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Depression, Anxiety, and Burnout: Where to Begin?

"Despite knowing the signs, I thought that it was just a transitory thing—the ups and downs of everyday life. But then I crashed." (Anonymous)¹

Even if you don't know what they mean, most people have heard of anxiety, depression, and burnout. It might be that you have a sense of these and what they mean through relating your own experience to them—yes! I have felt depressed, burned out, anxious, stressed, exhausted…—but how do they relate to (and differ from) each other? Are there clear separations, or is it that when you recognize these in yourself, you do in fact recognize them all?

Anxiety

Anxiety is all around, occurring at different moments in everyone's lives, sometimes very inconveniently. Relationships, work, school—all aspects of people's lives can be affected. When you worry about things, you can feel scared or fearful about them, but anxiety goes further than this. It can impact everyday life in a way that interferes with daily functioning and handling of tasks. While there are a variety of diagnosable anxiety disorders, some pervading symptoms include the following:

• Tension
• Restlessness
• Sleep disturbances
• Irritability and agitation
• Trouble concentrating
• Trouble controlling worry and panic

Anxiety can come from many sources, and although biological risk factors are a part of this (e.g. underlying illnesses), environmental causes are vastly important. Events that happen in one's life play a huge role as a source of anxiety across the lifespan. Changes bringing in losses of control, uncertainty, and even trauma can result in experiencing symptoms of anxiety. In this sense, anxiety can be a response to a perceived threat, risk, and danger. The manifestation of anxious symptoms alludes to a sense of hypervigilance: a physical feeling of needing to act, fight, fly, or freeze paired with intrusive, spiraling, or catastrophic thoughts. It can be helpful to think about anxiety on a scale—at one end, you might experience some intrusive thoughts and tension; at the other, you might experience nausea and hyperventilating that can be physically debilitating.

Depression

Depression is more than just feeling sad or low temporarily. Depression refers to a cyclic or recurring sense of hopelessness (and/or worthlessness), and for the purposes of diagnoses of various depressive disorders, can last for a few weeks or more. While diagnostic and psychometric tools can provide a framework of levels and types of depression, some key symptoms may include the following:

• Fatigue and low motivation
• A loss of hope and optimism
• Irritability and agitation
• A sense of worthlessness
• A loss of interest in pleasurable activities
• Sleep disturbances
• Physical pains (e.g. headaches)
• Suicidal thoughts or thought of self-harm

As with anxiety, a combination of biological, environmental, and psychological factors can be sources of depression. Life changes that leave you feeling stressed and unable to cope can lead to a loss of hopelessness. These changes can revolve around losses, uncertainty, and conflict in people's lives across many areas, including work, school, relationships, and home.

Burnout

Feelings of exhaustion, cynicism, hopelessness, and stress are common features of burnout. But what exactly is it? Is it anxiety, depression, or both?

Excessive and exhausting demands on your strengths and resources can lead to feeling burned out. Stress leading to a chronic or acute sense of fatigue can forge a path toward this, but more specifically, burnout is related to work or occupational demands. When resources, tools, and mechanisms of coping with excessive work-related stress are depleted, people can begin to experience symptoms of burnout. To put it simply, burnout relates to the workplace.

At first glance, burnout symptoms resemble those of anxiety and depression: impairments in concentration, sleep disturbances, energy depletion, and exhaustion. Despite the World Health Organization's (WHO's) International Classification of Diseases, 11^th edition (ICD-11) defining burnout, it is important to note that it is not conceptualized as a medical condition but instead as an occupational phenomenon in recent diagnostic manuals—that is, in relation to workplace environmental stimuli.^2–5

Making Meanings

At first glance, it might be difficult to discern burnout from anxiety and depression. In fact, there are overlapping symptoms with burnout that often lead to feeling anxious and depressed. Burnout, however, is not currently a diagnosable medical condition in the same way depression and anxiety are (according to the ICD-11 it is a "problem associated with employment or unemployment").⁴ There are also symptoms of depression, for example, that are not features of burnout, such as suicidal ideation. Anxiety can also be a feature of burnout, with intrusive thoughts about oneself stemming from worries and concerns about workplace self-efficacy where coping resources are scarce and diminishing fast.

In this busy modern world, people commonly acknowledge their own and each other's experiences by alluding to anxiety, depression, and burnout without necessarily being able to separate them. One might say or hear others say, "I feel so depressed today," "I'm really anxious about next week," or "you look so burned out." When people talk about these phenomena, they're probably talking less about diagnostics, statistics, and codes. Perhaps what they're accessing for reference is their own tacit knowledge—their reserves of experience and wisdom—and using the language to convey their own experience (along with sympathy and empathy to other's experiences).

Imagine being in space and looking at Earth through a powerful telescope. When you zoom in, you find your country, your region, city, or town. You can even see your house. But as you zoom out, what you recognize disappears, until, eventually, Earth is just a tiny pinprick among the vastness. When you zoom in, you make meaning. Zoomed out, you struggle to do this—and when people can't make meaning, they lose purpose. A process of moving toward burnout might be quite the same—the longer you feel fatigued, exhausted, and stressed, the greater the cost to self-efficacy (and risk of escalation).

Maybe then, looking after yourself and each other begins with intuition. Knowing might not just mean visiting your general practitioner or physician for advice and diagnosis, but possibly also paying attention to your feelings. As the grip of stress begins to tighten and you begin to feel symptoms associated with burnout, depression, and anxiety, it might be time to listen to your intuition.

Now more than ever, listening to the signs and symptoms that might tell you about overload is crucial to self-care and self-service. During the COVID-19 pandemic, people's ability to be able to cope and deal with the demands of everyday life may have lessened, and as time under lockdown increased, stress and fatigue became unwelcome partners in the day to day. Diagnostics might be able to tell you some things, but where experiencing depression, anxiety, and burnout are concerned, if you feel something is wrong, it probably is.

References

1. Anonymous. (2016, February 9). The secret psychologist: I started to experience depression, while treating it in others. The Guardian. Retrieved April 23, 2021, from https://www.theguardian.com/commentisfree/2016/feb/09/treat-depression-mental-challenges-psychologists
2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
3. Berg, S. (2019, July 23). WHO adds burnout to ICD-11. What it means for physicians. Retrieved April 23, 2021, from the American Medical Association website: https://www.ama-assn.org/practice-management/physician-health/who-adds-burnout-icd-11-what-it-means-physicians
4. Brooks, M. (2019, June 7). Burnout inclusion in ICD-11: Media got it wrong, WHO says. Medscape Medical News. Retrieved April 23, 2021, from https://www.medscape.com/viewarticle/914077
5. World Health Organization. (2018). International classification of diseases for mortality and morbidity statistics (11th Revision). Retrieved April 23, 2021, from https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/129180281