i
KULUNGUANA – ASSOCIAÇÃO PARA O DESENVOLVIMENTO CULTURAL CAPÍTULO I Da Natureza, Denominação, Duração, Sede e Objecto ARTIGO PRIMEIRO 1. A Associação adopta a denominação de “ KULUNGUANA – ASSOCIAÇÃO PARA O DESENVOLVIMENTO CULTURAL ”. 2. A “ KULUNGUANA – ASSOCIAÇÃO PARA O DESENVOLVIMENTO CULTURAL” mais adiante designada por Associação, é u