MD & DO Depression as a rising M4

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Lifeblood_20

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M3 here on my last rotation (4 wks left). I've struggled with mental health for years, but M3 year has been so stressful that things took a nose dive. I have a good support system, I see a therapist, I take meds, do what I can to take care of myself, but I feel like I'm hanging on by a thread. I haven't failed anything but I have gotten very mediocre clinical grades all year (probably gonna be 3rd quartile in my class) and just generally feel down in the dumps most days. I honestly want to take a LOA but feel that would be looked down upon when applying to residency and part of me just wants to grit my teeth and get through the last year and move on. I'm not applying to anything competitive for residency and I hope things are better as an M4 and I get time to get better mental health wise?

Sorry for the ramble. Appreciate any thoughts.

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Third year is tough because it's completely different than the first two years of medical school, as you now have different things expected of you and are working very long hours that you may not be used to. It also doesn't help that you're switching rotations every few weeks and different things are expected of you in different specialties. Basically, your thoughts and feelings are very justified. It's awesome that you haven't failed anything and are on track to graduate on time.

Fourth year is definitely a lot better because you are finally on more rotations in the specialty you are interested in, and there's usually much more elective time. I have heard that fourth year can be stressful if you are complying to a competitive specialty, but if you are interested in something not extremely competitive, fourth year will be very enjoyable and much better than third year. Definitely hang in there. We've all been in your shoes and you will get through this 😊
 
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If you feel like it is really all too much for you to deal with right now, you could take a research year.
 
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MS3 is definitely the worst year of medical school; most of my friends and I struggled with pretty bad situational depression, even those who weren't already struggling with mental health issues. MS4 is less painful, and you generally have more time for electives/rotations you're actually interested in rather than being forced to spend X many weeks/months getting exposure to things you'll never want to do again in your life.

That being said, if you need an LOA or a break, there's no shame in that, either. In addition to the research year suggestion, I know a few people who took a year for a master's program during medical school as well, if that's less intense.
 
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There is no right answer here obviously.

While I agree that fourth year is definitely better than third year (actually imo better than any year in med school), I wouldn't just assume you can grit your teeth and move on hoping things will get better. I'm not saying that you need to take a LoA (research year is a good idea, but make sure it would be with a non-obnoxious PI), but when you get through residency and start practicing as an attending, your stress certainly goes up. You're the one signing all the notes at that point literally and figuratively. I hope for none of us to have bad patient outcomes, but you will experience missed things, mistakes, or things you could have done better. It happens to all of us.

Depending on your personality, it takes a lot of work to not perseverate on those things, beat yourself up, or let it affect you in worse ways. Make sure you have your overall mental health in control before you move too much forward.

My school had a one year MPH as an MD/MPH program which I did. They also offered an MD/MBA. You could look into that option if available to you.
 
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Agree with everything here. M4 is the best year of med school, but the application process can be a stress-inducing beast. Look into what options are available to extend things out a bit as noted by other posters.
 
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Not directly mentioned yet, you want your mental health under the best control possible before starting internship.
 
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Not directly mentioned yet, you want your mental health under the best control possible before starting internship.
Absolutely, but I'd also argue that a gap year, as many others have suggested, may not be the solution for fine-tuning mental health. 4th year will allow for some decompression time. Upon returning from a PhD, the transition back into medical school-level work/expectations was jarring enough to leave me feeling absolutely hopeless during the first 2-3 rotations. On a more relatable scale, while we absolutely need breaks every once in a while, I often come back from vacations more stressed than when I left. Vacations are necessary long term, but the true benefit is felt when you get off work and realize you have a full week of nothing ahead of you. If OP wants to be primed for intern year and is experiencing burnout (vs. depression or another mental health crisis), I don't know if extended time off will solve the problem or set them up for success starting intern year.

@Lifeblood_20, I'm also feeling this way. I'm on my last rotation in a specialty I have no interest in, and I can barely motivate myself to prep for clinic. The days of frantically parsing through an UpToDate article to try to present the perfect HPI and generate the perfect differential/plan are fading fast. M3 is a demoralizing year, regardless of how poorly or how well you perform. I'm so sick of being quantitatively evaluated on minimal performance with next to zero chance to correct and show growth. We have rotations where, for 5-6 weeks, you rotate on a different service/clinic every day (e.g., colpo clinic, L&D triage, prenatal clinic, gyn onc, L&D floor, back to L&D triage with a whole new team, gyn surg, community gyn, etc...). If I've done well, it's never been for the right reasons. If I've done poorly, it's always been nearly 100% out of my control (e.g., attending mixes me up with someone else, I get paired with the salty resident who gives everyone dead average evals with no comments, etc...).

It sucks being the lowest on the totem pole. It sucks feigning interest in something you could care less about. It sucks going home every single day and having a new exam hanging over your head. It sucks knowing that the results of your performance this year can dictate the rest of your career. However, it will get better. Years from now we won't care that Dr. So-and-So gave us 3s despite never meeting us even once. We'll settle into whatever career works out for us, and the people around us will judge us on our interactions with them and our overall character, not the name on our diplomas. If this is burnout, trust that a year of M4'ing will get you right again. If it's something that needs dedicated psychiatric work, then I'd consider a research year.
 
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That being said, if you need an LOA or a break, there's no shame in that, either. In addition to the research year suggestion, I know a few people who took a year for a master's program during medical school as well, if that's less intense
Chiming in as someone who did this between 2nd and 3rd year.

Ended 2nd year the most miserable/suicidal I've ever been. Just absolutely at my wits end. Finished 3rd year last week and absolutely thriving, especially compared to the other rising M4s in my class. Scoring well, feeling well. Felt really invigorated going into 3rd year and still feel that way going into M4. Extremely excited for this year.

There are some aspects to it that suck. Definitely felt A LOT of shame about it the first few months, but overall was a good choice for me. You don't have to do it if you don't want to, OP, but definitely think it over if you're getting into a dark headspace.
 
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Thanks everyone for your comments. Had an honest meeting with admin. Going to move forth with M4 year with some accommodations/mandated mental health care. Hope it's for the best.
 
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I'm sorry to hear that you are suffering. As someone who also struggles with depression, I feel for you.

Depression does not have to get in the way of your career path. Find study strategies that work for you and better yet, reasons to leave your house in the morning. Get up and go to the library if studying at home does not work for you. Make appointments with TAs/profs and study dates with your classmates in order to get out of your head.

If medical school/being in the hospital is not something that excites you, then it's not for you. Stepping foot inside the trauma room should give you an adrenaline rush. If it doesn't, then you might want to re-consider what you're doing.
 
Just updating this thread to say that my school is giving me funds for student health insurance so I can be covered for more specialized psychiatric care. If any med school admin is reading this, this is what true support for medical students looks like.
 
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