Nervous exhaustion: symptoms, diagnosis and treatment

By Cristiano Antonino On Feb 20, 2023

The term ‘nervous exhaustion’ (neurasthenia or neuroasthenia) was introduced in the 19th century by an American neuropsychiatrist, George Miller Beard, who used it to refer to a pervasive condition characterised by chronic fatigue and disability

Today, in common parlance, ‘nervous exhaustion’ is used to refer to a general state of physical and mental fatigue and weakness that can include a wide variety of symptoms such as excessive sense of fatigue after mental exertion and difficulty in concentrating (resulting in reduced efficiency both at work and in other tasks of daily life), physical weakness, chronic fatigue, pain, difficulty in relaxing, dizziness, extrasystole, headaches, difficulty in sleeping, reduced ability to feel pleasant emotions (anhedonia), irritable mood (‘nervousness’).

In practice, the term ‘nervous breakdown’ has been, and still is, widely used to refer to a difficult period that causes symptoms attributable to depressive states and anxiety disorders.

Specifically, it is a condition that arises acutely after a particularly stressful period.

It can cause ‘mixed’ problematic mental states attributable to both a mood disorder and an anxiety disorder.

Symptoms of nervous exhaustion

So-called ‘nervous exhaustion’ has many of the symptoms of anxiety disorders and depression.

Apathy, listlessness, lack of energy, muscle weakness, lack of zest for life, sadness and melancholy are indeed typical symptoms of depression.

It may also happen that those suffering from depression also have panic attacks, an anxiety disorder, or vice versa.

So-called nervous exhaustion is often associated with somatisation and stress symptoms.

Often it is precisely the overload of the latter that can be the main culprit for the state of nervous exhaustion.

But what does it mean to be stressed? How can stress lead to such a decay in a person?

In humans, affective and situational instability are the main sources of stress.

They exert a considerable blocking influence on all patterns of adaptability, which are thus annihilated.

This favours the accumulation of a large amount of tension in the system.

When this tension is excessive, the stress reaction can become lethal and selective.

If it is not mediated by the hypothalamic-pituitary-adrenal axis (the system involved in the management of stress-response reactions), it can lead to nervous exhaustion.

When the organism is no longer able to respond to stressors and adapt, symptoms may occur that are very similar to those of anxiety and depression.

For example, initially, there may be a stage of hyperexcitability or weakness, irritability, hypersensitivity and reduced functional performance.

Subsequently, there may be psychosomatic symptoms, particularly vegetative ones, such as marked signs of fatigue and debilitation.

Later, more depressive symptoms may appear, including lack of pleasure, exhaustion, extreme fatigability and depressed mood.

Maintenance factors

If this condition persists over time, it leads to a negative secondary evaluation by the person, who will assess himself as weak, unable to react and mistaken.

These considerations further increase the symptoms described above, leading to a vicious circle that is self-feeding.

The environmental and family context can also influence the subject at this time of extreme difficulty.

Relatives, friends, companions, may accuse their loved one of not being able to cope with life.

Of being incapable and unable to cope with stress, getting angry and criticising them.

This in turn becomes a stressor, worsening an already compromised psychophysical condition.

How to deal with nervous exhaustion

What to do then when such a situation occurs? First of all, although stressful events have been the cause of such ‘exhaustion’, to get out of it it is not enough to eliminate the stressors.

One has to start with an initial behavioural modification and an action on the body, and then deal with more complex psychological and cognitive aspects.

Behavioural modifications

In fact, to slowly resume normal functioning, it is usually necessary to start with simple, minimal actions that can promote recovery and counteract the inertia of depression.

For example, monitoring daily activities.

It allows you to recognise what and how many activities you do during a day and thus increase only the pleasant activities.

Taking space for oneself, doing things one enjoys, helps to promote the apathetic release of the depressed mood.

Secondly, it has been recognised that constant physical activity, preferably outdoors (such as about 20 minutes a day of walking) promotes the release of mood-regulating endorphins.

This is crucial during particularly stressful periods.

Furthermore, if our nervous exhaustion has a good anxiety quota, it is possible to do relaxation exercises and meditations that stimulate the parasympathetic system.

The latter has a calming effect on our organism.

Mindfulness meditation techniques in particular can activate this system and encourage a return to an optimal level of activation.

Obviously, such techniques must be learned correctly and practised daily for them to take effect.

As if it were an exercise that must initially be learned and then mastered.

Cognitive interventions

When there is a resumption of one’s activities and stability from an emotional and physiological point of view, it would be helpful to understand which thoughts led to the nervous breakdown and which ones maintain the stress load.

It is necessary to recognise errors in reasoning, duty, self-blame and over/under-responsibility.

This helps to understand the cognitive distortions that foster depressed moods or anxious states, in order to be able to modify them.

Recognising and interrupting rumination or brooding, which are modes of thinking that first maintain the vicious circle, is crucial to breaking free of them.

To do this, however, it is advisable to seek the help of a good cognitive-behavioural psychotherapist.

In fact, we are not always able to observe our own thoughts or the processes we put in place at a cognitive level.

Problem solving

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Finally, learning a structured problem-solving method helps to reduce, where possible, symptoms that are aggravated by the presence of unresolved problems.

In fact, this method helps to understand the link between the symptoms and the problems afflicting the person, because if the problems are solved, the symptoms will also improve.

People who have had a nervous breakdown feel overwhelmed by the problems, so it is necessary to ‘break down’ the larger problems into smaller, more manageable sub-problems and find alternative solutions to deal with them.

When to get help to overcome nervous exhaustion

All of these tips are partly self-applicable, through self-help tools, depending on the level of severity of the symptoms described above.

However, it is always advisable to seek the help of an experienced professional to learn these strategies correctly, to be guided as to which ones are most useful for that particular type of person, and to work alongside someone who knows the problem.

Using a metaphor, after a knee operation, we will have a full recovery when we are followed in physiotherapy by a serious and competent professional.

Much better than risking doing exercises ourselves that will lead to even more problems in the future.

In any case, it is therefore necessary to tackle the problem from a psychological point of view, carefully evaluating the diagnosis and structuring a psychotherapeutic and, where necessary, psychopharmacological intervention, which aims to re-establish the conditions preceding the nervous breakdown.

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