Many people are confused about the difference between burnout and depression – so what does the literature say?
For the purposes of this article, let’s look at a common and historical way of dividing all depressions into those that come under the umbrella of:
- endogenous depressions – depression that is inherent to the patient’s physiology and psychology, possibly with family and genetic pre-disposition, and;
- exogenous depressions – depression precipitated by life events, situations such as relationship problems, work, bereavement etc.
Many forms of depression are a combination of the two – an external event can trigger an underlying depressive illness to become a full-blown clinical depression requiring medication and therapy.
What causes Depression – and what are the Symptoms?
Many factors and triggers can influence and exacerbate both categories, according to the NHS in the UK. Here are a few:
- giving birth;
- stressful events;
- family history;
- substance abuse;
- and illness, including chronic illness and head injuries.
Some of the symptoms of clinical depression include psychological symptoms such as low mood, low motivation and anxiety; physical symptoms such as moving and speaking more slowly, lack of energy, sleeplessness; and social symptoms such as avoiding contact with friends, neglecting hobbies and interests and having difficulties in your home, work or family life.
A Closer Look at Burnout
Burnout on the other hand, has been viewed as a syndrome developing in response to chronically adverse working conditions, or excessive or stressful conditions in situations over which the person feels they have little or no control, leaving them with no choices.
Burnout is thought to comprise emotional exhaustion, de-personalization, and reduced personal accomplishment. Emotional exhaustion, the core of burnout, itself reflects a combination of depressed mood and fatigue/loss of energy, and correlates very highly with other depressive symptoms (Schonfeld, Bianchi and Palazzi).
Burnout is not a psychiatric diagnosis but a concept of the occupational psychology concerning the impact of working conditions on the psyche of affected persons. Burnout can be a mediator for clinical depression. Severe burnout fulfills mostly the criteria for an adjustment disorder. Psychological/psychotherapeutic approaches preferably focus on stress reduction.”
Moving to Chronic Fatigue Syndrome, Blitshteyn and Chopra show “chronic disorders associated with fatigue (CDAF) share autoimmune or immune-mediated etiology. This could shift the focus from symptomatic treatment of fatigue and pain to targeted immunomodulatory and biological therapy.”
So what do the neural pathways in the brain do, when a person is totally overwhelmed by a situation or demand over which they perceive they have little or no control? If treatment for burnout needs to be focussed on stress reduction, and has been categorized more as an adjustment disorder, then the psychological and physiological symptoms of this overwhelming stress reaction may be more treatable than first thought.
The Role of Chronic Stress
According to the Mayo Clinic:
But when stressors are always present and you constantly feel under attack, that fight-or-flight reaction stays turned on. The long-term activation of the stress-response system and the overexposure to cortisol and other stress hormones that follows can disrupt almost all your body’s processes. This puts you at increased risk of many health problems, including: memory and concentration impairment, anxiety, depression, memory and other somatic symptoms.”
I would add to this an over-abundance and almost a “perfect storm” of electrical impulses that bombard our cognitive and planning areas of our brain long after the initial threat has subsided.
In Effects of Mental Fatigue on Brain Activity and Cognitive Performance, Masaaki Tanaka et al found that:
1. mental fatigue causes brain over-activation that is related to reduced cognitive performance and 2. mental fatigue induces decline in executive functions such as executive attention, sustained attention, goal-directed attention, alternating attention, divided attention, response inhibition, planning and novelty processing. In particular, conflict-controlling selective attention (response inhibition) was highly vulnerable to mental fatigue.”
Indeed, there is also evidence of region- and time-specific increase in neural activity, suggesting neural compensation (Henry Babu et al).
Why Nutrition is Important
All of the accommodating, compensatory and immune / biological / physiological changes in our brains and in our bodies, can lead to burnout and even progress to clinical depression and chronic auto-immune diseases if the source is not isolated and treated. It reflects a heightened and prolonged “fight” response that can reduce our ability to manage our emotions and executive functions for a period of time and reduce our adrenal glands to a state of exhaustion. Another factor in recovery therefore is the role of diet and particularly vitamins and amino acids in the treatment of mental fatigue and exhaustion.
Adelle Davis quotes a study where:
Physicians at the Iowa State University College of Medicine gave volunteers from the Iowa State Prison a formula diet adequate except for pantothenic acid. Urine analyses quickly showed a decrease in adrenal hormones, which fell progressively lower as the experiment continued. The men became quarrelsome, hot-tempered, and were easily upset. The investigators, fearing permanent damage might be done, then gave cortisone and 4,000 milligrams of pantothenic acid daily. The recovery was slow, and urine analyses showed that the adrenals were not restored to normal for almost three weeks. Yet these men were young, healthy individuals consuming a diet adequate in all other respects and presumably under no undue stress (although one took off and did not return). When the symptoms they developed – all typical of adrenal exhaustion – are superimposed on an ill person whose diet is woefully inadequate and who is enduring multiple stresses, a mild illness becomes a serious one…”
The Relationship between Burnout and Depression
- Mental fatigue can lead to clinical depression but is a contributing factor only.
- Mental fatigue has symptoms that correlate highly with other depressive symptoms.
- Mental fatigue can be a symptom of an underlying and perceived overwhelming stressor in a person’s life.
- Electrical impulses that bombard our cognitive and planning areas of our brain can last long after the initial threat has subsided.
- Mental fatigue and its symptoms can largely be addressed by removing the stressor or understanding it in a way that no longer poses a threat or stress.
- Mental fatigue requires a period of recuperation, rest, validation and support, and good nutrition for the person to return to baseline functioning.
In terms of counselling, I like to bring our discussion back to the area of choices.
Choices give us some control over seemingly overwhelming situations and events. Choices give us opportunity to recover. I like to ask:
- “When did I last take a fork in the road – did I take the right fork?”
- “What is the worst that could happen if I walk away from this job/situation?”
- “How can I take back some control over my life?”
The use of Cognitive Behavioural Therapy (CBT), especially in the areas of catastrophising and cognitive distortions such as “should / would / have to statements” and other compulsive and self-flagellating thoughts and feelings is helpful.
The outstanding message is this: Go easy on yourself. If you don’t make these changes for yourself, no-one else is going to do it for you. This is on a therapeutic background of validation, psychological support, and reward for small steps taken.
Author: Susan Ward, B Arts, B Soc Wk, AMHSW.
Susan Ward has a wealth of experience in helping people with issues like trauma, grief and loss, eating disorders, interpersonal violence, social anxiety, stress, depression, and difficult relationships.
To make an appointment with Accredited Mental Health Social Worker Susan Ward try Online Booking. Alternatively, you can call Vision Psychology Brisbane on (07) 3088 5422.
As per indicated in the article as well as:
- The Road Not Taken – a poem by Robert Frost.
- Let’s Get Well – Adelle Davis 1965 Harcourt Chicago