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Anxiety and Depression in the Workplace

In March 2009, our guest expert was Dr. Anthony Levitt, psychiatrist-in-chief at Women’s College Hospital and Sunnybrook Health Sciences Centre.

Dr. Levitt is a senior research scientist at Women’s College Research Institute, and a professor in the departments of psychiatry and nutritional sciences at the University of Toronto. His clinical and research interests focus on mood disorders, including postpartum depression, major depression, seasonal depression and thyroid illness. Some of his recent research explores how gender affects symptoms and expression of depression and suicidal thoughts, and also the effect of gender on substance abuse in patients with bipolar disorder.

Here are his answers on Anxiety and Depression in the Workplace.

Q: My spouse has been off work for 10 months on stress leave from his employer of 23 years. He is suffering from depression and anxiety and has had suicidal thoughts and was hospitalized for it. How do I try to help him get through this? I am overwhelmed and was told that I might be depressed as well. I couldn't handle that. So how do I help him and help myself through this extremely difficult situation?

A: Yours is indeed an extremely difficult situation. Often the best way to navigate through this is to speak to other people who have struggled with it. Self-help organizations such as the Mood Disorders Association of Ontario exist for exactly this reason. There are terrific resources for people in your predicament.

Do not neglect your own needs. When you are on a plane, the safety procedures card will remind you that if oxygen masks are required, you must place a mask over your own face before attempting to help others. It is the same principle with depression: in order to help your husband, you must first take care of yourself. As troubling as it may be to you that you may have depression, you must actively seek help. Depression is a treatable condition, and there are many options and alternatives available now.


Q: I periodically experience difficulties with depression and anxiety that affect my work in terms of my ability to communicate effectively with superiors as well as my overall productivity. I have debated about ‘coming out’ with my disability and requesting job accommodations to protect my job security but I feel there are more risks than benefits. What are your thoughts on this?

A: I wish we lived in a society where people could declare all sorts of illnesses – be they physical or mental – and find an accepting, compassionate, understanding system to accommodate all our disabilities. Unfortunately, this is not always the case. There are, however, counsellors and people with experience in these issues that can help you to find the best way to communicate your needs. There are job coaches, rehabilitation counsellors and employee assistance programs that can sometimes be of great help in this regard. If you are involved in psychotherapy or have a very caring and understanding family doctor or psychiatrist that you trust, a discussion with these people can also be helpful.


Q: I am in my late fifties and have been at my current job for almost 15 years. There are a lot of younger people joining my department and I am experiencing a lot of stress and anxiety related to this. I feel very out of place in a young looking work force. As a result I feel quite self-conscious at work. How can I deal with my anxiety about aging in a young work force?

A: It is possible that the anxiety and stress you describe are results of your issues with self image, but it’s always important to consider that anxiety and depression can actually precede feelings of stress at work. In other words, people can develop anxiety and depression spontaneously and then attribute it to issues at work or in relationships or other social issues.

As a first step, you need to have an evaluation by a trained health professional to determine whether the symptoms of anxiety you are experiencing are part of a more serious condition. If they are, the first action should be to get appropriate treatment. If, on the other hand, your concerns about self image at work are the main issue, then psychotherapy can be very helpful in allowing you to come to terms with and respond to what you perceive as the problem at work. There are many different kinds of psychotherapy available, but the two most commonly recommended for anxiety and depression are cognitive behavioural therapy and interpersonal psychotherapy. You can find a list of therapists online, through your local hospital, through a university department of psychiatry, or through the College of Physicians and Surgeons of your area. Your family physician may have a list of therapists that he or she refers patients to, or you can ask friends, family or colleagues if they have had a good experience in therapy and can recommend someone.


Q: I have been working in the same office for over 12 years. Even though the company has grown to over 80 people, I know everyone on a first-name basis. Last December I just couldn't face the company Christmas party. I planned to go, but that afternoon the mere thought of attending made my heart race, my hands shake and the walls close in around me. I had to ‘escape’ out the back door of the office. This is the third company social event I've missed and I find it has just become easier not to attend anything. I don't know why it's like this. I get along reasonably well with everyone, but in a social setting outside the office, I just want to curl up in a ball and dissolve into the background.

A: It sounds like you have a significant issue with social anxiety, and it sounds like it has come to the point where it is interfering with your life and your well-being. You may be surprised to know that one out of 20 people in Canada is affected by this condition, known as social anxiety disorder. It feels embarrassing, confusing and insurmountable, but the good news is that it is very treatable. Each year thousands of people return to social activities following successful treatment for social anxiety. It responds best to counselling or psychotherapy, but can also respond very well to medications. The psychotherapy that is most effective for social anxiety disorder is called cognitive behavioural therapy. The medications most often used to treat this condition are in a class called serotonin reuptake inhibitors (SRIs). There are some excellent web resources you can look into, but it is probably wisest to speak to your family doctor and to arrange for appropriate referral or treatment.


Q: Should I tell my manager (I work in health care) that I am suffering from high anxiety and depression? I suspect or know my work performance is occasionally affected. Mindfulness mediation helps me a great deal.

A: This is a very complex question. It depends on several critical issues: first, your relationship with your manager. If you have a longstanding and trusting relationship, chances are higher that he or she will respond respectfully. Second, it depends on the personality and leadership style of your manager: those who focus more on productivity than on people may not respond as well to this information. Third, it depends on how comfortable you are with discussing mental health issues. The more uncomfortable you are, the more the recipient will be uncomfortable. Finally, it depends on the culture of the workplace. Some workplaces encourage and support people with disabilities, talk openly about related challenges, and are committed to making accommodations. Other workplace cultures are secretive, non-collaborative and just plain prejudiced. Prior to revealing this information, you may want to have a discussion with a trusted friend or experienced counsellor or therapist who can guide you through the most appropriate way to share this information.


My boss is a micro-manager. My every move is questioned. She makes off-the-cuff comments in staff meetings. Then she comes to me after the meetings to address them. I feel very anxious in her presence and I am about to blow. I am also starting to resent going to work and am dreaming about work activities. Do you think it is time for professional help? Other staff members have told me that she is searching my office and asking where I am when I am not at my desk.

A: I do think that professional help is a good idea. Professional help may be able to assist you in reacting to your boss in a way that is healthier for you. It may help you to identify a range of appropriate and alternate responses.


Q: Will depression go away if one changes one’s workplace?

A: I wish it were as easy as that. In rare circumstances the workplace is the sole trigger for an episode of depression. In the vast majority of cases, depression leads to difficulties in the workplace and it will simply follow you to the next workplace. Before making big life decisions such as a change in work or changes in relationships, it is important to have a comprehensive evaluation of the depression by a trained professional. Depression may be responsive to counselling or therapy, or to medication, or both. Once the symptoms of depression have been controlled, coping with the stressors at work becomes much more straightforward. You can then make a wiser decision about your work and your future.


Q: I work in the field of disability management and a majority of my clients are on short-term disability from work as a result of depression and anxiety. What is a good indicator that a person is safe to engage in a return to work program?

A: This is a great question and I wish I had a straightforward recipe or a simple response. There are three components to determining when someone is ready and/or able to return to work. The first is worker readiness. This refers to how well the symptoms have been suppressed or eliminated, personal motivation and the aftermath of having left work in the first place. By that I mean, does the person feel they have burned bridges, or that there were unsolvable conflicts before they left? The second issue is workplace readiness. This has to do with any accommodation the workplace is prepared to make and how well the workplace handles mental health disabilities. The third factor is “bridging” – in other words, how capable are the worker and the workplace at creating a safe bridge, and what structures have been put in place for the person to successfully return to work?

If a person has had significant suppression of symptoms to the point where they are substantially more functional, and the workplace has made realistic accommodation, and there is a plan to reintegrate or “bridge” the worker, the return to work will be more successful.


Q: I love my job as a teacher, but my manager controls everyone and everything. She is bipolar and even places notices in our common area stating that bad bosses kill their employees through stress and anxiety. Can my many migraines or a colleague's miscarriage be caused by the stress she puts on us?

A: First of all, stress comes in many forms. One person’s stress is another person’s challenge, and therefore there is no exact relationship between stressors and health. However, it is safe to say that the fewer negative, unproductive and/or destructive stressors you have in your life, the more healthy you are likely to be. Having said that, learning techniques such as relaxation, yoga and mindfulness can help reduce frequency of migraines whether or not you are in a stressful environment.


Q: My workload is time-sensitive and I am very busy. We are short-staffed and many people at my workplace are short-tempered. I try to eat right, go to the gym and generally keep a sense of balance in my life. I thought I was coping pretty well, until a close friend pointed out that I never answer my phone when I am away from work, and I have stopped going out with my friends. When I started to think about it I realized that I have been going into work earlier and earlier on a regular basis. I thought it was because I could get work done when no one was there. What I have realized is that I am often just sitting there unable to start working and I end up staying later and later. I also took a hard look at my ‘balanced’ lifestyle and realized that I have been skipping the gym and hadn't noticed it. Worse yet, I have been eating comfort foods non-stop. I'm feeling pretty anxious about the state I find myself in. Any suggestions on how to get out of this downward spiral?

A: When one has been oblivious to significant changes of behaviour or lifestyle, it is sometimes difficult to change things on your own. Whether you choose a “life coach,” psychotherapy or seek a psychiatric evaluation, you will need a professionally trained person to help you sort through how this happened and how to get back onto a healthier track. I mentioned psychiatric help because some signs that you describe may be the symptoms of an episode of mental illness, and it’s important to have a comprehensive evaluation.


Q: What educational information would be most helpful for employees in coping with anxiety and depression in the workplace? What would be the best approach for an employer to promote a healthy work environment? Are there any educational speakers that could help educate employees so that they have a better understanding of depression and anxiety?

A: The following is a list of resources you might find helpful.

Ontario Works
Mood Disorders Association of Ontario

Editor’s note: National resources include:
Mood Disorders Society of Canada
Canadian Mental Health Association


Q: How do you separate anxiety and depression from burnout? How do you manage them so that they don't contribute to burnout, and vice versa?

A: Burnout is a catch-all phrase. On the mild end, it means a person might be experiencing some stress because of workload. On the more extreme end, it could indeed be referring to a mental illness such as depression or anxiety disorders. The distinction between these two extremes is that mild stress is usually not associated with significant physical symptoms (changes in sleep, appetite, energy), cognitive changes (such as poor concentration or memory, or difficulty making decisions) or persistent mood changes (sad and tearful, as well as loss of interest). By contrast, clinical syndromes such as depression and anxiety disorders are present almost all day, almost every day for weeks at a time, and include significant changes in physical, cognitive and mood symptoms.


Q: How can a person evaluate the difference between usual workplace pressures and an anxiety problem?

A: On the mild end of “usual workplace pressures,” a person might be experiencing some stress because of workload. On the more extreme end, it could reflect a major mental illness such as depression or anxiety disorders. Please see my response to the burnout question above.


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