HOW TO DIFFERENTIATE BETWEEN BURNOUT AND DEPRESSION

Let my start out by saying I realize there’s a lot of discussion on whether burnout and depression aren’t just two sides of the same coin. And to be honest, even after reading a lot on the subject I can’t say if I agree with that statement or not. Mostly because I generally struggle with the use(fulness) of diagnoses (but that’s for another blog haha). I don’t want to simplify something that is hugely complex. So why am I making this post that makes it sound simple? Because whether we like it or not, a lot of clients do value and use the distinction. That’s why I find it important to have a framework for myself to differentiate between the two, so I can communicate with my clients in their preferred terminology.

So let’s start out with the theoretical distinction between burnout and depression (don’t worry, I’ll list more specific difference further on).

Burnout Syndrome (WHO)

  • Emotional exhaustion—stress response 
  • Depersonalization or cynicism—negative response to job and to others 
  • Reduced personal accomplishment or inefficacy—negative response to self 

Symptoms Major Depressive Episode (DSM–5)

  • Depressed mood 
  • Diminished interest or pleasure  
  • Changes in body weight or appetite  
  • Changes in sleep habits 
  • Psychomotor agitation or retardation 
  • Fatigue or loss of energy 
  • Diminished ability to think or make decisions 
  • Feelings of worthlessness or unwarranted guilt 
  • Recurrent thoughts of death

As you can see burnout is defined as more than just emotional exhaustion. But seeing as this symptom is highlighted the most, it’s understandable that we might have a difficult time differentiating it from a depressive episode. With burnout however, the exhaustion will prompt the person to distance themselves from work on an emotional and cognitive level as a way to cope with the work overload. For example, nurses (especially during the pandemic) who experience burnout might become apathetic to the surrounding suffering, not because they don’t care, but because it’s the only way to keep moving forward while severely exhausted. 

Both exhaustion and depersonalization can then lead to feelings of inefficacy. The person is less accomplished in their work because they are too tired, or because they don’t care enough anymore. But it can also arise simultaneously with the other two symptoms because of problems in the work environment, in which case feelings of inefficacy (because for example, the organizational structure is slow) can lead to exhaustion and depersonalization.

With this information in mind, we could generalize that depression is something that impacts all areas of a person’s life, while burnout is closely related to the person’s work environment. I use these specific distinctions to separate the two:

Burnout Syndrome (WHO)

  • Predominant feeling: exhaustion, cynicism and inefficacy
  • Symptoms are tied to work (and fluctuations in workload for example)
  • Still experiences regular moments of happiness outside of work
  • Thoughts are preoccupied with work
  • Self-esteem is preserved (unless their value is highly tied to their work performance)

Major Depressive Episode (DSM–5)

  • Predominant feeling: Persistent depressed mood and diminished pleasure
  • Symptoms are persistent and influence all aspects of someone’s life
  • Feelings of happiness or pleasure are nearly absent 
  • Self-critical or pessimistic ruminations 
  • Feelings of worthlessness and self-loathing are common

To use an example:

If you offer someone with a depressive episode an all-inclusive holiday to their dream destination, this person will still feel depressed there. But if you offer this to someone with a burnout (while adding that this break won’t cause them more workload) they’ll probably have the time of their life and enjoy the experience (apart from maybe worrying about work-related stuff when getting home, similar to the Sunday evening dread a lot of people with burnout experience).

Of course if a burnout goes on for a long period of time, it might eventually turn over into a depressive episode impacting all areas of someone’s life. Some clients tend to minimize their suffering because it’s “just a burnout”, so in those cases, it can be important to also emphasize the overlap with depression as a motivator for change.

Maslach C, Schaufeli W, Leiter M. Job burnout.

Ann Rev Psychol. 2001;52:397-422. The Tired, Retired, and Recovered Physician: Professional Burnout Versus Major Depressive Disorder. Am J Psychiatry. 2018 Aug 1;175(8):716-719.

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