Research studies require a 6-week trial on a therapeutic dose of an antidepressant in order to determine whether the medication is efficacious. If you take this as your yardstick, a patient should have a 6-week trial of medication at the therapeutic dose. Following this the patient may be feeling better but not quite ready to return to work or maybe only with restrictions. These are very general terms and do not reflect the huge range in severity of illness or response rate of individuals.
If the patient has a milder form of depression and are responding well, they may feel able to return to work even before the 6-week trial dose is completed. Very severe depression might respond well to the medication but it may be six months or longer until the patient is fully functional. Many patients don’t tolerate or respond to the first medication tried, so a second medication must be tried which naturally delays return to work.
Insurance companies function on a medical model which does not accommodate psychiatric illness. They believe that, as with a leg fracture, you can predict with some certainty when the patient will be able to work. Psychiatry is not that simple and we often can’t say when the patient will be ready to return to work. When I’m completing these forms I usually say I don’t know when the patient will be ready to return to work. Often the answer only becomes clear when the patient is almost ready.
Insurance companies often penalize our patients because they claim the illness had onset prior to initiation of their policy. They fail to understand the chronicity and episodic nature of the illness. Patients can be entirely functional and doing well, working for years and only episodically non-functional.