Burnout, stress, depression, anxiety: what is the difference?

Burnout, stress, depression, anxiety: what is the difference?

9 March 2015
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Burnout: preventing it in 15 minutes per day

Dossier by Paul Koeck, MD
The Hotel chain ‘Logis’ invited burnout expert Paul Koeck, MD from ‘15Minutes4Me.com’ to discuss from a medical perspective how modern, active professionals kan stay mentally fit by enjoying life and preventing burnout.

Stress, burnout, depression, fatigue and anxiety: Definition and problem

Burnout is a dangerous illness which can result in death in extreme cases, if the signals are ignored. A definite medical definition does not exist, and as a result thereof there are as many definitions as there are researchers. In general, burnout is often compared to being tired or fatigued. Often, it is used as a synonym for stress.
In the traditional handbook of the classification of psychiatric disorders, the DSM IV, the term is not mentioned as a separate illness and is most alike the definition of depression. In general, most psychiatrists agree that burnout is something different. They often define burnout as being extremely exhaustion because somebody lives long-term in a way which is fundamentally against their nature. The real ‘treatment’ of burnout in the medical sense of the word is therefore often combined with a fundamental insight and changes in behavior helping the person live life as they really wish to live it. They learn to align their treatment with their deeper fundamental ‘existential’ life project. The person answers the question “What do I want?” for themselves and then lives accordingly. To some extent one could see burnout as an extremely strong ‘alarm signal’ which the body and mind give us to say: “Stop and change your life, because if you continue this way, you will die!”
So if you see it from that angle, burnout is a ‘friend’, warning us that it is high time to make a change in life. We will explain this more thoroughly:

1° Life joy

Life joy or contentment protects us against negative stress. by living happily and with joy, a type of ‘immunity’ or protection from negative stress is created. Luckily, life developed certain parts of our brain to be responsible for happy thoughts and feelings (particularly our left prefrontal cortex). It is similar to muscle training: the more you use a muscle, the better it develops. More muscle tissue is produced by using the muscle in question more often.

2° Stress

Stress is, in itself, something positive in nature. Stress helps us respond quickly and adequately in life-threatening situations so that we can survive. If a tiger plans to eat you, stress will help you to flee more quickly or to fight for your life. Acute stress at certain points during a week or month is a good thing. When the ‘triggers’ which cause stress happen too frequently (e.g. every text message, phone call, e-mail, communication which can focus our attention on something negative) our stress system becomes exhausted and inefficient.


Our memory for negative situations will be activated (as a side effect of excess adrenalin).

Cortisol kills cells in the hippocampus:

A long-term overdose of cortisol (a hormone produced in our adrenal glands) has a toxic effect to our hippocampus, which is a region in the brain. Up to 9% of our neurons or brain cells in the hippocampus can be killed by long-term negative stress. This was recently shown by new image forming techniques in neuroscience. The hippocampus is responsible for our memory and our ability to focus. Brain cells dying there explains the concentration and memory problems that are found after long-term stress. The hippocampus makes it so that we can link the information from the past to the information in the present in order to make decisions in the future.

Our forward-looking prefrontal cortex dies:

The zone in our brains which helps us to make decisions and plan things in the future, is the prefrontal cortex. Brain cells here, too, will slowly die. And even worse: the left prefrontal cortex which is responsible for positive thoughts and feelings dies first. That is why we become pessimists in a beginning depression. The right prefrontal cortex (negative thoughts ad feelings) follows later on when we slide deeper into the depression. This explains why we experience apathy or a feeling emptiness in a deep depression.

3° Depression, anxiety, fatigue: the third stadium

If stress is chronic, we end up in a vicious cycle of negativity and exhaustion. The phenomena described above lead to depression, anxiety or fatigue. On their own, useful functions in our body:
Depression helps us to do less, to take a break. Anxiety is the typical feeling which helps us create a distance from something which instills fear in us. Fatigue, too, makes us slow down, at least it does when we listen to our body and do not force ourselves through it.
Our Western economic model, our work ethic, does however make it so that we force ourselves through this and no longer listen to these useful (but sometimes unclear) signals. We use willpower, caffeine, nicotine or pills to force ourselves to go on, and if we continue with this for a long enough period of time, we are punished by stadium 4 … the real, medical burnout.

4° Burnout

In this stage, our complaints become chronic and have been present for months. We have ignored past warnings and completely collapse. Our memory and focus (hippocampus) have given up long ago, and our ability to plan the future and organize ourselves to reach the goals planned (prefrontal cortex) has also been affected. This stage should be the ultimate warning signal to put us to a definite halt and make us thing about who we are versus who we want to be.

5° Illness

The same mechanism which caused a chronic overproduction of cortisol and adrenalin, unfortunately also is responsible for our immune system, our response to infections and our general immunity. After long-term overloading of this system, it becomes deregulated and we are more vulnerable to outside attacks by, for example, bacteria, viruses or cancer cells. Even worse: this deregulation even makes it so that we start attacking ourselves: internal infection mechanisms could for example start attacking our vascular walls, causing arteriosclerosis.  This can lead to heart attacks, brain damage, and many other ‘societal problems’.

6° Death

If we have not taken any action even in the previous stage, we die. Indirectly, because we have not listened to our body during any of the stages. Because we did not live like we deep down wanted to live. Most causes of death are part of a group which is sometimes called ailments due to civilization. These can generally be prevented by living happily and healthily, and by learning how to reduce negative stress.

How can you prevent or treat stress, burnout, anxiety or depression?

We developed an online self-help program which enables you to work on  yourself for fifteen minutes per day in order to learn how to get stress, anxiety, burnout or depression under control.

Test which type of stress you experience

If you want to know what type of stress you suffer from, then do our free online self-test now.

Paul Koeck, MD

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