Why the Distinction Is Not Pedantry

Burnout appears in the ICD-11 as an occupational phenomenon: exhaustion, mental distance from work, and reduced professional efficacy, specific to the workplace context. It is explicitly not classified as a medical condition. Major depression is a medical condition, is present across every domain of life rather than only at work, and responds to treatment. The two feel similar from the inside and lead to completely different answers, which is why sorting them is the first thing worth doing.

• Burnout in the ICD-11 is occupational and context-specific by definition
• Depression persists on holiday, at weekends, and after leaving the job
• Burnout improves with genuine distance from the workplace; depression does not
• Anhedonia extending to things unrelated to work points toward depression
• Early-morning waking and psychomotor change point toward depression

What Actually Works for Real Burnout

If your presentation is genuinely occupational, the effective interventions are structural rather than pharmacological, and the research on this is reasonably consistent. Workload, autonomy, fairness and values alignment drive burnout more than individual resilience does. Selling a medication for that is selling the wrong product, and we would rather say so.

• Reduced workload and realistic hours, which is often the whole intervention
• Increased autonomy and control over how work is done
• Recovery periods long enough to matter, not a long weekend
• Addressing the specific workplace conditions producing it
• Individual resilience training is the weakest lever and often misapplied

When Depression Is Underneath

A significant share of people who describe burnout meet criteria for major depression, and some have had it long enough that the workplace explanation feels sufficient. Where depression is present and has resisted adequate treatment, ketamine has strong evidence and this is a reasonable place to be. The screening is what separates the two, not the label you arrived with.

• PHQ-9 for depression severity, scored before any consultation
• WHO-5 as a wellbeing measure that captures a different dimension
• Symptoms present outside work hours point toward a mood disorder
• Prior adequate antidepressant trials establish treatment resistance
• A positive screen changes what we are treating and how we describe it

The High-Responsibility Professions

Physicians, nurses, first responders, attorneys and pilots contact us often, and their situation carries a complication beyond the clinical one: fear that seeking treatment threatens a license, a clearance or a certification. That fear is not irrational, and it causes real delay in care. Tovani is a private-pay practice and does not report to employers, licensing boards or the FAA. Reporting obligations attached to your specific credential are yours to understand, and we will tell you plainly that we cannot advise you on them.

• Private-pay practice with no employer or insurer reporting
• HIPAA-protected records held outside any workplace system
• Certification-specific obligations vary and are yours to verify
• Aviation and some clearance contexts have particular requirements
• We will not tell you a treatment is unreportable when we do not know that

Candidacy

We do not treat burnout, because there is nothing to treat it with. We treat depression, including depression that arrived through overwork. If screening shows an occupational presentation without a mood disorder, the honest answer is that this is not the right service, and you will hear that during the consultation rather than after paying for a course.

• Adults 18 and over with depression identified on screening
• At least one adequate antidepressant trial at therapeutic dose and duration
• Symptoms present outside the work context, not only within it
• No active substance use disorder, psychosis, or untreated bipolar mania
• A sober support person present for every session