Going back to work after a severe depression

Patient Guide

The first day back, the fear that people will notice, and the difference between being fit for work and being recovered. A piece about returning after time off.

September 9, 20269 min read

Illustration for the article: Going back to work after a severe depression

The pass still works. That is the first thing he finds out, at the barrier, at ten past eight on a Monday morning. The door turns, someone says good morning without looking up, the lift goes up as crowded as it always went up. Nothing there has changed. He is the one who changed — and for a moment the building’s indifference feels almost like an insult.

At the desk, the computer asks for the old password. The email opens with a four-digit number next to the inbox. A colleague walks past, pats him on the shoulder and says he was missed. Another says nothing at all, and he spends twenty minutes trying to work out what that silence means.

Around eleven, the tiredness arrives. It is out of all proportion to what has been done — so far he has opened four messages and answered one. It is a tiredness that seems to come from the simple fact of being there: from holding his face together, from keeping the posture of someone who is fine, from saying “all good” in the right tone. And with it comes the thought that will keep him company for weeks: what if they notice?

People who have been through a severe depression and gone back to work tend to describe that first day with surprising precision. They remember the time, the clothes they chose, the first sentence someone said in the corridor. It is a day that gets recorded because it was lived on high alert, and high alert records everything.

What almost nobody talks about is the second month. When the novelty has worn off, when nobody asks how you are any more, and when the silent comparison begins with the person you were before all of it. That is usually when going back gets genuinely hard — and that is exactly when people tend to be on their own, because on paper it is all sorted.

Perhaps you recognized something in that description. Or perhaps you thought of someone — a colleague who came back recently and has been quieter than he used to be. Either way, it is worth saying straight away: there would be nothing wrong with that. Going back is one of the most demanding parts of the whole process, and it is the part almost nobody prepares you for.

Being fit to work is not the same as being recovered

This is the confusion that gets in the way most, and it is usually nobody’s fault.

A statement of fitness to work says something quite specific: that the person is in a condition to resume the activity with reasonable safety. It does not say that she is as she was before. It does not say that the tiredness is over, that the concentration is back to its usual level, that tolerance for noise and pressure is intact. Those things recover at their own pace, and almost always more slowly than the paperwork suggests.

What I tend to see is that the suffering improves before the functioning does. The person no longer wakes with that weight on the chest, can manage lunch, laughs at a joke. And still reads the same paragraph three times without taking it in. The two things live side by side, and the second one takes longer.

When that is not clear, what follows is predictable: the person reads the slowness as proof that none of it worked. And that conclusion is unfair to her.

The body comes back before the rhythm does

There is a set of difficulties that turns up with great regularity in the first weeks back, and is rarely said out loud.

Long reading is exhausting. A report, a case file, a technical note, a year-end summary — things that used to be got through in a morning now need breaks. Working memory fails on silly details: the name of the person just introduced, a reference number, what was agreed in Monday’s meeting. Long meetings, with a lot of people talking, leave a tiredness out of all proportion.

And there is a slowness in starting. It is not lack of will, and it is not laziness. It is the gap between knowing what needs to be done and being able to take the first step toward it. Anyone who works to deadlines feels that gap immediately, because the deadline did not move back with you.

None of this, on its own, means the depression has returned. Most of the time it means the functioning is still reorganising itself.

The fear of being found out

That fear has its logic. In many workplaces, the reading of someone who took time off is not a generous one, and it would be dishonest to pretend otherwise. A senior civil servant who was away, a lawyer who spent months out of the hearing rota, an executive who vanished for a whole cycle of targets — all of them know there is a conversation going on that they have no access to.

What I tend to notice is that the vigilance is expensive. The energy spent monitoring your own expression, calculating how long you can stay quiet, guessing what the other person is thinking, is energy that is not left over for the work. A lot of people end the day exhausted not by the job, but by the performance around it.

On telling or not telling: you owe nobody a diagnosis. That is your decision, and it can be taken case by case, with different people and in different degrees, and it can change over time. There is no correct answer that fits every workplace, and I am suspicious of anyone who says there is.

A gradual return, where it is possible

Going straight back to a full load is the most common route, and it is not the most comfortable one.

Where the contract and the structure allow it — and sometimes they allow more than the person imagines — coming back in stages tends to help: a lighter load at the start, a more protected diary for the first few weeks, a period without the tasks that carry most exposure. That is not a privilege and it is not weakness. It is recognizing that the capacity to hold a whole day of decisions is rebuilt through progressive use.

This is something to discuss with whoever is following the case, because it depends entirely on your actual situation: the kind of contract, the role, what has already been formalised. It is not a decision anyone takes by reading something on the internet.

What tends to frighten people needlessly

Some things happen almost every time, and almost every time they are read as catastrophe.

One bad day on its own. The first weeks back tend to swing, and a heavy day after three good ones does not undo the three. The comparison with who you were. It is unavoidable and it is a terrible measure, because it compares a present under reconstruction with an idealized version of the past. The feeling of faking it — that the competence other people see is a front. That one is perhaps the most common, and it tends to fade as the functioning settles, not as the person talks herself out of it.

And there is the grief for the time that was lost. A lot of people come back doing sums in their head: the months gone, the promotion that passed, the file that was handed to someone else. That feeling is legitimate and does not need to be fought off with optimism. It is just a poor adviser for big decisions taken in the first few weeks.

What deserves attention

There is also what should not be normalized.

When sleep comes apart again and stays that way for weeks. When energy drops again and stays low, rather than swinging. When the person starts withdrawing once more — turns down the coffee, stops answering messages, avoids the corridor. When performance falls persistently rather than occasionally.

In those situations it is not worth waiting for the appointment that was already booked for two months’ time. It is worth bringing the conversation forward with whoever is following you. Going back to work is a period in which the plan sometimes needs revising, and a revision made in time is a very different conversation from one made afterwards.

On going back without a guarantee

I am not going to tell you that going back is easy, or that it restores everything. Some things come back whole, others come back different, and some people discover along the way that they do not want to go back to exactly where they were. That is information too, and it deserves to be thought about calmly — not decided in the heat of the third difficult day.

What is worth saying is that the first day is usually the most frightening and the least informative. It tells you a great deal about the fear and very little about the capacity.

You do not have to conclude anything today. If going back is harder than it looked like it would be, that on its own is not a sign of failure — it is reason enough to talk to someone who knows the territory, before the bill gets any bigger.