Burnout
Burnout, or depression?
They look alike from the inside. Only one of them is a diagnosis, and only one of them can be measured and treated.
What burnout is
Burnout is not a medical diagnosis
The World Health Organization places burnout in the chapter of the international disease classification headed factors influencing health status or contact with health services — the section for reasons people seek care that are not themselves illnesses. It defines it as a syndrome resulting from chronic workplace stress that has not been successfully managed, and says the term belongs to the occupational context [1].
That is not a technicality. It means there is no agreed set of criteria to meet, no validated scale in routine use to score you against, and — the part that matters here — no trial has tested whether ketamine treats burnout. We are not going to tell you otherwise.
The overlap
What is usually underneath it
The symptoms overlap with depression to a degree that surprises most people. A review of the evidence found correlations between burnout and depression measures frequently above 0.60, and emotional exhaustion — the core of burnout — correlating more strongly with depression than with burnout’s own other dimensions [2].
In one of the studies that review examined, up to 90% of people who met the criteria for burnout also met the criteria for depression, and none of the burned-out participants were free of depressive symptoms altogether. The authors describe the theoretical line between the two as conceptually fragile.
Clinically, that matches what we see. People arrive describing exhaustion, cynicism about work and a sense of getting nothing done, and a proper assessment finds a depression that has never been named or treated.
A score, before and after. Without one, nobody can tell you whether anything changed.
What we actually do
Measure first, then decide
The first appointment is not a treatment. It is a question: is there a depression here, and how severe is it?
You are scored on a validated depression scale, and we go through your history, your medications and anything else that could be producing the same picture — thyroid disease, sleep disorders, anaemia and alcohol all imitate burnout convincingly.
There is something here that can be treated and, just as importantly, tracked. Ketamine has been tested repeatedly in depression, and that is the ground we would be standing on — not burnout.
We will tell you so, and we will not treat you. Workload, sleep, and a conversation with your own physician will do more for you than an infusion will, and you should not spend thousands of dollars finding that out.
A caution
Why overlap is not the same as evidence
It would be easy to argue that because burnout looks like depression, a depression treatment should work for it. That reasoning is tempting and it is not proof.
Post-traumatic stress disorder also overlaps heavily with depression. Two small trials of ketamine in PTSD were positive; the largest and most rigorous one, with 158 patients, found no difference from placebo. Resemblance did not predict response.
So we treat what we can measure, and we tell you which is which. If your depression score improves, you will see it. If it does not, you will see that too.
References
1. World Health Organization. Burn-out an “occupational phenomenon”: International Classification of Diseases. 28 May 2019. ICD-11, chapter: Factors influencing health status or contact with health services.
2. Bianchi R, Schonfeld IS, Laurent E. Burnout–depression overlap: a review. Clin Psychol Rev. 2015;36:28–41. PMID 25638755.
Related pages
Depression and mood Are You a Candidate? Safety, Risks and Limits Fees
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