A recent report published in the Lancet (21 February 2018) analysed data from 522 trials involving 116,477 people and concluded that 21 common antidepressants are more effective at reducing symptoms of acute depression than placebos, although some are less effective than others. Good to know.
Antidepressants such as ‘Selective Serotonin Reuptake Inhibitors’ (SSRIs) provide a much-needed ‘chemical crutch’ for those suffering from the debilitating effects of acute anxiety and depression. However, they can produce side-effects such as feelings of agitation or anxiety, dizziness, blurred vision, nausea, or low sex drive. Their value is in helping sufferers to return to some semblance of normality and to progress from there, but they may not address the underlying causes.
Prescriptions for these drugs are not short-term; those who need them often stay on them for months or even years without receiving further treatment such as Cognitive Behavioural Therapy (CBT).
According to HSE, 526,000 workers were suffering from work-related stress, depression or anxiety in 2016/17. This translates to an estimated loss of 12.5 million working days. Surely it is in the best interests of sufferers and employers alike to address mental ill-health problems earlier and more effectively rather than just treating the symptoms.
While the relief that can be gained from taking SSRIs is to be welcomed (especially as we now know that they work), I do wonder if taking them might cause other problems, especially safety problems. For instance, given the fact that some users of antidepressants can experience dizziness or blurred vision, they are sometimes advised to avoid driving or operating tools or machinery. But what if the sufferer’s work depends on doing just that? What if the sufferer is reluctant to come forward for fear of being stigmatised? How does the employer manage such a situation? One answer is to have an effective policy on the taking of prescription medication.
Workers should be reassured that they can advise their employer if they are taking any medication, regardless of type, that may compromise their ability to work safely; the employer does not always need to know exactly what medication is being taken, nor do they need to know what condition is being treated. What is important is that the employer makes arrangements to accommodate the worker’s condition and reduce the risk. In my view, such an approach may give workers who feel reluctant to come forward a little more confidence to do so.
Having said that, while the importance of antidepressants is acknowledged, would it not be better for all concerned to try to avoid the need for such drugs in the first place? Surely, if we could spot the symptoms of depression early enough we could intervene and provide the support that would help avoid the need for drugs to be taken and may prevent the loss of a valued worker. This would be better for the individual, the employer and for society as a whole, with lower costs to the health service and, in all probability, a lower possibility of more serious mental health problems developing over time.
Employers have a role to play here. The HSE have outlined a ‘Management Standards’ approach covering six key elements, which can be addressed to reduce the risks of work-related stress. These ‘Management standards’ are:
- Demands – considerations of workload, work patterns and the working environment;
- Support – including resources and encouragement from the organisation and line management;
- Relationships – avoidance of conflict and dealing with unacceptable behaviours such as bullying and harassment;
- Control – how much say a person has in the way they do their work;
- Role – workers must understand what is expected of them;
- Change – effective management and communication of organisational change.
Employers, through line management, should also be on the lookout for behavioural changes that may be signs of a developing mental ill-health condition. This should prompt a sensitive investigation into the cause, which may result in an accommodation being made that can help to avoid more serious and longer term consequences.
Although antidepressants do have an undeniably important role to play in the treatment of acute anxiety and depression, they are not the only answer. Employers and employees should work together to identify potential causes and act to prevent these from causing ill-health. Training and awareness is important here; it can equip employers to organise the workplace so as to reduce the potential causes of stress, as well as enabling them to recognise the symptoms and take prompt, effective action to address any issues. In so doing they will be helping to reduce the huge numbers of people who are currently unable to work due to these conditions, as well as helping to reduce the losses associated with time of work and recruitment of temporary replacement staff.