Correspondence (letter to the editor): Gaps in Review Article

The review article contains gaps; the authors did not include important aspects of the biopsychological and scientific medicine of recent years. Signs of exhaustion are core characteristics of burnout as well as depression, and these diseases are often subsumed into a single clinical entity. However, this is incorrect because depression is defined by means of many, clearly different, symptoms and not exclusively by “exhaustion”. From a biopsychological perspective, burnout can nowadays be characterized clinically by

• Excluding depression and fatigue (by means of clinical symptoms)

• Characterizing “exhaustion” by bio-typical somatic patterns, which is possible by measuring the diurnal profile of cortisol in the saliva, the neurotransmitters noradrenalin and serotonin in the urine, and qualifying the autonomic nervous system by means of heart rate variability and a detailed questionnaire test.

This approach was independently developed by Hellhammer et al (1) in the form of the “neuropattern” as well as by our own working group in a slightly different form (2). On the basis of the tests, four characteristic subgroups of burnout are found:

• Subjective “exhaustion”, but biological resources are intact

• Exaggerated uptake of noradrenalin

• Lowered concentrations of the “stress brake” serotonin

• Exhaustion of the adrenal production of cortisol.

This differentiation opens up targeted individual integrated measures, such as behavioral therapy, stress processing techniques and relaxation techniques, and substitution of deficient biological substrates. Epigenetic, neuroendocrine, immunological variables, which have a sustained effect, should also be included in the reasoning.

Burnout should be considered in a more differentiated manner and, in view of the rapid increase of psychiatric illnesses, should be approached by using modern scientific-holistic methods.