Imagine shining a flashlight at a wall in a dark, empty room. If you walk toward the wall, the light will contract. The closer you get to the wall, the smaller and more concentrated the beam of light becomes. By the time the flashlight is an inch from the wall, you’ll see a tight, bright circle of light surrounded by shadow and darkness.
Your attention is a lot like the beam of that flashlight. You can focus it closely and intensely on something, or you can relax it — allowing it to grow soft and diffuse. A lot of research — much of it recent — has examined the different types and qualities of attention and their associations with mental health and cognitive functioning.
This work has revealed that certain types of attention may tire out your brain and contribute to stress, willpower failures, and other problems. Meanwhile, activities that broaden and soften your attention may reinvigorate your brain and promote psychological and cognitive wellbeing. Whenever you train your attention on something — an act that cognitive scientists sometimes call “directed attention” — this requires effort.
More effort is needed when other things (i.e. distractions) are vying for your attention, or if the thing you’re trying to focus on is boring. According to a 2016 review from researchers at the University of Exeter Medical School in the U.K, your ability to effortfully focus your attention is finite. Just as an overworked muscle grows weak, overworking your attention seems to wear it out.
When that happens, a lot can go wrong. For one thing, your ability to concentrate plummets. Your willpower and decision-making abilities also take a hit. According to a 2019 study in the journal Occupational Health Science, attention fatigue may also contribute to stress and burnout.
There’s even some work linking attention fatigue to attention deficit hyperactivity disorder (ADHD). “The symptoms of ADHD and ‘attention fatigue’ so closely mirror each other that the Attention Deficit Disorders Evaluation Scale has been used as a measure of attention fatigue,” wrote the authors of a 2004 study in the American Journal of Public Health…..
Waking up already feeling worn out? Unable to overcome the afternoon slump? These may be signs that various lifestyle factors are taking a toll on your energy levels, leading to brain fog and straight-up exhaustion.
When constantly on the go, it may be difficult to find ways to recharge. However, Dr. Alfred Tallia, professor and chair of the Department of Family Medicine and Community Health in the Robert Wood Johnson Medical School, explained that more often than not, low energy levels can be remedied by adopting simple changes to your daily routine.
Unsurprisingly, emotional stress can leave you feeling less lively.
“Stress has a huge impact on your physical well-being. If you are feeling elevated levels of stress, it can absolutely contribute to low energy,” Dr. Nina Vasan, chief medical officer at mental wellness app Real, told HuffPost.
So, how can you combat unchecked stress to boost your energy levels? Vasan explained that it’s crucial to “find ways to integrate meditation or mindfulness into your daily life,” even for just five minutes each day. Experts also say that identifying coping skills that work for you — such as journaling or reading something that brings you joy — can help you destress and feel more energetic.
“If you’re consuming large amounts of caffeinated beverages throughout the day, it is probably going to affect your sleep pattern. This can then affect your energy levels,” Tallia said.
It’s important to note that suddenly cutting back on caffeinated beverages can also leave you feeling tired at first. As Tallia explained, “the body gets used to caffeine as a stimulant, and when it’s not present, you can experience an energy slump.”
Practice good sleep hygiene and establish a routine.
It goes without explaining that catching enough Zzzs is key to boosting your energy throughout the day. However, your energy levels are not just impacted by the amount of sleep you get each night, but by the quality of that sleep.
Even when practicing good sleep hygiene, you may find you’re waking up feeling fatigued. Raelene Brooks, the dean of the College of Nursing at University of Phoenix, said that could point to a sleep disorder such as sleep apnea. If you suspect you have a sleep disorder, don’t hesitate to pay your physician a visit.
“Even low-impact movement is shown to increase your oxygen flow and hormone levels, which give you a boost of energy,” Vasan explained. “It is the No. 1 tip I recommend to anyone feeling fatigued.”
Drink more water.
Dehydration is a common cause of low energy. According to Brooks, the science behind this is quite straightforward: “Our red blood cells carry oxygen. Ideally, a plump and round red blood cell allows for a full oxygen-carrying capacity,” she said. “When we are dehydrated, the red blood shrinks and this decreases the capacity for the cell to carry a full load of oxygen. Low oxygen levels are manifested by fatigue, irritability and restlessness.”
If you struggle with being mindful of your water intake, consider trying hacks such as investing in a smart water bottle to ensure you’re drinking enough H2O every day.
Be mindful of your screen time during the evening hours, and also during the day.
It almost goes without saying that excessive screen time at night can mess with your natural sleep cycle and energy the following day. As Vasan explained, “spending too much time on your phone, computer or watching your TV can cause fatigue by disrupting the neurotransmitters that are essential for sleep and restoration.”
However, the time you spend looking at your phone or computer during the day can also have a harmful impact on your energy levels. Too much screen time can lead to eye fatigue, which may trigger headaches and make it more difficult to concentrate.
We live in a digital world, so spending extensive time looking at a screen is unavoidable for most people. Making the “20-20-20 rule” a habit is a step towards tackling tiredness. According to Harvard Business Review, “when you’re working on a laptop, take a break every 20 minutes. Look at an object 20 feet away for 20 seconds to give your eyes a chance to relax.”
Avoid skipping meals.
If you ever skipped breakfast or worked right through your lunch break, you probably noticed you feel groggier than usual. While it’s totally normal to miss a meal, making a goal to regularly eat nutrient-rich meals and snacks throughout the day can increase your energy levels.
“Your brain needs nutrition to really function appropriately,” Tallia said. “A lot of people skip meals, and their blood sugar levels are going up and down all through the day.”
Moreover, Tallia said to steer clear of fad diets that encourage people to majorly cut back on caloric intake or to eliminate essential nutrient groups like carbohydrates. This can deprive you of energy. While it’s not uncommon to wake up feeling low on energy every once and a while, chronic fatigue could point to an underlying health issue.
“If you are eating well, getting enough sleep, integrating movement and exercise into your daily life but still feel tired for more than two weeks, you should consider reaching out to a medical professional,” Vasan said, explaining that a consistent drop in energy “can be an indicator of a host of mental and physical health issues ranging from fairly benign to severe.”
Ultimately, boosting your energy often comes down to taking inventory of different activities and current habits that could be draining you. Adopting just a few simple changes to your daily routine could be key to beating the fatigue once and for all.
Only a couple dozen doctors specialize in chronic fatigue syndrome (ME/CFS). Now their knowledge could be crucial to treating millions more patients. Kira Stoops lives in Bozeman, Montana—a beautiful mountain town where it sometimes feels like everyone regularly goes on 50-mile runs. Stoops, however, can’t walk around her own block on most days. To stand for more than a few minutes, she needs a wheeled walker.
She reacts so badly to most foods that her diet consists of just 12 ingredients. Her “brain fog” usually lifts for a mere two hours in the morning, during which she can sometimes work or, more rarely, see friends. Stoops has myalgic encephalomyelitis, or chronic fatigue syndrome (ME/CFS). “I’m considered a moderate patient on the mild side,” she told me.
ME/CFS involves a panoply of debilitating symptoms that affect many organ systems and that get worse with exertion. The Institute of Medicine estimates that it affects 836,000 to 2.5 million people in the U.S. alone, but is so misunderstood and stigmatized that about 90 percent of people who have it have never been diagnosed.
At best, most medical professionals know nothing about ME/CFS; at worst, they tell patients that their symptoms are psychosomatic, anxiety-induced, or simply signs of laziness. While ME/CFS patients, their caregivers, and the few doctors who treat them have spent years fighting for medical legitimacy, the coronavirus pandemic has now forced the issue.
Even if that proportion is 10 times lower for SARS-CoV-2, the number of Americans with ME/CFS would still have doubled in the past three years. “We’re adding an immense volume of patients to an already dysfunctional and overburdened system,” Beth Pollack, a scientist at MIT who studies complex chronic illnesses, told me.
The U.S. has so few doctors who truly understand the disease and know how to treat it that when they convened in 2018 to create a formal coalition, there were only about a dozen, and the youngest was 60. Currently, the coalition’s website lists just 21 names, of whom at least three have retired and one is dead, Linda Tannenbaum, the CEO and president of the Open Medicine Foundation, told me.
These specialists are concentrated on the coasts; none work in the Midwest. American ME/CFS patients may outnumber the population of 15 individual states, but ME/CFS specialists couldn’t fill a Major League Baseball roster.
Stoops, who is 39, was formally diagnosed with ME/CFS only four years ago, and began receiving proper care from two of those specialists—Lucinda Bateman of the Bateman Horne Center and David Kaufman from the Center for Complex Diseases. Bateman told me that even before the pandemic, she could see fewer than 10 percent of the patients who asked for a consultation. “When I got into those practices, it was like I got into Harvard,” Stoops told me.
ME/CFS specialists, already overwhelmed with demand for their services, now have to decide how to best use and spread their knowledge, at a time when more patients and doctors than ever could benefit from it. Kaufman recently discharged many of the more stable ME/CFS patients in his care—Stoops among them—so that he could start seeing COVID long-haulers who “were just making the circuit of doctors and getting nowhere,” he told me.
“I can’t clone myself, and this was the only other way to” make room for new patients. Bateman, meanwhile, is feverishly focused on educating other clinicians. The hallmark symptom of ME/CFS—post-exertional malaise, or PEM—means even light physical or mental exertion can trigger major crashes that exacerbate every other symptom. Doctors who are unfamiliar with PEM, including many now running long-COVID clinics, can unwittingly hurt their patients by encouraging them to exercise.
Bateman is racing to spread that message, and better ways of treating patients, but that means she’ll have to reduce her clinic hours. These agonizing decisions mean that many existing ME/CFS patients are losing access to the best care they had found so far—what for Stoops meant “the difference between being stuck at home, miserable and in pain, and actually going out once or twice a day, seeing other humans, and breathing fresh air,” she told me.
But painful trade-offs might be necessary to finally drag American medicine to a place where it can treat these kinds of complex, oft-neglected conditions. Kaufman is 75 and Bateman is 64. Although both of them told me they’re not retiring anytime soon, they also won’t be practicing forever. To make full use of their expertise and create more doctors like them, the medical profession must face up to decades spent dismissing illnesses such as ME/CFS—an overdue reckoning incited by long COVID.
“It’s a disaster possibly wrapped up in a blessing,” Stoops told me. “The system is cracking and needs to crack.” Many ME/CFS specialists have a deep knowledge of the disease because they’ve experienced it firsthand. Jennifer Curtin, one of the youngest doctors in the field, has two family members with the disease, and had it herself for nine years. She improved enough to make it through medical school and residency training, which showed her that ME/CFS “just isn’t taught,” she told me. Most curricula don’t include it; most textbooks don’t mention it.
Even if doctors learn about ME/CFS, America’s health-care system makes it almost impossible for them to actually help patients. The insurance model pushes physicians toward shorter visits; 15 minutes might feel luxurious. “My average visit length is an hour, which doesn’t include the time I spend going over the patient’s 500 to 1,700 pages of records beforehand,” Curtin said. “It’s not a very scalable kind of care.” (She works with Kaufman at the Center for Complex Diseases, which bills patients directly.)
This also explains why the cohort of ME/CFS clinicians is aging out, with little young blood to refresh them. “Hospital systems want physicians to see lots of patients and they want them to follow the rules,” Kaufman said. “There’s less motivation for moving into areas of medicine that are more unknown and challenging.”
ME/CFS is certainly challenging, not least because it’s just “one face of a many-sided problem,” Jaime Seltzer, the director of scientific and medical outreach at the advocacy group MEAction, told me. The condition’s root causes can also lead to several distinct but interlocking illnesses, including mast cell activation syndrome, Ehlers-Danlos syndrome, fibromyalgia, dysautonomia (usually manifesting as POTS), and several autoimmune and gastrointestinal disorders.
“I’m still amazed at how often patients come in with Complaint No. 1, and then I find five to seven of the other things,” Kaufman said. These syndromes collectively afflict many organ systems, which can baffle doctors who’ve specialized in just one. Many of them disproportionately affect women, and are subject to medicine’s long-standing tendency to minimize or psychologize women’s pain, Pollack told me:
An average woman with Ehlers-Danlos syndrome typically spends 16 years getting a diagnosis, while a man needs only four. People with long COVID might have many of these conditions and not know about any—because their doctors don’t either. Like ME/CFS, they rarely feature in medical training, and it’s hard to “teach someone about all of them when they’ve never heard of any of them,” Seltzer said.
Specialists like Bateman and Kaufman matter because they understand not just ME/CFS but also the connected puzzle pieces. They can look at a patient’s full array of symptoms and prioritize the ones that are most urgent or foundational. They know how to test for conditions that can be invisible to standard medical techniques: “None of my tests came back abnormal until I saw an ME/CFS doctor, and then all my tests came back abnormal,” said Hannah Davis of the Patient-Led Research Collaborative, who has had long COVID since March 2020.
ME/CFS specialists also know how to help, in ways that are directly applicable to cases of long COVID with overlapping symptoms. ME/CFS has no cure but can be managed, often through “simple, inexpensive interventions that can be done through primary care,” Bateman told me. Over-the-counter antihistamines can help patients with inflammatory problems such as mast cell activation syndrome. Low doses of naltrexone, commonly used for addiction disorders, can help those with intense pain.
A simple but rarely administered test can show if patients have orthostatic intolerance—a blood-flow problem that worsens other symptoms when people stand or sit upright. Most important, teaching patients about pacing—carefully sensing and managing your energy levels—can prevent debilitating crashes. “We don’t go to an ME/CFS clinic and walk out in remission,” Stoops told me. “You go to become stabilized. The ship has 1,000 holes, and doctors can patch one before the next explodes, keeping the whole thing afloat.”
That’s why the prospect of losing specialists is so galling. Stoops understands why her doctors might choose to focus on education or newly diagnosed COVID long-haulers, but ME/CFS patients are “just so lost already, and to lose what little we have is a really big deal,” she said. Kaufman has offered to refer her to generalist physicians or talk to primary-care doctors on her behalf. But it won’t be the same: “Having one appointment with him is like six to eight appointments with other practitioners,” she said.
He educates her about ME/CFS; with other doctors, it’s often the other way round. “I’m going to have to work much harder to receive a similar level of care.” At least, she will for now. The ME/CFS specialists who are shifting their focus are hoping that they can use this moment of crisis to create more resources for everyone with these diseases. In a few years, Bateman hopes, “there will be 100 times more clinicians who are prepared to manage patients, and many more people with ME/CFS who have access to care.”
For any mainstream disease, such events—a report, a guideline revision, a review article—would be mundane. For ME/CFS, they felt momentous. And yet, “the current state of things is simply intolerable,” Julie Rehmeyer, a journalist with ME/CFS, told me. Solving the gargantuan challenge posed by complex chronic diseases demands seismic shifts in research funding, medical training, and public attitudes. “Achieving shifts like that takes something big,” Rehmeyer said. “Long COVID is big.”
COVID long-haulers have proved beyond any reasonable doubt that acute viral infections can leave people chronically ill. Many health-care workers, political-decision makers, and influencers either know someone with long COVID or have it themselves. Even if they still don’t know about ME/CFS, their heightened awareness of post-viral illnesses is already making a difference. Mary Dimmock’s son developed ME/CFS in 2011, and before the pandemic, one doctor in 10 might take him seriously.
“Now it’s the flip: Only one doctor out of 10 will be a real jerk,” Dimmock told me. “I attribute that to long COVID.” But being believed is the very least that ME/CFS patients deserve. They need therapeutics that target the root causes of the disease, which will require a clear understanding of those causes, which will require coordinated, well-funded research—three things ME/CFS has historically lacked.
But here, too, “long COVID is going to be a catalyst,” Amy Proal, the president of the Polybio Research Foundation, told me. She is leading the Long Covid Research Initiative—a group of scientists, including ME/CFS researchers, that will use state-of-the-art techniques to see exactly how the new coronavirus causes long COVID, and rapidly push potential treatments through clinical trials.
While they wait for better treatments, patients also need the medical community to heed the lessons that they and their clinicians have learned. For example, the American Academy for Family Physicians website still wrongly recommends exercise therapy and links ME/CFS to childhood abuse. “That group of doctors is very important to these patients,” Dimmock said, “so what does that say to them about what this disease is all about?”
Despite all evidence to the contrary, many clinicians and researchers still don’t see ME/CFS as a legitimate illness and are quick to dismiss any connection between it and long COVID. To ensure that both groups of patients get the best possible treatments, instead of advice that might harm them, ME/CFS specialists are working to disseminate their hard-won knowledge.
Bateman and her colleagues have been creating educational resources for cliniciansand patients, continuing-medical-education courses, and an online lecture series. Jennifer Curtin has spent two years mapping all the decisions she makes when seeing a new patient, and is converting those into a tool that other clinicians can use. As part of her new start-up, called RTHM, she’s also trying to develop better ways of testing for ME/CFS and its related syndromes, of visualizing the hefty electronic health records that chronically ill patients accumulate, and of tracking the treatments they try and their effects.
“There are a lot of things that need to be fixed for this kind of care to be scalable,” Curtin told me. Had such shifts already occurred, the medical profession might have had more to offer COVID long-haulers beyond bewilderment and dismissal. But if the profession starts listening to the ME/CFS community now, it will stand the best chance of helping people being disabled by COVID, and of steeling itself against future epidemics.
Pathogens have been chronically disabling people for the longest time, and more pandemics are inevitable. The current one could and should be the last whose long-haulers are greeted with disbelief. New centers that cater to ME/CFS patients are already emerging. RTHM is currently focused on COVID long-haulers but will take on some of David Kaufman’s former patients in November, and will open its waiting list to the broader ME/CFS community in December.
(It is currently licensed to practice in just five states but expects to expand soon.) David Putrino, who leads a long-COVID rehabilitation clinic in Mount Sinai, is trying to raise funds for a new clinic that will treat both long COVID and ME/CFS. He credits ME/CFS patients with opening his eyes to the connection between long COVID and their condition.
Every ME/CFS patient I’ve talked with predicted long COVID’s arrival well before most doctors or even epidemiologists started catching up. They know more about complex chronic illnesses than many of the people now treating long COVID do. Despite having a condition that saps their energy, many have spent the past few years helping long-haulers navigate what for them was well-trodden terrain: “I did barely anything but work in 2020,” Seltzer told me.
Against the odds, they’ve survived. But the pandemic has created a catalytic opportunity for the odds to finally be tilted in their favor, “so that neither patients nor doctors of any complex chronic illness have to be heroes anymore,” Rehmeyer said.
When people ask me why I became a writer, I have plenty of reasons to list: Words bring me joy. I ask questions constantly. And when I hear a good story, I’ll repeat it again and again until my friends get tired of hearing it. But in July of 2021, these responses started to feel hollow.
I was burned out. “I feel like I sprained my brain,” I told my friend over the phone. When I wasn’t working, I felt fine; when I tried to use my head, it felt like putting weight on a bum ankle.
I know I’m not alone. At this moment, when work is isolating some people at home while putting others in danger, burnout seems particularly rampant. In a survey of 1,500 workers from Indeed in March 2021, 53 percent said they were burned out—up by nearly 10 percent from the previous year. Another survey of nearly 21,000 healthcare workers published that May in The Lancet found similar rates.
I wanted to regain my curiosity and the joy I find in language as soon as possible, so I reached out to scientists to find out what, exactly, was happening in my body—and what I could do to make it better.
Burnout is a phenomenon so old, they made a sin out of it, according to Gordon Parker, a professor of psychiatry at the University of New South Wales. Once called “acedia,” the eighth cardinal sin described a state of listlessness, apathy, and torpor observed in fourth century monks. “They would wake up one day and say ‘the sky is no longer blue,’” Parker said. These monks would stop getting pleasure out of life and would lose their faith in God.
They were more than just tired. They had forgotten the meaning of all that they did. And that pretty much describes burnout. The response to chronic stress goes beyond exhaustion; sufferers also experience a loss of idealism and feel like they’re bad at whatever they do. Those are the three prongs identified by the Maslach Burnout Inventory, the assessment most often used by psychologists to evaluate such mental fatigue.
And all that angst isn’t just in your head—it’s very much a physical phenomenon, rooted in the body’s stress-response system. Scientists studying the syndrome are particularly interested in the hypothalamic-pituitary-adrenal axis, also called the HPA axis. When we’re faced with a threat—say, a bear chasing us, or the prospect of responding to an ambiguously stern-sounding email—the HPA axis releases a hormone called cortisol. Cortisol helps the body run from whatever is threatening it; it raises our heart rate and helps our body harvest energy from glucose.
Cortisol also decreases activity in systems you don’t need when your life is in immediate danger, like the reproductive and immune systems. When the hypothalamus, a structure in the brain that acts like the control room for the HPA axis, detects high levels of cortisol in the blood, it’s supposed to say “okay, my work is done here,” and shut the stress response down.
Researchers can capture a snapshot of how the stress-response system is functioning with a test called the dexamethasone challenge. Dexamethasone is a drug that tells the hypothalamus to suppress the stress-response system. Given a dose of it, a healthy person should start producing less cortisol. But multiple studies have found that people with burnout have an altered response to the drug. Some studies find that those individuals don’t react to dexamethasone much, if at all—they continue pumping out more cortisol regardless.
Other researchfinds that people with burnout have an exaggerated response to the drug—they suppress cortisol more than the healthy controls do. Researchers hypothesize that these two seemingly contradictory findings represent two stages: burning out, and being burnt out.
“During the burning-out phase, the system is in overdrive,” Parker said. When stress is chronic, cortisol levels in the body keep going up, but the system doesn’t shut itself down. The burnt-out phase begins when that system is tapped out, says Renzo Bianchi, a psychologist at the University of Neuchâtel in Switzerland. “Your stress response gets so exhausted that you stop producing cortisol at high levels,” Bianchi said.
Cortisol may stress us out, but we also need the hormone to survive. It’s quite literally what gets us up in the morning. So when people enter this “burnt out” phase, they feel tired and cynical. They lose drive. They might even experience cognitive impairment and memory changes.
These symptoms might sound similar to clinical depression. But according to some scientists, including Christina Maslach of the Maslach Burnout Inventory, burnout and depression are not at all the same.
Burnout is a syndrome that may cause a person to become depressed; depression might predispose a person to burnout. But ultimately, burnout is distinct in that work is always at its root. People often feel better as soon as they’re able to get away from the cause of their stress, Parker said. That’s not usually the case with depression.
That distinction is important to make, because by treating burnout as an illness—like depression or an anxiety disorder—we risk offering the wrong solutions, Maslach said. You can’t self-care away your burnout, she added. It’s not so much about the individual as it is the situation they’re in. You have to remove the cause of your stress, and that often requires structural changes in the workplace.
That was disappointing for me to hear. When I reached out for expert advice, I’d already spent several of the preceding months focused on getting more sleep, running more often, and trying to take short vacations. All of these habits support good mental health, and might even offer short-term relief, Bianchi says—but they don’t get at the root cause of burnout. You can take all the time off you need, he says, but without identifying the root causes of your stress, you’ll eventually return to the same place.
In scientific literature that investigates risk factors for burnout, six come up again and again, according to a review co-authored by Maslach and published in the 2016 book Stress: Cognition, Emotion, and Behavior. There’s workload, the amount of autonomy you have, and fairness in the workplace. Then there’s reward—how much your work is recognized and compensated—and workplace community, or the social support you receive from colleagues or clients. Finally, values and meaning: whether or not the work you’re doing syncs up with your ideals.
Employers have the power to prevent burnout by creating a fair and supportive workplace, Maslach says—one where people feel like they have autonomy and are able to cope with their workload. But people with burnout may need to troubleshoot which factors are negatively impacting them so they know how to take action on their own. For some people, Maslach says, curing burnout might necessitate moving organizations or switching fields entirely.
That wasn’t my route. Instead, I worked through Maslach’s six risk factors like a checklist. The more I thought about it, the more I came to believe that my work load itself wasn’t the main problem; instead, I realized that it had been a long time since I’d thought about what had initially excited me about journalism—talking to scientists, love for the craft of writing itself, the thrill of finding a new story—in other words, my values.
I created spreadsheets of topics that intrigued me, scientists I loved speaking to, and projects I had long put on the back-burner. Then, I brainstormed ways to make time for them, blocking off chunks of time for tasks like going down internet rabbit holes in search of stories.
While I expected the answer to involve loads of rest, curing my own personal case of burnout turned out to be a lot of work. But it was worth it. Three months after starting this research, words excite me again. I’m back to annoying my friends with facts about frogs and physics. And several times a week, without fail, I spend an afternoon in the coffee shop around the corner to work on my personal creative projects.
Nine months ago, before my burnout began, I told a friend “I feel like I have the best job in the world.” By getting to the root of my stress, I’ve managed to get that feeling back again.
By: Isobel Whitcomb
Isobel Whitcomb is a freelance health and environmental journalist based in Portland, Oregon. Passionate about covering the intersection of science and the human experience, they cover everything from wildfire to chronic pain. Her work in Popular Science focuses on exploring the wellness industry and debunking health misinformation.
“Z73 Burn-out”. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). World Health Organization. 2019.
It’s a familiar feeling on a Friday evening. After finishing a gruelling day’s work, you finally agree with friends on where to meet for a night out. But by the time you have figured out what to wear and where you left your keys, a night on the sofa begins to sound more appealing than one on the tiles.
Now, scientists think they may be able to explain why you feel so weary before you have even reached the bus stop: your brain has slowed down to manage the strain. The brain could suffer from something similar to the painful buildup of lactate in muscles during physical exercise. This could be why hard mental yards – and resisting the temptation to give up throughout the day – feel equally taxing.
Prolonged mental activity leads to the accumulation of a potentially toxic neurotransmitter in the prefrontal cortex, according to a study published in Current Biology. The researchers suggest the brain slows down its activity to manage the buildup, offering an explanation to why we feel tired.
“Even when you resist scratching an itch, for example, your brain is exerting cognitive control,” said Antonius Wiehler of the Paris Brain Institute, the first author of the study. Repeated demands on cognitive control functions can lead to fatigue, he said. The prefrontal cortex is the region of decision-making and cognitive control, which is applied when the brain overrides an impulse or fights any kind of temptation.
The team monitored the brain chemistry of 40 participants while they completed repetitive tasks on a computer. They formed two groups, who performed either hard tasks or easy tasks for over six hours. The researchers measured levels of a neurotransmitter in the prefrontal cortex. They found a greater accumulation of glutamate in participants who were given the harder tasks.
Work that involves a lot of thinking requires the brain to repeatedly resist the temptation to do something less demanding. Unsurprisingly, this can leave people feeling tired, but the brain chemistry behind it has remained unclear. Now, researchers suggest cognitive control may lead to the accumulation of glutamate in the brain – of which high levels can be harmful because it overexcites neural cells.
“We found that glutamate was accumulating in the region of the brain which controls the tasks we set participants,” said Wiehler. “Our understanding is that the brain has some kind of clearance mechanism to counteract this, which may slow down activity.” The researchers posit that mental fatigue could be linked to recycling the glutamate that builds up during neural activity. “The accumulated glutamate needs to be cleared away, which we think is likely happening during sleep,” said Wiehler.
When participants were asked to report their level of fatigue, no definitive link between glutamate and fatigue was found – the groups performing hard and easy tasks recorded the same tiredness. Researchers said this could be due to fatigue being subjective, and those doing the easy task were unaware of the difficulty of the other.
“The fact that glutamate levels don’t track the reported fatigue is slightly disappointing, but not surprising because there is often a dissociation between biological features and self-reported fatigue,” said Dr Anna Kuppuswamy from the Institute of Neurology at University College London, who was not involved in the study.
The researchers monitored only glutamate but suggest other related substances could be linked to fatigue. “The study measures a single neurotransmitter in a very specific part of the brain, so we have to look at it more globally,” said Kuppuswamy.
But the results were encouraging, she added. “We know that during physical exercise lactate accumulates in the muscles, leading to muscle fatigue. It is kind of intuitive that something similar happens in the brain and this is good first evidence to suggest that.”
Mental exhaustion is a feeling of extreme tiredness, characterized by other feelings including apathy, cynicism, and irritability. You may be mentally exhausted if you’ve recently undergone long-term stress, find it hard to focus on tasks or lack interest in activities you usually enjoy.
Mental exhaustion often happens as a result of overuse, like physical overuse injuries. Even though you can’t point to it, it has more in common with repetitive stress injuries, like carpal tunnel or tennis elbow. Rather than overstressing a muscle group, mental and emotional exhaustion come from overstressing your mind.
Mental exhaustion is completely possible and is probably more common than it should be. After a long period of stress or time of intense emotions, mental exhaustion is bound to happen. Just like our bodies show symptoms after we push too hard, our minds are bound to display signs of mental exhaustion if we don’t take proper care.
Mental exhaustion can be caused by many things. Typically, though, people feel mentally tired after experiencing long-term stress. This is especially true if the stressors increase a person’s cognitive load or reduce their resources.
For example, you may be responsible for completing a challenging project with many moving parts and tradeoffs. This would require a high level of project management skills and political savvy (e.g., increased load).
Another example would be traveling for work. Constantly changing time zones would leave you feeling jet-lagged (reduced resources). Many stressors involve both reduced resources and increased load.
Work travel to an unfamiliar country where you don’t speak the language amps up the cognitive load. Taking care of a sick family member may involve coordinating medical care and interpreting unfamiliar terms while managing emotions (increased load). But you may also be getting less sleep (reduced resources). Over time, increased responsibility and stress plus poor self-care can result in mental exhaustion.
Though a wide variety of stressors can cause you to feel mentally drained, we’ve boiled down the 7 most common causes of mental exhaustion below.
1. Chronic stress
This is the most frequent cause of mental exhaustion. Chronic stress keeps your brain — and body — on high alert all the time. Over time, this begins to wear away at your well-being. Chronic stress can also lead to empathy or compassion fatigue. It can become difficult to muster an emotional response to the constant strain.
2. Uncertainty
The human stress response was designed to work efficiently in the face of short-term stress (think fight-or-flight). However, it’s a much less effective response to a constant, nagging feeling of uncertainty. Unfortunately, uncertainty has become far too normal of a feeling since the start of COVID-19 pandemic. This has made mental exhaustion more common than ever.
3. Work stress
Stress at work can take many forms. It can arise from a values mismatch, difficulty managing tasks and priorities, or a high-demand, risk-oriented job. Some jobs (or programs of study) involve a lot of new learning. They could also require processing and making sense of a lot of information. Whatever the reason, it’s not always possible to leave work at work. Left unchecked, workplace stress can even evolve into burnout. Your work stress could bleed into your weekends and ultimately, develop into a bad case of the Sunday scaries.
4. Family issues
Few things are more stressful than worrying about a family member. Being a caregiver for young children, sick relatives, or aging parents can be mentally taxing. Even if everyone’s healthy, families can bring all kinds of stressors. Divorce, disagreements, and estrangements have a way of following you into all areas of your life. Ultimately, family troubles can be a big cause of mental exhaustion.
5. Juggling multiple commitments
In addition to caring for family, many people have other commitments on their plate — those commitments come with details, schedules, logistics, and challenges. Balancing an intensive school or training program, a second job, or a freelance business can leave you feeling like you’re never “off.” If you’re not able to, or don’t know how to, manage your priorities, you’re at risk of becoming mentally drained.
6. Emotional stress
There are dozens of things that can cause emotional stress. No matter the cause, the experience is similar. Constant negative feelings, events, and circumstances can make it difficult to relax. This emotional exhaustion can quickly lead to mental fatigue.
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