Cox News Service ATLANTA --
Except for her husband and some other family members and close friends, no one knew about her depression. Not even her two children or her co-workers.
"I was very good at putting on a facade for people," said Rexrode, a patient care technician at Piedmont Fayette Hospital in Fayetteville, Ga. Rexrode, 37, hid her condition to avoid being ostracized.
"There's a stigma," said Rexrode, who has tried 60 different medications and electric shock therapy during the past 20 years.
"People look at you differently, like (you're) a crazy person. I didn't want the stigma placed on me. People don't understand. It's a disease, just like cancer."
Unlike many other illnesses, depression remains largely a societal taboo that affects about twice as many women as men, according to mental health experts.
Nowhere is that more evident than in the workplace. Depression costs U.S. business at least $44 billion a year in absenteeism, lost productivity and direct treatment costs, according to Mental Health America, an Alexandria, Va.-based nonprofit. Experts at Harvard Medical School, which has done extensive studies on depression's impact on the workplace, put that figure closer to $50 billion.
Last year, companies paid another $4 million in damages to depressed workers who sued their employers under the Americans With Disabilities Act, according to M. Lee Smith Publishers, a national newsletter on labor law trends.
Despite the consequences, many employers "aren't tuned into" depression, says Ronald Schouten, associate professor of psychiatry at Harvard Medical School. Some treat depression, often a chronic condition, as a temporary problem that can be fixed with a few visits to the internal employee assistance program, mental health experts say.
"People have insurance, but (mental health coverage) is not on parity" with other medical coverage, says Ellyn Jaeger, director of public policy and advocacy for Mental Health America of Georgia.
Those who have some type of mental health coverage often get only limited doctor visits, she added.
"That's not the kind of treatment any other illness gets," said Jaeger, who suffers from depression. "That's not adequate. Businesses, if they want a healthy work force, need to realize how serious depression is."
Some employers do. They are screening workers and educating them about the disease, as well as seeking assistance from the medical community.
Other businesses recognize the importance of the problem, experts say, but the high cost of coverage forces many to make hard choices about where their health care dollars will go. Ultimately, that often means mental health benefits get short shrift, even though depression is a leading cause of workplace disability worldwide, says Harvard's Schouten.
Beyond the stigma, employees who struggle with depression often encounter supervisors who aren't equipped to handle their condition, Schouten said.
"People are still worried that if they bring up an issue of someone having an emotional disturbance, they'll be sued," he said. "Other people just aren't comfortable talking about it."
But passage of the Family Medical Leave Act and the Americans With Disabilities Act in the past 15 years has made it more important that employers know how to deal with depression, says Susan Fentin, a partner with the labor and employment law firm Skoler Abbott & Presser in Springfield, Mass.
"I have tremendous sympathy for people who suffer from depression," Fentin said. "I also see it from the employer's side and how difficult it is to manage."
Compounding the problem can be the environment at many companies, where many employees are working extra hard and feeling overwhelmed. Experts say women disproportionately bear a lot of the load as they assume multiple roles: wife, mother, caregiver, worker. The pressure manifests itself as disturbances in mood, sleep, appetite, concentration and interests. Men often suffer depression in silence, they add.
Depression is one of the key obstacles preventing some working women from being successful at work, according to a study done a few years ago by the American Medical Women's Association and the National Mental Health Association (now Mental Health America). In the survey, eight in 10 women who had been diagnosed with depression said having the condition was a bigger barrier to their professional success than pregnancy, child care, elder care and sexual harassment.
"The pressure of work is one of the most common reasons for depression," said Dr. Dwight Bearden, a Macon, Ga., psychiatrist who has been in practice for 25 years.
Untreated, the disease is disruptive and, at its worst, debilitating. In some cases, it has derailed careers.
Rexrode, for instance, spent much of the 1990s cocooned in her darkened bedroom, blinds drawn. She was unable to work during that time.
"I'd get up in the morning. I'd get my kids off to school," Rexrode recalled recently. "I'd go back to bed until my kids came home from school. I cried all the time. I couldn't do anything."
It's a different story now.
Last November, Rexrode had a device called a Vagus Nerve Stimulator implanted. It sends mild, intermittent pulsed signals to the vagus nerve on the left side of the neck. That, in turn, sends signals to the part of the brain that controls moods. The surgery typically costs $40,000, a sum not covered by many insurance companies, including Rexrode's. But she became part of a study and only had to pay several hundred dollars.
Rexrode says the surgery was "my last hope." Except for the tiny jolts that make her hoarse sometimes, she feels the surgery has helped a lot, returning her to a more normal life. She goes to the movies, skating and shopping with her two children. In addition to working as a patient care technician at Piedmont Fayette, she'll attend Clayton State University in the fall, where she plans to get a degree to become a registered nurse.
Now, she says, "I get up in the morning and open the blinds."
Tammy Joyner writes for The Atlanta Journal-Constitution.
E-mail: tjoyner AT ajc.com.