Anxiety at Work: Adjustments, Support and Panic Attacks

If anxiety or depression is making work harder, you are not failing and you are not unusual. You also have more options than it may feel like right now. You do not have to tell your employer anything. If you do, they may have a legal duty to make reasonable adjustments, such as changes to your hours, your workload or the way you are managed. You can also get free help through the NHS, occupational health and the government's Access to Work scheme, some of it without your manager being involved at all.

If you are reading this because you have just had a panic attack at your desk, the short version is this: it will pass, slow your breathing down, stay where you are if you can, and look at the steps further down this page. If you are thinking about harming yourself or ending your life, stop reading and call 999, or call Samaritans free on 116 123 at any time of the day or night.

Signs that anxiety or depression is affecting your work

Mental health rarely announces itself at work. It tends to show up sideways, as small things that pile up until one day they are not small. Common signs include:

• Dreading Sunday evenings, or the walk in from the car park, in a way that feels physical.
• Reading the same email four times and still not taking it in.
• Putting off tasks you used to do without thinking, then feeling worse because they are stacking up.
• Avoiding meetings, phone calls or particular people.
• Checking your work over and over, or staying late because you cannot trust that it is right.
• Feeling flat and far away, as if you are watching yourself do the job.
• Snapping at colleagues, or crying in the toilets.
• Sleep going wrong: waking at 4am going over work, or sleeping for hours and still being exhausted.
• More sick days with headaches, stomach upsets or just feeling rubbish.

None of these on its own means you have an anxiety disorder or depression. But if several have been going on for a few weeks, and they are spilling into life outside work too, it is worth talking to your GP. Low mood most of the day, most days, for more than two weeks is a reason to get checked rather than to push through.

Is it you, the job, or both?

This matters, because the answer changes what helps. Some people bring anxiety or depression to work with them, and the job is simply where it shows. Others are fine until the job itself becomes the problem: an impossible workload, a hostile manager, constant change, no control over anything. Most people are somewhere in between.

If the work is a big part of it, your employer has duties beyond being kind. Employers must assess the risk of work-related stress, just as they assess other health and safety risks, and act on what they find. Our guide to stress risk assessments at work explains what that involves and how to ask for one.

Should you tell your manager?

You do not have to

In most jobs there is no general obligation to tell your employer about a mental health condition. Some safety-critical roles and regulated professions have their own rules, so check your contract or professional body if that applies to you. Otherwise it is your choice. It is also a choice you can make later, or make in part.

What telling can unlock

Under the Equality Act 2010, a mental health condition can count as a disability if it has a substantial and long-term effect on your normal day-to-day activities. Long-term generally means it has lasted, or is likely to last, at least 12 months. Plenty of people with longstanding anxiety or recurring depression meet that definition without ever thinking of themselves as disabled. If you do, and your employer knows or could reasonably be expected to know, they must consider reasonable adjustments and must not treat you unfairly because of it. GOV.UK and Acas both set out the detail.

Even if you are not sure you meet the legal definition, many employers will make changes anyway. It is usually cheaper than losing you.

Options in between

• Telling occupational health or HR, but not your line manager.
• Telling your manager you are dealing with a health issue that affects your concentration, without naming it.
• Telling a trusted colleague or union rep first and asking them to come with you.
• Using a fit note from your GP, which can describe what you need without spelling out the whole story.

How to have the conversation

Ask for a private meeting, not a corridor chat. Write down three things beforehand: what is happening, how it affects your work, and what would help. Managers usually respond better to "I am finding back-to-back meetings really hard at the moment, could I have a gap between them?" than to a general "I am not coping", because it gives them something to do. Ask for a short note of what was agreed. If the conversation goes badly, that is useful information too, and Acas can advise you on what to do next.

Reasonable adjustments for anxiety and depression

Adjustments for mental health are often small and cost little. What works depends on what is actually hard for you, so start there rather than with a list. That said, these are the kinds of changes people find useful:

• Hours: a later start if mornings are the worst part of the day, compressed hours, or temporarily reduced hours.
• Breaks: agreed short breaks you can take without asking each time, and somewhere quiet to go.
• Workload: regular check-ins to agree priorities, clear deadlines, and swapping a particularly difficult task, such as presenting or cold calling, with a colleague for a while.
• Communication: instructions in writing, agendas before meetings, notice before big changes, and feedback given privately.
• Environment: a quieter desk, a fixed desk instead of hot-desking, permission to wear headphones, or some home working.
• Appointments: time off for therapy or GP appointments, which may be weekly for a few months.
• Support: a named person to go to, a mentor, or a written plan agreed with your manager setting out your early warning signs and what helps when they appear.

Our guide to reasonable adjustments at work covers how to ask in writing and what reasonable means in practice.

What to do in a panic attack at work

A panic attack is a sudden rush of intense fear with very physical symptoms: racing heart, breathlessness, tight chest, shaking, sweating, tingling, feeling sick or dizzy, and a sense that something terrible is about to happen. It is horrible. It is not dangerous in itself, and the NHS describes panic attacks as usually lasting somewhere between 5 and 20 minutes. When one starts:

1. Do not fight it or run from it. If you can, stay where you are, or step somewhere quieter such as a toilet, stairwell or outside. Moving is fine. You just do not need to escape for it to end.
2. Name it. Tell yourself: this is a panic attack, it feels awful, and it will pass. Saying it, even silently, helps.
3. Slow your breathing. Breathe in gently through your nose for a count of about four, then out more slowly through your mouth for a count of about six. The longer out-breath is the part that matters.
4. Plant yourself. Feet flat on the floor, hands on the desk or on your thighs. Press down and notice the pressure.
5. Use your senses. Name five things you can see, four you can touch and three you can hear. It sounds silly. It gives your brain a job.
6. Cool down. Once you can move, sip some water or run your wrists under a cold tap.
7. Give yourself ten minutes afterwards before diving back in. You will probably feel wrung out. That is normal.

If panic attacks keep happening, agree a plan in advance with your manager or a colleague you trust: a word or signal that means you need to step out, a place you can go, and permission not to explain in the moment.

When it might not be panic: call 999 if you have chest pain that is new to you, spreads to your arm, jaw, neck or back, or feels different from your usual panic attacks, or if you simply are not sure. Heart problems and panic attacks can feel alike, and nobody in A&E will mind being told it turned out to be anxiety.

Getting support beyond your manager

Occupational health

Many larger employers have an occupational health service. They can advise your employer on adjustments and on whether you are fit for particular duties. They do not usually treat you, and they normally share recommendations rather than your medical details, though it is sensible to ask exactly what will be passed on. Our guide to occupational health referrals explains how to prepare. Some employers also have an employee assistance programme, often a confidential phone line or a few counselling sessions. Check your staff handbook or intranet.

Access to Work Mental Health Support Service

If you are in work or about to start a job and have a mental health condition, the government's Access to Work scheme includes a free, confidential Mental Health Support Service offering advice and a personal support plan over several months, which you can usually use without involving your employer. Northern Ireland has its own version, so check eligibility on GOV.UK or nidirect.

NHS talking therapies and your GP

In England, adults can refer themselves to NHS Talking Therapies for anxiety and depression without seeing a GP first. Search for NHS Talking Therapies on the NHS website to find your local service and refer online. Services offer treatments such as cognitive behavioural therapy (CBT) and guided self-help, and many offer phone or video sessions, which helps if you are working. Waiting times vary by area. In Scotland, Wales and Northern Ireland the routes are different, so start with your GP or your local NHS website.

Your GP is still worth seeing, particularly if your mood is very low, you are not sleeping or eating properly, or you are leaning on alcohol to get through. They can talk through treatment options, refer you on and issue a fit note.

Time off, fit notes and going back

If you need time off, you can self-certify for the first seven days. After that you need a fit note. Fit notes can be issued by GPs and, since 2022, by certain other registered professionals including nurses, pharmacists, physiotherapists and occupational therapists. A fit note does not have to say you are not fit for work. It can say you may be fit for work with advice, such as a phased return, altered hours, amended duties or workplace adaptations. That option is underused, and for anxiety and depression it can be the difference between keeping going and going off sick. Our guide to fit notes explains how to use one well.

If you have been off, coming back gradually is usually better than a cliff-edge return to full duties. A phased return builds your hours and responsibilities up over a few weeks, with a plan agreed in advance. Ask for a return-to-work meeting before your first day back, not on it, so you know what to expect when you walk in. Agree who knows what, so you are not answering "where have you been?" twelve times before lunch.

If you are in crisis

• Call 999 or go to A&E if you have seriously harmed yourself or feel you cannot keep yourself safe right now.
• Call NHS 111 if you need urgent help but it is not an emergency. In England, choose the mental health option.
• Call Samaritans free on 116 123, any time, day or night, to talk to someone.
• Tell someone near you. A colleague, a mental health first aider, anyone.

You do not need to be sure it is bad enough. If you are worried about yourself, that is enough.

Where an occupational therapist fits

Occupational therapists look at what you need and want to do in your day, and what is getting in the way. For work and mental health, that can mean:

• Pinning down which specific parts of the job are hardest and why, rather than a general sense that work is too much.
• Building a daily routine that supports sleep and mood, with work as part of it rather than everything else squeezed round it.
• Planning a graded return to work with realistic steps, and adjusting it as you go.
• Practical strategies for concentration, organisation and energy.
• Writing a report setting out practical adjustments for your employer, occupational health or an insurer.

An occupational therapist is not a replacement for psychological therapy or medical care. Your GP leads on diagnosis and treatment, including any decisions about medication, and talking therapies such as CBT are delivered by trained psychological therapists. If you are under a community mental health team, there may already be an occupational therapist in it. A private occupational therapist can be useful alongside all this, particularly for return-to-work planning or a clear adjustments report, and should always be registered with the HCPC.

Frequently asked questions

Can I be sacked for having anxiety or depression?

If your condition counts as a disability under the Equality Act, it is unlawful to treat you unfairly because of it, and your employer must consider reasonable adjustments. Employers can still manage absence and performance, but they have to do it fairly. If you are worried, talk to Acas or your union early rather than waiting.

Do I have to tell a new employer about my mental health?

Generally, no. Employers are restricted in the health questions they can ask before offering you a job. You can choose to tell them later, for example once you know what adjustments you might need.

Is anxiety classed as a disability at work?

It can be. It depends on whether it has a substantial and long-term effect on your normal day-to-day activities, not on the diagnosis itself. If you are unsure, the GOV.UK guidance on the definition of disability and Acas are good places to check.

Can I get a fit note for stress, anxiety or depression?

Yes. Your GP, or another professional who can issue fit notes, decides based on how it affects your ability to work. Ask whether a may be fit for work note with suggested changes would suit you better than a not fit note.

What if my manager is part of the problem?

Go to HR, another manager or occupational health instead. You can also raise a formal grievance, and a union rep or Acas can help you think through your options. A stress risk assessment can be a less confrontational way to get the issue looked at.

How long does a panic attack last?

The NHS says most last between 5 and 20 minutes, though it can feel much longer. If you are having them often, see your GP or refer yourself to NHS talking therapies, as panic is very treatable.

Next steps

If you would like practical help planning a return or setting out adjustments, see our work and ergonomics page, our functional assessments and reports page, or current guide prices, and choose your area below.