This piece is part of in-Training Mental Health Week.
One of the things that I have struggled with most in medical school is depression. Not learning to recognize, diagnose or treat it, but actually dealing with the effects of this terrible condition.
Depression snuck up on me as school became increasingly stressful and isolating, but it only became a disruption to my life during my second year. Shortly after starting treatment for depression, I found out that one of my closest friends was also dealing with depression, and had been all year. In her case, the disease was severe enough to affect her grades and force her to repeat a year. I soon realized that this problem is much bigger than myself, and needs to be talked about openly. This is my story.
During my second year, the intensity of coursework increased as Step 1 loomed closer. At the same time, I felt that I had less control over my own life. I began to feel increasingly isolated, and I had less time to visit my family and keep up with friends outside of medical school. Looking back, I see that I have grown apart from many of my college friends simply due to lack of time.
Seeing friends post on social media about their weddings and new families made me feel behind in life, even though I approached earning my MD. As I became increasingly distanced from support systems depression grabbed me by the hand and pulled me down into darker spirits. Throughout the late winter I was constantly angry, and a few times I felt so frustrated that I broke down crying. It surprised me to see my emotions surface this way: I have never been much of a crier.
Finally, in March of 2014, my mom had it with my constant anger and irritability and insisted that I go to my family physician, who started me on an SSRI. I had been very reluctant to go because I felt like a failure. I felt that by admitting I needed help with my mood, I was giving up, unable to control yet another aspect of my life. I didn’t really want to start taking a medication, even though I knew logically that it would help. Socially and emotionally I was struggling, but academically I was doing fine at that point, and with Step 1 imminent, I told myself that I didn’t want to change anything. Still, I think a large part of my hesitance was an internalized stigma, a perception that I was giving up and losing even more control by taking medication for depression. I would prescribe an SSRI in the blink of an eye for someone else, but accepting it for myself was much harder to handle. Now, I would balk at anyone who suggested I give up my SSRI.
Over the course of this past year, there have been many ups and downs. On my surgery rotation, I had a few particularly dark weeks when I didn’t have enough time for self-care and was required to spend all of my time in the operating room, an environment that I find very stressful and an area of medicine that I don’t enjoy. The longer hours on the more demanding clerkships made my feelings of isolation emerge once again, leading to to irritability with all the minor issues. I also faced the hardship of constantly receiving the feedback such as, “You’re good at surgery, but you need to seem more interested, even if you don’t like surgery that much.” I wanted so desperately to tell my residents and attendings that it was hard to show an interest in a field I didn’t like, when at times I didn’t even have interest in doing the things I love.Because I’d been required to move to a new campus for my clinical years, I also had to find a new doctor. I brought up to her that I felt my depression wasn’t completely controlled, because though I was doing much better than before, I still felt that I was exhausted on a daily basis. I still didn’t enjoy my usual hobbies as much as I once had, and I was still lonely. She listened to my concerns, but in the end wrote them all off as “just part of being a medical student.” I have found that is not an uncommon perspective — that the symptoms of medical student-ism and depression can be frighteningly similar.
So I started to wonder, is depression just part of life as a medical student? I mean, who hasn’t felt tired and unfocused, gotten a little moody every now and again, and started sleeping whenever they can in medical school? Who has the time or energy left at the end of the day to enjoy their regular activities and keep up with old hobbies and friends who don’t know what medicine is like? Who hasn’t felt guilty when they spent time doing something other than study when there’s still so much to learn about medicine?
I believe this is a form of stigma surrounding depression and mental health problems that is somewhat unique to medical school. I had an attending giving a lecture on depression ask my class to think of how many people we knew with the signs of depression listed on his lecture slide, “not including medical students, because you’ve all got some of these.” During my psychiatry rotation, my classmate and I left our lecture on the management of depression talking about which SSRIs we were taking. Another classmate and I frequently commiserated about how on point the online comic Hyperbole and a Half can be when it comes to depression. Depression is, in fact, everywhere in medical school.
I am not suggesting that all medical students will develop major depressive disorder, or even a milder depression; it’s much more complicated than that. Still, recent attention given to mental health in medicine and the increased awareness of physician, resident and medical student suicide indicate that there is a problem. If medical students are just expected to show signs of depression at some point during their education, there’s something wrong with the system.
This culture has even made me question my diagnosis of depression: maybe my brain chemistry is okay, and this is just how life is now that I’m on my way to becoming a physician. Do I have depression or just severe medical student-ism? No wonder so many physicians do not recommend becoming a doctor to others, and even actively discourage it at times. Going into a career we love to take care of the well-being of others shouldn’t come at the expense of our own mental health, especially this early in our education.
I don’t have an answer to resolve the troubling trends in the mental health of physicians and physician-trainees. But I know something is wrong and we need to address it rather than to keep ignoring it and stigmatizing mental health problems. I’ve tried to be open about my struggles with depression with my classmates this year, and I truly believe that this has helped us become more supportive of one another, and helped me to accept my depression and do what I can to overcome it.