As medical students, we spend years preparing for the daunting hurdle that is the summer between the third and fourth year of medical school, a twelve week stretch in which you prepare for USMLE Step 2, perform at your highest caliber on a sub-internship in the specialty of your choice, and craft your application to residency. Accordingly, as I approached this part of medical school myself, I expected its accompanying level of academic stress. I had not, however, prepared for what coincided with this time.
I have navigated obsessive compulsive disorder with recurring episodes of major depression for the better part of the last ten years. These symptoms provided me with a baseline level of distress, but they were always manageable and had never before required urgent intervention. This changed throughout my USMLE Step 2 study period. The isolating nature of exam preparation, with day after day of solitary study hours, created the perfect storm. What began as manageable discomfort spiraled into overwhelming distress. For the first time, I found myself in a depressive episode which felt insurmountable.
Despite having taken my first steps into therapy a few months prior, I was overwhelmed by this current episode and desperate for relief. I found myself contemplating medication for the first time in my life, and as I began my fourth year of medical school, I prepared to begin an SSRI for the first time. First, I did as all good medical students do and turned to research, hoping to set my expectations appropriately. I found reassurance in matter-of-fact descriptions of mild, transient changes. It, however, was not long until I also read about widely variable rates of insomnia, fatigue, weight loss and more, leaving me struggling with uncertainty. To top it off, I did as all bad medical students do and read SSRI horror stories on Reddit. My quest for clarity had only clouded my judgment, leaving me more hesitant than ever before.
At an impasse, I voiced my apprehension to my girlfriend, who reminded me of the obvious solution to see an actual psychiatrist rather than rely on a sea of PubMed abstracts. When I met my psychiatrist, months of pent-up anxiety and analysis immediately poured out of me. She validated my fears with candor, acknowledging the frustrating trial-and-error nature of SSRI prescribing. She addressed my concerns, stating that I would likely only need a modest dose; sexual side effects, while real, were often more manageable than anticipated; in her anecdotal experience, weight gain concerns were largely overblown. I was convinced and began an SSRI.
The initiation was largely unremarkable until my dose increased about a week in, when my fears quickly materialized with unfortunate precision. I experienced sexual side effects, appetite reduction and weight loss, daytime fatigue and nighttime insomnia, and on top of it all, worsened anxiety. In my final clinical rotations, I felt like a shell of my former self, unable to conjure the engagement and competency that I had developed through years of training. To complicate things, the medications were working. The calmness in my mind brought relief I had not experienced in years. Desperate for guidance, I confided in two friends who I knew were also on SSRIs.
My friends’ responses brought comfort quickly, as they told their stories of starting medications with the humor that typically accompanies awkward tales of adolescence. Our conversations also revealed something unexpected. While mental health conversations are increasingly normalized, candid conversations about medication experiences related to mental health remain rare, still shrouded in stigma. Four months into treatment, I find myself living in profound relief from years-long mental struggles. My side effects gradually faded into the background, and I found myself thriving in ways I hadn’t thought possible. Yet even as I celebrated my own progress, I couldn’t shake my friends’ observations about the persistent silence surrounding medication experiences, a conversation which echoed a larger truth about our profession’s unfinished journey toward true openness about mental health treatment.
With the steadily rising tide of SSRI prescriptions and the well-documented prevalence of mental health conditions among health care workers, one may expect the process of beginning medication to be easier to navigate. Yet my struggle to embrace this treatment, despite my position as a medical student on the cusp of graduation, reveals a telling paradox. This disconnect between my professional knowledge and personal hesitation suggests a crucial gap in how we approach mental health medication. My experiences demonstrate the strides we have made in destigmatizing conversations around mental health, and outline the meaningful work required to extend this openness to conversations around treatment.
How can we better shepherd patients through the challenging early weeks of SSRI treatment? Adverse effects remain the primary reason patients abandon SSRIs, particularly during those crucial first weeks. Moreover, patients rarely volunteer information about their struggles, making active solicitation of side effects essential. What if we conducted more frequent check-ins during the initiation period, particularly in the critical first month? What if we set better expectations regarding the potential for side effects to be life-disrupting rather than mild, temporary inconveniences? Would we then have a greater impetus to engage patients in shared decision-making about the timing of treatment initiation and help patients choose, when possible, less demanding periods in order to weather the adjustment phase? By aligning treatment initiation with patients’ lives, we might forge a path toward better adherence and improved outcomes.
Adherence to these medications has fundamentally improved my quality of life—a gift that I hope others are able to receive. I persevered only because others who had walked this path before me offered their stories and support. For this reason, I share my medication experience, in hopes that shared experiences will push down stigma and empower trainees that so often find themselves as patients.
Image Credit: Depression” (CC BY 2.0) by Ryan_M651
Contributing Writer
Johns Hopkins University School of Medicine
Jacob is a fourth year medical student at Johns Hopkins University School of Medicine in Baltimore, Maryland class of 2025. In 2020, he graduated summa cum laude from University of Michigan with a Bachelor of Science in kinesiology. He enjoys reading, collecting watches, and pickup basketball (claim to fame: once almost played with Adam Sandler) in his free time. After graduating medical school, Jacob would like to pursue a career in internal medicine with considerations of a career in pulmonary/critical care or medical oncology.