Are Burnout and Depression Two Sides of the Same Coin?

A common accusation from the media and skeptics: “Burnout is only a euphemism for depression.” What’s behind this? Is burnout really a fad and ultimately, only a hidden depression?

Burnout depicted by a burned match between other matches in a row

Our Working Environment and the Fear of Failure

Burnout is a relatively new occurrence that was first publicly discussed in the 1970s. The term arose in relation to social and caring professions: Especially social workers seemed to be more susceptible to “burning out” due to the extreme workload. Today however, burnout is more often associated with managers than with nurses or social workers.

Very often, burnout can hide an underlying depression. Some experts believe that “burnout” sounds better and makes reconciliation with the own self-image easier for those affected. After all, the term “burnout” implies that a lot has already been achieved in the past. Depression, on the other hand, is associated by many with weakness.

However, it’s odd that we have so differing opinions of burnout and depression, because the symptoms are very similar.

Burnout Is Not an Independent Illness

The term burnout doesn’t appear in the diagnostic catalog of doctors and psychotherapists. It is an additional diagnosis, which is often given in combination with another illness. You can still receive time off from work on the basis of an additional diagnosis, but it is not considered a separate disorder.

The symptoms of burnout aren’t clearly defined, and the official definition is surprisingly vague: “problems related to life-management difficulty “.

In a revision of the catalog, which is expected to be published in 2022, more detailed characteristics of burnout were described for the first time.

“Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:

  • Feelings of energy depletion or exhaustion
  • Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job
  • Reduced professional efficacy”

Additional Diagnoses and Therapy

Other examples of additional diagnoses, like the burnout syndrome, are “lovesickness” or “occupational exposure to noise”. However, life crises or extraordinary burdens are not mental disorders. Only when a person develops a depression, for example, as a result of these difficulties, a diagnosis of the disorder and, usually, therapy become necessary.

For someone who is on the brink of burnout, a week of vacation can work wonders, while a holiday for a person in a depressive episode might even worsen the symptoms.

Burnout Sees the Cause, Depression Counts the Symptoms

Unlike burnout, the symptoms of depression are clearly defined. Internationally, they are the same. When diagnosing depression, a doctor or psychotherapist uses only the patient’s symptoms. Although the causes of the disorder can be an important topic in psychotherapy, they usually don’t play a role for the clinical picture of depression itself.

Burnout, on the other hand, puts its focus on where the exhaustion comes from. While depression can be diagnosed without any context, it’s the context that is central to burnout. And so, the individual phases of increasing exhaustion are regarded as an explanation model.

Although the clinical picture is virtually the same, when the cause of deep emotional and physical exhaustion is permanent work overload, some experts today prefer to call it burnout rather than depression.

Diagnoses Don’t Require Causes

Referring to causes in diagnoses can be problematic, because the ‘International Classification of Diseases’ (ICD) describes mental illnesses based on measurable symptoms. Causes are of enormous importance in terms of prevention and avoiding relapses, but for diagnoses they don’t serve any purpose and are often even a hindrance.

This is because they aren’t as objectively measurable as symptoms: It isn’t as easy to unfailingly find the correct cause and effect. Most often, possible causes of the disorder are recognized in time during psychotherapy.

Think of it this way: Doctors diagnose lung cancer on the basis of the symptoms and positive test results – the disease is objectively measurable. Whether the patient is a smoker is irrelevant for the diagnosis itself.

Burnout Is Not Imagined

Although there is no independent burnout diagnosis, this in no way means that those affected are making up their suffering. The symptoms of people affected by burnout are very real and show up in a recognizable pattern.

While depression can either be slow, or sudden and seemingly unfounded, burnout syndrome usually develops gradually with very typical, consecutive phases. Some researchers describe the course of exhaustion in three stages, others distinguish six stages.

Stage 1 of Burnout: Overstraining

The trigger for the burnout process is usually a phase in which those affected invest an excess of energy. The reason could be idealism: You’re “burning” for something and invest all your energy into it.

However, the increased use of energy could also arise due to worry: Maybe it’s a fear of rejection or of not being able to finish a project in time. In this first phase of overstraining, the threat of burnout is very rarely recognized. However, one warning sign might be, if it’s very difficult for someone to ‘switch off’ in their free time.

Stage 2 of Burnout: Indifference

When hard-earned rewards are postponed over and over again, the initial eagerness will turn into frustration. Commitment will decrease, while expectations grow. Often those affected develop an inner reluctance to their tasks, similar to resignation: Work becomes pointless routine, those affected become emotionally dull, cynical, and less sensitive towards their friends and co-workers.

A concrete warning sign in caring and social professions can be when nurses or teachers, for example, no longer respond to the problems of patients or students.

People struggling with burnout may react emotionally, even aggressively, to their environment, or they may start blaming themselves. In the latter case, the symptoms are nearly indistinguishable from depression: Feelings of inner emptiness, depressed mood, and pessimism.

Stage 3 of Burnout: Despair

Reduced motivation also reduces the willingness to perform. Those experiencing burnout are less able to concentrate, make more mistakes, are less creative, and feel unable to cope with everyday life. Additionally, they can feel indecisive and increasingly indifferent. The overstrain can also result in people withdrawing themselves socially and neglecting their hobbies. Boredom and lethargy set in.

Physical complaints often go hand in hand with psychological ones. Backaches or headaches, heart or digestive problems, sleep disorders, nightmares, and sexual problems are typical. Finally, this last stage of burnout has covered all symptoms of depression, making the two experiences practically identical. One literally feels “burned out”, with very little hope of improvement.

Splitting Hairs or Helping?

In the end, burnout and depression are practically the same thing. That creates a problem, however: If the term burnout is used excessively, we’re running the risk of watering down a depression diagnosis. At the same time, an additional diagnosis also brings its advantages: This way, it’s often a bit easier for people to share with others what they are struggling with. This goes especially for affected men who feel pressured by society to be invincible.

In addition, the high prevalence of burnout syndrome sends an unmistakable warning sign to the working world: too much workload is a menacing cause of depression. And now, more and more companies are paying better attention to a good work-life balance of their employees.

Moving Forward

All of this shows that we need to work towards fully accepting depression as a society, in the way we accept burnout. Therefore, the warning signs, no matter what you call them, should be taken seriously.

The good news? There are so many possibilities of improvement with psychotherapy, including conflict and stress management, self-management, relaxation exercises, and strengthening self-confidence. Therapy can be very effective, the complaints can be counteracted, and life will get better again.

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