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Superman and Wonder Woman aren't real. The rest of us are, which is why it is okay to ask for help - particularly when it comes treating anxiety disorders, depression and burnout, writes Penny Haw le urnout, depression and anxiety disorders are different illnesses, but they share several important traits. They are all real and highly prevalent, and each carries the unfortunate, age-old stigma of mental illness. It's ridiculous, really. We don't hide conditions such as broken bones ("Would you like to sign my cast?") or asthma (lust a minute, I need to fetch my pump"). But, fearing others will judge and treat us differently, many of us downplay, deny and even try to hide mental ailments. Burnout, Mental illness ISN'T ALL IN THE MIND depression and anxiety disorders are illnesses. They are not character flaws. And, unlike many character flaws, they respond to treatment and can be controlled. But help is required. Ego, says Johannesburg psychiatrist and clinical psychologist Dr Frans Korb, adds to the reluctance to seek treatment. People find it hard to admit they need help, particularly psychological help, because they imagine it's a sign of weakness. "Depression and anxiety disorders are biological illnesses. There are certain chemicals in the brain, including serotonin, noradrenalin and dopamine, which regulate mood and the way people feel. When the concentration of these chemicals becomes abnormal, people need medication to restore the balance. That is why the conditions need to be treated from a medical point of view," he says. "Unfortunately, stigma works against people coming forward for help. However, once patients accept their condition is medical, it reassures them and they are more inclined to seek professional help." The lines that distinguish burnout, depression and anxiety disorders are sometimes blurred. A 2014 study entitled Relationship between burnout and depressive symptoms: A study using the people-centred approach concluded that "burnout and depressive symptoms seem to cluster together and develop in parallel". At the same time, it is not unusual for someone with depression also to suffer an anxiety disorder or vice versa. According to the Anxiety and Depression Association of America, almost half of those diagnosed with depression are also diagnosed with an anxiety disorder. When this happens, the symptoms are more severe and can take longer to resolve. To understand them, it's necessary to consider the illnesses individually. BEGINNING WITH BURNOUT Perhaps because it is a more recently identified illness and generally relates specifically to stress in the workplace (while depression and anxiety disorders are broader phenomena that touch all aspects of our lives, whether at work, home or play), burnout does not suffer the same stigma as the other two. It is, however, no less dangerous. Burnout, says Cape Town psychologist Anelle Naude-Lester, is a state of extreme emotional, psychological and physical exhaustion, resulting in a loss of interest and motivation. It happens when we continually accept and respond to demands without pausing to confirm that we have the means to meet them. Just as there is a limit to the number of plates a waiter can carry, there is a limit to how much a person can take on before everything comes crashing down. "The road to burnout is often paved with good intentions," adds Naude-Lester. "Being hardworking, motivated and idealistic are not harmful — until you add new responsibilities and unrealistic expectations to the mix non-stop, don't take care of yourself, measure and judge yourself harshly, and ignore your general health." Working too hard and taking on ever-more responsibilities can, she says, be the effect of burnout, rather than the cause. Being productive becomes a lifeline, even after it has stopped being satisfying. You appear to be capable of juggling endless demands without faltering. You're admired, even envied, by others. Sometimes it takes the unforeseen to happen to trigger the final fallout. Perhaps you experience retrenchment, divorce, death or even a relatively minor setback. Suddenly, you're overcome by waves of exhaustion, frustration and helplessness. Your endless "to-do" lists seem insurmountable and meaningless. You feel unappreciated and alone. The engine seizes and burnout ensues. "Burnout," says professor of philosophy and former contributing editor of Pgchology Today, Sam Keen, "is nature's way of telling you you've been going through the motions, [but] your soul has departed." When people reach a point where they need to take time off work because of burnout, they often feel they have let others down. This a dangerous time. If the condition is left untreated, it can lead to depression. BURNOUT WARNING If you answer "yes" to any of these questions, you might be heading for burnout: Doing more and more, but accomplishing less and less? Doing ever-more, but feel less and less appreciated? Making endless lists and convinced you alone can do what needs to be done? If you stop, everything will fall apart? Exhausted, but sleep doesn't help? Sad for no obvious reason? Experiencing a lack of purpose and meaning? Feeling increasingly detached from relationships? Source. Psychologist Anelle Naude Lester It is not unusual for someone with depression also to suffer an anxiey disorder or vice versa. Images: (DiStock.com/PeoPlelmages/Squaredpixels DEALING WITH DEPRESSION Diagnosed when someone feels persistently unhappy, empty, tearful and hopeless, or has lost interest in almost all activities, depression is a complex illness. Other indicators include fatigue, feelings of worthlessness, changes in appetite, insomnia or excessive sleeping, agitation, lack of concentration, and recurring thoughts of suicide or death. Of course, circumstances make us all feel this way at times. Depression is when the symptoms are intense, last for more than two weeks and are severe enough to cause suffering and/or the inability to function normally. Aches, pains and a weakened immune system are also markers of the illness. "Recognising your own depression can be difficult," says Korb. "It often takes comments by partners, friends or colleagues — like 'you are different', 'you are not yourself', 'you are not the same' or 'you don't laugh or join in the fun anymore' — to make you aware you are not well. It's important to take heed of these observations. They indicate you might need help." According to the World Health Organisation, depression will be the leading cause of disability worldwide by 2030. The illness significantly impacts on productivity. In addition to general fatigue and low energy, impaired intellectual abilities mean patients have trouble focusing, making decisions, solving problems, and planning and remembering tasks. In fact, The Impact of Depression at Work study conducted by the South African Depression and Anxiety Group (SADAG) shows that when an employee has depression, but continues to go to work, she or he is five times less productive than an employee who takes time off from work for treatment. Even so, two-thirds of people with depression do not seek help. This is why, says the operations director of SADAG, Cassey Chambers, it is important to emphasise that depression, anxiety and burnout can be treated and controlled like almost any other illness — even when they occur at the same time. headaches, sweating, trembling and twitching. They may feel out of breath, lightheaded and even nauseous. GAD can be very debilitating, making it impossible to carry out normal activities. Some GAD patients are driven to unusual repetitive actions or compulsions, and are diagnosed with obsessive-compulsive disorder (OCD). "GAD is a condition that sometimes quietly pervades a person's life and then takes over quickly," says Durban anxiety coach Sarah Rogers. "Although I think we need more awareness around it — no one should have to suffer anxiety silently — I do see more and more people seeking help for GAD. This is helped, at least in part, by the increased availability of other avenues for treatment beyond the traditional therapeutic space, including life coaching, support groups and social work therapy." 'Anxiety disorders can be successfully treated with non-invasive, occupational therapy in children as young as three or four," says Kerry Wallace, a Cape Town occupational therapist specialising in early intervention in children. "We see many cases of early-onset anxiety, which, when effectively treated, prevents future disorder. We encourage parents not to delay in seeking help when they notice their children are overly anxious." Burnout, depression and GAD are far more prevalent than we realise. If you think you or anyone you care about might be suffering from any of these conditions, encourage them to get help immediately. As is the case with any other illness, accurate diagnosis is the first step to safe and effective treatment. Let's stop the stigma and embrace good mental health. 410 DO YOU HAVE AN ANXIETY DISORDER? If you identify with several of the following persistent symptoms, you might be suffering from an anxiety disorder: You are always tense and worried. Your work, school or family responsibilities are affected by your anxiety. You avoid everyday activities because you are anxious. You are beset by fears you know are irrational, but cannot get rid of them. You believe terrible things will happen if you don't do specific things a specific way. You experience unexpected bouts of heart-pounding panic. You imagine danger and disaster await you around every corner. Source: US National Institute of Mental Health Working too hard and taking on ever more responsibilities can be the effect of burnout, rather than the cause.AND THEN THERE IS ANXIETY Studies show a high percentage of people with major depression also suffer generalised anxiety disorder (GAD). Because they so often appear together, GAD and depression are referred to as "the fraternal twins of mood disorders". But, although they share similarities and treatment is sometimes the same, GAD and depression are fundamentally different. Everyone experiences anxiety. It's normal under many circumstances, but chronic, continuous anxiety is not. People with GAD experience fear, panic and fretfulness in situations where most are unconcerned. They are likely to experience constant anxiousness and have panic or anxiety attacks without obvious triggers. People with GAD often have difficulty falling or staying asleep. The condition can be accompanied by symptoms such as muscle tension, WHERE TO FIND HELP Consult your GP. Call SADAG on 011 234 4837 8am-8pm. SADAG 24-hour helpline: 0800 12 13 14. SMS SADAG 31393 (they will call you back).