Globally, burnout levels have risen in part due to the aftermath effects of COVID-19, and in part due to the ‘eat, sleep, work, repeat’ daily grind. In Australia, workers are experiencing a higher level of burnout at 62%,1 whilst across the Tasman, burnout rates for Kiwi workers are at 70%, compared to a global average of 48%.2 So, given this is a significant issue for our society, how do you know if you or your patients are experiencing burnout?
The symptoms of burnout include:
- Exhaustion
- Anxiety
- Indifference
- Depression
- Irritability and anger
- Sleep disturbance
- Lack of motivation or passion
- Cognitive problems
- Impaired performance
- Becoming asocial
- Emotional lability
In addition to these symptoms, the negative effects of burnout can have significant impacts on relationships, work/home life and self-care.
Distinguishing burnout from other conditions such as clinical depression can be challenging, as many symptoms overlap.3 Assessing burnout involves the use of a combination of scales such as the Sydney Burnout Measure (SBM), the Depression Anxiety Stress Scale (DASS), along with clinical reasoning.
Burnout is often attributed to spreading oneself too thin, but how does this excessive and/or prolonged stress result in the development of burnout?
The biology of burnout
In the face of acute stress, the body responds via the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis activating the ‘flight or fight’ response. The ANS reacts within seconds, initiating the sympathetic-adrenal-medullary (SAM) axis whilst downregulating the parasympathetic nervous system, increasing heart rate, blood pressure and the release of adrenalin and noradrenalin. Simultaneously, but at a slower rate, the limbic system signals the HPA axis to release a cascade of hormones including glucocorticoids, influencing blood sugar, energy and the immune system.
This chain of events is fundamental for survival and thus beneficial in small amounts. However, excessive and/or prolonged stress is suggested to inhibit the return of these systems to homeostasis resulting in a constant ‘flight or fight’ state which has been linked to burnout.4
Additionally, other factors predispose one to ‘burning out’ such as age, relationship status3 and gender, with higher rates of burnout reported in women compared with men.5
Many women return from work to home, ready to start their “second shift”3
Personality traits can also put one at risk, where individuals with dominant attributes of perfectionism, diligence, an inability to say no and a work-focused persona are much more likely to develop burnout.
Reigniting the burned out flame
Whether your patient is already burned out or on the road to burnout, both are recoverable. Ensuring they are receiving core nutritional support is vital in helping them rebuild whilst optimising the stress response to promote resilience. Essential nutrient vitamin C, when dosed at 500 mg twice daily for four weeks contributed to improved cognition along with increased work/study motivation and focus, factors that are diminished in burnout.6 Further, vitamin C and B vitamins can be depleted during chronic stress, thereby hampering homeostatic regulation of both the ANS and HPA axis. These vital nutrients are found in Vitamins B5, B6 and C for Stress and Adrenal Health. Magnesium status is impacted by prolonged stress and supplementation has been shown to alleviate the impact of stress.7 Magnesium is a core ingredient of Mental and Physical Energy Powder which provides foundational nutrition support for feelings of exhaustion. When magnesium was combined with vitamin B6, this combo diminished stress in severely stressed adults by more than 40%.7
For patients feeling exhausted and depleted but wired we can consider the herbs Rehmannia glutinosa (rehmannia) and Panax quinquefolius (American ginseng). This duo of herbs, as contained in Rehmannia Complex for Nervous Exhaustion, assists to re-establish healthy HPA axis function, offer neuroprotection and support energy levels at times of prolonged stress.8,9 For those at the other end of the spectrum who have lost their joie de vivre, Herbal and Nutritional Support for Adrenal Health may be more appropriate. The combination of adaptogenic herbs Withania somnifera (withania), Eleutherococcus senticosus (Siberian ginseng) and Rhodiola rosea (golden root) have shown to improve cognitive performance10 and reduce the impact of mental and physical stress.11,12
The road from burnout back to wellness can be difficult, as it involves addressing contributing factors such as the cause of the stress, perfectionism tendencies and poor lifestyle choices. Practitioners can support their patients during this journey with foundational nutrition and targeted herbal support.
References
1. Tamaray P. Australian employees suffer mass burnout. Human Resources Director. Published October 4, 2022. https://www.hcamag.com/au/specialisation/mental-health/australian-employees-suffer-mass-burnout/422659#:~:text=The%20latest%20Microsoft%20Work%20Trend,average%20of%2048%25%20of%20employees.
2. Bergh R van den. NZ workers are more likely to suffer burnout than in any other country – report finds. Stuff. Published May 24, 2023. https://www.stuff.co.nz/business/132127430/nz-workers-are-more-likely-to-suffer-burnout-than-in-any-other-country–report-finds#:~:text=New%20Zealand%20workers%20are%20more,59%25%2C%20the%20report%20said.
3. Parker G, Tavella G, Eyers K. Burnout – A Guide to Identifying Burnout & Pathways to Recovery. Allen & Unwin; 2021. doi:10.4324/9781003333722-1
4. Bayes A, Tavella G, Parker G. The biology of burnout: causes and consequences. World J Biological Psychiatry. 2021;22(9):686-698. doi:10.1080/15622975.2021.1907713
5. Saad L, Agrawal S, Wigert B. Gender gap in worker burnout widened amid the pandemic. Gallup. Published December 27, 2021. https://www.gallup.com/workplace/358349/gender-gap-worker-burnout-widened-amid-pandemic.aspx
6. Sim M, Hong S, Jung S, et al. Vitamin C supplementation promotes mental vitality in healthy young adults: results from a cross-sectional analysis and a randomised, double-blind, placebo-controlled trial. Eur J Nutr. doi:10.1007/s00394-021-02656-3
7. Pouteau E, Kabir-Ahmadi M, Noah L, et al. Superiority of magnesium and vitamin B6 over magnesium alone on severe stress in healthy adults with low magnesemia: a randomized, single-blind clinical trial. Plos One. 2018;13(12):e0208454. doi:10.1371/journal.pone.0208454
8. Panossian A, Wikman G. Effects of adaptogens on the central nervous system and the molecular mechanisms associated with their stress—protective activity. Pharm. 2010;3(1):188-224. doi:10.3390/ph3010188
9. Scholey A, Ossoukhova A, Owen L, et al. Effects of American ginseng (Panax quinquefolius) on neurocognitive function: an acute, randomised, double-blind, placebo-controlled, crossover study. Psychopharmacology. 2010;212(3):345-356. doi:10.1007/s00213-010-1964-y
10. Reay JL, Scholey AB, Kennedy DO. Panax ginseng (G115) improves aspects of working memory performance and subjective ratings of calmness in healthy young adults. Hum Psychopharmacol: Clin Exp. 2010;25(6):462-471. doi:10.1002/hup.1138
11. Speers AB, Cabey KA, Soumyanath A, Wright KM. Effects of Withania somnifera (Ashwagandha) on Stress and the Stress- Related Neuropsychiatric Disorders Anxiety, Depression, and Insomnia. Curr Neuropharmacol. 2021;19(9):1468-1495. doi:10.2174/1570159×19666210712151556
12. Anghelescu IG, Edwards D, Seifritz E, Kasper S. Stress management and the role of Rhodiola rosea: a review. Int J Psychiat Clin. 2018;22(4):1-11. doi:10.1080/13651501.2017.1417442
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