Burnout Is Not Depression

Burnout is a combination of emotional exhaustion, depersonalization, and reduced sense of personal accomplishment

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Adam Grant is a renowned organizational psychologist, a professor at the Wharton School of the University of Pennsylvania, and a New York Times bestselling author. Recently, Grant declared that burnout was a manifestation of clinical depression. "It's time to recognize burnout as a medical condition," Grant tweeted to his 417,000 followers. "Across occupations and countries, if you're burned out, odds are you're depressed. Burnout is emotional exhaustion—being so drained that you have nothing left to give at work."

Burnout has come to the forefront of the public discourse amid the seismic shifts in work-life balance wrought by COVID-19. To successfully establish burnout as a subset of depression would mean widespread adaptation and acceptance among the public and the medical community, leading to more resources for researching and assisting those suffering from burnout.

While this is a laudable outcome, the fact remains that burnout and depression represent two different conditions with distinct causes and treatments; merging the two would detract individuals from receiving the proper care they need.

Burnout and depression feature different constellations of symptoms

Jessi Gold, M.D., M.S. is an assistant professor in the Department of Psychiatry and the Director of Wellness Engagement and Outreach at Washington University School of Medicine in St. Louis. As a practicing psychiatrist, she takes care of health care workers and college students—two populations that have been heavily impacted by mental health crises during the pandemic.

Gold states that she considers burnout a stepping stone to, but distinct from, depression. She explains that unlike depression, which may be caused by many different triggers, burnout is related specifically to the workplace. It is also a risk factor for depression. She adds, "Having burnout doubles your chance of having suicidal thoughts."

"Burnout is also a combination of three things," says Gold. "One is emotional exhaustion. The second is depersonalization, and the third is a reduced sense of personal accomplishment." Gold explains that none of these things are symptoms of depression alone, though some may overlap (e.g., emotional exhaustion can look like fatigue or even insomnia). But she explains that depression is much more of a constellation of symptoms, including change of mood and interest, and can even include suicidal thoughts. The International Classification of Diseases (ICD) lists depression as a "depressive mood or loss of pleasure accompanied by other cognitive, behavioral, or neurovegetative symptoms that significantly affect the individual's ability to function." Notably, the ICD also specifies that burnout "is not classified as a medical condition."

While, of course, burnout can significantly affect someone's day-to-day life, it does so differently than depression might. Gold explains that in the patients she sees, depression can have life-changing, often pervasive effect: "Many people with depression can't function, can't work, or can't interact with other people. If we say that everyone with burnout is experiencing depression in all these different states, it really does a disservice to the experiences of many people with depression."

Burnout and depression may require different interventions

Gold has written extensively about her personal and professional experiences with depression and burnout, which have informed her understanding of how the two conditions differ. She adds, "It feels different to be burnt out or to be depressed. Anyone who has ever been one or the other, or has even been burnt out and depressed at the same time could tell you that."

On top of that, because the conditions have different presentations, they also often have distinct solutions. Gold adds, "Someone who's burnt out might not need an antidepressant. In contrast to someone with depression, someone who's burnt out might not even need to see a mental health professional; they might instead need time away from work or to address their work schedule or have some help managing some stuff in the workplace." Gold explains that for burnout, the solutions are often systematic: how to design a system for the individual (if they want to), as opposed to biologic or even psychologic treatment. She does point out, however, that she believes therapy can help most people, so it can help those with burnout, too.

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Keeping the two conditions separate would enable those struggling with them to identify the solution that would be the most appropriate for them.

Equating burnout to depression shifts the responsibility from the workplace to the individual

Equating burnout and depression sends the wrong message regarding who holds the most power and responsibility for a person's mental wellbeing.

According to Gold, patients' genetic, biological, and psychosocial factors all contribute to the severity of mental disorders. In this sense, depression is a deeply personal affliction, and those who have the most volition to address their depression are typically the patients themselves. This does not mean that depression is a personal weakness or anyone's "fault"; it simply points to how risk factors for depression can be compounded in one individual.

In contrast, burnout is framed by a person's relationship with work and the circumstances surrounding his or her physical, mental, and emotional labor. Even individuals without a propensity for mental illness experience burnout because they may feel a lack of purpose and meaning in their work. In this sense, the workplace has the most power—and responsibility—to prevent and alleviate their workers' burnout. The individual in this setting is merely collateral damage.

"When people focus on the factors that contribute to one's wellness, you are assigning responsibility," says Gold. "So, for depression, we are looking at how the person, their experiences, and their biology react, versus, in burnout, how individuals react to challenges created by the institutions. If work is causing the problem, then institutions must shoulder some of the responsibility for the individual's condition."

Workplace solutions for burnout, Gold suggests, would include things like cutting down on paperwork and increasing vacation time, while workplace solutions to depression might involve access to mental health treatment and changing the culture of stigma around mental health in medicine.