Depression at Work: How to Keep Working and When You Need Sick Leave

How Depression Affects Your Work

A depressive episode, as defined in ICD-10 and ICD-11, is much more than a bad mood. Its core features are a persistently low mood and a loss of interest or pleasure for most of the day, nearly every day, for at least two weeks. These are accompanied by changes in sleep and appetite, fatigue, feelings of guilt and worthlessness, difficulty concentrating, slowed movements or, on the contrary, restlessness, and thoughts of death. DSM-5 describes major depressive disorder using a similar set of criteria.

At work, depression often shows itself before the person realizes they are ill. Simple tasks take twice as long, an email has to be reread several times, and decisions keep getting postponed. Colleagues notice irritability or withdrawal. Many people try to make up for the slump by working overtime and staying late, which deepens exhaustion and locks in a vicious circle: the worse the results, the harsher the self-criticism and the deeper the depression.

Cognitive symptoms

Problems with attention, memory and speed of thinking in depression are called cognitive symptoms. A person forgets arrangements, loses the thread of the conversation in a meeting and cannot keep several tasks in mind at once. This is not a sign of stupidity or incompetence: with successful treatment, cognitive function usually recovers, although sometimes more slowly than mood does.

Presenteeism: working on autopilot

Presenteeism is when an employee is physically at work but, because of illness, works at a much lower level of efficiency. It is common in depression: people are afraid to take time off in case they are seen as weak, and they push themselves through work for months. For both your health and the quality of your work, this strategy is usually worse than getting timely treatment.

Signs That It Is Depression, Not Just Tiredness

Ordinary tiredness goes away after a weekend or a vacation; depression does not. If you come back from vacation feeling just as empty, if mornings are hard and evenings are slightly easier, and if you no longer enjoy even the things you used to love outside work, depression should be considered. An important sign is a change in self-esteem: you start to feel that you are bad at your job, that you are letting everyone down and are about to be fired, even though there are no objective reasons for it.

Burnout and depression overlap, but they are not the same thing. In ICD-11, burnout is described as an occupational phenomenon linked to chronic workplace stress, not as a mental disorder. If, however, the symptoms spread to your whole life, including family, hobbies, sleep and appetite, and last for weeks, that is a reason to see a psychiatrist to rule out depression.

• Low mood or a sense of emptiness nearly every day for two weeks or longer
• Rest and weekends do not restore your energy
• Morning is the hardest part of the day, and evenings feel a little easier
• Loss of interest not only in work but in your personal life as well
• Waking up too early or, on the contrary, sleeping 10–12 hours without feeling refreshed
• A constant sense of guilt and thoughts like "I'm letting everyone down"
• Thoughts of death or that everyone would be better off without you

Can You Work While Depressed?

For many people with mild or moderate depression, working is actually helpful: it gives structure to the day, social contact and a sense of self-worth. Clinical guidelines, such as the NICE guideline on depression in adults, treat support for employment as part of recovery. But this works only under two conditions: treatment has started, and the workload matches your current abilities rather than your previous ones.

Continuing to work is harmful if the job itself is the main source of stress, if you feel intense anxiety every day before leaving for work, or if impaired concentration increases the risk of mistakes that are dangerous for you or others, for example when driving, operating machinery or working in healthcare. In these situations a temporary break is not a weakness but part of treatment.

What helps you cope at work

Break tasks into short steps and write them down to take the load off your memory. Schedule the hardest work for the time of day when you feel better. Take short breaks every 60–90 minutes and get out into daylight. Do not take on new commitments while you are in treatment. Keep a regular sleep schedule, even if you feel like "finishing things up" in the evening.

What to avoid

Do not try to make up for the slump with overtime and night shifts: this deepens exhaustion. Do not relieve tension with alcohol: it disrupts sleep and worsens depression. Do not make major decisions about quitting or changing careers at the peak of your symptoms: depression paints the future in dark colors, and the conclusions you draw often turn out to be wrong.

When Do You Need Sick Leave for Depression?

A certificate of temporary incapacity for work (sick note) is issued by a doctor when an illness temporarily prevents you from doing your job. In depression, the grounds are usually severe or rapidly worsening symptoms: marked slowing down, inability to concentrate, severe insomnia, refusing food, intense anxiety, and also the start of treatment, when the first weeks require monitoring and a lighter routine.

An absolute reason to stop working and seek help urgently is thoughts of suicide, a sense of hopelessness or psychotic symptoms. In that case, the question is no longer about sick leave but about safety. Issuing a sick note usually requires an in-person examination at a medical organization authorized to do so. During an online consultation, a psychiatrist will assess how severe your condition is, tell you whether there are grounds for a break from work and explain how to arrange it.

Duration and extension

The length of sick leave is decided by the doctor on an individual basis and, if necessary, extended according to the rules in force in Kazakhstan. With depression, it is important that the break does not turn into isolation: days at home are better filled with a routine, walks, psychotherapy and the prescribed treatment rather than lying in the dark with your phone.

If sick leave is not an option

Sometimes official sick leave is undesirable, for example if you work under a contract. Alternatives include annual leave, unpaid leave, temporarily switching to shorter hours or remote work, and redistributing tasks. Discuss the options with your doctor and, if you feel ready, with your HR department.

Should You Tell Your Employer About Depression?

No, that is your decision. The Code of the Republic of Kazakhstan "On Public Health and the Healthcare System" protects medical confidentiality: information about the fact that you sought care, your diagnosis and your treatment is not shared with third parties without your consent, except in cases expressly provided for by law. Your employer only needs to know that you are temporarily unable to work; they do not need the details of your diagnosis.

If there is trust within your team, being partly open can help: a manager is more likely to accommodate you if they understand you are recovering from an illness. You can put it neutrally: "I have a health issue, I'm being treated, and I need a flexible schedule for a few weeks." You do not have to name the diagnosis. If your company has a staff psychologist or an employee assistance program, you can also use them confidentially.

How to Return to Work After Depression

Going back to work after a break is a vulnerable period. Even when you feel well, energy and concentration return gradually, and jumping straight back to a full workload can trigger a setback. It helps to agree on a plan in advance: in the first days, familiar and manageable tasks, clear deadlines and short regular check-ins with your manager.

It is important not to stop treatment once you feel better. Antidepressants and psychotherapy are usually continued for several more months after symptoms disappear to reduce the risk of another episode; the duration is decided by the doctor. Stopping treatment on your own when you return to work is one of the most common causes of relapse.

1. Discuss the date and format of your return with your doctor in advance
2. Start with a reduced workload or familiar tasks
3. Keep a to-do list so you do not have to hold everything in your head
4. Keep up a regular sleep schedule and physical activity
5. Watch for early signs of worsening: sleep, appetite, irritability
6. Continue treatment for as long as your doctor has recommended

How Depression Is Treated in Working People and What Can Be Done Online

Standard treatment for depression includes psychotherapy, medication or a combination of both. Among psychotherapy approaches, cognitive behavioral therapy has the strongest evidence base; behavioral activation and interpersonal therapy are also used. Medications include antidepressants from different classes; the drug, dose and duration are chosen only by a doctor. Severe depression with a high level of risk may require inpatient treatment.

An online psychiatrist consultation is convenient for working people: it can take place during a lunch break or in the evening, without taking a day off or visiting a dispensary. At Psychiatry Online, the psychiatrist conducts a detailed interview by video, assesses the severity of depression using clinical rating scales, draws up a treatment plan and monitors your progress. An in-person examination is needed if you require a sick note, tests to rule out physical causes such as thyroid disease or anemia, or if your condition is severe.

When to see a doctor

• Low mood and loss of interest have lasted more than two weeks and do not go away after rest
• Because of concentration problems, you are making mistakes you never used to make
• You wake up at 4–5 a.m. and cannot fall back asleep, and you feel drained during the day
• Family or colleagues notice that you have changed: you have become withdrawn or irritable
• You have started drinking more often to relax and relieve tension after work
• You have thoughts that life is meaningless or that you are a burden to others
• You are already in treatment, but after 4–6 weeks there is no improvement or you feel worse

Questions and answers

Reviewed by

Pavel Kornilov, MDPsychiatrist

Depression, anxiety disorders, OCD, bipolar disorder; online medication selection and adjustment.