On Working With Depression

Recently, a close friend asked me a question:

How do you work with depression?

Authors Note: this article is now 6 years old, and how I work with mental health issues has changed significantly, based on the learnings of working with this methodology over the past 5-6 years.

Luckily, it was a question I’ve given some fair amount of thought to, and something I’ve learned through trial and error over the years. I’ve previously written about my own depression and mental health issues, so I won’t go too much into that here.

I will, however, urge you to speak with your doctors or to call one of the various hotlines where trained professionals can offer you support and advice.

My friend actually asked me a more refined question than that mentioned above, specifically, they asked me: “What point do you take the day off sick because of depression?”

The answer I responded with went a little like this:

Firstly, I don’t take a day off sick for depression. I never take a day off sick for depression, to me, sick days are for things like you have the flu or a bad sore throat or a migraine. That is, sick days are physical.

If I don’t take a sick day for depression, then what do I do? Well, firstly and foremost, I make sure the people I report to (managers, client, etc), are informed and know that I suffer from depression. From there, I start the conversation about how we can manage it.

Yes, how we can manage it, it’s important that they’re on your side, because if they’re not, I guarantee you: awful things will happen, and I’d recommend you look for a new job.

Now that the person I report to knows about my depression and understands it, the conversation about how we can manage begins. In this conversation, it’s important not to put all the onus on them, and instead come to the party with something. For instance:

I’ve not recently had a bad depressive phase, but I do occasionally get them, and I also get burnt out more easily than others. However, I tend to find taking some time out helps, and I’m able to get back to normal fairly quickly (about 1–2 weeks)

This tells your manager multiple things:

1. Your current state of mind; do they need to plan for an absence in the near future?
2. That you might burn out more easily than other people, and that can both cause and be a result of your depression.
3. How you think you can manage it, or respond, when depressive state happens.
4. How long your phases tend to last, such that if a depressive state strikes, then your manager can respond and plan around that time frame.

Listen to what their response is. Most likely, they’ll question the taking time off, but even if they don’t, the next part is important: suggest that you split your sick leave in two:

1. Regular sick leave (for the physical things)
2. Mental health leave (for depression)

Ask for the regular sick leave to be metered, as normal, but then request that the mental health leave is made unmetered, but monitored. There shouldn’t ever be a limit on the number of days you can take off because your mental state isn’t what it should be.

The manager will likely question or challenge you on this, in which case, it’s important to have a good response. The way I’ve approached this in the past is by agreeing to track mental health days in a spreadsheet or calendar, have guidelines for when you can take these days, and also a contingency plan for if you need more than the usual number of consecutive days off (e.g., 2–4 weeks instead of 1–2 weeks).

The hardest of those are the guidelines for when you can take days off. For me, I typically use points to decide whether I should take a day:

• Are my thoughts are so congested that I can’t focus on effectively doing my job?
• If my office involves traveling by tube or train, then: If I think I may have chance of suicidal thought?
• Am I sleeping correctly? Am I so tired that I really can’t get into the office and would I be likely to fall asleep there?
• Would my presence in the office would likely have a strong negative impact within my team or with my co-workers? (e.g., short temper, strong to extreme apathy or motivation)

On the tracking of mental health, especially in the case of depression, I’d recommend keeping a mood log and/or regular PHQ-9 tests. Whilst I was in several bad phases last year, I was tracking my moods in a mood log, which I would then show to my manager.

I track my PHQ-9s with a beautifully designed app called D Test (iOS), whilst I typically don’t show this to my manager, I do share it with my doctor and/or mental health worker.

That’s all I’ve really got on how to work with depression.

It’s hard, but using the above, I’ve started to manage it better. The above is based on a lot of lessons learnt after things went extremely bad for me in December 2011, and a lot what I’ve suggested is based on strategies my colleagues and I came up with at State.com, where they went to great lengths to support me. From there I’ve evolved that over the last year of working for other companies and as a consultant.

As a final closing footnote, if you think you’re suffering depression, talk to your doctor or a mental health professional. Talking about our problems is the first step to resolving them. I have a friend who once convinced me to chat to my GP about it, and in some ways, I suspect that I owe my life to that conversation.