Psychiatric Care for Work Performance

Work can be one of the first places a mental health concern shows up: missed deadlines, trouble focusing, procrastination, irritability with colleagues, or the sense that you are working harder for less. These struggles often reflect anxiety, ADHD, depression, sleep problems or burnout rather than a lack of effort or ability.

How our physicians help

Our physicians look for what is getting in the way and how it connects to the rest of your life. Care can combine psychotherapy, practical strategies and medication management from the same physician. Appointments are unhurried and confidential, with care that fits a demanding schedule.

Signs that work is getting harder than it should be

Capable people often hide this well. Output may look fine while the effort behind it climbs.

• Working nights and weekends to produce what used to fit in a normal day
• Rereading the same email, or losing the thread in meetings
• Rechecking finished work many times, or sitting on it because it never feels good enough
• A slide after a promotion, a new manager or a move to remote work
• Constant fear of being found out, even when your reviews are good

Working out why your job has become harder

We start with plain questions. Has this been true in every job, or only this one? Did it begin with a new role, a loss or a change in your health? You can bring performance reviews if that helps, and we do not need to hear from anyone at your job.

Sometimes the honest finding is that the job itself is the main problem, because of an unworkable load or a harsh setting, and we will talk about that too. We also look for these patterns:

• ADHD, often when a promotion or remote work removes the structure that kept things on track
• Anxiety, when worry and over-preparing eat up hours
• Depression, when slowed thinking and low drive make ordinary tasks feel heavy
• Bipolar disorder, when stretches of high output and little sleep are followed by crashes
• Alcohol, cannabis or stimulants being used to wind down or keep up

Treatment that fits a working life

When improvement comes, it is usually gradual, over weeks to months, and no treatment can fix a role that is a poor fit.

• Cognitive behavioral therapy (CBT) targets procrastination and perfectionism by working on the thought patterns behind them.
• Acceptance and commitment therapy (ACT) teaches you to act on your goals while doubt or anxiety is present, instead of waiting for it to clear.
• Antidepressants in the SSRI and SNRI classes can help anxiety and depression. They usually take several weeks, and nausea, restless sleep or sexual side effects are possible.
• ADHD medications can improve attention in people who have ADHD, and can also affect sleep, appetite and anxiety.
• Beta blockers, a class of heart medications, are sometimes used for the physical symptoms of performance anxiety, such as shaking or a racing heart. Some people, including those with asthma, may not be able to take them.

Accommodations and your privacy

You decide what, if anything, your workplace hears about your care. We do not contact an employer unless you ask us to and give written permission, except in the limited situations described in our privacy notice.

Under the Americans with Disabilities Act, many employees with a qualifying condition can ask for reasonable changes at work, such as written instructions, a quieter workspace or more flexible hours. An employer may ask for limited medical information to support the request. Not every employer or job is covered, and we cannot give legal advice. Your physician can talk through whether a request makes sense for you.

Signs it is time to talk to someone

Reach out if you have been put on a performance plan, if you have made mistakes that scare you, or if you feel sick before work starts. It is also time to call if you are thinking of quitting mainly to make the pressure stop, or if drinking or other substance use is how you get through the week.

If the pressure has led to thoughts of suicide or of hurting yourself, call or text 988 (the Suicide & Crisis Lifeline) or call 911. We are not an emergency service. A setback at work can feel final, and many people find their footing again with treatment.

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