Those of us in the working world, the academic world, or really anyone with a proper 9-to-5 (not a literal 9-to-5, with apologies to people who work graveyard shifts especially) feel it from time to time. We don’t get ‘tired,’ that’s for chumps. We go another level, friends – that level where affirmations, positivity, motivational speeches, and even the strongest coffees that you can think of can’t reach us. We’re talking existential tired. This. Is. Burnout.
Not that kind of burnout, you silly person (although it is pretty cool) – I meant this. I’m talking about the result of all the stress that one builds up over time that flat-out causes physical, mental, or emotional exhaustion. Maybe even all three. And it isn’t pretty. Oh, there are tell-tale signs of burnout – a quick Google search (you’re doing this at work, aren’t you?) can give you all sorts of signs. However, we humans are complicated. Different people have different brains, therefore we’re all going to take to burnout in different routes and will have different outcomes. I should probably pick a different word other than ‘different’, I’m sure it makes a difference-
Anyway, we can tell (usually, well hopefully) what our signs of burnout are in ourselves, maybe in others, but there must be some kind of biological marker. Some kind of signal that our bodies emit when we’re at burnout’s door and maybe we can have some kind of documentation that we can send to HR before we go off our rockers and emit a different kind of signal-
In this week’s Featured Article (I just got here after more than 300 words!?), the authors propose such a marker – saliva. Really, read the article if you like (especially because it is open source), Pilger et al. suggest checking saliva, specifically for cortisol.
Cortisol is known throughout the web as the ‘stress hormone.’ According to the Mayo Clinic (have you been clicking some of the links I have on here?), cortisol is a hormone that is part of our fight-or-flight response. As a result, it signals the body to release glucose and tissue-repair substances. Of course, if the stress is always present, your body pretty much goes haywire because it’s always in stress mode. There’s anxiety, depression, weight gain, memory issues, and all sorts of Bad Things. Those probably cause more stress in turn – nasty vicious circle, isn’t it? Still, if it’s something produced in the body, there must be a way to diagnose it, hopefully without repeated blood-drawing. That‘s going to get stressful after a while.
Pilger et al. tried their hypothesis – that patients diagnosed with burnout have elevated cortisol levels in their saliva compared – on patients undergoing stress treatments at the Health and Prevention Center, Sanatorium Hera in Vienna, Austria. A total of 97 individuals were screened with a questionnaire and were thus divided into a control (the baseline for comparison) and treatment groups; the latter were the ones undergoing stress treatments. Saliva was collected at home (the patients had to do it themselves) several times in the morning just after waking up, around noon, and just before going to bed. They weren’t allowed to have breakfast or smoke, especially in the early-morning collections (but yes I’m sure they could eat after collections, geez). The authors also analyzed the samples for other markers, specifically myeloperoxidase, interleukin 6, and homocysteine. Considering that these are often associated with inflammations, especially heart disease, these are pretty good candidates to scan as part of a stress test.
So what did the authors find? Despite the groups being statistically similar in terms of age and gender distributions, the ‘stressed’ treatment group had higher levels of cortisol in their saliva than those in the control group. However – this explains the title of the Featured Article – the cortisol levels remained high for the stressed patients, leading to a greater difference between themselves and the control group in the midday and just before going to bed (‘nadir’). Some good news: the stressed patients showed quite the progress after four months of treatment. Not only did their psychological screening show lower scores for stress, but their cortisol levels dropped. Interestingly, the higher the stress level pre-treatment, the less the change after treatment. One way to interpret that is that maybe one could be just too off the deep end. Maybe longer treatment…?
Before I wrap this up, the authors didn’t find anything out of the ordinary with the other inflammation biomarkers. Hey, I’d be stressed out too if my ticker’s having issues. Maybe I should relax with some chocolate. But where to go from here? According to the authors, it turns out that checking salivary cortisol levels is better done in mid-day or before bed than in the morning. I’d say that checks out. Come on, you know you’re not as stressed in the morning, just after you wake up to have breakfast, which is often the best meal of the day (I know it is for me – breakfast makes me happy, but that’s probably just the confirmation bias talking) as opposed to after work or class, when you’ve had to deal with all sorts of different people that for one reason or another causes you different levels of stress, and you have to find different ways of dealing with it-
On a more serious note, though: stress and burnout is no joke. If you think you’re showing signs of burnout, don’t attempt to self-diagnose or self-medicate – no amount of online research is an adequate substitute for a mental health professional or GP, so don’t be afraid to reach out to a professional. They might even tell you to take it easy for a time – imagine getting that on a doctor’s note.
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Featured Article: Pilger A, Haslacher H, Meyer BM, Lackner A, Nassan-Agha S, Nistler S, Stangelmaier C, Endler G, Mikulits A, Priemer I, Ratzinger F, Ponocny-Seliger E, Wohlschläger-Krenn E, Täuber H, Scherzer TM, Perkmann T, Jordakleva G, Pezawas L, Winker R. (2018). Midday and nadir salivary cortisol appear superior to cortisol awakening response in burnout assessment and monitoring. Scientific Reports 8:9151. DOI: 10.1038/s41598-018-27386-1
Featured Image: Public Domain (Author: Gerd Altmann, 2012)