What to Know About Depression and Disability

Medically Reviewed by Poonam Sachdev on December 06, 2022
5 min read

Many people feel sad or depressed at times, but major depressive disorder (MDD) is a persistent, profoundly serious type of depression. This type of depression affects every aspect of your life, including your relationships, your hobbies, and your job. 

In some cases, depression can be severe enough that you’re unable to work anymore, or you’re unable to work at the pace or productivity level you once were. When that happens, it’s important to know your rights regarding accommodations and Social Security Disability Insurance (SSDI).

Depression is a common medical and mental health condition that causes sadness or loss of interest (apathy) in your everyday life. Depression affects the way you think, the way you feel, and the way you act.

Worldwide, depression is very common. The World Health Organization (WHO) estimates that around 5% of adults have some form of depression. 

A survey from the National Institute of Mental Health (NIMH) found that in 2020, an estimated 21 million U.S. adults, 8.4% of the U.S. adult population, suffered at least one major depressive episode. For this survey, NIMH mainly used the definition of major depressive episode from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which defines it as a period of two or more weeks in which a person has a depressed mood, loss of interest or pleasure in daily activities, and a majority of the symptoms listed below.

Depression symptoms.Symptoms of depression as well as the severity of these symptoms can vary wildly from person to person. Symptoms may include:

  • “Brain fog” — difficulty thinking, concentrating, and making decisions
  • Changes in appetite
  • Depressed mood
  • Feeling sad
  • Feeling worthless or guilty
  • Fixating on past behaviors, self-blame
  • Irritability or frustration that may lead to angry outbursts, even over small things
  • Lack of energy, fatigue
  • Restlessness
  • Sleep problems — either trouble sleeping or sleeping too much
  • Slowed movements or speech
  • Thoughts of suicide or death
  • Weight changes unrelated to dieting or other medical conditions

To qualify for a diagnosis of depression, your symptoms must last at least two weeks and affect your level of functioning.

Many things can mimic the symptoms of depression. Medical conditions like a brain tumor or thyroid problem can have similar symptoms. Likewise, other mental health conditions or emotions like grief can often look like depression. For these reasons, it’s important for a practitioner to rule out other causes before diagnosing a patient with depression.

Depression causes. Many, many things can cause depression. It’s common for major life changes, like divorce, the death of a loved one, or the loss of a job, to cause depression, but even someone who lives an ideal life can experience depression. Risk factors for depression include:

  • Brain chemistry. Your brain needs the right amounts of chemicals to function properly, and if the balance of these chemicals is off, it can lead to mental health conditions, including depression.
  • Environmental factors. Living amid abuse, neglect, poverty, or violence can increase your risk of developing depression.
  • Genetics. Depression can run in families, especially if the depression is caused by a problem with your brain chemistry.
  • Personality. Some personality types, like those who have a pessimistic outlook or are easily overwhelmed by stress, may be more prone to depression.

Depression treatment. The brain is a tricky organ that science doesn’t fully understand. As a result, a treatment that works for one person may not work for another. Treatment for depression is often medication, therapy, or a combination of both. Patients may have to experiment to see what works best for them.

The Americans With Disabilities Act (ADA) includes major depressive disorder in its definition of mental impairment. It also points out that an impairment is not the same thing as a disability. To qualify as a disability, your impairment must “substantially limit one or more major life activities.”

In the listing of psychiatric disabilities and disorders for Social Security qualification, the requirements for major depressive disorder are outlined in section 12.04. This section is divided into criteria A, B, and C. To qualify, you need to satisfy criteria A plus criteria B and/or C.

For criteria A, you must have medical documentation of at least five of the following symptoms:

  • Depressed mood
  • Diminished interest in almost all activities
  • Appetite disturbance with change in weight
  • Sleep disturbance
  • Observable psychomotor agitation or retardation
  • Decreased energy
  • Feelings of guilt or worthlessness
  • Difficulty concentrating or thinking
  • Thoughts of death or suicide

Criteria B explains how these symptoms have affected you. You need either extreme limitation of one or marked limitation of two of the following:

  • Understanding, remembering, or applying information
  • Interacting with others
  • Concentrating, persisting, or maintaining pace
  • Adapting or managing oneself

Criteria C notes how serious and persistent the disorder is, and you must have a documented history of MDD over at least two years. You need evidence of both:

  • Medical treatment, mental health therapy, psychosocial support(s), or a highly structured setting(s) that is ongoing and that diminishes the symptoms and signs of your mental disorder
  • Marginal adjustment, that is, you have minimal capacity to adapt to changes in your environment or to demands that are not already part of your daily life

The ADA states that most employers must provide reasonable accommodations to qualified employees with mental health disabilities. Reasonable adjustments are adjustments within the work or work setting that allow employees with disabilities to adequately perform the essential functions of their job.

While the ADA does not specifically state what these accommodations should be, the Office of Disability Employment Policy offers several suggestions for how workplaces can accommodate employees with mental health conditions. These include ideas like:

  • Allowing employees to take breaks according to personal needs rather than on a set schedule
  • Allowing employees to telecommute and/or work from home when possible
  • Allowing sick time to be used for mental health and providing flexible use of vacation time
  • Educating and training employees about their accommodation rights
  • Offering flexible scheduling, such as part-time hours or adjusting working hours
  • Letting employees have food and drinks at their workspace
  • Modifying job duties by dividing them into smaller tasks or offering assistance
  • Providing equipment and technology like digital assistants
  • Scheduling meetings to check in with employees
  • Taking steps to reduce or remove distractions, like adding room dividers or allowing noise-canceling headphones when appropriate