What If Burnout Is Actually Depression?
The symptoms can be similar. So how do you know what you’re experiencing?
Every year, dozens of medical leaders and health care administrators travel to Half Moon Bay, California, a beach town 30 miles south of San Francisco, to learn how to help their doctors combat burnout. The Chief Wellness Officer course is part of Stanford’s WellMD Center, an initiative designed to keep stressed-out doctors mentally and physically healthy by promoting evidence-based practices like exercise and mindfulness.
The idea of “burnout” goes back to the 1970s, when American psychologist Herbert Freudenberger coined the term to explain the consequences of extreme stress in “helping” professions like health care.
Since then, the meaning of “burnout” has evolved. It now applies to more professions than just health care workers and includes more symptoms — for example, “errand paralysis,” as writer Anne Helen Petersen describes her inability to complete mundane tasks. In her viral BuzzFeed article about millennials and burnout, Petersen argues that anyone can get burned out, because it’s the product of a culture that demands people go on working even when their internal resources are depleted.
By definition, burnout is more than just “work stress.” Being burned out can also lead to deterioration in the quality of one’s work, which can result in a negative self-image. The ongoing stress that accompanies burnout is also linked to a heightened risk for mental illness: According to a recent study of burned-out resident doctors, burnout can contribute to a higher risk for depression, along with suicide and substance abuse.
Recently, some researchers have attempted to capture exactly how much burnout affects U.S. workers: A 2018 study found 28% of the general U.S. workforce experiences “overall burnout,” while a Gallup study from the same year found that 23% of American workers report feeling burned out “often or always.”
Burnout has become such a hallmark of American culture, especially among millennials, that Petersen calls it “the contemporary condition.” But as much as it defines the zeitgeist, only recently was burnout formally recognized as an occupational phenomenon by the World Health Organization (WHO), which defines it as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.”
The link between burnout and depression
The WHO maintains that burnout is in its own category, separate from any medical or mental health diagnosis, including depression. Some experts believe burnout is a risk factor for developing depression — or, for those who are already diagnosed with major depressive disorder, a trigger for a depressive episode. But they disagree that the two basically describe the same condition.
“I can tell you that the symptoms look identical,” says Dattilo. “When someone describes the symptoms of burnout, those are all going to show up in depression, too.”
Other researchers think we’re misunderstanding burnout altogether — and that rather than a totally separate phenomenon, it’s just another name for depression.
Depression and burnout symptoms can look a lot alike. Natalie Dattilo, PhD, a psychologist at Brigham and Women’s Hospital in Boston, says they’re usually both driven by a sense of helplessness. Both burned-out and depressed people often feel ineffective, like they can’t gain traction — that nothing seems to be working, no matter how hard they try to get out of a slump.
“I can tell you that the symptoms look identical,” says Dattilo. “There’s not much distinction. When someone describes the symptoms of burnout, those are all going to show up in depression, too.”
Irvin Schonfeld, PhD, a professor of psychology at The City College of New York and the CUNY Graduate Center, researches the correlation between depression and burnout. He says it’s the emotional exhaustion, the core component of burnout, that mirrors depression most distinctly.
“Depression and emotional exhaustion symptoms correlate with each other highly enough that they appear to be measuring the same thing,” says Schonfeld. “The emotional exhaustion component of burnout, which is the core of burnout, is thus reflective of a depressive condition.”
He has conducted a number of studies on the correlation between burnout symptoms and depression symptoms. His research focuses on comparing the continuums of emotional exhaustion and depression, using symptoms from depression screening surveys like the Patient Health Questionnaire (also known as the PHQ-9).
In a 2016 study of 1,386 schoolteachers, Schonfeld and his colleagues found that subjects’ scores on depression symptom scales and the emotional exhaustion scale for burnout correlated very highly. In further studies, Schonfeld and co-author Renzo Bianchi found similarly high correlations between emotional exhaustion and other depression scales.
In a separate 2016 study of 6,351 Austrian physicians, researchers found that doctors who had symptoms of burnout were more likely to suffer from depression, and that the three components of burnout symptoms tended to correlate more highly with depression than with each other.
Schonfeld and Bianchi’s work found the same correlation, suggesting that burnout and depression may not be distinct experiences.
Is burnout just depression at work?
Many researchers view burnout symptoms as strictly a work-related syndrome, separate from any medical condition, because the majority of burnout research is related to occupational burnout. Depression, on the other hand, is seen as more omnipresent and universal — a medical condition that can impact all aspects of a patient’s life.
But Schonfeld says the distinction between someone’s work and home life isn’t so black and white. Someone’s work environment can contribute to their existing general depression, or even cause new depressive symptoms. “There is a lot of evidence that indicates depressive symptoms become elevated when people work in adverse conditions,” he says. Particularly, people who have jobs with heavy workloads and little autonomy are at risk for developing elevated levels of depressive symptoms.
For example, Schonfeld’s work suggests that when teachers get jobs where they’re exposed to violence or disrespect, their depressive symptom levels rise.
Dattilo says this is especially true if work-based burnout begins to strain other areas of someone’s life, which is common, since stress often comes with physical and emotional symptoms. “If burnout affects you in other areas, like your relationships or your health — if you feel in general like nothing you do seems to make a difference — that’s going to feel and look a lot more like depression.”
Burnout might be a less stigmatizing way of talking about depression
Since burnout and depression can look the same clinically and there’s scientific evidence they’re not separate conditions, why is depression so commonly pushed aside to an entirely separate category? Labeling emotional exhaustion and its associated symptoms as “burnout” could be easier to swallow than calling yourself “depressed.”
“I think there is less stigma attached to the word ‘burnout’ than the word ‘depression,’” Schonfeld says. “Some people may prefer to call what they are suffering ‘burnout’ for that reason.”
For example, physicians who are overworked and emotionally exhausted could put their jobs in jeopardy if they label their symptoms as a mental illness like depression. And people who recognize their burnout symptoms as depression might find themselves even more exhausted by the hurdles treating depression brings, like accessing medical care.
But for people to manage their burnout and the health symptoms associated with exposure to chronic stress, Schonfeld says it’s important to recognize burnout for what it is: a kind of depression that occurs in reaction to terrible working conditions. “There are evidence-based treatments for depression, and people can be helped by them. We have to get these people the help they need,” he says.
Redefining burnout means changing how it’s treated
It may seem like an issue of semantics, but how psychologists and organizations understand burnout is the basis for how it’s treated. If someone is burned out in the traditional work context, it might seem like a natural solution to take some extra time off work.
But if burnout is recognized as depression, then a few personal days isn’t the right way to manage it.
In general, Schonfeld says people with burnout aren’t going to see many benefits to their mental health if their only approach is taking a few days off — the “half-life” of a vacation is about two weeks, which means the same negative feelings will kick in once people get back to their normal routines at work. Instead, people with depressive symptoms would be better served by the support of a psychotherapist or psychiatrist who can prescribe an antidepressant if necessary.
Dattilo says the priority should be getting people the help they need to deal with emotional exhaustion. “In research, it’s important to have clearly defined criteria so you know exactly what you’re trying to study, but in clinical practice, I’m more interested in helping people find relief from their symptoms than whether we call it ‘burnout’ or depression,’” she says. “No matter what you call it, it’s important to deal with your mental health in work and in life. There’s no reason to suffer.”