Bipolar and pre-professional student

[Doodledog]

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Posted anonymously for an SDN user

I haven't heard anyone else talk about this, so this seems like a good place to start a discussion on it. I would really appreciate any advice you all could give me.

I'll be blunt; I'm bipolar. Obviously this raises a red flag the size of a small state. I'm not your stereotypical drug abusing, hedonistic bipolar though. I'll describe it a bit before I ask my questions.

I have had multiple episodes of mania and depression since I was very young. I wouldn't say that it compromises my judgment, but it does tend to destroy my personal life.

In my case, it's genetic. I didn't learn this until after I got myself help, but mood disorders are very common in my family. I guess it's not surprising that I have a very classical presentation.

The mania is not that much of a problem. When I'm manic, I can do amazing things. Example: I took 24 credits of life science courses, and even though I averaged three tests per week, I received a 4.0 and the highest grade in several of the classes while having a social life. I can go for over a month on 4-5 hours of sleep per night. The major downside is that I can be a real jerk sometimes when I'm manic. I can contain it long enough to interact with strangers, but those I'm around normally (friends, coworkers) tend to take the brunt of it. I get this holier than thou attitude, and I have no hesitation when it comes to bragging about my abilities.

The depression is a double edged blade. When I'm depressed, I work harder to help people because I have this 'if I can't be happy at least I can help someone else be happy' attitude, and I tend to self-sacrifice myself. I also get physically sick very easily. It doesn't affect my objectivity, in fact, it may improve it slightly. It does make my own life a living hell, and as a result, I'm usually a bit grumpy all the time. I can work just fine, but I usually end up at home in bed 95% of my free time.

I don't typically discuss the depression, but I don't hide it either. It's much more common and understood, so I have no problem dealing with the stigma. As for the mania, I never mention it.

I currently take medication, but I use the absolute lowest effective dose - much lower than the normal recommended dose. As a result, I have no side effects. Since I've started though, I have transient symptoms quite often (more often than before). I don't have the 3-24 month episodes that I used to though. I don't take Li either. I take lamotrigine, so people can't necessarily tell I'm bipolar. (Some people use it for depression only, and it seems to be the only thing that helps my depressions.)

I paid for the doctor visits and medications out of my own pocket, so there is no official diagnosis or record of my condition. The doc thinks I should avoid disclosing it as well since it dosen't compromise my objectivity, and it doesn't exist on paper. I think I do a pretty good job managing it as well, but only medication can manage the physical problems.

It may sound like it, but this isn't a mild case of bipolar. I tend to get almost all of the manic/depressed symptoms simultaneously, and they can be pretty severe. Overall, I wouldn't consider myself to be a severe case, but I'd definitely be a moderate case. Sometimes I feel like an amputee running the Ironman, but I just keep fighting the best I can.

1) Is there any reason I should disclose this to anyone?

2) Should I disclose it to the student health center, or should I just see a professional in private and hide it from everyone else.

3) What was your reaction to my story? Does the idea of a bipolar physician bother you?

4) Once my life becomes more stable, I plan to, with the help of my doc, decrease my medications as much as possible. My doc definitely doesn't like that idea, but he still figures any medication I will take is better than none at all. I prefer to deal with the illness as much as I can, but I still understand there are aspects of it I can't control at all.

5) There's always a chance the medication may stop working. What do you think of that? Should I consider myself a potential liability?

Sorry I wrote a novel. Any comments or advice would be appreciated. This is kind of a big deal for me. On one hand, it may never be an issue, but on the other hand, it could cause licensing problems.

 

[NotAProgDirector]

1) Is there any reason I should disclose this to anyone?

I'm assuming the OP is not actually in medical school yet. There is absolutely no requirement to disclose this during the application process. Each school will have a set of minimum criteria for acceptance -- you'll need to review those, but none of them are going to prevent you from going to medical school

2) Should I disclose it to the student health center, or should I just see a professional in private and hide it from everyone else.

Once you get into medical school, then it will be your choice whether you want to disclose it or not. There will be some sort of "intake" by your student health service, and they can assess whether you are physically and mentally fit to attend medical school. It's unclear to me exactly how much you must disclose to them -- they can give you a questionnaire regarding their minimum requirements, as long as you can honestly answer those questions I think you;d be fine.

However, disclosing it to student health can be a big plus. They will likely have handled something like this before, and they will be the most knowledgable about your education / workload, and would be immediately and proximately available if you started to get into trouble.

Even if you do disclose it to student health, it will not be a part of your academic record unless you need an LOA at some point (or run into some other problem). IN that case, it still might not be in your record, other than "Medical Student XXX required a three month LOA for medical reasons, but then returned to full duty without further problems".

3) What was your reaction to my story? Does the idea of a bipolar physician bother you?

No more than a physician with any other illness. If you can do the work, then there is no problem.

Therein lies the potential problem -- can you handle the stress / workload of medical school and residency? In my experience, the stress and sleep deprivation of medical school and residency can unmask / destabilize anxiety and depression issues. Should you start to struggle, require medical LOA's, etc, you might find your residency options limited. Worst case scenario, if you were to not complete medical school (or fail out of a residency) you could have huge loans with no way to pay them back.

You also mentioned that when your illness flares, it is reflected in your relationships with those around you. Remember that much of your evaluations as a clinical medical student and resident are based on how well you can work on a team, with other residents, students, nurses, and faculty. If you're a jerk to them, you will not get good grades no matter how smart you are.

Remember that this is only a POTENTIAL problem. You could also do just fine. There's no way to know, and you'll have to decide what feels best to you.

4) Once my life becomes more stable, I plan to, with the help of my doc, decrease my medications as much as possible. My doc definitely doesn't like that idea, but he still figures any medication I will take is better than none at all. I prefer to deal with the illness as much as I can, but I still understand there are aspects of it I can't control at all.

Although everyone's experience with med school / residency is different, I think it's fair to say that this pathway does not usually make your life "more stable". You should seriously consider staying on your meds if you go this route, to give you the best chances overall. If you're in medical school and doing well, then you can always wean the meds off. Then again, in situations like this, the patient with the disease often has the worst perspective on their illness, and stops meds just when things are getting better because "things are getting better".

5) There's always a chance the medication may stop working. What do you think of that? Should I consider myself a potential liability?

Anything can happen. Good people develop horrible problems all the time. No use worrying about something that might happen.

 

[eforest]

1) Is there any reason I should disclose this to anyone?
No. This is your private business.

2) Should I disclose it to the student health center, or should I just see a professional in private and hide it from everyone else.
I consider bipolar to be a medical problem, so I tell people at the health center. I'm taking medication and I think it's important that they know.

3) What was your reaction to my story? Does the idea of a bipolar physician bother you?
I think that as long as the physician is controlling his/her illness and can physically/mentally handle medicine, I don't care what is in your medicine cabinet or medical records. The thought of a bipolar medical student might bother my patients- I have no idea because I don't ask- but it's not an issue, they'll never know.

4) Once my life becomes more stable, I plan to, with the help of my doc, decrease my medications as much as possible. My doc definitely doesn't like that idea, but he still figures any medication I will take is better than none at all. I prefer to deal with the illness as much as I can, but I still understand there are aspects of it I can't control at all.

Don't make any assumptions about eventually decreasing your medications. Sure, you'll get to a point in your life when things are very stable... but you still need to remember you have a chronic illness that needs maintenance.


5) There's always a chance the medication may stop working. What do you think of that? Should I consider myself a potential liability?
It is very good that you are thinking of this. You need to make sure you are aware of your moods so that you know when you are starting to have problems and need an adjustment.

Sorry I wrote a novel. Any comments or advice would be appreciated. This is kind of a big deal for me. On one hand, it may never be an issue, but on the other hand, it could cause licensing problems.

Med school is really really hard and BPD makes it harder. My medications are expensive so I've got more debt than other people. I dont have the luxury of pulling all nighters all the time, so I have to budget my time. If I have an issue- i.e. the pharmacy screwed up my prescription- I don't have time to solve it. Even small problems become an issue.

It's hard, but, BPD is not a contraindication to medical school.

 

[chrisisinnocent]

Keep in mind that while this will not be an issue while you are applying to med school and in med school itself it will become an issue when you will be applying for a license.
Depending on the state, you will be asked more or less detailed questions about any conditions that may affect your ability to practice medicine. You may have to self disclose your condition in order to be truthful on those applications. Medical boards view their role as protecting the public from potentially dangerous physicians and as such they tend to take a dim view of any psychiatric conditions. You may find it hard to become or stay licensed. They would much rather deny a license based on potential risk rather than wait for an incident to respond to.
Finally think of taking care of yourself. the demands and stress of medicine are huge and this becomes greater at every step of the process. You may find that working in medicine will exacerbate your condition. I have seen medicine bring on breakdowns in fairly "normal" people, for you this may be catastrophic when combined with your condition.
There are no set answers anyone could give you and the decision is ultimately yours but you should keep in mind the risks involved in pursuing medicine. Good luck!

 

[dragonfly99]

No you don't have to disclose this to your medical school. It likely won't come up in the application unless you have a poor or sporadic academic record, or not good LOR's.

The above poster is right in that it could become an issue with medical licensing. The issue of needing a leave of absence/medical leave during medical school could become an issue with residency and licensing also. However, I would think that if you do well in med school and residency, it wouldn't be that much of an issue. You also could choose not to disclose anything on your medical license application. Usually they ask if you have any conditions THAT WOULD AFFECT YOUR ABILITY TO PRACTICE MEDICINE. If you never had problems in med school or residency, you might be able to answer "no".

Tildy is right when she says that grading is largely subjective during 3rd and 4th years of medical school. It's mostly based on whether people like you vs. not. Being smart helps, but not that much. It's mostly based on personalities. So if you have problems w/other folks, you might end up with low grades in 3rd year. These mostly determine what residency you can do.
Just food for thought.

<4) Once my life becomes more stable, I plan to, with the help of my doc, decrease my medications as much as possible. My doc definitely doesn't like that idea, but he still figures any medication I will take is better than none at all. I prefer to deal with the illness as much as I can, but I still understand there are aspects of it I can't control at all.>
This is the one statement that concerns me a huge amount. This shows that you don't have great insight into your illness, and the fact that you are likely to need med(s) throughout med school and residency. Going off your med could be seriously dangerous to you AND your future patients. Also, you seem to understand that this is "biochemical" in your case but you are implying it isn't in some other patients. I disagree. It is a "real" thing, just like high blood pressure or high cholesterol. I think there are some people who actually have personality disorders who are misclassified as bipolar, who probably don't have a "biochemical problem", just behavioral - but that's not really bipolar disorder, is it?

<5) There's always a chance the medication may stop working. What do you think of that? Should I consider myself a potential liability?>
Most bipolar patients can be successfully treated. It looks like you have been, and have been managing your condition well. You could always switch to a different med if yours stops working. Everyone is a "potential liability". There are docs with no bipolar disorder who become alcoholics, drug users, etc. There are docs who are not compassionate and care only about money. They are a liability. You could become a liability if you choose not to treat your bipolar disorder and/or you become decompensated. I think if you are following closely with your psych doc, and you have some close friends/family who are aware of your condition and can tell/warn you if they see signs/symptoms of decompensation, that would be a good start as far as ensuring that that doesn't happen.

Good luck with whatever you do. People with bipolar are in all walks of life. There was a student with it in my college and now she is a successful attorney...partner in a firm in a large city.

 

[andrea]

Hey there!

I'm a third year medical resident with type I Bipolar. I take lithium and lamictal and have been through everything you've talked about. I passed all three steps of boards, I'm moonlighting and planning to graduate. So know that it can be done! It is very challenging - my intern year was one of the worst years of my life. Every night of call seemed to set off my mania. Now things have settled down, thank God. So there will always be struggles that the rest of the kids don't have to deal with, but if you want it bad enough, you can do it. Feel free to PM me anytime.

Andrea

 

[eforest]

It's nice to read about someone else in the same boat who's actually made it to and through residency! Despite all that I've achieved I still harbor doubt sometimes. Congrats!

 

[andrea]

It's nice to read about someone else in the same boat who's actually made it to and through residency! Despite all that I've achieved I still harbor doubt sometimes. Congrats!

Thanks! Hang in there. Hey, I read some of your blog. Totally awesome. Wish I had done something like that myself.

 

[Regnvejr]

Quite a few physicians have bipolar disorder, but you just don't hear much about it. The licensing boards, residencies and medical schools would like to know, but the bias is horrendous, especially with licensing boards.

The physicians with Bipolar disorder that I know off, have NOT told the licensing boards. They also use outside psychiatric sources and pay all treatment and medications in cash.

However, as longas you and the people who know you are attuned to your mood and when it is necessary to adjust treatment, then there is nothing that should stop you from becoming a fine physician.

But, as dragonfly expressed, the seeking minimal doses of medications is dicey, given the fluctuating nature of Bipolar disorder. Going through demanding studies, the increase in dose to give a wider margin of control seems more advisable, though I don't know you well enough to say that. Definitely discuss those dynamics with your prescriber. Lamictal frankly do not have significant side-effects at stable doses even when the dose is high.