SSRI, Residency, Licensing

[crownheim]

For a while, I had been feeling dead on the inside. Not happy, not sad, just
a feeling of complete, deadweight, zen- like inertia with not a single fluctuation on the emotional scale, save for vague, gray waftings of melancholy.

At a certain point, it dawned upon me that the extent to which I was not giving a f may well be a cause for concern, so I went to the primary physician, who gave a dx of depression and rx of SSRI, which I accepted without much deliberation.

Now I am concerned that this will affect my residency application and licensure.
I quite dislike the idea of being on psych meds and being dependent on anything,
so I have no intention of being on it for long, if at all.

Would this record of temporary use of SSRI impact in anyway my chances in residency or application? Do I now have a rx of depression on my records, and will it harm my professional career in anyway?

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[LilKangaroo]

No. No.

 

[OrthoTraumaMD]

No. Speaking from personal experience.

 

[IslandStyle808]

If they do the usual 10 panel drug for residency, then it shouldn't. I've done this for medical school twice and had no issue (I use SSRIs also).

 

[mvenus929]

I quite dislike the idea of being on psych meds and being dependent on anything,
so I have no intention of being on it for long, if at all.

Just because this drives me a little crazy--would you say the same thing about Synthroid? Metformin? Lisinopril? No? Then what makes an SSRI different? CBT might be able to help you and is certain worth a shot, but the attitude of being completely against a basic psych med is silly.

Would this record of temporary use of SSRI impact in anyway my chances in residency or application?

No.

Do I now have a rx of depression on my records

Probably, because the docs need to put in some sort of diagnosis in order to prescribe the medication. But your medical records are your medical records, and people aren't going to demand to see them--they just want to know if you have anything that will impair your ability to function.

and will it harm my professional career in anyway?

No. Well, with the exception that if you don't get your depression treated properly and under control, the stress of residency will very likely make it worse. But the actual applying and getting a job part? No.

 

[Bacchus]

It won't. It may affect your disability insurance declarations, however. PM me if you have questions.

 

[Peach Newport]

If they do the usual 10 panel drug for residency, then it shouldn't. I've done this for medical school twice and had no issue (I use SSRIs also).

Question, if you were drug testing people who held lives in their hands, why would you use a 10 panel? Why not a full, comprehensive UA?

 

[IslandStyle808]

Question, if you were drug testing people who held lives in their hands, why would you use a 10 panel? Why not a full, comprehensive UA?

I don't really know a good answer nor a logical rational. There are residencies that do only use a 10 panel screen (referring to the paneling in this case; blood testing etc. they can do), but I cannot say if the vast majority are the same. An SSRI is not addictive in most cases, so that might be part of the reason.

The answer to your questions is a matter of where do you draw the line. You can be strict and believe that no doctors should drink alcohol during their time as a practicing physician. Or be relaxed where marijuana use, whether its medical or recreational, is okay as a practicing physician.

I myself am not sure what side I'm on for your question. I'm just answering the question at face value.

 

[mimelim]

In the state that I work, you would have to disclose being on an SSRI to the medical board when you are getting your license. It would not prevent you from getting a license, but has to be reported. Regarding residency? Would not affect in the slightest as nobody would know.

 

[Crayola227]

look through my past posts about how to navigate medical school/residency and mental health challenges

try searching "residency" and "mental health" or "depression"

I don't mean to discourage you from getting the care you need, but discretion and care are warranted

 

[NickNaylor]

Ultimately, it will depend on the state in which you are applying for licensure.

In Texas, there is no blanket requirement to disclose whether or not you're receiving ANY kind of psychiatric treatment or taking ANY kind of psychotropic drugs, though this is a relatively recent change over the last few years. Instead, the question asks about conditions or medications which may impair your ability to practice medicine; an SSRI is unlikely to meet that definition.

I previously dealt with significant anxiety and took an SSRI, and I never disclosed this on my licensure application as I didn't think it was relevant and it did not impair my ability to practice medicine (or, in this case, to work with patients and learn). In contrast, I do think taking benzodiazepines would likely meet that threshold, so you would probably need to disclose that.

Again, it will depend on the requirements of the specific state you are trying to get licensed in as each state as slightly different requirements and expectations. Whatever you do, though, follow the instructions completely. At that end of the day, the fact that you took an SSRI is unlikely to cause any problems with your licensure, but lying - or otherwise operating in a grey area - will absolutely cause you problems.

 

[CherryRedDracul]

Question, if you were drug testing people who held lives in their hands, why would you use a 10 panel? Why not a full, comprehensive UA?

Because it's a waste of money.

 

[AnxiousMD2018]

I don't see how they would find out you took a SSRI even if you don't disclose it. Your personal heath records are confidential.

 

[atomi]

Try getting an aviation medical certificate if you are a pilot on an SSRI. Virtually impossible. FWIW there are certain individuals and professional organizations that frown heavily on any psychotropic.

For residency and medical licensure? You’re fine unless you are obtaining without a prescription and get caught.

 

[OrthoTraumaMD]

God i feel like if more physicians took care of their mental health (via meds therapy or otherwise), the world would be a better place for doctors and patients. We all freak out when we see doctors smoking and are like “how can you do that when you know what it does?” ...and yet we ignore or accept grossly untreated depression, anxiety, etc in ourselves and our colleagues. So many of us die by suicide...even one is too much.


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[Mass Effect]

In the state that I work, you would have to disclose being on an SSRI to the medical board when you are getting your license. It would not prevent you from getting a license, but has to be reported. Regarding residency? Would not affect in the slightest as nobody would know.

Hopefully, a doctor in your state will sue the pants off the medical board for requiring any such thing.

 

[hallowmann]

You'll be fine for residency for sure (it'll never come up). You may have to disclose it to a medical board for licensing as described above, but its not something that would prevent you from getting a license. There's about a million docs out there in the US. I wouldn't be surprised if at least 25-30% were on an SSRI now, let alone ever in their lives.

Just because this drives me a little crazy--would you say the same thing about Synthroid? Metformin? Lisinopril? No? Then what makes an SSRI different? CBT might be able to help you and is certain worth a shot, but the attitude of being completely against a basic psych med is silly.

Completely agree. That said, stigma does exist, but it should be the last reason to not get treatment for a potentially life-threatening condition like depression.

 

[A Nonie Meus]

Just because this drives me a little crazy--would you say the same thing about Synthroid? Metformin? Lisinopril? No? Then what makes an SSRI different? CBT might be able to help you and is certain worth a shot, but the attitude of being completely against a basic psych med is silly.



No.



Probably, because the docs need to put in some sort of diagnosis in order to prescribe the medication. But your medical records are your medical records, and people aren't going to demand to see them--they just want to know if you have anything that will impair your ability to function.



No. Well, with the exception that if you don't get your depression treated properly and under control, the stress of residency will very likely make it worse. But the actual applying and getting a job part? No.

OP, I seriously doubt saying you have been treated for depression will cause much of a fuss. But, people should be aware of serious ongoing issues with medical licensing and what their state specifically asks. Medical boards are not created equal and many have on past occasions asked to see medical records if you answer yes to one their draconian questions regarding past mental health or substance abuse. Here’s a story of a doctor in MN:

Do Docs Deserve Mental Health Privacy?

More than half of states are not in compliance with the Americans with Disabilities Act in which they would only be able to ask about mental health issues and they’re CURRENT impact on functioning. Some states have really asinine questions altogether. Here’s an example of Pennsylvania’s on past substance abuse: “have you engaged in the intemperate use or abuse of alcohol or narcotics or other drugs or substances...?” Well, technically if you’ve ever been drunk and you answer no here, you have falsified your licensing application.

Other states are way worse (eg Texas). Some states lump questions about mental health in with questions about sexual deviance, drug trafficking and other crimes. The implication there is clear.

There are even stories of docs who have disclosed their mental health history, and have subsequently been forced to complete some sort of inpatient 90 day mental health evaluation or substance abuse treatment (even though they lacked a substance abuse history). North Carolina’s Physicians Health Program was actually under audit for allegations of being in cahoots with some of the facilities they were referring docs to. There are some horrific stories out there.

It’s no wonder physicians have the suicide rate we have, when we feel like we cannot even get treatment without jeopardizing our medical license.

Doctors fear mental health disclosure could jeopardize their licenses

Do US Medical Licensing Applications Treat Mental and Physical Illness Equivalently? - PubMed - NCBI

https://www.google.com/amp/s/mobile.reuters.com/article/amp/idUSKBN1CF2N9





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[Crayola227]

OP, I seriously doubt saying you have been treated for depression will cause much of a fuss. But, people should be aware of serious ongoing issues with medical licensing and what their state specifically asks. Medical boards are not created equal and many have on past occasions asked to see medical records if you answer yes to one their draconian questions regarding past mental health or substance abuse. Here’s a story of a doctor in MN:

Do Docs Deserve Mental Health Privacy?

More than half of states are not in compliance with the Americans with Disabilities Act in which they would only be able to ask about mental health issues and they’re CURRENT impact on functioning. Some states have really asinine questions altogether. Here’s an example of Pennsylvania’s on past substance abuse: “have you engaged in the intemperate use or abuse of alcohol or narcotics or other drugs or substances...?” Well, technically if you’ve ever been drunk and you answer no here, you have falsified your licensing application.

Other states are way worse (eg Texas). Some states lump questions about mental health in with questions about sexual deviance, drug trafficking and other crimes. The implication there is clear.

There are even stories of docs who have disclosed their mental health history, and have subsequently been forced to complete some sort of inpatient 90 day mental health evaluation or substance abuse treatment (even though they lacked a substance abuse history). North Carolina’s Physicians Health Program was actually under audit for allegations of being in cahoots with some of the facilities they were referring docs to. There are some horrific stories out there.

It’s no wonder physicians have the suicide rate we have, when we feel like we cannot even get treatment without jeopardizing our medical license.

Doctors fear mental health disclosure could jeopardize their licenses

Do US Medical Licensing Applications Treat Mental and Physical Illness Equivalently? - PubMed - NCBI

https://www.google.com/amp/s/mobile.reuters.com/article/amp/idUSKBN1CF2N9





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Thank you for the links.

This supports what I've always said - you need to get treatment, but you must consider how things will "look" and how to answer these forms.

 

[WiseOne]

Be aware that some of the SSRIs can show up as false positives on drug screens.

 

[mehc012]

Just because this drives me a little crazy--would you say the same thing about Synthroid? Metformin? Lisinopril? No? Then what makes an SSRI different? CBT might be able to help you and is certain worth a shot, but the attitude of being completely against a basic psych med is silly.

Yeah, actually. Becoming dependent on any of those things would bother me. I'm sure I'll hit a point in my life where I need a daily medication, but that will be a hard adjustment for me no matter what it is, and I will try every other possible route before considering it. Just as I've tried everything I can think of to avoid requiring an SSRI or consistent therapy in my life, and how I refuse to go to the doctor about what I'm 99% sure is a form of asthma (though I do keep inhalers around for the occasional times when it gets very uncomfortable). Just not a fan. When you add in the extra stigma associated with mental health diagnoses, I'm not sure why this is so surprising to people.

 

[MEN2C]

Try getting an aviation medical certificate if you are a pilot on an SSRI. Virtually impossible. FWIW there are certain individuals and professional organizations that frown heavily on any psychotropic.

It's crazy right? Like would you rather have pilots who are being treated for depression or pilots who aren't being treated for depression? You can't just will away depression. The only thing stuff like that does is makes sure people don't get help because it would jeopardize their careers...

Same thing with physicians. Some of the questions they ask on the licensing forms are absolutely ridiculous.

 

[WiseOne]

Pilots are allowed to be on SSRIs.

Guide for Aviation Medical Examiners

They do require documentation of being stable for 6+ months on the SSRI (fluoxetine, celexa, lexapro, sertraline are the only SSRIs permitted). Paroxetine most likely not allowed due to anticholinergic effects.

 

[Shigaliketoxin]

Try getting an aviation medical certificate if you are a pilot on an SSRI. Virtually impossible. FWIW there are certain individuals and professional organizations that frown heavily on any psychotropic.

For residency and medical licensure? You’re fine unless you are obtaining without a prescription and get caught.

Are SSRIs really psychotropic? Serious question, because I've never heard them referred to like that.

Also the anecdote about aviation may be interesting, but it doesn't add anything to the discussion. There are plenty of drugs professional athletes can't take that normal humans (GASP doctors are normal humans) can't take.