# Sick leave for anxiety or depression in Spain: how it works and how to use it to recover > For weeks you have arrived at work with your stomach in knots. How sick leave for anxiety or depression works in Spain, and why, without treatment, you will probably go back just the same. *https://mypsicotest.com/en/blog/sick-leave-for-anxiety-spain/ · Published: 2026-09-25 · 8 min read · MyPsicoTest team* For weeks you have been arriving at work with your stomach in knots. You sleep four hours, you cry in the car before going in, and Sunday afternoons have turned into a countdown. One day, at the GP about something else, it all comes out at once, and the doctor tells you something you did not expect to hear: that you cannot carry on working like this. **Sick leave for anxiety** or depression is far more common than people let on, and it comes wrapped in practical doubts and a good deal of guilt. This guide explains how it works in Spain, what you are paid, what is worth doing during it and — most importantly — why sick leave that is not used for treatment tends to end with a return to work in the same state you left. ## Yes, you can be signed off for anxiety or depression Mental health is not a separate category. **Sick leave for depression** or anxiety is temporary incapacity due to common illness, exactly the same as you would get for a hernia or pneumonia. Spain's [Social Security](https://www.seg-social.es/wps/portal/wss/internet/Trabajadores/PrestacionesPensionesTrabajadores/10952/28362) defines the benefit as covering lost income when a person, because of illness or accident, is temporarily unable to work and needs healthcare. It is neither a privilege nor an exception. The [World Health Organization](https://www.who.int/news-room/fact-sheets/detail/mental-health-at-work) estimates that around **12 billion working days** are lost worldwide every year to depression and anxiety, and that in 2019 about 15% of working-age adults had a mental disorder. It is, by some distance, one of the most common reasons for sick leave. The guilt that tends to come with it — "I am not that bad", "other people have it worse", "they will look at me oddly" — is largely one more symptom. When someone with flu cannot work, nobody asks them to prove it. ## How to get it and who signs it off ### Your GP is the one who issues it You do not apply to your employer or to Social Security directly. For the first 365 days, sick notes, confirmation notes and discharge notes are issued by a doctor in the **public health service**, that is, your primary care GP. They assess whether your condition prevents you from working and, if so, issue the note and give you a copy. It pays to go prepared, because the appointment is short. Be clear about which symptoms you have, since when, and how they are affecting you at work specifically: mistakes, forgetting things, panic before walking in, insomnia that leaves you useless by mid-morning. Describing the functional impact is more useful than saying "I feel terrible". ### Confirmation notes Depending on the estimated duration of the episode, the doctor will see you at intervals to renew the note. For very short episodes, under five calendar days, they can issue the sick note and the discharge at the same appointment. With anxiety or depression the leave is usually longer and involves several reviews. ### Reviews by the mutual insurer and the INSS Besides your GP, the collaborating mutual insurers and the National Social Security Institute (INSS) have oversight powers, so you may be called for a review. It is not a suspicion against you: it is part of the procedure. From day 365 onwards, it is the INSS that decides whether the leave continues. ## How much you are paid For common illness, the usual case, [Social Security sets](https://www.seg-social.es/wps/portal/wss/internet/Trabajadores/PrestacionesPensionesTrabajadores/10952/28362/28365) the benefit at **60% of the regulatory base from day 4 to day 20**, and **75% from day 21 onwards**. The first three days are not covered by the public benefit. Two qualifications that change the numbers considerably: - **Your collective agreement may improve it.** Some collective agreements top up the benefit or cover those first days. It is worth checking before assuming anything. - **If the cause is your work, the classification may differ.** When the leave arises from a workplace accident or an occupational disease, the rate is 75% from the first day of entitlement. There is a procedure for determining which classification applies; if you believe your situation comes from your job, get employment advice. ## Sick leave is a pause, not a treatment This is the part almost nobody mentions, and the one that most determines how things turn out. Sick leave removes the daily pressure in one go, and that brings relief. But on its own it does not touch what brought you there: the anxiety continues, the low mood continues, the pattern that overwhelmed you is still intact. Plenty of people spend weeks at home waiting to "feel better", and when they are signed back they return to the same place with the same tools. A month later, they are where they were. What helps the leave actually achieve something: - **Keep a minimal routine.** Get up at a similar time, eat at regular hours, leave the house every day. Sick leave is not house arrest, and isolation makes both anxiety and depression worse. - **Protect your sleep.** It is the first thing to break and the thing that amplifies everything else. - **Move.** A daily walk is not a luxury: it is part of treating low mood. - **Start treatment as soon as possible.** This is the key point. The weeks of leave are an opportunity that rarely comes back: you have time, energy that is not being spent at work, and a clear reason to begin. If the public route has a waiting list, the pathway and the alternatives are set out in [Seeing a psychologist on Spain's public health system: how it works](https://mypsicotest.com/en/blog/psychologist-public-health-spain/). - **Do not spend the day monitoring work.** Checking your work email "just in case" keeps the alarm switched on. If you can, disconnect completely. ## When work is the cause Sometimes the anxiety or depression comes from outside work and the job simply cannot be sustained any more. Other times the job itself is the problem: impossible workloads, no control whatsoever, conflict, a manager who humiliates. The WHO lists among the risks to mental health at work excessive workloads, insufficient control over the job, discrimination and job insecurity. Telling stress, anxiety and burnout apart helps you understand what needs to change; we break it down in [Stress, anxiety or burnout: how to tell what is happening to you](https://mypsicotest.com/en/blog/stress-anxiety-or-burnout/). And if the cause lies clearly in the work environment, bear it in mind for the return: going back to the same place with nothing changed is the recipe for relapse. In those cases, alongside treatment, it may be necessary to speak to your company's occupational health and safety service or to an employment adviser. ## How to go back to work without relapsing Being signed back does not mean being at a hundred per cent, and the return is a delicate moment. ![Woman walking through the revolving door of an office building on returning to work after sick leave](https://mypsicotest.com/assets/img/blog-volver-al-trabajo-despues-de-una-baja-1200.webp) - **Prepare it before the last day.** Think about which specific situations worry you and how you will handle them. If you are in therapy, it is a good subject for the final sessions. - **Do not go back to compensating.** The temptation to prove you are fine by working twice as hard is the quickest route to relapse. - **Decide what you share.** You are under no obligation to explain the reason for your leave to anyone. You can say whatever feels comfortable, or nothing. - **Watch for the warning signs.** The insomnia returning, physical tension as you approach work, Sunday afternoons with your stomach in knots. Catching them early lets you act before you are back at square one. ## Where to start If you are thinking of asking for sick leave, or already have it, bringing your situation in order helps both at the GP and at a first psychological appointment. Screening questionnaires put a number on what you are feeling: the [Anxiety Test](https://mypsicotest.com/en/anxiety-test/) measures worry and physical arousal, the [Depression Test](https://mypsicotest.com/en/depression-test/) covers mood, and the [Burnout Test](https://mypsicotest.com/en/burnout-test/) and [Stress Test](https://mypsicotest.com/en/stress-test/) help when work overload is at the centre. They are in the [psychological tests](https://mypsicotest.com/en/psychological-tests/) catalogue, free and anonymous, and the result is calculated on your own device. If you are unsure whether anxiety or mood weighs more, [Anxiety or depression: how to tell them apart and what to do if you have both](https://mypsicotest.com/en/blog/anxiety-or-depression/) sorts it out. To take the step towards treatment, [When to see a psychologist: signs, common doubts and what happens in the first session](https://mypsicotest.com/en/blog/when-to-see-a-psychologist/) covers what happens at a first session, and if your leave lets you do it from home, the checks for choosing well by video call are in our guide [Online psychologist: how to choose well and what to expect from video-call therapy](https://mypsicotest.com/en/blog/online-psychologist-how-to-choose/). ## Frequently asked questions ### Can I be signed off for anxiety? Yes. Anxiety and depression give rise to temporary incapacity due to common illness, like any other illness that prevents you from working. Your primary care GP assesses and issues it, deciding on the basis of how it affects your ability to work rather than on the diagnostic label. ### How much am I paid on sick leave for depression? For common illness, the Social Security benefit is 60% of the regulatory base between day 4 and day 20, and 75% from day 21 onwards; the first three days are not covered by the public benefit. Some collective agreements improve on these figures, so it is worth checking yours. ### How long can sick leave for anxiety last? There is no fixed duration: it depends on how you progress and is reviewed through confirmation notes. For the first 365 days it is managed by the public health service; from that point on, the INSS decides whether it continues. ### Can I leave the house while on sick leave for anxiety? Sick leave does not require you to stay shut in. Going for a walk, running errands or doing activities that are part of your recovery is compatible with it and, in fact, usually helps. What is not advisable is doing things that contradict the reason for the leave or your doctor's instructions. ### Do I have to tell my employer the leave is for anxiety? You do not need to explain the reason. The diagnosis is health data and is specially protected. What you tell colleagues or your manager is your decision, and you can simply say you have been on medical leave. ### Can an online test be used to get sick leave? No. Sick leave is a medical decision your doctor makes after assessing you. What a screening questionnaire can do is help you arrive at the appointment with your information in order and a concrete measure of how you are, which can later be compared to track your progress.