In short
Burnout and depression look similar from the outside, and the difference decides the treatment. The most important step is not a wellness programme, it is a proper assessment.
- Depression is pervasive and persistent, lasting at least two weeks, rather than lifting on a good weekend.
- It often shows up as physical symptoms only. In a study across 14 countries, 45 to 95 per cent of people with major depression reported physical symptoms alone.
- Anhedonia, loss of interest or pleasure, is the question that has to be asked directly, because many people will not volunteer low mood.
Condition Overview
What is being ruled in or out?
Four possibilities, and they overlap.
| Exhaustion from load | Lifts with genuine rest and recovers on holiday |
| A depressive disorder | Pervasive and persistent for two weeks or more, and does not lift with rest |
| A medical cause | Thyroid, iron, sleep apnoea, alcohol, medication side effects |
| Another psychiatric condition | Anxiety, alcohol use, and less commonly bipolar disorder, which changes treatment entirely |
Why is this so often got wrong?
Because depression frequently presents without any complaint of low mood. In a study of 1146 people with major depression across 14 countries, the proportion reporting only physical symptoms ranged from 45 to 95 per cent, and 11 per cent denied psychological symptoms even when asked directly.
Men in particular are less likely to report low mood, and more likely to present with alcohol use or risk taking.
Which physical symptoms are the clues?
- Fatigue and low energy
- Sleep disturbance
- Back pain, headache and non specific musculoskeletal pain
- Concern about health that exceeds the severity of the symptoms
The number of symptoms matters. In 1000 primary care patients, the prevalence of a depressive disorder ranged from 2 per cent in those with zero to one physical symptom to 60 per cent in those with nine or more.
Is a screening questionnaire enough?
No. Screening tools are sensitive but not specific, and in primary care 60 to 75 per cent of positive results turn out to be something other than major depression.
A negative result is more informative: it effectively rules major depression out. So the questionnaire is a starting point, not a verdict.
What is the question people are not asked?
Whether they have lost interest or pleasure in things they used to enjoy. People who present with physical symptoms are more likely to recognise this than to describe themselves as depressed.
It is a specific question and it has to be asked explicitly rather than inferred.
When to See a Doctor
- Exhaustion has not lifted after a holiday or a genuine break
- You have lost interest or pleasure in things you used to enjoy
- Sleep, appetite, concentration or motivation have changed and stayed changed for two weeks or more
- You have several physical symptoms with no clear cause
- Alcohol has increased, or you are relying on it to switch off
- Thoughts of harming yourself or that life is not worth living, which need same day assessment
- You cannot carry out your usual responsibilities at all
- Periods of unusually elevated mood, reduced need for sleep or uncharacteristic risk taking, which change the diagnosis and the treatment
How Dr. Felix Assesses This
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1
What is actually happening and for how long
Duration and pattern matter most. Depressed mood as part of a disorder is pervasive and persistent for at least two weeks, unlike the intermittent low mood that follows a setback.
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2
Physical symptoms taken seriously in parallel
Medical causes are investigated alongside rather than after, because pursuing them in parallel is both faster and less alienating. Thyroid, iron, sleep, alcohol and medication are all checked.
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3
A structured symptom scale, used properly
A validated scale documents the symptoms including thoughts of self harm and sets the urgency, but it does not make the diagnosis. A positive result is a reason to look further, not a conclusion.
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4
The differential that changes treatment
Anxiety, alcohol use and any history of elevated mood are asked about specifically. Up to three quarters of people with major depression have at least one other psychiatric condition, and a history of mania changes management entirely.
Treatment Options
Performance Longevity Program
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Executive Longevity Program
Why three appointments and not a monthly programme? Because there is no evidence base for an optimal check up frequency,…
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Longevity Consultation
What happens in the appointment? Roughly half of it is history. What you do, how you sleep, how much you…
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Why Early Treatment Can Matter
Why does distinguishing them matter?
Because the treatments diverge. Exhaustion from load responds to load. A depressive disorder responds to specific treatment and often does not improve with rest alone.
Getting this wrong in either direction is common. Non specialists both under diagnose and over diagnose depression, and under diagnosis is the more frequent error.
What happens if a medical cause is found?
It is treated first where it can be treated quickly. If the timing of symptoms coincides with a new medication or a condition such as an underactive thyroid, it is reasonable to correct that and see whether the symptoms resolve before treating anything else.
Where both are present, and that is common in people with chronic conditions, both are treated.
What about alcohol?
It is asked about directly, because it can mimic depression, coexist with it, or cause it. Disturbed sleep, loss of interest, fatigue and impaired functioning at work are all common to both.
It is also the factor most often left out of an executive health assessment, and the one most likely to be the actual answer.
Is anxiety the same thing?
Not quite, and the distinction is practical. Anxious depression accounts for up to half of major depressive episodes.
A useful clue: people with generalised anxiety tend to worry about the future, while people with depression tend to dwell on the past. Early morning waking, marked self criticism and thoughts of self harm point toward depression.
Why Early Treatment Can Matter
Why does distinguishing them matter?
Because the treatments diverge. Exhaustion from load responds to load. A depressive disorder responds to specific treatment and often does not improve with rest alone.
Getting this wrong in either direction is common. Non specialists both under diagnose and over diagnose depression, and under diagnosis is the more frequent error.
What happens if a medical cause is found?
It is treated first where it can be treated quickly. If the timing of symptoms coincides with a new medication or a condition such as an underactive thyroid, it is reasonable to correct that and see whether the symptoms resolve before treating anything else.
Where both are present, and that is common in people with chronic conditions, both are treated.
What about alcohol?
It is asked about directly, because it can mimic depression, coexist with it, or cause it. Disturbed sleep, loss of interest, fatigue and impaired functioning at work are all common to both.
It is also the factor most often left out of an executive health assessment, and the one most likely to be the actual answer.
Is anxiety the same thing?
Not quite, and the distinction is practical. Anxious depression accounts for up to half of major depressive episodes.
A useful clue: people with generalised anxiety tend to worry about the future, while people with depression tend to dwell on the past. Early morning waking, marked self criticism and thoughts of self harm point toward depression.
The right diagnosis first
Exhaustion, depression, a medical cause and alcohol all look similar from outside and are treated completely differently.
What under diagnosis costs
Depression most often presents as physical symptoms, and in 1000 patients the prevalence rose from 2 per cent with one symptom to 60 per cent with nine or more.
One appointment, both tracks
Medical causes and mood are assessed in parallel rather than one after the other, which is faster and more accurate.
Cost & Consultation Investment
The consultation is quoted individually, and any blood tests are quoted before they are ordered. The panel is short and aimed at the medical causes that mimic this picture: thyroid, iron, glucose, liver and kidney function. Where onward referral to a psychiatrist or psychologist is the right step, that is said plainly rather than avoided, and the consultation is not extended to fill time.
Frequently Asked Questions
It describes a state rather than a defined disorder, which is exactly why the assessment matters. The useful question is whether what you have is exhaustion from load, a depressive disorder, a medical cause, or more than one of them.
Duration and pervasiveness. Depression as part of a disorder is persistent for at least two weeks and does not lift with rest. Loss of interest or pleasure in things you used to enjoy is the single most useful question.
That further assessment is worth doing. In primary care, 60 to 75 per cent of positive depression screens turn out to be something other than major depression. A negative result is more informative than a positive one.
Yes, and this is the most commonly missed presentation. Across 14 countries, 45 to 95 per cent of people with major depression reported only physical symptoms, and 11 per cent denied psychological symptoms when asked directly.
Not without knowing what is going on. Reducing load helps exhaustion from load. It does not treat a depressive disorder, an underactive thyroid, sleep apnoea or an alcohol problem.
Not necessarily. Referral is right for severe symptoms, thoughts of self harm, or any history of elevated mood. Many people are managed without it, and you will be told plainly which applies to you.
A short panel aimed at the conditions that mimic this: thyroid function, full blood count and ferritin, glucose, liver and kidney function. A broad screen adds little and produces borderline results that need chasing.
Evidence
Where this information comes from
Every figure on this page is taken from the sources below. All of them are free to read, so you can check them yourself.
- Cardiovascular diseases
- Cardiovascular disease: risk assessment and reduction
- Hypertension in adults: diagnosis and management
This page is general medical information and does not replace a personal consultation. Trial results are averages across large groups, not a prediction for any one person.