In a society that depends on intellectual productivity for competitiveness in our economy, impairment in work function can be detrimental. In order to maximize “human capital,” there is mounting interest in understanding how to optimize brain health at both the individual and population level.

It is well established that mental illness significantly affects individuals’ ability to contribute to complex modern workplace demands, reducing work function and productivity while simultaneously increasing absenteeism and disability costs.1, 2 Notably, major depressive disorder (MDD) has been reported to affect work outcomes more negatively compared with other mental illnesses due to its high prevalence and its recurrent and chronic illness course.3

The assumption has been that cognitive impairments in MDD are a consequence of an acute major depressive episode (MDE). However, some individuals with MDD have reported experiencing cognitive impairments and reduced psychosocial/work functioning prior to their first MDE. The presence and persistence of cognitive impairment in individuals with MDD prior to and following an MDE independent of psychotropic treatment suggests that cognitive impairment can be conceptualized as a fundamental feature of MDD, rather than a consequence coinciding with depressive symptoms.4

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This observation is backed by convergent evidence evaluating depression in the workplace, “cost of illness” studies, and population-based morbidity studies indicating that presenteeism — the impaired ability to function effectively at work — accounts for approximately three-quarters of workplace costs, estimated at $78.7 billion.2, 5, 6 These data engender concern over substantial productivity losses and indicate that the majority of remitted individuals with MDD continue to experience psychosocial/workplace impairment and are dissatisfied with their overall therapeutic outcomes.1, 7 This indicates a need to identify aspects of MDD beyond the emotional burden of the illness that mediate work functioning (ie, an individual’s capacity to adequately complete work responsibilities).8