High-Level Job? Don't Get Depressed, Treatment Might Not Work For You

It probably shouldn't come as a surprise but a high-status job means you are less likely to respond to treatment for depression.

Could it be the stress, the tension, the high expectations of those around you?

Up to a third of patients who receive drug treatment for depression do not respond to treatment.  Although there is a wealth of research showing that low social and economic status is associated with a greater risk of depression, there has been little work focusing on how occupational levels respond to treatment.

 A group of international researchers from Belgium, Italy, Israel and Austria enlisted 654 working adults attending clinics for depression, and classified their work according to occupational level, according to newswise.com,  336 (51.4%) of whom held high occupational level jobs, 161 (24.6%) middle-level, and 157 (24%) low level. Around two-thirds of the patients were female (65.6%), which reflects the normal gender difference in reported depression. Most patients were treated with SRIs (Serotonin Reuptake Inhibitors), although other pharmaceutical agents were also used, as well as psychotherapy. Those in the higher levels were found to have received fewer SRIs and more psychotherapy.

On analyzing results after treatment, they found that 55.9% in the highest occupational group were resistant to treatment. In contrast, only 40.2% of the middle-level workers remained treatment resistant, and 44.3 of the low-level workers. This difference was also reflected in the degree of remission, with only around one in 6 in remission in the higher status group, as against around one in 4 for the other groups.

“Though these findings should be considered preliminary, they indicate that high occupational levels may be a risk factor for poor response to treatment," say researchers. "A number of variables may explain these findings. For example, 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 behavioral differences”.

Co-worker Professor Joseph Zohar (ECNP Past-President, Tel-Hashomer, Israel) adds, “This shows that the need for precise prescribing is not only related to the symptoms and genetics but also to occupational level.  One might need to prescribe different medication for the same disorder and need to take into account the occupational level in order to reach optimum effect."


"The results of this study might sound counterintuitive, but people with highly demanding jobs are subject to a lot of stress, and when they breakdown with depression it may be particularly difficult to cope with their previous life," notes Professor Eduard Vieta (ECNP Executive Committee member and Chair of the Department of Psychiatry and Psychology, Hospital Clinic, University of Barcelona).

He pointed out that an alternative explanation may be that high-status job patients may be more prone to request psychosocial treatments without the support of pharmacotherapy. "The ideal treatment of depression is, in general, the combination of both pharmacotherapy and psychotherapy."


So if you're at a high level and become depressed, should you just fake it and take it?  No, of course not. 

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