Depression in Medical School

[Yamster2]

I'm a first year medical student, and I've been dealing with depression for a number of years now, since early in high school. I'm definitely better compared to before, but still dealing with it. I only started seeing a therapist last year, although she had to move, and then I started seeing another one who has been a bit better. I actually started medical school last year but was performing poorly because I was having so many bad days and couldn't focus, so I took a leave of absence and rejoined this year. Last year I was performing well below average on exams, but this year fortunately I got close to the top score on the first theme and then somewhat above average on the second.

I'm feeling badly now because I know that I can be doing better than I am and getting more out of this year than I am. Not performing as well as I can obviously just makes me feel even worse than I already do. I just have some days when I don't want to get out of bed and then lose all that time, although I end up compensating for that later on with late nights, some cramming if necessary, etc. It's not that I want to switch fields or that what's making me depressed can really be resolved. I've dealt with a number of things in the past. One thing that gets me down a lot is feeling extremely lonely. My family and I basically don't speak to one another, my friends from undergrad have went off into different careers all over the place, and while I get along really well with all my classmates, I don't really interact with my classmates that much other than some small talk when I bump into them or occasionally going out.

I'm wondering if anybody has successfully dealt with this or what advice anyone might have. I already took some time off with my leave of absence. I don't want to take more time off. I do try to exercise regularly although I've been getting into a bad cycle of losing time from studying because of this and then blowing off exercise time to study instead, which then just makes me feel bad about not exercising.

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[jl lin]

I'm a first year medical student, and I've been dealing with depression for a number of years now, since early in high school. I'm definitely better compared to before, but still dealing with it. I only started seeing a therapist last year, although she had to move, and then I started seeing another one who has been a bit better. I actually started medical school last year but was performing poorly because I was having so many bad days and couldn't focus, so I took a leave of absence and rejoined this year. Last year I was performing well below average on exams, but this year fortunately I got close to the top score on the first theme and then somewhat above average on the second.

I'm feeling badly now because I know that I can be doing better than I am and getting more out of this year than I am. Not performing as well as I can obviously just makes me feel even worse than I already do. I just have some days when I don't want to get out of bed and then lose all that time, although I end up compensating for that later on with late nights, some cramming if necessary, etc. It's not that I want to switch fields or that what's making me depressed can really be resolved. I've dealt with a number of things in the past. One thing that gets me down a lot is feeling extremely lonely. My family and I basically don't speak to one another, my friends from undergrad have went off into different careers all over the place, and while I get along really well with all my classmates, I don't really interact with my classmates that much other than some small talk when I bump into them or occasionally going out.

I'm wondering if anybody has successfully dealt with this or what advice anyone might have. I already took some time off with my leave of absence. I don't want to take more time off. I do try to exercise regularly although I've been getting into a bad cycle of losing time from studying because of this and then blowing off exercise time to study instead, which then just makes me feel bad about not exercising.

Find a reputable psychiatric practitioner (psychiatrist or psychiatric NP) and don't put it off. Start looking now! Do the intake and get moving w/o thinking or waiting for the motivation to do it. Just do it regardless of what you feel like doing or not doing.

Regarding aspects of self-care, regular exercise does help many over time. Proper nutrition, really taking care of you is absolutely essential.

So in my view, there is something to understanding the the nature of the depression. Some folks have may struggle with depression their entire lives--like those for example that have Type I DM have to struggle with their disorder their entire lives. For some folks, it's 99.9% organic for them--in their brain. And so they must look at it like managing any other chronic disorder--mitigate negative effects, monitor closely, and take really good care of themselves. Personally, I also think a good therapist is a great thing for ANYONE & EVERYOne. I mean a really good therapist with a good fit will greatly benefit anyone, depressed or not, if they just open themselves up to it. The key is in finding someone not only educated/skilled in it, but someone truly talented and to-the-soul good at it. Plenty of people are educated in it. Not everyone is really meant or born to do it. Finding the right fit with therapists is a wonderful thing. Medications can be very helpful, but these must be monitored closely by people--licensed professionals that really know what they are doing.

For people that have certain types of depression, one of the biggest obstacles to over come IMO is acceptance. No, you don't have to live your life in constant oppression of anxiety and depression. I mean, rather, the person accepts that there will be bumpy days and some days will be better than others. So in developing habits and accepting that you may have this, for lack of a better example, chronic pebble in your shoe, you mitigate, however you can--in a healthy manner, the negative effects and keep moving. It's kind of like people just out surgery. They hurt, so they don't want to move, when indeed, in most of the cases, getting up and out of bed and moving around is exactly what they need--immobility can be a killer.
Your joy can come back, but you will have difficult days, perhaps for the rest of your life. Look at it this way. In one way or another, who doesn't?????

People will tell you to fight it. That can be easier said than done without the right kind of help and support. I wouldn't say that fighting it is wrong; but I think it is better to say, keep it in check. Yea. It's there showing it's ugly face, and so what? Between proper treatment and your own self-determination, you can decide whether or not it will have total dominion and oppression over you, or if it is more like having lost a limb and having to put on that prosthesis and just keep moving every day. You don't have to let it cripple you to the point of destroying your whole life and quality of life--especially if you get the right treatment and support, and if you start taking really good care of you.
Now, if you feel like it is smothering you, you need to get help faster than ASAP! Seriously.

Also, it's imperative to have a thorough work-up by a reputable physician--sometimes it needs to be done more than once or via a second opinion--another physician. That's OK. Thyroid issues can be borderline or are otherwise missed--suboptimal thyroid issues I worry are often missed. I won't argue with anyone over it, but I firmly believe that hormonal dysfunction or sub-optimal function can play a role in certain mood disorders. At any rate, it can't hurt to get a thorough physical and work-up.

I also believe that there are certain individuals who are physiologically predisposed to suboptimal neurotransmission, and thus, they may have to have some form of medical treatment for their whole lives, or at least a lot longer than they had originally thought. And there are times this means changing the medicines after a while, so you need a good psychiatrist or at least a very smart, highly experienced psychiatric nurse practitioner that understands how to effectively watch and monitor your condition and treatment with you.

I have no idea what the nature of your depression is; but be assured that it can be effectively treated and it's impact mitigated by certain types of support, treatment, and self-care.

Best wishes and take care.

 

[jl lin]

Also, you don't have to kill yourself at a gym everyday. Be realistic and go for a walk--whatever for 30 minutes. The key is to make it part of your daily habit. See someone first. Talk about any sleep difficulties. Address anything that could stand in your way of setting up a routine.

Also, some people handle being alone better than others. I am good with people, and I also love my alone time. When you get regulated between your doctor and therapist, and then you make a routine and start eating healthy and taking the right supplements--and seriously limit or cut out alcohol and cigarettes or such all together--then perhaps you can start studying in small groups, or you can find small group gatherings through local churches or other organizations. You can volunteer maybe an hour or two per week. You should only stay in bed if you are so sick you can't get out---serious flu or something that would probably put you in the hospital anyway. Get the right amount of sleep--at least 7.5 hours is needed for most people, believe it or not. Take advantage of daylight. SAD gets bad this time of year--and can make matters worse for people with MD or PDD or the like.

Job 1. is to get into to see someone reputable ASAP.
2. Get a thorough PE and work-up
3. Get names of therapists as well. You have to try these therapists on like shoes, so to speak. They aren't one-size fits all, and it can take time to find the right one, so don't give up.
4. Set your schedule for the next day.
5. Get to bed early and set alarm
6. Get up and start your routine--whether you eat first before you exercise or after--differing views on this. Just remember to eat right throughout the day an drink plenty of water--as pure as you can get it--unless a physician has told you that your have some issue where you'd have to keep your daily volume tight. (Listen, IDK your medical hx.)
7. Keep your visits with docs and therapist and write out, discuss, and work on goals and address them accordingly.
8. Take your meds as prescribed and call if your having any trouble with them in-between visits--or if you are feeling worse from them.
9. Take your coursework in reasonable increments of study and take reasonable, necessary breaks to refresh, rehydrate, whatever.
10. See about small groups.
11. Find somewhere to volunteer. It doesn't have to be a lot of hours or far away. Just get out there and focus on others for a little while each week.
12. Talk with your therapist about reaching out to certain family members, maybe, one-by-one--by snail mail, email, etc. I think writing is an ideal way to communicate things many times. At the very least, write about these things regularly in a journal. It's amazing when you go back later and re-read and see how things have changed or how you may have grown.

 

[TBV]

Yeah man Psychiatrist ASAP, no need to go it alone.

 

[Goro]

Depression is poorly managed on anonymous internet message board. Get professional help, STAT!!

 

[jl lin]

Re-read what I wrote. The overriding point is to get into motion and find a reputable psychiatrist or appropriate professional not later but now. That's your first step. There are other things that can or may be included, and I personally stand by many of those things in terms of management; but in association with the right professional/s. You need to do research and/or get referrals now, as in yesterday. And you needn't get stuck feeling defeated. PM me if you would like, but mostly, get an appointment with the right professional by no later than Monday. If you are feeling absolutely desperate, go to the ED then, but don't sit there waiting for the bottom to fall out.

 

[youngman1234]

I feel you. I've definitely been there.
Personally, I think that It would be a really good idea to approach this with a problem solving perspective.

Can you narrow down the things that make you unhappy?
1. Is it performing less than optimally academically?
have you tried hiring a tutor? Have you looked into punching different study materials?

2. Damn, the feeling isolated and lonely from classmates is tricky. It also doesn't help that you're coming in from a leave of absence.
Have you tried studying in the library? And working with people who are there studying. Just to have that level of fellowship?

 

[cbrons]

Find a reputable psychiatric practitioner (psychiatrist or psychiatric NP) and don't put it off.

Dont see a "psychiatric" NP...

 

[Raininleuf]

if you need help please see your doctor (not sdn)

 

[Salt Salt]

If you think your depression is rooted in feeling isolated, you need to join a few extracurriculars pronto. I'm surprised no one else has suggested that. You need regular, relaxed interaction with people to grow your social life. Once that's in place, you'll enjoy school much more!

 

[jl lin]

Dont see a "psychiatric" NP...

That's unfair. I know some excellent psychiatric NPs that have immensely helped clients. Also, many psychiatrists do not take insurance of any kind, which is why there is a growing need for psychiatric NPs. Personally, I would want to know about the actual practice and reputation of the practitioner, regardless of physician or NP, but that isn't always possible. Again, you can't always get in to see a psychiatrist depending on where and insurance. Secondly, I know personally of an NP that showed infinitely greater judgment with a particular patient than the pt/client's psychiatrist. I really depends. I am often on the other side of this, especially with say CRNAs and the need to be closely supervised by anesthesiologists, etc. But in this area, it's really not the same thing, and it is highly dependent on the experience and insight of the particular practitioner. And once more, a person cannot always get in or even find a closely psychiatrist that will take their insurance. FP docs are often over run with managing these patients, b/c of this issue is various areas.

The point is that the person needs to see a reputable practitioner ASAP. If they find that this practitioner is somehow lacking or not helping them, then they have to do the work of seeking out another. That's the way it is. You have to put in the work of seeking and finding. If it gets critical for the person, then they need to go to the ED, and let the physicians there get the right people to see them before they hurt themselves or someone else.

 

[jl lin]

if you need help please see your doctor (not sdn)

Yes, you can also contact your primary care physician, if he or she is available.

 

[Psai]

Dont see a "psychiatric" NP...

Half the people I saw during my psych rotation were there because of mismanagement by their "psychiatric" np

 

[jl lin]

If you think your depression is rooted in feeling isolated, you need to join a few extracurriculars pronto. I'm surprised no one else has suggested that. You need regular, relaxed interaction with people to grow your social life. Once that's in place, you'll enjoy school much more!

Yes I did suggest that, but depression is a potentially very dangerous condition, and it is often complex, and bottom line, the OP needs to see a professional ASAP. Not to panic, but to get a proper evaluation and a working plan, which will be highly individualized for the OP. Treating such disorders is not a one-size fits all kind of deal. None of us has one iota what the OP's condition or type of depression is or is rooted in, and we would be foolish to say over the Internet. I only offer some general things that may be helpful, but they were all wrapped around the OP getting the right help ASAP. True depression usually doesn't get better on it's own. Not by a long shot.

PS: sorry if I seem like I am coming off strong. This is something that this person should make top priority. People see the word depression, and if they know anything at all about it, they get seriously concerned. It can be an absolute bear.

 

[cbrons]

That's unfair. I know some excellent psychiatric NPs that have immensely helped clients. Also, many psychiatrists do not take insurance of any kind, which is why there is a growing need for psychiatric NPs. Personally, I would want to know about the actual practice and reputation of the practitioner, regardless of physician or NP, but that isn't always possible. Again, you can't always get in to see a psychiatrist depending on where and insurance. Secondly, I know personally of an NP that showed infinitely greater judgment with a particular patient than the pt/client's psychiatrist. I really depends. I am often on the other side of this, especially with say CRNAs and the need to be closely supervised by anesthesiologists, etc. But in this area, it's really not the same thing, and it is highly dependent on the experience and insight of the particular practitioner. And once more, a person cannot always get in or even find a closely psychiatrist that will take their insurance. FP docs are often over run with managing these patients, b/c of this issue is various areas.

The point is that the person needs to see a reputable practitioner ASAP. If they find that this practitioner is somehow lacking or not helping them, then they have to do the work of seeking out another. That's the way it is. You have to put in the work of seeking and finding. If it gets critical for the person, then they need to go to the ED, and let the physicians there get the right people to see them before they hurt themselves or someone else.

Not gunna derail the thread but NPs dont go to med school, dont do a residency and dont have to pass step 1 2 or 3. I think i would trust someone who did all of the above before a person with on-the-job training.

NPs arent meant to be sought out as a first option, but rather as a back up in the event that there are no physicians available. And they should be supervised.

 

[username456789]

Also, many psychiatrists do not take insurance of any kind, which is why there is a growing need for psychiatric NPs.

Wut.

 

[Salt Salt]

Yes I did suggest that, but depression is a potentially very dangerous condition, and it is often complex, and bottom line, the OP needs to see a professional ASAP. Not to panic, but to get a proper evaluation and a working plan, which will be highly individualized for the OP. Treating such disorders is not a one-size fits all kind of deal. None of us has one iota what the OP's condition or type of depression is or is rooted in, and we would be foolish to say over the Internet. I only offer some general things that may be helpful, but they were all wrapped around the OP getting the right help ASAP. True depression usually doesn't get better on it's own. Not by a long shot.

PS: sorry if I seem like I am coming off strong. This is something that this person should make top priority. People see the word depression, and if they know anything at all about it, they get seriously concerned. It can be an absolute bear.

Not saying that OP shouldn't seek help. Just that, since s/he explicitly said that social isolation is a huge part of his/her depression, that that would be a good place to start.

 

[jl lin]

Not gunna derail the thread but NPs dont go to med school, dont do a residency and dont have to pass step 1 2 or 3. I think i would trust someone who did all of the above before a person with on-the-job training.

NPs arent meant to be sought out as a first option, but rather as a back up in the event that there are no physicians available. And they should be supervised.

corons, you already did derail this thread. Clearly you don't understand the situation across the country. Also, you don't understand that especially in an area of HC such as this, it depends on the overall clinical experience put together with the didactic of the individual practitioner.

I won't go into a lot of detail, but I know a client just recently that had to switch to the psychiatrist, b/c the PNP had to move elsewhere. Ct had great rapport with the PNP. PNPs been doing psych for 20 years and knows exactly what PNP is doing. After years of this poor ct bouncing around improperly diagnosed and treated, this PNP finally was able to get the ct straightened out to very good functional status over a two year period. After the NP was moved, however, the ct's case was assigned to a psychiatrist. After psychiatrist took over and started jerking around with the ct's meds, the ct end up in a very bad, dangerous situation. In certain areas, depending upon experience and certain things, it will come down to the expertise and insight of the individual practitioner.

Speak you bias as you would like. I am strongly opposed to midlevel overstep, but you are missing the boat on this one. I have over 20 years in nursing and healthcare. I am not a stupid or foolish person or clinician.

Finally, there are not as many "back-ups" for clients as is necessary in many areas, and of the psychiatrists that are available, many of them will not take patients/cts insurance, private or public funding. Please do your research, and get some experience before you comment.

Derail of thread over.

 

[67552931811]

corons, you already did derail this thread. Clearly you don't understand the situation across the country. Also, you don't understand that especially in an area of HC such as this, it depends on the overall clinical experience put together with the didactic of the individual practitioner.

I won't go into a lot of detail, but I know a client just recently that had to switch to the psychiatrist, b/c the PNP had to move elsewhere. Ct had great rapport with the PNP. PNPs been doing psych for 20 years and knows exactly what PNP is doing. After years of this poor ct bouncing around improperly diagnosed and treated, this PNP finally was able to get the ct straightened out to very good functional status over a two year period. After the NP was moved, however, the ct's case was assigned to a psychiatrist. After psychiatrist took over and started jerking around with the ct's meds, the ct end up in a very bad, dangerous situation. In certain areas, depending upon experience and certain things, it will come down to the expertise and insight of the individual practitioner.

Speak you bias as you would like. I am strongly opposed to midlevel overstep, but you are missing the boat on this one. I have over 20 years in nursing and healthcare. I am not a stupid or foolish person or clinician.

Finally, there are not as many "back-ups" for clients as is necessary in many areas, and of the psychiatrists that are available, many of them will not take patients/cts insurance, private or public funding. Please do your research, and get some experience before you comment.

Derail of thread over.

^Allnurses would be so proud.

^You're right, you aren't, because you aren't a physician.

 

[Microshaft]

came in not expecting MD vs NP thread

left satisfied

oh and OP don't kill yourself. school can be a lonely place. Once u graduate and start work it will be good you feel me?