The people who ask about burnout are usually still working. They answer messages on the train home and still meet the deadlines, but each week costs more than the last, and Sunday evenings have started to feel like a weight. Somebody has used the word burnout, a manager or a partner, and it fits well enough. What they want to know is whether it is the whole story.
That is the real question: burnout or depression, and does the difference matter. It does. The two overlap, but they are not handled in quite the same way, and underneath both there is sometimes a third possibility, a physical cause that nobody has checked. Telling them apart takes a proper history, not an online quiz.
If you are at immediate risk of harming yourself or someone else, call 999 or go to A&E. For urgent mental health help, call NHS 111 and choose the mental health option, or call Samaritans free on 116 123, any hour.
How can a GP tell if it is burnout or depression?
Burnout is not a diagnosis in the way depression is. It describes what long, unrelieved pressure at work does to energy, engagement and confidence. Depression is an illness that the same pressure can set off, and once it takes hold it no longer stays at work. What I look at in clinic is where the symptoms live, and whether they have started to travel.
Where the exhaustion lives
I ask what a good weekend looks like now, and how the last holiday felt by the third or fourth day. With burnout there is usually some recovery away from work, even if it shrinks each time and the dread returns by Sunday afternoon. With depression, the flatness comes on holiday too. That one question decides nothing on its own, but it tells me where to look next.
Detachment from the job, or from everything
Burnout tends to bring a detachment aimed at the work: going through the motions, a shorter fuse with colleagues, a sense that effort no longer changes anything. Depression tends to drain enjoyment from everything, including the parts of life that have nothing to do with work. If the cycling, the cooking or seeing friends have also gone grey, I take that seriously.
Sleep, in detail
Almost everyone under strain sleeps badly, so the detail matters more than the complaint. Lying awake rehearsing tomorrow's meetings is common with work stress. Waking at 4 in the morning with a heavy, hopeless feeling that eases a little as the day goes on is a pattern I associate more with depression. I ask about screens, caffeine and alcohol too. Not to lecture, but because a body running on all three will feel burnt out whatever else is going on.
The physical layer
This is the part that gets skipped once everyone has agreed it is stress. Low iron in someone who stopped eating lunch months ago. A thyroid that has slowed gradually over a year. Disturbed breathing at night in someone whose partner mentions the snoring. Perimenopause in a woman whose concentration slipped at the same time as her sleep. Low vitamin D or B12, blood sugar that has drifted, the long tail of a viral illness. Each of these can look like burnout from the outside. I examine where it is relevant and, if blood tests would help, I explain which and why. Months spent managing stress when the thyroid is the problem are months lost.
What the job is actually asking
I ask about hours, how much control you have over them, and whether anyone notices the effort. The answers shape the plan, because treating burnout purely as a personal failing, when the work itself is the problem, only gets you so far. Sometimes the most useful part of the appointment is saying that out loud.
Safety, and the rest of the load
I ask everyone under this kind of strain about thoughts of not wanting to be here. People in demanding jobs often keep these to themselves because they are still functioning, and still functioning is not the same as safe. I also ask about home, money and caring responsibilities. The pressure at work is sometimes only the visible part of a much larger load.
Then a plan
If it looks like burnout without depression, the plan centres on recovery: sleep, boundaries, and often a conversation with work about what has to change. If depression has taken hold, the plan also includes treatment, whether talking therapy or treatment options discussed with you. Often it is a bit of both, and I say so plainly. If I am not sure, I say that too, and we look again in 2 to 3 weeks.
When should work stress make you book sooner?
Most people can wait for a routine appointment. Book within days if any of these apply:
- Thoughts of suicide or self harm, or thoughts that are becoming harder to set aside. If the risk is immediate, use the crisis routes above.
- Drinking more, or using anything else, to switch off at night.
- Palpitations or breathlessness you have been putting down to stress. Get these checked rather than assumed; sudden or severe symptoms need 999.
- No longer managing to get to work, or getting there but making mistakes that worry you.
- Sleep that has fallen to a few hours a night for more than a week or two.
Do you need time off or a fit note?
Sometimes, though often not for as long as people fear. Where clinically appropriate after assessment, I can provide a fit note, and the option that says you may be fit for work with changes, such as phased hours or altered duties, is often more useful than a blanket signing off. There is more on that in my piece on sick notes for mental health. If an employer asks for a fuller view on adjustments, an employment or reasonable adjustments report is £495 and is also written after assessment. The full list is on our medical report fees page.
How does Clinique Alpa approach burnout?
You see me in clinic at 466 Green Lanes for 30 minutes. The fee is £100 and it is stated before you book. The clinic is open Monday to Friday 09:00 to 20:00 and on Sunday 09:30 to 17:30, which helps if leaving work in the middle of the day is part of the problem. Bring a rough note of your hours and sleep over the past fortnight, and any recent blood results.
If you would rather start from home, a 30 minute video consultation is £79.99, booked and paid online, and currently with Dr Alpa J. Morawala. Video suits problems that do not need an examination. If the physical side needs checking, coming into clinic is the better first step.
This is private care alongside the NHS, not instead of it. With your consent, a summary goes to your NHS GP. If low mood rather than work sits at the centre of things, my piece on seeing a private GP about low mood may be closer to what you need.
Written by Dr Mitesh Parmar, MBBS MRCGP, Principal GP and Clinical Director at Clinique Alpa, 466 Green Lanes, Palmers Green, London N13 5PA. This article is general information, not personal medical advice. In an emergency call 999. For NHS advice call 111 or visit nhs.uk.