Anxiety or disorder? Sadness or depression? Unpacking the signs of mental health conditions

Brazil is grappling with a silent crisis that directly impacts workers’ lives and the nation’s economy. In 2024, over 470,000 work absences were recorded due to mental health disorders, marking a ten-year high, according to data from the Ministry of Social Security. Of these, 141,000 were linked to anxiety and 113,000 to depression, reflecting a staggering 68% increase from 2023, when 283,000 benefits were granted for such reasons. This surge underscores the urgency of recognizing when common feelings like anxiety and sadness cross into debilitating illnesses. Real-life cases, such as Amanda Abdias, 28, who stepped away after years of triple shifts, and Marcela Carolina, 44, who has battled depression for two decades, highlight the profound toll these conditions take on individuals across the country.

Anxiety and depression, though natural to some extent, can spiral into pathological states that paralyze those affected. Anxiety, a typical response to urgent or uncertain situations, becomes a disorder when it dominates daily life. Depression, far beyond fleeting sadness, is defined by a persistent loss of pleasure and energy. Leading the causes of work absences, these disorders are fueled by pressures at work, past traumas, and social inequalities, with women bearing the brunt, accounting for 64% of cases. The numbers paint a grim picture of a growing public health challenge that demands attention.

This alarming trend isn’t new but reached critical levels in 2024. Lingering effects of the pandemic, job market instability, and traumatic events like the floods in Rio Grande do Sul have driven the sharp rise in cases. As the government rolls out measures like updating Norma Regulamentadora nº 1 (NR-1) to monitor workplace mental health, the public needs clarity on the signs of these disorders and the steps to address them effectively.

When anxiety turns into illness: the breaking point

Anxiety is a natural human response, triggered by danger or anticipation. However, it morphs into a disorder when it ceases to be situational and begins disrupting everyday routines. In 2024, generalized anxiety disorder accounted for 141,000 work absences, making it the top mental health-related cause for leave. Its manifestations range from excessive worry to intense panic attacks, affecting millions of Brazilians in diverse ways.

Physical signs of an anxiety crisis are unmistakable. A surge of adrenaline, driven by the brain’s amygdala, sparks reactions like rapid heartbeat, excessive sweating, tingling limbs, and even vomiting. Unlike in a healthy state, the body fails to counteract these effects, trapping individuals in a constant fight-or-flight mode. Beatriz de Oliveira, who has lived with anxiety for over a decade, shares how financial strain pushed her to a breaking point where work became impossible, illustrating the disorder’s crippling potential.

Multiple factors feed into anxiety, including chemical imbalances in the brain, unresolved traumas, and high-pressure environments. Women, facing dual burdens of lower pay and domestic responsibilities, dominate the statistics, with data showing they earn less in 82% of professional fields and saw a 10% rise in femicide cases over the past five years. Treatment options range from therapy focused on stress management to medication, always guided by professionals.

Depression beyond sadness: what makes it debilitating

Contrary to popular belief, depression isn’t just about tears or gloom. Labeled by the World Health Organization (WHO) as one of the most disabling conditions globally, it’s characterized by a sustained drop in mood and vitality, often without overt sadness. In 2024, 113,000 absences were tied to depressive episodes, a sharp jump from 63,000 in 2014. Anhedonia—the loss of joy in once-pleasurable activities—stands as a core symptom, alongside shifts in sleep, appetite, and focus.

Real stories underscore its severity. Marcela Carolina, enduring depression for over 20 years, describes how it halts her ability to work at times, worsened by her identity as a Black woman, a group facing 45% higher suicide rates than white Brazilians. The condition stems from a mix of economic struggles, grief, violence, or events like the Rio Grande do Sul floods, which claimed 183 lives and spiked absences to 37,000 in the state in 2024. Irritability and pessimism often appear too, mistaken for mere grumpiness.

Though not curable, depression is treatable. Psychotherapy paired with antidepressants, tailored by psychiatrists and psychologists, manages episodes that may last weeks, months, or years. The WHO warns that severe cases impair social and professional functioning, explaining its rank as a top cause of disability worldwide.

Social triggers and the burden on women

Brazil’s mental health crisis isn’t just personal—it’s deeply societal. Women, comprising 64% of absences due to anxiety and depression, face twice the depression rates of men. This disparity mirrors structural inequities: lower wages, family caregiving duties, and higher violence exposure. In 2024, the average age of affected women was 41, with leaves lasting up to three months.

Workplace toxicity and instability amplify the issue. Practices like “pejotização” (outsourcing via individual contracts) and lean staffing increase stress, while the pandemic and natural disasters, such as the southern floods, leave lasting scars. In Rio Grande do Sul, 18,000 absences were tied to anxiety and depression, nearly half of the state’s 37,000 mental health-related leaves. Experts note that lack of social support and financial insecurity are common triggers.

Government action includes updating NR-1, now mandating oversight and fines for companies neglecting mental health. Yet, cases continue to climb, with populous states like São Paulo, Minas Gerais, and Rio de Janeiro topping absolute numbers, and Distrito Federal, Santa Catarina, and Rio Grande do Sul showing the highest proportional rates.

Warning signs: spotting the shift

Knowing when anxiety and depression stop being normal emotions is key to seeking help. For anxiety, rapid heartbeat, cold sweats, and unrelenting fear signal a disorder, especially if they disrupt daily life. For depression, lack of drive, exhaustion, and hopelessness stand out, even without visible sadness. The two often overlap, with anxiety raising depression risk and vice versa.

Key signs to watch for include:

• Anxiety: palpitations, excessive sweating, uncontrollable worry, and panic attacks.
• Depression: anhedonia, sleep or appetite changes, low self-esteem, and suicidal thoughts.
• Shared traits: poor focus, irritability, and strained personal or work relationships.

Distinguishing normal feelings from disorders requires professional input. Antônio Geraldo da Silva, president of the Brazilian Psychiatric Association, stresses that these conditions sap quality of life, making early detection vital to prevent worsening.

Treatment paths: what works

Tackling anxiety and depression demands tailored strategies. For anxiety, therapy targeting stress reduction, coupled with better sleep and exercise, helps milder cases. In severe instances, medications restore brain balance. For depression, psychotherapy and antidepressants form the backbone, with ongoing adjustments to handle episodes, whether one-off or recurring.

In 2024, Brazil’s Unified Health System (SUS) expanded access to drugs like fluoxetine and amitriptyline, free at basic units and Psychosocial Care Centers (CAPS). Extreme cases, like comedian Whindersson Nunes’ public hospitalization, show that suicide risk may necessitate drastic steps. The focus remains on avoiding blame and seeking expert care at the first sign of decline.

Crisis timeline: how it unfolded

The rise in mental health issues in Brazil follows clear milestones, mirrored in absence stats:

• 2014: 203,000 mental health leaves, including 32,000 for anxiety.
• 2020: Pandemic sparks a steady climb in cases.
• 2023: 283,000 absences signal ongoing growth.
• 2024: Record 470,000 leaves, with 141,000 for anxiety and 113,000 for depression.

This timeline reveals how external shocks—like the health crisis and natural disasters—merged with chronic issues like job insecurity to fuel a perfect storm.

Workplace toll: hard-hitting numbers

Brazil’s productivity is reeling from the mental health surge. Of 3.5 million INSS leave requests in 2024, 470,000 were for mental disorders, up 68% in a year. Anxiety tops the list at 141,000, followed by depression at 113,000, with bipolar disorder (51,000) and stress reactions (20,000) also rising. Over a decade, anxiety-related absences soared over 400%, from 32,000 in 2014 to today’s figures.

Regionally, Rio Grande do Sul logged 37,000 cases, while Alagoas hit 2,700. Leaves averaging three months strain businesses and public coffers, and burnout, at 4,000 cases, remains underreported. NR-1 updates aim to shift this, but prevention and accessible care are critical to stemming the tide.