Managing bipolar disorder in medical school

[california_poppyseed]

Hey there guys! Hope you guys are having a good day. If you've stumbled across this post thanks for taking a moment out of your day to interact.
I've read some articles published by writers on the Student Doctor Network about managing bipolar disorder in medical school, as well as chatting with family friends in medical school who have it too. Does anyone out there have it too, and have any tip of how to manage it during school? I take all my meds, go to therapy every week, follow my treatment plan from my providers and obviously I have my great service doggo. But I know hours and stress can be whack, so for those of you who might relate, what do you do that helps you stay sane and productive?
Thanks you guys

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[Goro]

Wise @Mad Jack, thoughts?

 

[Rapsidy]

Bipolar 1 or 2? Do you get mania even with the meds? How long do the depressive episodes typically last? How severe are the depressive episodes? Have you been hospitalized for it before? It’s all going to be very subjective to how you respond to medication and how your body then responds to the medication under the extreme stress that medical school will put you through.

For context, I was a social worker before medical school and have seen several residents and students hospitalized for bipolar as well as a practicing doctor who was not managed with medication at all and came to us with severe mania and paranoia. Clearly they got through medical school, but what you have now to cope may be different with the stress of medical school. More often than not we were admitting students for the severe depression and suicidality rather than mania, unless they started abusing stimulants to help with studying (which I’ve seen a few cases as well).

Understand if you don’t want to post about all that in a public forum so feel free to DM, but it really is very subjective to the severity, and how well you deal with incredible levels of stress. What happens if you don’t have your dog, your usual coping mechanisms? Will you need to change insurance in medical school and lose access to your medications or providers who know you well?

Can someone who bipolar succeed in medical school? Absolutely, but it’s not going to be easy.

 

[california_poppyseed]

Bipolar 1 or 2? Do you get mania even with the meds? How long do the depressive episodes typically last? How severe are the depressive episodes? Have you been hospitalized for it before? It’s all going to be very subjective to how you respond to medication and how your body then responds to the medication under the extreme stress that medical school will put you through.

For context, I was a social worker before medical school and have seen several residents and students hospitalized for bipolar as well as a practicing doctor who was not managed with medication at all and came to us with severe mania and paranoia. Clearly they got through medical school, but what you have now to cope may be different with the stress of medical school. More often than not we were admitting students for the severe depression and suicidality rather than mania, unless they started abusing stimulants to help with studying (which I’ve seen a few cases as well).

Understand if you don’t want to post about all that in a public forum so feel free to DM, but it really is very subjective to the severity, and how well you deal with incredible levels of stress. What happens if you don’t have your dog, your usual coping mechanisms? Will you need to change insurance in medical school and lose access to your medications or providers who know you well?

Can someone who bipolar succeed in medical school? Absolutely, but it’s not going to be easy.

I'll keep it public so hopefully this'll help other people in the future!
Bipolar 2. No mania while on meds, thank god. Depressive episodes are bad, I need to see my pscyhiatrist soon (haven't been able to nab and appointment since everyone is so backed up which is understandable) so I definitely need to adjust meds. But I respond to meds pretty well. I have a great support system and a fairly good lifestyle.
I don't do great without my service dog, I'm much more susceptible to the stress-induced hallucinations and cycling as well as dissociating. But I manage... to whatever extent you call that LOL. I think I will have to change insurance as by the time I am in my third or second year I will be off my parents' insurance. But my older brother is thinking of picking psychiatry for his residency, so I have that going for me.
Thanks for your response.

 

[Moko]

I have a great support system and a fairly good lifestyle. I don't do great without my service dog, I'm much more susceptible to the stress-induced hallucinations and cycling as well as dissociating. But I manage... to whatever extent you call that LOL.

This isn't what you want to hear, but I'm concerned about your wellbeing if you choose to pursue medicine. You don't seem to be anywhere close to being 100% well, which you should be prior to starting medical school. Medical training is a furnace that will exacerbate any existing problems (and unearth undiagnosed ones while at it). Your support system and lifestyle will likely suffer particularly during residency. Your service dog may pass away while you're still in training. If you are this prone to exacerbations and serious manifestations, you may end up hurting both yourself (physically, mentally, and/or financially) and your future patients. If there is any other career path that seems interesting and fulfilling to you, do consider that strongly before pursuing medicine. Medical training is demanding and expensive. Any success stories you find will be heavily skewed by survivorship biases. Best of luck and just my thoughts.

 

[Med Ed]

I'll keep it public so hopefully this'll help other people in the future!
Bipolar 2. No mania while on meds, thank god. Depressive episodes are bad, I need to see my pscyhiatrist soon (haven't been able to nab and appointment since everyone is so backed up which is understandable) so I definitely need to adjust meds. But I respond to meds pretty well. I have a great support system and a fairly good lifestyle.
I don't do great without my service dog, I'm much more susceptible to the stress-induced hallucinations and cycling as well as dissociating. But I manage... to whatever extent you call that LOL.

Ultimately medicine isn't about those providing care, it's about those receiving it. I am concerned that if you pursue medical school it will come at substantial risk to both yourself and those you are responsible for.

 

[Rapsidy]

I'm much more susceptible to the stress-induced hallucinations and cycling as well as dissociating. But I manage... to whatever extent you call that LOL.

I concur with @Moko I would have serious concerns for you with symptoms like that. You could easily put patients at risk, open yourself up to lawsuits/lose licensing or harm yourself if you are struggling with hallucinations and dissociation. Medical school is likely going to be one of if not the most stressful time in your life and if stress is your trigger then you are at a very high risk of relapsing and falling behind/being dismissed. Accommodations can be made, but will they be enough?

Why medicine is the question really. If you are dead set nothing anyone says here will change your mind, but there are plenty of other paths to take that can be similar to medicine with far less stress and toll on your mental health.

 

[LunaOri]

You might want to consider PA school instead. Their training program and working hours are much more manageable.

 

[Mad Jack]

Wise @Mad Jack, thoughts?

As it's within my field I have to be fairly careful.

Taking prescribed medication, prioritizing sleep, and making sure you are eating appropriately and avoiding alcohol, marijuana, or any substance use are the best ways of minimizing your chances of recurring episodes. OP, is your school aware of your diagnosis? If it is on file it can be helpful with regard to helping you obtain accommodations in a timely manner if you require them, but I don't know how well your particular school does with accommodations.

 

[voxveritatisetlucis]

As it's within my field I have to be fairly careful.

Taking prescribed medication, prioritizing sleep, and making sure you are eating appropriately and avoiding alcohol, marijuana, or any substance use are the best ways of minimizing your chances of recurring episodes. OP, is your school aware of your diagnosis? If it is on file it can be helpful with regard to helping you obtain accommodations in a timely manner if you require them, but I don't know how well your particular school does with accommodations.

Good insight.

I believe that the op is considering applying or applying this cycle

 

[Mad Jack]

Good insight.

I believe that the op is considering applying or applying this cycle

Will be something to consider when they cross that bridge then, I suppose.

You might want to consider PA school instead. Their training program and working hours are much more manageable.

If they can survive PA school they can survive med school. I would have concerns with regard to both given the hallucinations induced by stress. I've seen some very bad decompensations in residents of various mental illnesses over the years- generally if you have something, expect that it will get worse than it has ever been.

NP school tends to be far more manageable with regards to time and hours, and may be a better fit given the stress-induced nature of symptoms present. It may also be easier to get and retain a license, as many medical boards will eye prior diagnosis with psychotic symptoms very carefully and not give second chances should a major incident occur. Nursing boards tend to be more forgiving in that area.

 

[deleted1100659]

1. if you do go to medical school, make sure you're 100% stable on medications. You know that the effects of psych meds are not an instant fix, and if you decompensate then that could really cause a set back. I do not think anyone should pursue medical school unless psychiatrically stable for a prolonged period of time.

2. Im not sure how the service animal will work in all scenarios. For example, how would that work on surgery rotations? Seeing patients on long call days? Could be really tricky feeding the dog/taking them to the bathroom. Also overnight call would be hard with bipolar, but you could possibly get out of this. As you know, lack of sleep can worsen bipolar.

3. Normally if there are psychotic symptoms then its bipolar 1

4. its possible to do ok with bipolar 2 disorder but you have to be honest as far as expectations. There will likely be multiple rough periods and residency, even for psychiatry, is not easy. When I was a psychiatry intern I would work 14 days straight some months. Couple times worked 21 days straight. You would need to do well in med school and ideally match into an attending driven program with good hours otherwise you're at a much higher risk of decompensating.

There are a lot of variables here.

 

[Mad Jack]

1. if you do go to medical school, make sure you're 100% stable on medications. You know that the effects of psych meds are not an instant fix, and if you decompensate then that could really cause a set back. I do not think anyone should pursue medical school unless psychiatrically stable for a prolonged period of time.

2. Im not sure how the service animal will work in all scenarios. For example, how would that work on surgery rotations? Seeing patients on long call days? Could be really tricky feeding the dog/taking them to the bathroom. Also overnight call would be hard with bipolar, but you could possibly get out of this. As you know, lack of sleep can worsen bipolar.

3. Normally if there are psychotic symptoms then its bipolar 1

4. its possible to do ok with bipolar 2 disorder but you have to be honest as far as expectations. There will likely be multiple rough periods and residency, even for psychiatry, is not easy. When I was a psychiatry intern I would work 14 days straight some months. Couple times worked 21 days straight. You would need to do well in med school and ideally match into an attending driven program with good hours otherwise you're at a much higher risk of decompensating.

There are a lot of variables here.

You can have psychotic features with bipolar II, what separates it from bipolar I is true mania. I see this occasionally in people that have psychotic features in their depressive state, but who do not have true manic episodes nor psychotic features with their hypomania.

Agree that service animals would be a hard no in many environments for safety, as they present infection risks, allergy risk, and other risks to patients. The only environment I've seen service animals be allowed in is outpatient therapy.

Agree with med stability and night accommodations.

 

[deleted1100659]

You can have psychotic features with bipolar II, what separates it from bipolar I is true mania. I see this occasionally in people that have psychotic features in their depressive state, but who do not have true manic episodes nor psychotic features with their hypomania.

Agree that service animals would be a hard no in many environments for safety, as they present infection risks, allergy risk, and other risks to patients. The only environment I've seen service animals be allowed in is outpatient therapy.

Agree with med stability and night accommodations.

you can- what im saying is its just not typical and is more common in bipolar 1. Psychotic symptoms are concerning for mania, often the only thing seperating 1&2 is the duration or lack of hospitalization. If OP had bipolar and had episodes of mania would be fairly concerned. Being hospitalized during medical school does not seem fun. And OP does not seem completely stable with the medications, or at least its somewhat unclear from the original post.

Also even in a CMH setting its rare I see full blown mania, usually they present during a depressive episode.

 

[Mad Jack]

you can- what im saying is its just not typical and is more common in bipolar 1. Psychotic symptoms are concerning for mania, often the only thing seperating 1&2 is the duration or lack of hospitalization. If OP had bipolar and had episodes of mania would be fairly concerned. Being hospitalized during medical school does not seem fun. And OP does not seem completely stable with the medications, or at least its somewhat unclear from the original post.

Also even in a CMH setting its rare I see full blown mania, usually they present during a depressive episode.

I see a lot of full-blown mania, but I do inpatient primarily. My prior spot we had a very, very high acuity community mental health center where we had a high caseload of schizophrenia, schizoaffective, and bipolar disorder patients- probably 60% of the caseload. Had a few that would decompensate in a manic fashion due to med nonadherence or substance use, which usually was a full-on clinic crisis due to the severity of behaviors. Naked patients ranting about god while aggressively wielding fire extinguishers sort of situations.

Needless to say, a a sizeable number of bipolar II patients eventually convert to bipolar I (20-25% if diagnosis was made in adolescence, 5-7.5% if it was made as an adult), so avoiding decompensations and avoiding putting oneself in situations that could lead to decompensation would be advisable.

 

[deleted1100659]

I see a lot of full-blown mania, but I do inpatient primarily. My prior spot we had a very, very high acuity community mental health center where we had a high caseload of schizophrenia, schizoaffective, and bipolar disorder patients- probably 60% of the caseload. Had a few that would decompensate in a manic fashion due to med nonadherence or substance use, which usually was a full-on clinic crisis due to the severity of behaviors. Naked patients ranting about god while aggressively wielding fire extinguishers sort of situations.

Needless to say, a a sizeable number of bipolar II patients eventually convert to bipolar I (20-25% if diagnosis was made in adolescence, 5-7.5% if it was made as an adult), so avoiding decompensations and avoiding putting oneself in situations that could lead to decompensation would be advisable.

Im on the other end, im in the outpatient side of things once they leave our CSU. Where im at though, they arent able to get physicians to work in their inpatient unit and there hasnt been a psychiatrist there in years, only midlevel providers.

But yeah, ultimately this seems like a very challenging predicament, OP. Not to be a debbie downer, I just think of my experience in med school and residency. The amount of pressure it can be at times can be very challenging. I think you should definitely have a talk with your psychiatrist and see what they think as well.

 

[HuskyMD Emeritus]

Another consideration is in the future, when you are applying for hospital or clinic privileges, or license, there will be questions in the application regarding mental health issues/impairment. These questions will come up every 2 years when you renew your license and privileges. Your references and chief of service will also be asked to address any mental health impairments in these applications. If you have any lapses, your practice privileges and license will be at risk.

 

[Angus Avagadro]

As the sagacious @Goro is fond of saying, medical school is a crucible. I believe it will frequently exacerbate underlying mental and emotional conditions. Agree with @Mad Jack . I would be up front with the school and have all your support systems and accommodations lined up so you can quickly access them should the need arise. Good luck and best wishes!

 

[Goro]

As the sagacious @Goro is fond of saying, medical school is a crucible. I believe it will frequently exacerbate underlying mental and emotional conditions. Agree with @Mad Jack . I would be up front with the school and have all your support systems and accommodations lined up so you can quickly access them should the need arise. Good luck and best wishes!

Furnace, actually. One of my students committed suicide a few years ago, and this is still a sensitive area for us.

This is the first time I've been able to post about it. Actually.

So I'm not an "ableist", I'm a "wantmystudentstosurvivemedicalschoolist".