Depression Is Tougher to Shake If You’re the Boss

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Life at the bottom of the office totem pole can feel stressful, demeaning, even downright miserable at times, but being the boss has its own set of problems: A new study from a team of European psychiatrists found that that the higher you are in the workplace hierarchy, the more difficult it becomes to treat depression.

The study, which was recently published in the journal European Neuropsychopharmacology and highlighted by the Los Angeles Times, followed 654 full-time workers who had been diagnosed with depression, sorting them into three groups according to their position on the corporate ladder (high, middle, or low status). To meet the minimum treatment threshold for the study, participants had to have already taken at least a four-week course of antidepressants; some supplemented the drugs with psychotherapy.

The researchers checked in with their subjects after they’d received two different treatments for depression — either switching drugs, switching from drugs to psychotherapy (or vice versa), or adding one of those two types of treatment to a preexisting regimen of the other. If a participant’s symptoms hadn’t gotten any better by that point, they were considered “treatment resistant” – a label that ended up applying to around 56 percent of high-level workers, compared to 40 percent and 44 percent for low- and mid-level employees, respectively.

As the Times noted, the findings were a little bit counterintuitive: The high-powered employees were “more likely to get psychotherapy in addition to antidepressants,” which “is considered the standard of care in treatment of major depressive disorder.” The authors didn’t provide any explanation in the paper as to why that might be the case — “our study does not provide sufficient data to direct these speculations,” they wrote — but in the study press release, co-author Siegfried Kasper, a psychiatrist at the Medical University of Vienna, offered a few theories: “There may be specific working environment demands and stressors; people may find it difficult to accept or cope with illness, or to continue with medication; or there may be other factors, related for example to cognitive, personality and behavioural differences,” he said.

For now, though, the researchers argued that the reason is less important than the practical implications of their research: For one thing, it may provide a way for doctors to provide more personalized care, giving them one more detail to help them tailor treatment plans to each patient. And more broadly, it adds another layer of nuance to conversations about mental health in the workplace: “The results of our study should be of interest to clinicians and to the scientific community but also to employers and political bodies responsible for monitoring the wellbeing of employees,” they wrote. “The high cost of depression in the workplace … should also motivate greater efforts to improve recognition and acceptance of treatment” and “reduce the stigma against acknowledging mental health problems” — a part of office culture, fittingly, that starts at the top.