I’m sitting at my desk on a Saturday trying to get work done. It’s November of 2019. But just like every day for the past three months, I can’t complete a single task. Just opening my email inbox has become painful. I have little to no motivation, energy, or joy.
When I describe this apathy and fatigue to a therapist, she says: “If we’re anxious for long enough, we’ll eventually become depressed.”
That must be it. Maybe I’m depressed. Research shows that low to mild levels of anxiety can be normal and healthy; they keep us alert, safe, proactive, and productive. Manageable anxiety drives us to overcome challenges at work, propose effective solutions, and collaborate on shared goals.
But now my tank reads empty. I procrastinate on everything. I’m too tired to be anxious. Since anxiety no longer has a productive place to go, it disappears.
After a year of living this way, I decide to make a major career shift. I withdraw from my Ph.D. program. And for the first time, I have no concrete plans for the future. My sole focus becomes rediscovering what makes me happy. And then something amazing happens.
Healthy anxiety returns in the form of motivation. My passion to write and create is reignited. I’m inspired and excited about the future again. And from this excitement erupts a realization: I hadn’t been clinically depressed at all. I was burned out.
But what’s the difference? And why do we — including clinicians — often confuse the two?
Depression is the leading cause of disability worldwide and impacts over 264 million people, according to the World Health Organization. Although depression can arise at any point in one’s lifetime (and more than once), it typically first occurs between ages 18–25.
Symptoms include depressed mood, anhedonia (i.e., diminished pleasure or interest in things), change in appetite, insomnia or hypersomnia, feeling worthless or guilty, fatigue, poor concentration, psychomotor agitation, and thoughts of suicide or death.
Although symptoms fall on a spectrum of severity like any clinical disorder, one must experience at least 5 symptoms for at least 2+ weeks to meet diagnostic criteria. Depression is pervasive; it makes it difficult for one to experience joy in nearly all areas of life for much (if not all) of the day on most days.
Some people can pinpoint exactly what they believe to be the cause of their depression such as a major life transition, stressful life event, or past abuse and trauma. It’s important to note that major depressive disorder is different from grief and posttraumatic stress disorder (PTSD), although these things can certainly coexist.
Others experience depression and have no idea why. This can lead to feelings of guilt. Maybe you’ve thought “I have everything I need. I shouldn’t feel this way” or “Others have it much worse than I do”. But discounting the reality of our mental health only worsens symptoms. There are often other factors at play beyond our control like genetics and biochemistry.
The good news is that depression is one of the most widely researched topics in mental health. It is also one of the most treatable. There are many scientifically validated interventions and strategies to improve daily functioning.
In some cases, it’s possible to minimize or eradicate symptoms of depression through self-employed strategies.
Changes in diet have been shown to improve overall mood and alleviate depressive symptoms. Increasing one’s intake of selenium (e.g., Brazil nuts, whole grains), vitamin D (oily fish, eggs), Omega-3 fatty acids (e.g., flaxseed, walnuts), antioxidants (e.g., berries, vegetables), and protein (e.g., animal or plant-based like tofu, lentils, and chickpeas) can improve mood and sleep.
The benefits of exercise in treating depression are also well-established. For example, one study found that depressed adults who began walking for 20 to 40 minutes 3x per week for at least 6 weeks showed a significant reduction in symptoms compared to a group that did not exercise regularly.
If you’re not yet ready to consider psychotherapy or medication, implementing a healthier diet and regular exercise into your routine has shown significant benefits. Setting and accomplishing small goals is also helpful in alleviating depression.
None of these treatment approaches should be considered in isolation. Indeed, many doctors and clinicians recommend a combination of therapy, improved diet and exercise, and medication.
I’m a major advocate for the importance of therapy in treating mental health. Research shows that people who engage in therapy have better psychological outcomes compared to those who do not.
Although cognitive-behavioral therapy (CBT) is one of the most common modalities for treating depression and anxiety, there are additional approaches guiding therapeutic intervention.
No matter which approach works best for you and your therapist, the process is designed to be a collaborative effort to identify unhelpful thought patterns and behaviors that may be contributing to your depression.
I’ve seen a handful of therapists throughout my lifetime and can personally attest to its immeasurable benefit to the quality of my life. No need to wait until you’re depressed either. There’s a reason we go to the doctor for check-ups, not just when we’re sick. It’s preventive. Here are some tips on beginning your search for a therapist.
Although there is still a stigma surrounding the use of medication in treating mental health, antidepressants can literally save lives. After consulting your doctor or psychotherapist, you may find it helpful, even imperative, to supplement treatment with an antidepressant. Others find their depression lifts over time without medication.
Selective serotonin reuptake inhibitors (SSRIs) are among the most commonly prescribed medications worldwide. It’s always important to discuss potential side effects with your doctor and/or therapist. Since I am neither, this article won’t outline the pros and cons of antidepressant use. However, I encourage everyone to do their own research and advocate for their needs.
Ultimately, this decision should be between you and your healthcare professional(s). If you or someone you know is in crisis, here is the link to the National Suicide Prevention Lifeline.
The term “burnout” was first introduced in the 1940s but was not systematically analyzed until the 1970s by a psychologist named Herbert Freudenberger.
Thanks to the research of psychologist Christina Maslach, three major clusters of burnout have since been identified.
1. Emotional and physical exhaustion
2. Cynicism and depersonalization (i.e., perception of observing oneself from outside one’s body)
3. Diminished sense of personal effectiveness
Other symptoms include fatigue, body aches, headaches, and gastrointestinal disorders. Cynicism may manifest through anger, frustration, or feelings of isolation. Changes in appetite and sleep may occur as well.
Unlike depression, burnout is not traditionally recognized as a medical diagnosis. Most countries, including the United States, describe burnout as an occupational condition. Indeed, this is a key difference; the cause of depression may be unclear or arise “out of the blue”, while burnout more clearly results from an occupational source or work stress.
One report argues the five main causes of burnout are: 1) unreasonable time pressure, 2) lack of managerial support, 3) lack of role clarity, 4) unmanageable workload, and 5) unfair treatment.
So, who is most likely to experience burnout?
Freudenberger (1974) argues it is primarily “the dedicated and the committed”. This is why those in the helping professions (e.g., physicians, nurses, social workers, counselors) are experience burnout at higher rates. These are roles marked by long hours and excessive demand of one’s energy, resources, and emotional capacity.
More women than men tend to experience burnout in their lifetime. Some studies suggest this is due to differences in work conditions; women make up more of the helping profession/human services job sector and have been shown to have, on average, less authority in the workplace.
My experience as a burned-out graduate student looked like cynicism, irritability, disillusionment, and dissatisfaction. I was emotionally exhausted and felt unable to focus on even the most mundane tasks. I had lost my sense of purpose, direction, and meaning in the work I was doing.
Of course, I didn’t attribute this to burnout at the time. I didn’t yet have the language for it. It seemed neither did my therapist.
Researcher and author Brené Brown shares she once heard a priest say: “If you don’t want to burn out, quit living like you’re on fire.”
We live in a culture that prioritizes hustle and productivity at the cost of employee or student wellbeing.
Unfortunately, because burnout is not considered a clinical mental health disorder like depression, it’s harder to obtain an accurate diagnosis and receive proper solutions.
When my exhaustion first arose, I thought the problem was me. I believed if I just pushed harder, worked more, and stuck it out things would magically improve. Or at least I would adjust to the pressure.
But I was wrong. Who wants apathy in place of misery? I wanted to feel alive again. So, after a year, instead of continuing to drown, I chose to get out of the water.
When I left the culture of academia, I regained my sense of clarity, purpose, and drive. I took my intellectual curiosity with me and utilized it in ways better suited to my values and goals.
It’s clear in retrospect that not only was I not the problem but neither was my burnout. The problem? A profession or work environment that doesn’t fit and leads to depletion.
Indeed, Freudenberger argued that since burnout is linked to undesirable job conditions, it should therefore be approached at an organizational level not just at an individual level. His suggestions include shorter working hours and more staff supervision, support, and training.
Quitting one’s job is not always the feasible — or even optimal — choice in many cases. There are other science-backed strategies to alleviate symptoms of burnout.
This includes everything from improving our diet (i.e., meal planning over vending machine runs) and making time for exercise. We make time for things we prioritize. Those 20 minutes spent scrolling could be reallocated to a brisk walk outside the building. Five minutes of a lunch break could be spent practicing mindfulness, deep breathing, meditating or praying.
One thing I’ve started doing is tracking my daily activities in an Excel spreadsheet. In the evenings, I give the day an overall rating from -2, -1, 0, +1, +2. At the end of the month, I track how much time spent on which tasks were most likely to result in a higher rating for the day. Then I schedule my time accordingly.
This doesn’t necessarily mean you need to put in a 2-week notice.
It starts with considering: which elements of my job are fixed, and which ones can I alter? Can you delegate certain tasks to others? What projects can you put on hold? Can you temporarily work from a new environment or at home? Sometimes implementing these changes requires advocating for your needs to a boss or supervisor. Don’t be afraid to do so. It will likely improve the quality of your work.
One of the hardest parts of both depression and burnout is feeling like you’re in it alone. There can be shame wrapped up in our exhaustion, which inhibits us from reaching out for support.
Research shows that support systems help us better cope with stress and improve our motivation. Support can come from anywhere: friends, family, colleagues, or therapists. It can also provide us different but equally important things such as emotional support, comfort, advice, information, or a new perspective.
Much like depression, burnout leaves us feeling trapped and helpless. But we get to choose how we respond to our circumstances.
It’s important to a) name what we’re feeling, b) take steps to change/improve our circumstances where we can, and c) establish connections to those who can help in circumstances we cannot. Then we will be on the road to recovery.
If it feels like you’re drowning, look for a life raft nearby to catch your breath. And if that doesn’t help, it might be time to get out and swim in new waters as I did.