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DiSability inSurance
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 Continued >
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.
For Producer Use Only. Not for Public Distribution.
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
metlife.com
BDUW23396 L0613329940[0514] 2013 METLIFE, INC. PEANUTS 2013 Peanuts Worldwide For Producer Use Only. Not for Public Distribution.

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