The fevers came in the evenings.
They never crossed into real illness. Thirty-seven point something on the thermometer. Enough to feel the heat on my neck and to feel chilly in my bones. Not enough to explain the exhaustion underneath it.
They arrived as the light faded, when the children had finally settled and the house had gone quiet. The day’s demands were over, and there was nothing left to distract me from how I felt.
At that time, I was living on the other side of the world.
There was no family nearby. No village. No one who had known me long enough to notice that something had changed.
I had lost more weight than I ever had in my life. My appetite had simply disappeared. I would put food in front of myself and feel nothing. No hunger. No interest. Eating became another task to remember rather than something my body asked for.
So I did what frightened, exhausted people often do.
I opened a search engine.
Weight loss. Low-grade evening fevers. Fatigue that sleep wouldn’t fix.
The internet suggested leukaemia.
I booked the blood tests. I sat in a foreign clinic waiting for someone to name whatever had taken hold of me.
The results came back normal.
No infection.
No tumour.
No deficiency.
Nothing the tests could explain.
We settled on stress because there seemed to be nothing else to settle on.
What the tests couldn’t see
The word stress is strangely tidy. It sounds almost manageable, as though it belongs on a to-do list somewhere between “pay the bills” and “book the dentist.”
It wasn’t tidy.
Stress, in that season, meant moving across the world with two young children. It meant homeschooling a son who was deeply unhappy in classrooms, long before either of us understood why. It meant spending every day locked in power struggles with a child I knew was brilliant but could also see was suffering in ways I couldn’t yet explain.
It meant trying to build a small business in the scraps of time left over because stillness had always felt like falling behind.
It meant shouting at the kids far more often than I want to remember, then lying awake replaying those moments, wondering why I couldn’t become the mother I was trying so hard to be.
While I was busy holding everything together, my body had quietly begun keeping its own account.
The disappearing appetite.
The evening fevers.
The weight slipping away.
Looking back, they weren’t random symptoms at all. They were signals. My nervous system was raising a flag long before my mind was willing to admit anything was wrong.
It wasn’t the first time.
The body always knew first
As a child, I did well in school. The grades came easily with little effort.
Then I moved to a school filled with children who were just as capable, and something inside me began to unravel.
The harder I studied, the worse I seemed to perform.
I would spend weeks preparing for an exam, walk into the room already feeling underprepared, and go cold the moment the paper landed on my desk.
Questions I had revised for suddenly looked unfamiliar.
My stomach tightened.
My palms sweated.
Whatever I knew scattered.
I emptied what was left onto the page and walked out convinced I simply wasn’t clever enough.
The stomach pains arrived before every major examination.
They were real enough that I was taken for medical tests. The adults around me searched for an illness to explain them.
No illness was ever found.
Now I understand what my body had been trying to say.
My nervous system was sounding the alarm in the only language it knew.
Even today, my gut usually notices before my mind does.
I still lose my appetite before I recognise I’m overwhelmed.
I still feel tension in my body before I can name what I’m carrying.
For most of my life, I treated those signals as problems to be solved instead of messages to be understood.
Back then, though, I didn’t have words like anxiety, sensory overload, autistic burnout, or nervous system dysregulation.
I had only one explanation.
I wasn’t trying hard enough.
So I tried harder.
Is it burnout, or is it depression?
It’s the only strategy I ever really trusted. When something felt hard, I assumed the problem was me, and that the cure was more effort. More hours. More discipline. More pushing through.
For most of my life, that hid the cost well enough.
Here is the strange part.
I spent a decade as an occupational therapist, much of it in oncology and palliative care. I could recognise depression in the people I cared for. I just couldn’t recognise it in myself.
Every time I collapsed, I asked the same question and never quite answered it. Was I depressed? Or was I simply used up?
Autistic burnout and depression can look identical from the outside. The same exhaustion. The same flatness. The same retreat from people, noise, and light. The clearest difference I’ve found is the wanting. In burnout, the desire is still there, but the capacity is gone. In depression, the desire itself goes grey. Rest and a lighter load slowly refill the first. Neither reaches the second.
That distinction looks clean on the page. Living inside it was anything but.
What autistic burnout feels like from the inside
There was a job I loved that slowly emptied me out. Long days, a long commute, an environment that asked more of my heart than it ever returned. I loved the work itself right up until I became a shell doing it. I took three months of unpaid leave, came back no better, and eventually left for good.
That season has its own story, and this isn’t it. But it taught me the shape of the thing.
That was what confused me for years. I still cared deeply about the work. If I was so flat, so empty, so unable to get out of bed, how could that care still be waiting underneath it all?
That was the clue I kept missing.
In every one of my collapses, the wanting stayed.
I wanted my work. I wanted to write. I wanted, more than anything, to be a softer mother than the one who kept shouting.
The wanting was never the problem. It was fully alive, pressed against a body that couldn’t act on any of it.
That gap, between wanting and doing, is what autistic burnout feels like from the inside.
It’s the tiredness rest doesn’t touch, because rest was never the whole answer. The load was. And the load never lifted.
There was another season I couldn’t name at the time.
When my first son was born and my milk wouldn’t come, I sank into something I had no words for. I wasn’t sad about him. I loved him past reason. But I was undone. Sleepless. Worrying in circles. Quietly resentful of a world that had tipped over and refused to right itself.
Was that depression? The particular grief of a body that wouldn’t do what bodies are meant to do? The first turn of a burnout that would take years to surface?
I still don’t fully know.
Lives don’t sort themselves as neatly as screening forms do.
Why the screeners get it wrong
This is the part that matters, if you’re reading this at two in the morning, trying to work out which one you are.
Most depression screens ask about mood. They ask whether you’ve lost interest in the things you used to enjoy.
A masked autistic woman can answer that honestly and still be misread. Because the interest hasn’t gone. It’s intact, and out of reach. Those are not the same thing, and there’s no box for the difference.
They ask whether you feel tired. You do.
But the tiredness of burnout has a texture the questionnaire can’t feel. It’s tied to demand. It lifts when the demand lifts. It comes back the moment you pick the load up again.
Autistic adults get told they have treatment-resistant depression when the truth is simpler and harder. No treatment aimed at mood was ever going to reach a problem of load.
You cannot medicate your way out of a life that asks more of your nervous system than it has to give.
And the standard prescription for depression is the exact wrong medicine for burnout. Get out more. Stay busy. Both ask the nervous system for more, when the whole problem was more. I know. Try harder was my version of that prescription.
The one question I ask myself now
I’m better at this than I used to be. Not cured of the confusion. Just quicker to interrogate it.
When the emptiness arrives now, and it still arrives, I ask myself one question first.
Do I still want things? Or have I stopped wanting them?
If the wanting is there and only the doing has failed, it’s burnout. And the answer is subtraction. Fewer demands. More quiet. The unglamorous, guilt-soaked work of doing less.
For someone built like me, that’s the hardest medicine there is.
Rest has never felt natural. Stillness has always felt like falling behind. Every time I found a little room to breathe, I filled it. Another project. Another plan. Another way to be useful and not a burden. When those efforts failed, I told myself the same old story. I wasn’t capable. I needed to do less.
It has taken me a long time to hear do less as mercy instead of defeat.
If the wanting itself has gone grey, if I look at my children, my writing, my whole life, and feel the colour drained out of all of it, then it isn’t burnout.
It’s depression.
And depression needs more than rest. It needs help I can’t give myself.
And if what’s fading isn’t the wanting of things but the wanting to be here at all, that’s not a question to sort alone, and not one to sit with until morning. It deserves a professional, now.
Some seasons are both at once, the burnout wearing the depression’s coat, and I’ve stopped needing to name them perfectly before I’m allowed to respond.
What I have instead is that first question, the one about wanting. And a body that has always known before I did.
The gut that tightens. The appetite that quietly leaves. The fever with no infection behind it.
My body has been sending the same message my whole life, in the same plain language. I just spent forty years treating the messenger as the problem.
I’m still learning to listen.
Some evenings, I still can’t tell whether I’m sad or simply spent.
But I’ve stopped reaching first for try harder.
Burnout, or depression. I still can’t always tell them apart, and I’ve stopped believing that telling them apart was ever the point. The point was to stop. To ask. To listen to the body that knew all along.
The question hasn’t gone away. I’ve just stopped being afraid of it.
A few questions I am asked
How do you know if it’s autistic burnout or depression?
The most useful question I’ve found is about wanting, not mood. In burnout, the desire for your work, your people, your interests is still there. The capacity to act on it has gone. In depression, the wanting itself fades. Rest, reduced demands, and the right supports tend to ease burnout over time. Depression usually needs more than rest, and more than you can give yourself alone.
Autistic burnout is not just a phrase the internet passes around. Researchers, many of them autistic, first defined it formally in 2020: long-term exhaustion, loss of skills, reduced tolerance to stimulus, from years of demands that outran support. It isn’t in the diagnostic manuals yet. Depression is. That gap is part of why so many of us are misread.
Can you have autistic burnout and depression at the same time?
Yes. This is the part the tidy comparisons miss. A long enough burnout can tip into depression, and a depression can leave you so depleted that burnout follows. They overlap. They feed each other. Some seasons are honestly both. Needing to sort them perfectly before you respond is its own trap. You can start lightening the load and reaching for support at the same time.
How long does autistic burnout last?
Longer than people expect, and longer the longer it went unnamed. Mine has come and gone in cycles across a lifetime, each one lifting only after something drastic changed the demands. There’s no fixed timeline. The honest marker isn’t the calendar but the load. Burnout eases when the nervous system is finally given less to carry, and returns when it’s asked for too much again.
If you’re somewhere near the beginning of this, you might want to read The Long Way to the Room, the complete map of what an adult autism and ADHD assessment actually involves, from the first doubt to the report. And if what you’re carrying feels less like a question and more like a grief, The Silence Between Knowing and Writing is where I wrote about the depression that came after my own diagnosis.
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