Work it out

I've been suffering from depression for about six years now. I've never been officially diagnosed but I've had courses of counselling and psychotherapy. My depression has a massive effect on my daily life, but I've always been able to make sure my work doesn't suffer too much.

Lately, though, I feel that things are getting worse. My work is no longer untouched by my problems and I'm worried about how to handle it. When I filled in my pre-employment health questionnaire I didn't mention my mental health difficulties, mainly because I've never been diagnosed or taken medication.

Am I better off getting a proper diagnosis and making my employers aware of it? I'm scared that I'll just make things worse for myself by having my record tarnished and always having to make people aware of my illness. How would I even go about getting help anyway? I've found doctors to be rather inexperienced and ineffectual when it comes to mental health issues.

I'm also concerned about the ignorance of some of my senior colleagues, and whether they have the ability to understand what life is like for me. Any advice would be gratefully received.

It sounds like the last six years have been hard for you. Ensuring your depression doesn't affect your work - despite the impact it has on your daily life - takes a lot of strength and can also be very draining. Feeling unable to control your depression anymore, in terms of it affecting your work, must be difficult to come to terms with. Particularly when you're so concerned about the way your employer and colleagues may handle your situation if they found out about the depression you are experiencing.

Anything you declare in terms of your health to your employer will have to be kept strictly confidential. The stigma attached to mental health is sadly still present, and it's understandable you feel uncomfortable telling your colleagues about your situation. Please be reassured, you don't have to if you prefer not to, but it may be worth considering opening up to someone you trust at work, even if it isn't your direct manager. You might find that having one person at work who understands, and who you can talk to when you're finding things hard, helps to ease your worries.

You say you've had counselling and psychotherapy but have never actually received a diagnosis or medical treatment. Did you access the counselling independently or via your doctor (GP)? Some GPs do have more knowledge and experience required to deal with mental health problems more effectively than others.

It is the role of the GP to assess your symptoms and refer you onto specialist help and support according to your needs, such as a psychiatrist or therapist. If you feel your GP has been unhelpful, perhaps it would be worth considering the option of joining a different GP practice or requesting to see a different GP.  You can search for all local practices via NHS Direct or by phone on 0845 46 47.

Once your situation and symptoms have been assessed and a professional diagnosis has been given, it may be easier for you to make positive steps forward towards recovery. Depression can be treated in a number of ways. Combining medical with talking treatments such as cognitive behaviour therapy (CBT) can, in many cases, prove to be more successful as a way of exploring underlying issues, identifying and resolving possible causes of depression. As with medication, some talking treatments can work better for some than others. Although you might feel like you've tried everything to help work through your depression, it's important to remember there are still alternative options.

Your GP should be able to explore these and any other options with you, or refer you onto an appropriate counselling or similar services. You could also try contacting the British Association for Counselling and Psychotherapy (BACP) if you wish to seek this form of support independently. Complementary medicines and therapies, such as reflexology and reiki may also be worth considering as an option.

Sometimes opening up to family and friends about your feelings can help too.  It is understandable that some people prefer to keep things from those they are close to for fear of upsetting them. But often, once people know the situation, they are able to offer help and support. Of course, this can be hard and sometimes people find it easier to talk to someone they don't know.

Just to let you know, Depression Alliance provides advice and support to those affected by depression. Their website is full of useful information, publications, access to a national network of self help groups and a penfriend scheme.

SANELINE is a national mental health helpline offering confidential emotional support and information to anyone experiencing mental health problems. They will be able to give you the time and space to talk about how you are feeling, without judging you or telling you what to do. If you feel this could help, you could call them on 0845 767 8000.

Updated: 06/06/2011

Question answered by SANE