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David Mrazek, M.D.
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David Mrazek, M.D.
David Mrazek, M.D.
Dr. David A. Mrazek is chair of the Department of Psychiatry and Psychology at Mayo Clinic, Rochester, Minn., and a professor of psychiatry at College of Medicine, Mayo Clinic. Dr. Mrazek has developed a federally funded psychiatric pharmacogenomics research program and implemented clinical psychiatric pharmacogenomics services at Mayo Clinic.
He has received numerous awards including the Award for Creativity in Psychiatric Education from the American College of Psychiatrists and the Agnes Purcell McGavin Award for Distinguished Career Achievement in Child and Adolescent Psychiatry from the American Psychiatric Association. He currently serves as chairman of the board of the American Board of Psychiatry and Neurology.
Dr. Mrazek has focused his current efforts on using pharmacogenomics testing to improve clinical care. One of his specific goals is to decrease the risks of taking psychiatric medications.
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Depression blog
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Nov. 5, 2008
Managing depression in the workplace
By David Mrazek, M.D.
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Work is a big part of our lives. Depression affects you no matter if you are at home or at work. Severe depression can affect your ability to perform your job efficiently.
A buzz word in the literature and press is presenteeism. This means that you are physically at work, but at the same time, are ill. The illness can be medical or psychiatric. The illness can range from mild to severe.
Presenteeism can have a significant negative impact on performance, yet can be difficult to measure.
You continue to go to work despite being severely ill or depressed for many reasons. You may feel you will lose your job. You may want to keep your mind active and have structure in your day. You need your paycheck so you can continue to put food on the table and pay the bills. You do not have paid sick leave and therefore, you have to go to work. You go to work because you feel a duty to your employer and co-workers. You go to work to help your customers.
This is not meant to judge people if they do or do not go to work when ill. The purpose is to provide education and awareness.
How can you manage your depression in the workplace? Make sure you are following up with your health care provider on a regular basis. Follow your treatment plan and take medications exactly as prescribed. Call your provider if you have questions, concerns or are experiencing a worsening in your symptoms.
At work, keep yourself active and challenged. Clearly understand your job description and your employer's expectations of you. Talk with your employer if you need assistance. Use resources available to you in the workplace such as human resources or an employee assistance program. Work can provide a sense of pride and accomplishment and therefore, boosts your self-esteem. Set yourself up for success by treating and managing your depression!
Please share your experiences with depression in the workplace and the issue of presenteeism.
80 comments posted
February 9, 2012 3:20 p.m.
I believe if I had not had work to do, I might not have made it through my last severe depression. I got very little done in the morning, but as afternoon came on, I would come out of it a bit and could do something. I was very fortunate in that I was permitted to work from home, so my morning hours long crying jag was not up for public consumption. But my boss regarded me as weak after my recovery. Little does he know - I'd like to see him do 25% of my output under those conditions.
- Sherril
February 6, 2012 1:10 p.m.
Seriously? I expected a more insightful and less superficial post--at least one that had a story or personal insight. This could have been cribbed straight from a pamphlet written for HR. I expected more from something posted through Mayo.
- Julia
January 29, 2012 5:10 a.m.
it is an ongoing struggle to be productive at work while in major depression. my latest episode caused me to be out of work for 3 weeks. i have good support at home and work and have been in therapy for many years. the depression was set off by a crisis at work and it is understood by my superiors. so i am really very lucky. i had one unsuccessful suicide attempt while on Zoloft,which i did not tell anyone at work about except my boss. she insisted that i have my medication reviewed. the medication was changed 2 weeks ago and i am beginning to feel better. i also started meditation classes and walking daily on the beach - bare feet and in the wind, rain, heat - it has grounded me somehow. the meditation helps me to sleep without sleeping tablets for the first time the past month. i listen to guided meditaion by kelly howel when i go to bed. it puts me into a deep sleep within minutes - wonderful! i find i am more present at work because i sleep better. i still struggle with consentration, but i take a walk to the restroom or to another department when i realise it. i also try to get back to focus on my breathing. i try to be as responsible as possible in my work by arriving on time - it is not easy, but 3 out of 5 days i manage. i work an hour or so later to be sure my employer gets their pound of flesh out of me. i am a senior manager and need to be sure to still model good work ethic to employees. this is easier said than done. moment to moment is all i can manage for now.
- ss
January 14, 2012 12:04 a.m.
I was recently diagnosed with depression. I've been on Wellbutrin for over six weeks now and it's not helping. I just had my first visit with a counselor this last week. I have a follow-up with the psychiatrist in the practice and I'm hoping he will either up the dosage or find some other med. And I'm hoping the counseling will help. Anyway, a few months ago I moved positions within my company. One of the challenges I face in managing my depression at work is, not only am I new in the department, but this is also a career change. The job requires much more face time, meetings and etc. I am supposed to be a project lead and I am finding it very difficult to come out of my shell because of my depression and low self esteem. I also have difficulties concentrating. These things are making it difficult to be effective in my new job. The other issue I'm having is I can't find any counselors who have appointments on evenings or weekends. So figuring out how to disappear while I go to counseling has been tough. I have chosen a practice that is close to my home and my commute to work is about 1 hr 15 min. To make the appointments I really need to work from home on that day. On the surface my manager seems flexible, however, I'm also getting the sense that her flexibility is more for "once in a while" situations. Even though per HR policy, all I'm only required to say that I have an personal appointment to go to, I just don't feel comfortable telling my boss that.
- KD
January 10, 2012 4:18 p.m.
My workplace isn't very helpful at all, I attempted suicide last month putting me in hospital for a few days, I returned to work the day after been discharged and got taken in the office and basically told how I was a let down to the company etc. I work in warehousing on long shifts (so not a lot of thinking needed) and my shift patten is changed weekly, making it difficult to time medication and stay awake and active throughout the day. I had a big anxiety attack the other day causing a blackout, I went to tell my team leader and got 'what you want me to do about it, I'm not a doctor' as a response, I don't seem to be getting any help or support from my workplace and it is really dragging my mood down, On the way home I have to go over a bridge to cross the river and every time I cross, I think about jumping. I am going back to my doctor to ask about been signed off, even though that will cause some stress as I don't get sick pay, I'm really stuck here and don't know where to turn, I try to talk to work and get remarks that just make me feel worse. I just feel like I'm getting nowhere with this. They isolate me and refuse me to have my breaks when I need them. Theres been times I've worked hard and hit big targets and still been put down for it, I just feel like I can't do anything there without been dragged down.
- Carl
November 13, 2011 10:46 p.m.
I currently work for a government agency. Because of depression I miss work about 2 days a month, and I'm late nearly every day. I have filed an FMLA (Family and Medical Leave Act) form signed by my doctor. A supervisor explained to me that FMLA does not have to be taken all at once. It covers me being late and missing a day to two at a time, up to 12 weeks a year. My doctor used the diagnosis of migraine (which I also get) on the FMLA form, knowing that not everyone understands depression. It has not effected my performance reviews, and I was approached about my interest in being promoted. I'm sure it's easier to use FMLA n a government job than private, but it's worth looking into.
- LP
October 28, 2011 5:33 p.m.
I work in a psychiatric hospital, so I am surrounded by those who are as depressed as I am sometimes. I find I'm ok once I'm at work (feeling like I'm really helping others), but have a really hard time getting to work....I have SAD so as the winter progresses I have to watch my call-off's. I find it harder and harder to get to work. I have solved some of this problem by working evenings 3-11, which allows me to wake up with the light in the morning, as well as using a light box, but it is a constant problem which plagues me daily.
- Sandy
October 18, 2011 12:49 p.m.
My experience on two occasions has been that I have been recognized for my potential and promoted, but had limited success because of low self confidence/esteem and memory problems that my psychiatrist says is the depression and not the medications that I am on. Also, because I am socially isolated (multiple failed friendships resulting in my no longer trying to make friends) I think my language skills are not what they once were. I am reading Feeling Good by Dr Burns again, but can not seem to finish it or other books. Have tried going back to school several times to complete my degree but have given up because I can,t concentrate. On the up side I have a very supportive wife, a good job with a good probability that I will soon be off shift work and available counseling. I have stopped going to the psychiatrist because he never wanted to speak about what was concerning me, my mess have been unchanged for over a year, and I lost confidence in him-I asked him about finding someone who practices cog therapy and he dissuaded me stating it would be expensive and not many physicians practice it (which seemed to surprise my family md). I should request another consult to someone else! Sorry for the long-winded note. This is my first entry. Not sure how many people read through these entries but there. S probably value in journaling, and I am sure that many people probable do read some of these entries
- LS
October 12, 2011 5:49 a.m.
I am so blessed. My workplace - a Christian high school - has been excellent as I have struggled with major chronic depression. My Head of Department keeps an eye on me and helps me see when I have the black dog on my shoulder - my principal has given me time off and exempted me from things like camps when I am not coping. In return, I try to do over and above my job whenever I am well, stand in for teachers who are ill, and generally be as useful as possible over and above my job. Although I struggle, God has blessed me and I am grateful.
- boydie72
August 17, 2011 8:42 p.m.
Beware about being a hero at work. In these economic times you may feel pressured to work 50-60 hours per week or even more. You may be doing 2-3 people's job so the company can save money. But constant and never ending stress day after day with micromanaging nitwits who demoralize you, will hurt you very badly mentally and physically. I officially went into depression and job burnout after only a few months after starting a new high tech job. I work across multiple time zones, countless "bosses", a disorganized array of mess, and only constant negativity from countless overworked angry developers. If you see yourself in this picture, get out while you can. I can now only stay awake 1 to 2 hours maximum. I have lost 12 lbs, can't do simple tasks or remember things like paying bills. I am on meds, and seeing a psychologist. But I wonder if I will ever remember again. I have only a few dollars in my bank account. This is truly hell. But I just tell myself, even if I take a simple job to get out of this mess it's better than giving up. Don't ever give up on yourself. You are your best friend. Just say NO to horrible working conditions and constant pressure.
- Lora
July 6, 2011 1:52 a.m.
July 6th,2011. I just noticed it's 2:40 am and I'm still up. That makes it difficult to handle going to work. Crying because of home issues or seeing something sentamental while at work isn't comfortable. Thee most difficult thing for me is not having energy in the morning and feeling overwhelmed at just the prospect of picking out an outfit, showering, fixing my hair,makeup and getting out the door. Sometimes i get to bed earlier and purposly pick out cloths for the next day before bed and occasionaly shower before bed. That way I have a jump on things. All this is along with medication. I've decided not to expect to be happy and just accept unhappy. Then if happy things come along ,I will enjoy them. I used to expect to be happy. Doesn't work for me . I have experienced many losses in my recent life and just when I think I'm getting over the pain of that one, surprise, surprise, here comes another. Hurray. I've alwo been dealing with thoughts of death alot lately. Don' t want to hurt my loved ones, so I better tell my doctor.
- nancy
March 17, 2011 11:50 p.m.
I am on my 3rd attempt to return to work after being severly depressed for th last 5 years. I work in a pharmacy and you would think there would be some understanding of the problems. I have been there 20 yrs and know my job but there are some days I just can't face it. I am lucky to have a union on my side. anybody facing problems my want to check out a human rights charter thru the United nations. Good luck to everyone. It can be a long road but gaining acceptance in the workplace will be worth it.
- Louise
February 12, 2011 12:21 p.m.
I've had depression most of my adult life, and I am glad to come across this term "presenteeism," as it provides handle for talking about how depressives can deal with the need to work. I sympathize with notmuchhelp below, but I think HR is neither your friend nor your enemy. If I ran a company, I wouldn't knowingly hire a bunch of people with problems like mine, neither would I seek to weed them out and get rid of them. We need to be productive to justify our paychecks - so I do my best. I test the waters, only tell people I think are trustworthy, and, in my company at least, I don't go to HR. The good news is that if I can manage to be productive enough and put a good face on and be positive even when I don't feel it, my personal battles are none of my employer's business. Let's face it, part of what we get payed for is to work with others and playing a good positive role. Thanks for the article.
- Jim
January 13, 2011 4:49 p.m.
I have had severe depression since I was I was 20. By that time I had had two suicide attempts. Over the years, 22 now, sometimes I have told a boss and sometimes not. It really depends on the person. I have never told HR, they are not on your side. I tell my immidiate boss/supervisor and perhaps a trusted co-worker so that when I come in looking like the walking dead, they know why. I mean, we do look bad some days. It is very hard to go to work some days. I do my best. I have also develops SAD in winter time now too, so that really adds an element of bad from November to March. There is no right or wrong thing to do, do what you feel is right. Part of lifting above the illness is the support network and that should includes people at work. I find it helps when some know. That way when others ask them if I am ok, they can say yes, she's ok.
- Anita
November 14, 2010 7:14 p.m.
Gina, you wrote that you're concerned about going into a job interview after several years of being out of work, partly for depression. You are not obligated in any way to disclose that about yourself. If they ask why you were out of work for so long, tell them someone in your family was very ill and you cared for them. It's not a lie. It would be improper for them to pry for more details. But if they ask something along the lines of who the family member was, tell them it's a personal matter you'd rather not discuss with a stranger but your family is well again and you're ready to get back to work. Good luck out there.
- Scott
November 7, 2010 2:12 p.m.
If you will allow me to finish my last sentence from the post below: And yes Virginia, it's as ok to cry as it is to laugh! Both were given to us to allow us to express and cope with our human condition as we journey through life together.
- Clint
November 7, 2010 2:07 p.m.
I was diagnosed in 1994, but have lived w/"the curse" since childhood (I remember wanting to die as a child). Bad parenting, insensitive "friends", family and co-workers all make our already difficult lives even more demanding. I won't even go into the ignorance about mental illness that runs rampart in our culture. My heart goes out to you all who have mustered the strength and boldness to share your lives here on this forum. On the work issue, I agree with those on here who have warned about sharing the truth of your illness with your employer - by and large most employers cannot be trusted with this kind of information. There's enough proof of this to go around the world a "gazillion" times. So what do you do? One - take the best care of your self that you can (be kind and good to yourself, don't "give-in" and beat yourself up!). Two - find people who you can trust and talk to them (this is not always within your family). Three - Get right with God (He does understand - cling to Him first and foremost) and Four - Force youself to "get out there" and do things you enjoy (exercise, music, crafts, volunteering, watching funny movies....anything that you even remotely like to do). My own coping method is humor (especially at work). The most important thing I have learned is: Never, ever, ever, ever give up. Life can be very unpredictably good to us, if we keep trying. And last but not least: Yes, Virginia, it's as
- Clint
October 27, 2010 10:36 a.m.
Hello, I have suffered from Depression since I was in my mothers womb. I have been to hell and back many times, I know how it feels not wanting to get up, not even wanting to shower, etc, etc. I have learned a way to beat that. I recently read a book that has 4 different phases that change your life. Since I always try different things, I did try this book. In the first 4 days, I started feeling the need to love myself above all things. My mind, my soul are just acting positive and different. It only takes 1 hour a day. The writer asks that you do it for a month, I will do it for the rest of my life. It feels great. Her book is called "Why run when you can fly". by Isha and the system is "The Isha system". This is a miracle to me and I pray it will be for all of you that read this and get the book. The lady is from Australia, the book reached me by coincidence by a friend who purchased it in Peru during her recent vacation. Since then I have purchased different Isha books. To me it is so weird waking up in the morning and telling myself, I bless me, I bring blessing, love, peace, etc, etc, for this day. I pray that you experience a life change, by the way, the book only cost me 11:98 in Amazon. When I said I had been to hell and back I meant it, from emotional, physical and sexual abuse from a step father, to not practicing what I studied. Depression has kept me from practicing medicine. My mind has been a cloud for so many years, I used to forget all t
- MAGNOLIA
May 6, 2010 1:03 p.m.
On April 20 I was hit by the freight train known as depression. That was a Tuesday. My boss asked what was wrong, and I explained it to him. He was (and is) cool with it. I also told trusted co-workers, friends and family. I even started a blog http://ridingtheblackwave.blogspot.com/ Anyway, it's been three weeks now, I am taking lexapro/ativan and doing OK. I still have some really disheartening and disturbing thoughts, but that's part of the depression game. I figured for me, this is a very tough illness and I want everyone I trust and love in my corner. I am also working with a psychiatrist, taking meds, and beginning a cognitive behavioral therapy group next week. This is about my mental wellbeing, my health and my future and I take it very seriously. No need to waste time feeling "ashamed" by someone elses stigma problems. It's a common illness, but serious as well. Don't let anyone tell you otherwise. And if your fired for it, sue them. Then can learn human compassion from getting hit in the pocketbook. :) Keep with it my friends. It's gets better, and you get stronger.
- Aaron
April 29, 2010 7:38 p.m.
I was diagnosed with major depression in December 2008. I recognized I was having a problem but for months did not know exactly what the problem was or how to approach it. I suspected depression from doing some research on my own and went to my doctor for her diagnosis. She confirmed I had severe depression and prescribed medication. I contacted the EAP where I worked at the time and set up counseling. There were some issues at work (to keep it short here) so I approached my supervisor and the plant leader disclosing my depression. Later (after I was demoted) I found out the employer said they had concerns with my performance but at the time I disclosed my condition, they said nothing. I remained employed until they found a "reason" to terminate me. I could write pages and pages on how the employer treated me, but due to ongoing litigation I have with them in relation to this subject, I cannot disclose much detail. My whole point here is that the stigma of depression is very real and widespread, even among employers who "claim" they understand depression. There are employers who do understand this illness and take extraordinary measures to help their employees. My congratulations and thank you to those employers who do care about their employees. My advice to employees who may be going through depression and want to get help from their employers, do your homework, know your employer well, and document everything. I sincerely hope others will not nhave to
- Loyd
April 10, 2010 2:57 p.m.
I have very deep depression brought on my stress, loos of loved ones by death, break-up's in relationships, my job causes depression, money problems cause depression, I have been off of work several times due to deep depression, also very scared that I would loose my job, or co-workers would talk about me behind my back, the last time it was three weeks off of work due to a break-up that caused my depression to come on, anything that seems to good bad triggers something in my brain that I can't think straight, I worry about the future, I worry about the present time, I worry about being alone and dying alone, I have family but they also have their own lives and their own families, I sit home alone at nights, on weekends I'm alone, I was married once for 7 years and have one son, my son is my gift from the Good Lord he is what makes me get through the difficult times of deppression that the good Lord for my son because he is my savoir and my beautiful baby boy he is going to be 12 years old I have him every other weekend , his mother my ex-wife puts more stress on me always wanting more money, I do not have a college education, I work as a custodian making around 12.18 an hour I have to try to support my self and my son when he is with me, and support him when he is at his mothers house, even though they have a 188,000 dollar house new van and a car, and I live in a apartment, and have a ton of bills, child support, health insurance, and a unreliable truck , i cry everyday
- Roberto
March 28, 2010 6:06 p.m.
Thanks for this article!! It really helped to explain a form of tolerance or passive existence that limits seeking appropriate therapy for potentially treatable illness.
- Brunetta
March 23, 2010 4:34 p.m.
what's the name of that company that supports people with depression? I want to work there! Yes while it is better to go to work than stay home and do nothing it certainly is very hard to put that face on and pretend just so you can get by financially. I would love to be able to go to HR and tell them that the schedule is difficult for me to work when things are bad but I'm no idiot. If they find out that I have a mental illness then I can kiss my job good by. ANd finding another job is very hard to do when you are dealing with depression. It takes enourmous energy.
- kat
March 8, 2010 3:15 a.m.
Maybe Im expecting too much here, but this article on dealing with depression at work is lousy. It is not only not advisable to share your issue with HR, but a gross misunderstanding of the modern workplace culture to advise depressed people to go to HR- these people are not there to help you, they are there to help the company! They will document any issues you have in such a way as to make it easier to get rid of you; they are there to protect the organization from you- they are not on your side! Telling them anything about it may lead to items in your file, lack of promotions, being let go, financial trouble and perhaps worsening depression.
- notmuchhelp
February 22, 2010 12:44 p.m.
I have a strong family history of depression, bi-polar & major depression. I have had recurring major depressive disorder for most of my life since highschool..I am now 58. Your term, presenteeism is so right-on for me. I have missed very little work due to depression, in some ways it is easier to go to work put on my work hat(I am a nurse) and do the job I know how to do..it is a comfort zone if you will because I know what I am supposed to do there. It is when I am home, that i struggle. Tears, fears, anxiety, anger, lethargy, saddness and isolation are the norm for my "personal" time. After each episode, I feel like I have been beatup, or hit by a truck. It is painful just to move or even think. My depressive /anxiety episodes can last for hours or days, I cannot reach out for help during those times, but if I am scheduled to work, I can slip into the expected role, do my job, then ,sometimes it breaks the cycle, sometimes not. I am a perfectionist on the job, which adds stress, but also helps me stay on track. In my profession, mistakes & bad performance can have catastrophic effects. So yes, I am there, I am "present", I do a good job, but I am useless when it's my time. This cycle replays over & over despite meds, therapy, and a very understanding husband. Does my employer know? Absolutely not. I am afraid to let them know..that stigma is alive and well, I hide behind the truth and my genetics. It's heartening to hear the stories told her
- Lyn

80 comments posted