Alison Cowan was on a fast-track career path in a large London marketing agency when, at the age of 27, she had a breakdown relating to clinical depression.

Her employers asked her to tell colleagues she had a virus. They expressed disappointment in her and said they would not have employed her if they had known she suffered from the illness.

Ms Cowan took some time off and returned to work - only to be treated like an office junior. The company eventually asked her to leave, offering her a small pay-off. "My line managers made me feel like they were being generous to me but they were actually being very abusive," she says. A couple of years later she bumped into some former colleagues who looked shocked to see her. They had been told she had HIV.

In spite of legislation in Europe and the US on discrimination at work and a growing public awareness of mental health issues, the workplace can be an unforgiving environment for those suffering from depression. The condition still carries a stigma that makes few willing to admit to it publicly. Yet according to Mind, the UK mental health charity, nearly three in 10 employees will have a mental health problem in any year, mostly anxiety and depressive disorders.

For many employees with depression, particularly those at a senior level, silence seems the only option - a point that was reinforced last week when Lord Dennis Stevenson, a senior City executive who is chairman of HBOS and former chairman of Pearson, the owner of the Financial Times, admitted he has suffered from depression for years, describing it as "hell on earth".

"Depression is a major clinical problem and something like one in five people suffer from it. One in three people get close to the edge," says a partner in a top City firm who has suffered from the illness. "Ten years ago there was a terrible stigma attached but slowly it is getting better."

Today Ms Cowan has a senior job in the City and, partly as a result of her personal experience, has become vice-chairman of Mind. "A job that I had been proud of had turned into something oppressive and negative and about telling lies. Now I know my rights."

Clinical depression is characterised by a malfunction in the limbic system, the brain area associated with emotion and motivation. It can occur just once, several times or can be a lifelongdisorder. The cause is partly genetic but depression may be brought on by hormonal changes, drug abuse or excessive drinking. Many doctors believe one of the common triggers is stress.

"The classicsufferer is the highly ambitious executive who wants to be seen to be doing well, constantly pushes himself and never takes time off. Ultimately he goes too far," says a former investment banker. "These people are the best employees because they work the hardest and they want to do well. I can spot the personality type within four seconds. It is a stupid company that holds depression against its employees. I think it is closely related to creativity."

The high-risk, macho ethos of the Square Mile and Wall Street is often cited as part of the problem. "It's more common in the public sector to receive help but in the world of high finance you have to roll with the punches. You can't afford to reveal any weaknesses," says a corporate financier.

So how should companies respond when they find that an employee is in difficulty? Many offer "employee assistance" programmes, usually in the form of confidential helplines and counselling. Some banks, such as Société Générale, even go so far as paying for therapy. UBS, the investment bank, runs stress management seminars, offers corporate counselling and has an in-house "care team".

"There are processes in place in most City firms," says a former human resources director of a large City bank. "They are always confidential so we would receive a bill stating how many individuals were taking part but not their identity."

But in spite of such policies, many employees with depression say they would never consider confiding in their colleagues, let alone seek help from their employer, for fear of being written off.

"Most people don't use these help schemes. Many executives have privately said to me that they wouldn't even go to their doctor for fear of future references that would jeopardise their career," says Andrew McNeilis, a managing director at Talent2, an executive coaching firm.

This can make it hard for those at the top to assess the extent of the problem. "People don't generally admit to it," says the chief executive of a second-tier investment bank. "We have had some people take a sabbatical and disappear. We do offer some paid leave but they usually decide it's the wrong environment for them to work in. It is perceived as a weakness. I don't see a lot of it."

One partner at a UK law firm says: "A lot of people get invalided out of the legal profession following a breakdown, or total inability to cope. Most don't come back. Ultimately you become a cost to the business, it comes down to economics. If you are a superstar and are worth more to the employer stabilised, then they may bring you back into the fold."

Lord Stevenson has called on companies to raise awareness and create a "culture of humanity" where managers are not afraid to show their emotions. Some employees say they would like their employers to offer more flexible working arrangements, provide quiet rooms and allow people to work from home more often. Correcting the stigma towards depression cannot be done overnight, say sufferers, in spite of the willingness of HR departments to show they are progressive and tolerant.

"The City will tolerate many peccadilloes, including alcoholism," says Mr McNeilis. "It will pay for rehabilitation at the Priory for a narcotic habit. It will even turn a blind eye to sexual deviancy. However, the one thing no one ever wants to discuss with their line manager is depression."

At first hand: one sufferer's account of the workplace blues

"One evening, for no apparent reason at all, I suddenly felt very uncertain about what I had to do the next day. The feeling of anxiety grew and the spiral was swift. I thought I was losing my mind. I was unwell and needed help fast.

"Mental health problems only usually come to the employer's attention when it's too late. A pull-your-socks-up attitude simply doesn't work. My company was brilliant. They told me to go away, turn off my computer and BlackBerry and not to come back for three months. I fled to the doctor and found there were plenty of other people just like me.

"I came back and continued working but didn't enjoy a moment of it, it was just day-to-day survival. Things eventually improved - two steps forward, one step back. Most companies are not as understanding as my own.

"What employers need to know is that depression is real, the sufferer can do nothing about it and it overtakes at enormous speed. The first step for companies is to look out for clear signs such as people who are over-focused on work, never take holidays and work all hours. Work is too central in their lives and they tend to judge the whole of their identity by their success or failure. These are the people that always end up with problems."

艾利森•考恩 (Alison Cowan)在伦敦一家大型营销公司升得很快，但在27岁的时候，临床抑郁症让她崩溃了。

雇主让艾利森告诉同事，她得了传染病。雇主对艾利森表示失望，并称如果事先知道她患有抑郁症，是不会雇佣她的。

休息了一段时间后，艾利森回去工作，却被当作办公室新人对待。最终，这家公司要求她辞职，支付给她一小笔遣散费。艾利森表示："部门经理想让我觉得他们好像很仁慈，其实他们非常残酷。"几年后，艾利森碰到了以前的一些同事，他们看见她似乎感到非常震惊。有人告诉他们，她感染了艾滋病病毒。

尽管欧洲和美国都已立法反对职场歧视，而且公众的精神健康意识不断提高，但对于抑郁症患者而言，职场也可能是冷酷无情的。这种病症仍然带着不好的名声，因此很少有人愿意公开承认患有抑郁症。但据英国精神健康慈善机构Mind统计，在任何一年，都会有30%的雇员存在精神问题，大部分是焦虑症和抑郁性疾患。

对于很多患有抑郁症的雇员，尤其是职位比较高的人，沉默似乎是唯一的选择。这一点最近得到佐证--金融城高管、英国哈利法克斯苏格兰银行(HBOS)董事长丹尼斯•史蒂文森勋爵(Lord Dennis Stevenson)承认，自己患抑郁症已有多年时间，并将之形容为"人间地狱"。史蒂文森勋爵曾是英国《金融时报》母公司培生集团(Pearson)的董事长。

"抑郁症是一个严重的临床问题，差不多20%的人都有这方面的问题。三分之一的人会接近患病边缘，"一位患有这种疾病的金融城大公司合伙人称。"十年前，抑郁症非常为人所不齿，但慢慢地，情况已有所好转。"

如今，艾利森在金融城的一个高级岗位上工作，并且成为英国精神健康慈善机构Mind的副董事长（部分原因在于她身患抑郁症的个人经历）。"我曾引以为傲的一份工作最后变得消极、令人压抑，而且全是谎言。现在，我知道自己的权利了。"

临床抑郁症的特征是脑边缘系统紊乱。脑边缘系统是大脑中与情感和动力有关的区域。这种病症可能只发作一次或是几次，但也可能成为永久的疾患。它的部分诱因是遗传因素，但荷尔蒙变化、滥用药品或是过度饮酒也可能引发抑郁症。很多医生相信，一个普遍的诱因是压力。

"典型的抑郁症患者是极具雄心的管理人士，他们希望别人看到自己干得很好，不停地逼迫自己，从不休假。最终，他干过了头，"一位前投行人士称。"这些人是最优秀的雇员，因为他们工作最为努力，并且希望做好。我可以在4秒种之内认出这类人。只有愚蠢的公司才会将抑郁症看成雇员的过失。我认为抑郁症和创造力紧密相关。

金融城和华尔街崇尚高风险和男子汉气概的风气，常常被指认为是问题的一部分。一位企业金融家表示："在公共领域，接受帮助更为常见，但在高级金融的世界里，你必须迎难而上。你不能显示出任何缺陷。"

那么当企业发现雇员有困难的时候，它们该如何应对呢？很多企业提供"雇员帮助"计划，通常是以保密热线和心理辅导的形式。法国兴业银行(Société Générale)等一些银行甚至走得更远，会报销治疗费用。投资银行瑞银(UBS)开办了压力管理研讨会，提供企业心理辅导，并设立了内部"关怀小组"。

"大多数金融城公司都有相关程序，"金融城某大型银行前任人力资源总监表示。"他们总会保守秘密，所以我们会收到一份单据，声明有多少人参加，但不会提到他们的具体身份。"

但尽管有这些政策，很多患有抑郁症的雇员还是表示，他们绝不会考虑向自己的同事坦白，更别提向雇主求助了，因为他们害怕被打入冷宫。

"多数人都不会去使用这些帮助项目。很多高管私下告诉我，他们甚至不会去看医生，因为害怕日后被提及时会影响自己的前途，"高管培训公司Talent2的董事总经理安德鲁•麦克尼利斯(Andrew McNeilis)表示。

这会让高管难以评估问题的严重程度。"人们通常不会承认（患有抑郁症），"某二线投行的首席执行官称。"我们曾经有一些人申请休长假，然后一去不返。我们的确提供带薪假期，但他们通常会认定，这个工作环境不适合自己。这被看成一个弱点。我认为这没有什么道理。

某英国律师事务所的一位合伙人表示："很多人在崩溃或完全丧失应对能力后，就退出了法律行业。多数人不会再回来。最终，你成为企业的负担，归结到经济问题上。如果你是超级巨星，价值比雇主稳定情况的成本更高，那么他们可能会重新将你拥入怀抱。"

史蒂文森勋爵呼吁企业提高这方面的意识，创造"人性文化"，让管理人士不再害怕展示自己的情感。一些雇员表示，他们希望雇主更灵活地安排工作，提供静音休息室，并允许人们更多地在家工作。患病者表示，不管人力资源部门多么愿意展示自己的进步性和宽容度，抑郁症恶名的消除都不可能一蹴而就。

"金融城会容忍很多种小毛病，包括酗酒，"麦克尼利表示。"它们会支付雇员在Priory的戒毒的费用。它们甚至会对性变态视而不见。但是有一件事谁都不想和自己的部门经理讨论，那就是抑郁症。

第一手资料：职场抑郁症

"一天晚上，没有任何明显的原因，我突然感到非常不确定自己第二天要做什么。焦虑感不断增强，情况迅速恶化。我以为自己要疯了。我非常难受，急需帮助。"

"雇主注意到雇员的精神健康问题时，往往为时已晚。那种自我振作的态度根本不管用。我的公司非常棒。他们让我离开，关掉电脑和黑莓，三个月内不要回来。我逃到了医生那里，发现还有很多和我一样的人。"

"我回来后继续工作，但一点也不高兴，那只不过是每天为生存而战。最终，情况有了改善--进两步，退一步。多数企业都没有我的公司善解人意。"

"雇主需要知道的是，抑郁症确实存在，患病者对它无能为力，它发病的速度异常迅速。企业要做的第一步是，留意明显的信号，例如那些对工作过度专注的雇员，他们从不休假，无时无刻不在工作。工作占据了他们生活中过于中心的位置，他们往往会完全以工作上的成败来评价自己。正是这些人在最后总会出现问题。"
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