Predicting antidepressant treatment without controlling for depression is ill-advised.

Madsen et al. (2015) examined the prospective association between work-related burnout and antidepressant treatment in human service workers. The authors defined work-related burnout based on exhaustion symptoms assessed in the occupational context. They concluded that work-related burnout is an important risk factor for antidepressant treatment. While we read the authors' article with interest, we think that the internal validity of their study is threatened by the absence of assessment and statistical control of depression. This state of affairs undermines the conclusions drawn by the authors. Given that the aim of the reported studywas to examine the link between burnout and antidepressant treatment, the nonconsideration of depression (both in terms of depressive symptoms and depressive disorders) is particularly problematic. Because of this omission, the authors cannot establish that burnout independently affects antidepressant intake. Put differently, whether burnout accounts for variance in antidepressant intake that is not explained by depression cannot be determined, leaving the study results largely uninterpretable. Many studies have shown that distinguishing burnout from depression is challenging (Ahola et al., 2014; Bianchi and Laurent, 2015; Bianchi et al., 2014, 2015a, 2015b; Hintsa et al., in press; Rydmark et al., 2006; Wang et al., 2012). For example, in a recent, nosology-focused study, no diagnostically significant differences were found between burned out workers and clinically depressed patients in terms of reported depressive symptoms (Bianchi et al., 2013). At an etiological level, (chronic) work stressdfrom which burnout is supposed to result (Weber and Jaekel-Reinhard, 2000)dis also known to be an important depressogenic factor