How long does it take to recover from exhaustion disorder?

The acute phase and the recovery phase

Exhaustion disorder is a diagnosis made by healthcare. According to 1177, one of the requirements is that the symptoms have been triggered by stress lasting at least six months. Socialstyrelsen's insurance medicine guidance (försäkringsmedicinskt beslutsstöd) then describes a course in three parts.

Before falling ill there is often a long period of symptoms that come and go. According to the guidance it can last for several years, and it is the easiest part to dismiss as a tough patch. The early signs have their own article: early signs of burnout at work.

The acute phase is when everything comes to a stop. The Institute of Stress Medicine describes it as a period of total exhaustion and chaos. According to the guidance, it usually subsides within a few weeks.

The recovery phase is the long one. The guidance says it can last for many years, with lingering symptoms and a marked inability to tolerate stress. It is in this phase that the question “how long does it take?” is really being asked, and that is why the answer differs so much from person to person.

How long sick leave usually lasts

Socialstyrelsen's guidance is what doctors and Försäkringskassan (the Swedish Social Insurance Agency) work from. For exhaustion disorder, it states that full-time or part-time sick leave may be appropriate for up to six months in the acute phase. Where cognitive difficulties persist — memory and concentration are not working — full-time sick leave may be appropriate for up to a year or more.

Two things are worth knowing about those figures. They are benchmarks, not a prognosis for you in particular; it is the doctor who assesses each individual case. And this part of the guidance was last updated in 2017, so if you need the current rules for your sick leave, ask your doctor or Försäkringskassan.

The Institute of Stress Medicine adds something important: you do not get well just by being on sick leave. Sick leave gives you room, but it is what happens during it that decides the recovery.

What the follow-ups show

The Institute of Stress Medicine in Region Västra Götaland has followed 217 patients treated for exhaustion disorder, with questionnaires two, three, five and seven years after they sought care. The results are clear in two ways, and both need saying.

It takes a long time. Seven years after first seeking care, about a third were still clinically exhausted. Around seven in ten described an increased sensitivity to stress, around four in ten cognitive problems, and nearly nine in ten still had at least one symptom. Only 16 per cent considered themselves fully well.

The prognosis is still good. The institute considers that most people can get back to a reasonably normal life, and few of those who were still exhausted were on sick leave. Most were working — many after changing something about their work, such as their hours or their tasks.

One way to read the figures: for most people the goal is not to become exactly as they were before, but to have a life and a job that work with a body that speaks up sooner. 1177 says the same thing in other words — many notice that they can take less stress than before.

Why it goes up and down

What tends to surprise people most is that recovery is not a straight line. The Institute of Stress Medicine describes it as slow, with progress that goes up and down over periods of varying length.

A pattern many people recognise looks roughly like this. A good week comes along, the energy is back, and you seize the chance to do everything that has piled up. A few days later the exhaustion is back, sometimes worse than before. It is easy to read that as not getting better. In my experience it more often means the load increased faster than the body could keep up with.

That is why a steady pace matters more than the good days. Better a little every day than a lot on the days it works, and very little on the days it doesn't.

What helps recovery

Which treatment is right is for healthcare to decide. According to 1177, it can include learning about stress, advice on lifestyle habits, CBT, talking to a counsellor, psychologist or occupational therapist, physiotherapy and medication for sleep problems or depression, and sick leave when needed.

The Institute of Stress Medicine gives a few pieces of advice that keep coming back:

Regular routines first. Meals and sleep at fixed times, and a calm pace. It sounds too simple to matter, but it is the foundation everything else is built on.

Sleep and movement before everything else. Physical activity should be moderate and regular, and start gently. Then activities that give energy and joy are added, a little at a time.

Learn your warning signs. 1177 writes that if you learn to recognise your own signs early, and plan in recovery, you can prevent becoming ill again. What recovery actually is — and why rest is not always enough — is covered in stress and recovery.

Back to work

Socialstyrelsen's guidance is clear: the return to work needs to be gradual, and going straight back to full-time work is usually counterproductive. Part-time sick leave is common at the start of the return.

The Institute of Stress Medicine points out that it is not unusual for memory and concentration to still be impaired when you start working part-time again. That is why the working environment matters a great deal at the start: a calm environment, clearly defined tasks, breaks and going home on time. It is important that the employer is involved early, and the occupational health service or a rehabilitation coordinator can help.

How the return can be set up in practice, both for the person coming back and for the manager, is covered in returning after sick leave.

Coaching is not treatment and does not replace healthcare. But once healthcare has done its part, coaching can be a support in what decides whether it lasts: boundaries, priorities and what should be different this time.

The most important thing

If you take away only one thing: expect months, not weeks, and expect it to go up and down. That is not a sign that you are doing something wrong. That is what recovery from exhaustion disorder looks like for most people.

And the other half of the same thing: most people get back to a life and a job that work. Often not exactly as before — but a life where you notice sooner when it is starting to get too much.

Sources

• Socialstyrelsen, Försäkringsmedicinskt beslutsstöd: Utmattningssyndrom (“Insurance medicine guidance: exhaustion disorder”; last updated 30 January 2017).
• 1177, Utmattningssyndrom (“Exhaustion disorder”; last updated 31 March 2023).
• Institutet för stressmedicin, Region Västra Götaland, Råd och behandling vid utmattningssyndrom (“Advice and treatment for exhaustion disorder”; updated 9 February 2024).
• Institutet för stressmedicin, Långtidsuppföljning av utmattning visar att en tredjedel har symptom efter sju år (“Long-term follow-up of exhaustion shows that a third have symptoms after seven years”; 4 May 2020) and Symtom efter utbrändhet kvarstår efter lång tid — men på sikt är prognosen god (“Symptoms after burnout persist for a long time — but in the long run the prognosis is good”; 16 February 2021).

Best wishes, Mikael GlännströmWellbeing coach, author and father of two