Depression Is Making You Sick, But Can You Take Time Off To Heal?

• In a world where mental health is increasingly less stigmatized, some employers are still skeptical, believing that conditions like depression do not warrant taking sick leave.  
• Employer skepticism is typically rooted in ignorance regarding what depression, from a scientific perspective, is: a physiological illness that causes both physical and psychological symptoms that can be debilitating. 
• Many workers with depression power through it most of the time, but given depression’s potential for complete debilitation, it can necessitate sick days off from work.  

Before the pandemic, it was much more normal to arrive at work sick. If it was the type of illness you knew yourself to be capable of working through, you just didn’t tell anyone.   

Times, however, have changed. After the pandemic hit in March 2020, not going anywhere at all — let alone work — while sick became commonplace, and this has stuck for most people; including many of those who used to “tough it out” at work with a cold.  

Times have also changed in other ways: mental health stigma has considerably decreased, for example. Conditions like depression are increasingly being treated as what they are: health conditions, as opposed to character flaws or a lack of willpower. It is still a general assumption, however, that a condition like depression is not justification for using sick days. 

On the one hand, depressed people themselves feel this way; one symptom of depression is the downplaying of one’s illness, also known as “self-invalidation.”  

On the other, some employers share this invalidation, despite a direct correlation between the availability of sick leave and workers mental health. Workers with no sick leave option are much more likely to be depressed than those with that option.  

Depression is not just a psychological condition, but it is also a physiological illness 

One common cause of this line of reasoning about depression’s supposed unsuitability for sick leave is the nature of its illness type. Because it is a mental illness, it is often assumed that depression is just psychological. 

Such an assumption implies that depressive thoughts are to blame and it is, therefore, a person’s responsibility to participate their way out of their depressive state.  

An assumption like this ignores what is so elegantly put by the Stanford psychologist Robert Sapolsky’s lecture on depression: depression is primarily a physiological illness , not just a psychological one.  

Hence, in many cases, it is simply not possible for a depressed person to “will” themselves out of a depressed state, as the cause could be a lack or surplus of various neurotransmitters like serotonin, dopamine, and norepinephrine.   

These lacks or surpluses are devastatingly taxing on the body because they induce chronic cortisol spikes, which lead to symptoms like psychomotor slowing (i.e., the feeling that an experience has slowed down; extreme brain fog) and even rapid aging.  

When depression is framed like this, it makes sense that workers with depression cannot always just show up to work anyway. That choice is often beyond their control because the symptoms they experience have neurochemical causes that can leave them bedridden.  

Sapolsky is especially insistent on this because of how widespread this misunderstanding about depression is. Depression is often characterized by long periods in which symptoms are low-grade — where, outwardly, a depressed person is indistinguishable from a non-depressed person.   

Depression warrants sick days and an employer’s compassionate consideration  

Depression is an illness with a physiological basis that causes physical and psychological symptoms, making it just as worthy of sick days as any other illness.  

Workers do not necessarily have to be open about their diagnosis, but they will have to ask for sick leave.  

Workers can say that “the sick leave is for mental health” without further description, as, by law, workers cannot be discriminated against in doing so, and employers are obliged to provide sick days.  

Employers should establish an environment where no judgment or stigma is expressed towards a worker for deciding to take sick leave for mental health. Instead, a setting of care and compassion is necessary to help workers struggling with depression reduce sick days.  

In addition, research from Cochrane shows that employer-initiated mental health interventions can reduce sick leave days more than self-initiated treatment.  

Employers can gently ask workers how they feel and if they think they need a break from work — even implicitly nudge workers to take time off if the situation flagrantly warrants it, like if a worker is exhibiting excessive absenteeism.