Burnout: Burnout versus depression
Joanna is a 42-year-old female who has called her doctor’s office for an appointment because she thinks she is suffering from depression. Over the past 5 years, she has started feeling worse and worse. She finds it difficult to get out of bed in the morning, feels as though it takes forever to wake up and get going. When she comes home from work she has only the energy to order some takeout and then sits down on the sofa to binge watch tv. She often falls asleep on the sofa and once she wakes up she moves to bed where she sleeps well until 2 AM when she wakes up with her mind racing. It can often take hours for her to fall back asleep. Her job has been going really well and recently was promoted to branch manager which means her stress levels have increased. 2 years ago she went through a messy divorce and since then has started to feel depressed.
To the average person, Joanna would sound depressed. However, when we look at the DSM 5 criteria for depression she doesn’t fit the entire picture:
DSM-IV Criteria for Major Depressive Disorder (MDD)
- Depressed mood or a loss of interest or pleasure in daily activities for more than two weeks.
- Mood represents a change from the person’s baseline.
- Impaired function: social, occupational, educational.
Specific symptoms, at least 5 of these 9, present nearly every day:
- Depressed mood or irritable most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).
- Decreased interest or pleasure in most activities, most of each day
- Significant weight change (5%) or change in appetite
- Change in sleep: Insomnia or hypersomnia
- Change in activity: Psychomotor agitation or retardation
- Fatigue or loss of energy
- Guilt/worthlessness: Feelings of worthlessness or excessive or inappropriate guilt
- Concentration: diminished ability to think or concentrate, or more indecisiveness
- Suicidality: Thoughts of death or suicide, or has suicide plan
Clinically speaking, over the years of practice the major differences between burnout and depression is that with depression there is overwhelming sadness, lack of motivation, pleasure and joy on almost all days. However, with burnout Joanna still laughs, enjoys hanging out with friends and is enjoying the challenges of her job, it is only the lack of motivation to get off the couch and go out and do these activities that are lacking. It is due to this lack of motivation that she feels she may be depressed. She wants to get out and exercise, she wants to go out for drinks with her friends but when it comes time to do these activities she is much happier to stay home on the couch and binge watch some Netflix.
Joanna’s case is not unique. I see similar cases like this on a daily basis. The sad part of these cases is that they often present to my office after having been on anti-depressants (normally selective serotonin reuptake inhibitors, SSRIs) for quite some time which has not helped their overall complaints at all. Worse, since starting the medications they have suffered a nasty side effect of weight gain making them feel even worse than before.
Unfortunately, the medications do not help in cases like this because they fail to address the imbalance in the body. SSRI’s work on increasing serotonin levels in the brain which ultimately should help with mood. However, what is not being addressed is the part of the endocrine system which is out of balance. This is the hypothalamus, pituitary and adrenal glands. (HPA axis) It is the imbalance caused by chronic stress and imbalance in life which has caused every single one of Joanna’s symptoms and no matter how long she stays on her medications if the HPA axis imbalance is not addressed her symptoms will never improve.
Ultimately if you think you are battling depression or know someone who sounds like Joanna, have them see a medical professional versed in burnout and HPA axis dysfunction. You may save them a huge amount of frustration but more importantly, their quality of life will improve and they will get back to truly living a full and rewarding life.