Depression and Burnout

The Douglas Institute Foundation recently ran a public education and fundraising campaign. One of the topics it chose was “Burnout.”It seems that everyone has a different idea about what burnout is and most people confuse it with depression (and with good reason because “Burnout” is not a well-defined term). In order to help shed some light on burnout and depression, I wrote three articles that will appear in the next edition of Mammoth, an electronic journal put out by the Stress Center of the Douglas Research Center. (All the articles are also available in French.) Much of the content was written for the website “leburnoutsesoigne.com” I decided to elaborate on some concepts and broke the content up into three parts in order to make it more readable.The first article is on the question of what exactly is Burnout, what is depression, how are they similar, and how are they different.
The second is called “A sidebar on Depression.” Although I had only intended to touch on depression since I was writing for our Burnout campaign, I found that it was too long to squeeze into the other two articles (hence the term “Sidebar”). I think it summarizes depression’s causes pretty well.
The third is an article on burnout per se. An edited and considerably shorter version was published in Journal Métro Montréal on May 8, 2007.

Here is the first one:

“I’m burnt out. Can I be depressed? Camillo Zacchia, Ph.D.Psychologist – Douglas Institute

Are you burnt out, or have you ever felt like you were on the verge of it? What is burnout anyway, and is it the same as depression?Whatever it is, it certainly seems to have affected a large number of individuals. Burnout claims so many of us that it is by far the single greatest cause of sick leave in any company. A significant portion of everything you pay for, from the pants you wear to the blood test your doctor orders, goes to defray the cost of burnout.

What is burnout?
Burnout is not an official term or diagnosis in the field of mental illness. It is a term that was originally used to refer to a sense of fatigue and an inability to function normally in the workplace as a result of excessive demands on the individual, especially among helping professionals.Today, there is no agreement among scientists as to how we should define burnout. Some see it as an exclusively work-related phenomenon, while others see it more broadly.In the general population, the term “burnout” is like any other popular notion. It continuously evolves. Over time, it can almost take on a different meaning for each individual. Some people, for example, use the term “burnout” when they are feeling bored with their employment and want to seek new challenges. Others may use the term to describe a major depression. They may do so because depression still carries a powerful stigma.For the most part, though, we normally use the term burnout when referring to the inability to handle the pressures related to work.

What is depression?
Depression is a complex phenomenon involving both internal mechanisms and external influences. It is diagnosed when a person has a depressed mood (feeling sad, empty, tearful, etc.), or has lost interest or pleasure in most or all activities. It is also accompanied by several other indicators that can include changes in appetite, sleep problems (either insomnia or excessive sleep), fatigue, agitation, feelings of worthlessness, difficulty concentrating, and recurrent thoughts of suicide or death.
Recognizing yourselves in the above list of criteria is not necessarily a problem. Many difficult situations in life can make us feel this way from time to time. The important question is one of intensity and duration. It is considered depression when the symptoms last for more than two weeks and when they are sufficiently intense so as to cause either significant personal suffering or a loss of the ability to function normally. (For more details on understanding depression, see “A sidebar on depression”.)

How are they related?
Burnout is generally seen as a specific problem related to stress in the workplace, whereas depression is a broader phenomenon that can permeate all areas of our lives. But can we really separate the two terms cleanly? In fact burnout and depression are highly related and the terms are sometimes used interchangeably.In theory we can see burnout alone. Most people can burn out if we continue to ratchet up the demands on them without giving them the means to meet those demands. In such cases, although they will feel just like any other depressed person, they will quickly return to normal if we remove them from the situation.The same goes for depression. It may have nothing to do with work or stress. A major depression will often persist regardless of whether the individual remains at work or stays home.
In most real cases, though, the lines cannot be so easily drawn. Let’s take, for example, the case of people with a strong sense of responsibility and a tendency to be perfectionists. Such people will normally function very well. They tend to bring high standards to their jobs since they feel bad when they see shoddy or incomplete work. As a result, they take on many tasks and deliver the goods. Employers and colleagues begin to rely on them more and more. If they then reach a point where they must take time off work because of burnout, would they not feel like they have let everyone down? Would they not be depressed and feel like failures? In such cases, the depressive feelings tend to linger even though the person is removed from the stressful situation that may have helped produce those feelings in the first place.
Now, if we see these personality traits in the workplace, would we not also see them in many other circumstances? Would these people not also have a tendency to feel like failures when their kids are having trouble in school, or when they may be going through a divorce, for example?
The relationship between depression and burnout is also evident in cases that would normally be described as a pure depression, and where work is not normally an issue. People suffering from a major depression will feel agitated, fatigued and have trouble concentrating. They feel no satisfaction or pleasure even when a task is accomplished successfully. It is not hard to imagine that their productivity will suffer. Even simple tasks become heavy burdens. In such cases, work-related pressures often become the proverbial straw that breaks the camel’s back. Work per se is not the problem but it becomes a contributing factor to depression. The inability to function at work then contributes to the depressed person’s sense of failure and guilt. When these people must take time off work they are often described as being on a “burnout leave,” even though they meet the criteria for a major depression.

How does it matter?
Although for many people the term burnout may carry less of a stigma than depression, the label used is probably less important than the desire to get their lives back on track.The role of the psychologist or psychiatrist remains the same regardless of whether the person consults for the treatment of depression or for burnout. The professional must assess the factors that contribute to the problem in order to be able to address them. External factors can include specific situations or general circumstances. Internal factors can include both biology and personality. Regardless of whether an inability to set limits and an overly strong sense of personal responsibility contributes to excess stress at work, or to unmanageable burdens in our personal lives, this inability must still be addressed in treatment.

What must be done in either case?
Whether you are going through a burnout or a depression, or both, as is often the case, you will still suffer in much the same way and would still benefit from treatment.One thing is certain, unless something changes, the problem will not go away on its own. If things didn’t work out before, they will not suddenly go well after having taken some time off. That change can be biochemical or situational, it can involve a new attitude or new skills, it can even be as simple as deciding to accept your old situation as it was, but this time without the constant struggle to change it. Whatever it is, something must be different.
The two main forms of treatment are psychological or pharmacological. Regardless of the cause, both forms of treatment can be beneficial. Sometimes a combination of both treatments is most effective. It is generally recommended that for mild to moderate forms of depression, the psychological treatment called cognitive-behaviour therapy (CBT) is the best choice. If the response is not adequate, then medication can be added. For moderate to severe depression, a combination of antidepressants and CBT is usually recommended from the outset. In reality, additional factors such as attitude about medication, or availability of affordable psychological services, often play a major role in determining treatments.
Antidepressants target brain chemistry. Most people feel less bothered by events when they take medication and can thus cope much better with situations. Cognitive behaviour therapy seeks to change how we interact with the world by either teaching us new skills or by examining and altering the attitudes that affect how we react to and interpret the events around us. It can help us set limits. It can teach us to question our standards, our attributions, and our biases. And it can help us develop a better sense of priorities and balance in our professional and personal lives.

Here is the article on the causes of depression:

A sidebar on depression

Depression is a complex phenomenon that is often misunderstood by the general public. Is it a disease in the traditional sense? Or is it simply a reaction to life events? In essence, depression can be seen as either a disease or as a reaction.

Disease: Some forms of depression can be understood in the same way as any other disease. In such cases, there appears to be something wrong with how the brain is functioning. Brain chemistry seems to be altered in such a way as to have a major impact on mood, and these mood changes do not appear to be strongly linked to any obvious external event. Bipolar depression, where moods can swing from profound states of depression to phases of mania where the person feels almost superhuman, is one example of what would generally be considered a medical disease.
Biochemistry: Having said this, it is certainly possible, and indeed probable, that biological mechanisms affect all of us and are important contributors to all forms of depression, even when the brain is functioning normally. For example, although we do not have an exact understanding of how they affect us, we know that factors such as our hormonal and nutritional states do impact mood.
Innate temperament: If you’ve ever had more than one child or any number of siblings, you have seen how no two individuals have the same temperament. We are clearly all born with our own package of traits and tendencies. Some of us are more adventurous, while others are more hesitant. Some get angry easily, while others have a tendency to take things in stride. In the same manner, some people generally seem to be happy most of the time while others tend to be serious and pessimistic.
Environmental influences: Although our innate temperament is a major component of personality, our traits are also affected greatly by our experiences. We are shaped by our family values, by our society’s culture, and by every experience we have ever had. This unique blend implies that a particular situation can never be understood, or reacted to, in the same way by any two individuals.
Life-altering events: Although all events are experienced through our personal values and beliefs, some are so challenging that depression is almost inevitable. The death of a loved one, for example, will normally have a profound effect on all of us. In such cases, strong depressive feelings would be considered a normal reaction. Although we may all require a significant amount of time before we can return to a relatively normal level of functioning, for some people the depression lingers and goes beyond what is normally observed.
A history of events: The vast majority of people who consult for depression do not do so as a result of a single event. They have often struggled with depressive symptoms on and off for much of their lives. They normally report a lifelong history of real or imagined failures. Although a significant event may have triggered an episode of depression and pushed them to consult, the vulnerability was most likely always there.
The common thread – Personality: The result of – and sometimes the cause of – the factors mentioned above is the personality that defines us. Biochemical variables and innate temperament interact with our development. The personalities that emerge within us then affect how we deal with the world. It is our understanding of events and our reactions to them that makes some of us vulnerable to depression.
Some personalities are simply more prone to depression. Unassertive people, for instance, will often feel trapped in unsatisfying situations, perfectionists will always feel disappointed in themselves or upset at others, dependent individuals will often find themselves in situations where they may be taken advantage of. This is why we must try to understand our personal patterns if we are to protect ourselves from depression. If we have such vulnerable patterns and do not alter them, either through pharmacological or psychological means, depression is likely going to remain a lifelong struggle.
The best way to understand depression is to understand the various factors that influence our moods. We are, of course, biological beings. Everything about us is in our brains: thoughts, memories, attitudes, moods, intelligence, and all else that makes us human. One can therefore argue that all psychological problems are caused by biochemical imbalances in our brains. However, our biochemistry has most certainly been influenced by our upbringing and our experiences. It is for these reasons that we must consider both the internal and the external factors listed below in trying to understand depression and its causes.

And finally, here is the longer version of article on Burnout: