In the last 17 months, workplaces are prioritizing their employees’ physical health above all else. But what happens when employees’ mental health falls to the wayside?

“Depression is a constellation of symptoms — and one must show five out of nine symptoms with some of the symptoms in question as slight as a change in appetite (markedly lost or increased), depressed mood, loss of pleasure, brain fog, changes in sleep and low energy,” said Dr. Diane McIntosh, psychiatrist and chief neuroscience officer at TELUS, during a Benefits Canada live webinar at the end of June.

With a variety of permutations of these symptoms, depression can take different forms and often flies under employers’ radars, with profound impacts on both the suffering individual and the workplace environment.

Read: Understanding the journey of a patient with depression

Also speaking during the webinar, Dave Gallson, national executive director at the Mood Disorder Society of Canada, said depression is the leading cause of disability leave for all Canadian employers, not to mention the leading cause worldwide, affecting 350 million people. “The cognitive symptoms are most powerful at work and they impede you from performing to your best ability.”

These symptoms can render you “unable to work at your usual level or speed, which impacts your teammates and that impacts your employer,” he added, referring to presenteeism. Instead, an employee may have a frequent need to repeat tasks, feel tired all the time or even physically ill, but they come to work because they need to pay the bills and end up costing the employer more than absenteeism.

If depression is so pervasive in the workplace, why are so few people willing to come forward and admit they’re struggling? Both speakers agreed that the main reason is stigma. Depression has been so heavily stigmatized over the last few decades that “workplaces have employees asking if people will think they’re a burden or unable to do their work,” said McIntosh. “The fear of confidentiality is rooted in stigma. That, or they don’t have a full awareness of the resources available to them.”

Read: A look at ‘brain fog’ and its impact on employees

In a similar vein, McIntosh emphasized that proper care can only come after further eradication of stigma, “which is pervasive across all areas of the country, but especially in medicine . . . . I’m here to tell you that depression is a medical disorder, it can become a chronic disease and we need to be more aware of the mind-body connection . . . . Most illnesses like this are neuroprogressive — they provoke changes in not only your brain function, but also your brain structure.”

Once a person has experienced one depression, they have a 50 per cent chance of another depression, she said. At two depressions, the chances of a third are 75 per cent. And, after three depressions, it’s certain a person will experience a fourth which is when depression goes from acute episodes to chronic and inflammatory.

As such, it’s essential that all mental illnesses are “diagnosed early and treated fully” to avoid long-term harm, said McIntosh. Since depression is a highly individualized disease, so must be the treatment plan. Medication is reserved for moderate to severe cases of depression, but there are treatment options such as talk therapy, psychotherapy, cognitive behavioural therapy and even “adopting a Mediterranean diet, which has been proven to contribute to a healthy gut microbiome, and doing some kind of exercise for 30 minutes a day can have similar neurological effects as antidepressants.”

Read: Plan members increasingly open to pharmacogenetics, virtual care

Pharmacogenetic testing, she noted, has an important role in the treatment plan for depression. In addition, Gallson stressed the individualism of drug metabolism as one of the key reasons for personalized treatment. “So much of what happens in psychiatry is comfort-based, what the doctor feels comfortable prescribing,” added McIntosh. “Pharmacogenetic testing is so important because it installs algorithm-based medical care: what does the evidence tell me based on your medical makeup?”

However, employees often have limited treatment choices due to high cost or lack of access. Patients sometimes do well on generic medication, which is necessary because of the accessibility of generic brands, but employees do need access to the newly funded and branded products to individualize treatment effectively, noted Gallson.

“People are starting to see the benefits of innovative drug companies,” he said, referring to the coronavirus vaccines. “But if you’ve got $500 or even $1,000 in mental-health coverage, that’s not enough. That’s only a couple of therapy meetings and, at that point, there isn’t even enough trust built up to get an individual to open up about what’s really bothering them.”

McIntosh and Gallson agreed that the return to work after a depression is more than possible and encouraged. “Work is good for you, for your neuron growth, your financial wellness, your sense of purpose and your social connectedness,” said McIntosh, noting such a return must be gradual.

Read: Return-to-work strategies needed for employees with depression

“Normally, when someone returns to work after an extended time away, there’s a cake and balloons and everyone welcoming you back,” said Gallson. “When someone returns to work after depression, people shy away from you because they don’t know how to greet you. That can add a burden to the worker. A depressed person shouldn’t have to worry about their job being at risk.”

So how can employers help support employees with depression? Offer services early on when people are showing signs of struggling, rather than when they are already in a crisis, suggested Gallson. “[Make] your environment such that people trust that the system cares for them. Employers must treat mental health like the world treated the coronavirus pandemic — with urgency and genuine care, as its death rate is higher than that of any infectious disease.

“Depression is sneaky and it lies to you,” he added. “It fools you at every turn and tries to convince you that you will never recover and that you’re not prepared to address the issue. You need to look at recovery as trial and error — science evolves, research evolves, drug therapies evolve . . . . Some people say you can find hope from within, but I say find it wherever you can.”

Read: Co-ordinated treatment plan required to get staff with depression back to work