Mental exhaustion, neurasthenia (‘surmenage’) and burnout are terms that have been used interchangeably throughout the years, with variations in their definition and use. Generally, these terms refer to the inability to cope with chronic psychological stress, mainly at work (but not limited to work) because of insufficient resources to meet (work) demands.
The diagnosis is not part of the DSM classification and there are no strict diagnostic criteria. Treatment recommendations are mainly based on practical experience.
The 2018 Dutch NHG guideline states that being ‘overworked’ or ‘mentally exhausted’ (in Dutch, ‘Overspanning’) can be diagnosed when four criteria are met. The first (1) is having at least three of the following stress symptoms: fatigue, disturbed sleep, irritability, lability, not being able to deal with busy environments, excessive worrying, feeling pushed, concentration problems and forgetfulness. This may lead to (2) (feelings of) loss of control in daily living and (3) malfunctioning. Furthermore (4), these symptoms cannot be attributed to a psychiatric disease.
Burnout is considered a severe form of mental exhaustion / overwork when these symptoms persist for at least six months and feelings of fatigue / exhaustion are in the forefront. We refer to all diagnoses with ‘mental exhaustion’ because it’s not possible to distinguish mental exhaustion from burnout within the FaMe-Net data.
In the course of mental exhaustion / burnout, three phases are distinguished. In the first (crisis) phase, rest and acceptance are important, with practical advice on how to structure the day. In the second phase, the problem and possible solutions are defined and discussed, followed by the third phase in which the patient can try to implement possible solutions and find a new balance. In the treatment phase, the GP can collaborate with the mental health nurse in general practice (in Dutch, ‘poh-ggz’) and an occupational health physician. Interventions such as mindfulness or coaching may help. In complex cases, the help of a psychologist might be needed or, in occasional cases, a referral to secondary care is warranted.