An overview of depression
Functional impact

of depression

In addition to dysfunction across domains of cognition, depression also produces wider functional impairments in daily life.1 In fact, depression is ranked as the leading cause of disability worldwide, and is also a major contributor to the global burden of disease.2 Functional disability in daily activities is one of the most important consequences of depression, yet it is also one of the least understood.1

Depression impacts patients in the workplace, increasing both presenteeism (loss of productivity due to attendance despite illness) and absenteeism (failure to attend work due to illness), which in severe cases can result in cessation of employment.3 Abilities to maintain household responsibilities and manage finances can also decline, in addition to reduced quantity and quality of social relationships and community ties.1


Professor Nutt, the Edmond J Safra Chair in Neuropsychopharmacology at Imperial College London

Professor Nutt explains how the cognitive symptoms of depression can affect patients’ performance at work

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Professor Nutt - Presenteeism in depression

The impact of cognition on depressive course

The cognitive symptoms of depression also affects the course of a patient’s condition, and has been associated with earlier onset of depression, longer episode duration and increased risk of relapse.1,4–6 The link between cognitive dysfunction and risk of relapse is of particular importance, with one study showing that over 75% of patients with residual cognitive symptoms relapsed within 10 months of achieving ‘remission’.7 This, coupled with the functional impact of depression, creates a cyclic association between onset of symptoms, functional impairment, and relapse:


  1. Jaeger J et al. Neurocognitive deficits and disability in major depressive disorder. Psychiatry Res 2006; 145(1): 39-48.
  2. Depression Factsheet. WHO. Available at: Accessed August 2015.
  3. Lerner D, Henke RM. What does research tell us about depression, job performance and work productivity? J Occup Environ Med 2008; 50(4): 401-410.
  4. Papakostas GI. Cognitive symptoms in patients with major depressive disorder and their implications for clinical practice. J Clin Psychiatry 2014; 75(1): 8-14.
  5. Trivedi MH et al. Cognitive dysfunction in unipolar depression: implications for treatment. J Affect Discord 2014; 152-154: 19-27.
  6. Majer M et al. Impaired divided attention predicts delayed response and risk to relapse in subjects with depressive disorders. Psychol Med 2004; 34(8): 1453-63.
  7. Paykel ES et al. Partial remission, residual symptoms, and relapse in depression. Dialogues Clin Neurosci 2008; 10: 431-437.
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