Depression can have a huge impact on all aspects of daily life. Often people carry on for a long time before they seek help.

Many of the people we talked to had faced difficulties at work when they were depressed. Some said stress at work had been a major factor in their depression, or that feeling depressed had increased levels of stress about their jobs.

Symptoms such as insomnia, inability to concentrate or being unable to motivate themselves to get up and dressed in the mornings can cause difficulty for work lives. People worry about how they are perceived by others, that they are performing badly, or that they are thought of as lazy or “work-shy”.

In some instances people said it hadn’t been until things reached breaking point at work that they finally sought help from the doctor and been prescribed an antidepressant. Sometimes colleagues noticed something was wrong. Stephen’s colleague noticed he had been taking a lot of time off work for “minor” reasons, which was uncharacteristic, and advised him to see his GP.

People worried that if they admitted that they were struggling it could jeopardise their position. They thought they might be judged, that their job security might be compromised, or that they could be seen as “slacking”. Stuart echoed many people’s feelings about talking openly to an employer about mental health problems: “It’s still very difficult to go into work and say ‘I’m suffering from depression’, you know? Those feelings of failure; you feel that somehow people are going to look down on you, you’re not going to be promoted, you’re going to be first up for redundancy next time around.”

Some people felt embarrassed and didn’t want colleagues to know they had mental health problems. Emma, who was usually a very “private person” felt “humiliated” when colleagues witnessed her distress at work.

People with depression can become expert at hiding their feelings which can make it all the more difficult when things spill over in the workplace. Steve had worked in hospitality for many years and said it was a culture in which you had to keep up a positive front. “I’m someone that’s on antidepressants behind the scenes but actually if you met me in the work environment you would probably never see me without a smile on my face, and it’s not being fake, I’m just avoiding things”.

Thomas was studying for a PhD when he became unwell. He feared that if the university knew he was unwell and unable to cope, that his funding could be removed and he might lose both is income and home. “The consequences for me were quite great with someone in the college thinking that I was quite ill, which I was, but I didn’t want them to know that and I felt that taking antidepressant medication was a sure sign that I was ill and being treated for being ill.”

People said the work culture was often pressured and busy and it could be difficult to admit you weren’t coping. Several men said the “macho” culture in their workplace made it harder for them to be open. Stuart and Gerry both had worked in industries where depression was seen as a weakness or not tolerated. Thomas reflected, “If a man breaks down in tears, no one knows quite how to respond. It really, really throws people. It’s quite different.”

Taking time off work was a major concern to people. Some said that they had been “signed off” by the GP when they had first been prescribed an antidepressant, to give them time to adjust, or to rest.

Andrew said when he first started taking citalopram it had been difficult to concentrate at work. He was fortunate to have had a flexible job so was able to cover up the fact that he wasn’t coping.

When Olivia X was taking Seroquel (quetiapine) she felt it stopped her from being able to function creatively at work. Melanie felt her position as a manager was compromised because she wasn’t on top of things, and she felt that people had taken advantage of her.

Thomas and Gerry both found it difficult to take time off work for medical appointments and had invented excuses rather than explain the real reasons for absences from work. Rachel had difficulty maintaining regular working hours because of insomnia and side effects from the antidepressants she had taken. “Your job might always start at 9 o’clock on a Wednesday morning or whatever but I can’t guarantee what Tuesday night would have been like.”

There may also be financial implications for people, as entitlement to sick pay varies. Rachel is currently unable to work because of severe persistent depression, and has had problems about the assessment for fitness to work, and claiming benefits. Melissa left her job because she was unable to cope. Collette’s employers had taken her off “front-line duties” in the emergency services and she ended up losing her job.

Commonly people felt wary about disclosing that they were taking antidepressants, or had taken them in the past on job applications. People worried about medical questionnaires that asked for their medical history. They felt telling a potential employer they were taking antidepressants, or had done in the past could be detrimental, or even stop them from being offered employment. Roisin was very clear that it was something to hide. Her experience of being on selection committees at work reinforced her views: “Absolutely no way have I ever disclosed that information because it would mean that I would probably not have got any of the jobs that I’ve had.”

Rachel had mixed feelings. “I still don’t know what is the right one to do whether you, you know, I’ve been both – I’ve concealed and I’ve been open on, on applications.” Several people pointed out that any information you provided should be confidential, but nonetheless not everyone felt confident that it would not influence decisions. Despite concerns about potential discrimination, some said they felt that they would declare their medical history to a prospective employer and that they wouldn’t want to work for an employer where mental health problems were seen negatively.

Rachel and Collette said it was important to declare that you were taking antidepressants if it could affect your work, for example if you had to drive for your job, or were taking care of children.

People had mixed views about discussing antidepressants with work colleagues. Steve noticed differences between organisations he’d worked at in the south of England compared with the north. He said “(In London) even though we were friendly you wouldn’t go into your office and start talking about antidepressants.” But when he went to stay with his parents who lived in the north of England he said, “People are more open about it up here… they hide it a bit more down south: somebody turned around to me and said, when I was first put on them, ‘you have no idea that most of the people around you are medicated.'”

Tim works for a psychotherapy organisation and reflected on how much he told his colleagues: “I don’t think I ever mentioned I was taking antidepressants, but I did mention that I was doing psychotherapy.”

Although some people had experienced discrimination and prejudice at work, many had been surprised to find that employers, managers and colleagues had been very supportive. Some had been offered help from occupational health departments, or were given access to workplace counselling schemes. Employers had allowed people to reduce their hours, work flexibly, or gradually return to work on a ‘phased’ basis. Colleagues had also often been supportive and helpful, and sometimes people found that being open about being on an antidepressant encouraged others to do the same, so they had ended up “comparing notes” with people at work.

Although it can be difficult to be open about being depressed and taking antidepressants, some people said that they made a point of telling people they worked with because it was helpful for others to know. Stuart reflected, “I was surprised by people’s reaction… at how sympathetic people were and how many people at work actually said, you know, ‘I feel the same way’.”

Several people were employed in professions concerned with mental health, or did voluntary work, and were able to draw on their own experiences, or said they were attracted to that kind of work through their experience of being treated for mental health problems. Simon is a GP and has specialised in mental health and psychiatry. Collette works for the emergency services. Tim works for a psychotherapy organisation.