A sadness that doesn’t go away. Activities devoid of pleasure. Persisting fatigue even when you get sleep.
Thoughts that things are hopeless or that you’re helpless to deal with life. Starting to slip up on your work or turn in projects late. There are a few of the symptoms residents have described to RWBC when they sought help for suspected depression.
These residents were linked to confidential help and their depression improved. If you suspect you may have depression, you are not alone. Rates of depression are higher in medical students and residents than in the general population with upwards of 30% of residents reporting depression compared to 12-19% lifetime occurrence for the general population. Occurrence of depression among residents in Marshfield appears to match that noted in other residency programs. A 2008 survey of our residents (N=52), using the Beck Depression Inventory, found that 26% scored in the moderately depressed range and 3% in the severely depressed range (M. Gaulke, July 2008 personal communication).
Depression is important to address
Depression can interfere in your life in many ways, affecting your relationships with loved ones, impairing your training, impacting your manner with patients and misleading you into doubting your abilities and choice to be a physician. Left untreated, depression is more likely to recur, more likely to disrupt your career, more likely to affect how you counsel your patients on their own mood concerns and may lead to thoughts of suicide. AMA, ACGME, Marshfield Clinic and Marshfield Medical Center recognize that physicians are human and do experience depression. These organizations recognize depression as a treatable medical condition, not a sign of weakness or grounds for removal from residency. RWBC was created in part to encourage and facilitate residents to obtain consultation early with their concerns for depression. Please contact us for a confidential consultation on your concerns.
Below is a link to a self-test for depressive symptoms. This is meant to help you learn the manifestations of depression. This is not for diagnostic purposes. Please do not use this tool to treat yourself. Remember, self or peer prescribing is expressly prohibited and may lead to termination from training as well as legal repercussions. Please come talk with RWBC, a friend, your mentor or others and get help, don’t treat yourself.
Ways to address depression. Here are some basic guidelines:
- Learn about depression. Check reputable links for information such as the
National Institute for Mental Health.
- Talk with trusted people about your concerns. Family, friends, your mentor, program director, RWBC or ERC. No matter who you contact, just do it, don’t keep it secret.
- Have a primary care physician with whom you can share your concerns. This person will be an invaluable resource for you as you deal with your depression.
- Engage in self-care activities. Rest, exercise, get good nutrition, moderate caffeine and limited alcohol use. Check some of the suggestions found under Burnout on the RWBC website for additional suggestions.
- Seek consultation and treatment.
- Use Web-based resources to build resilience
Depression is effectively treated and does not need to interfere in your life and your success in residency. Please talk with us or someone about your concerns.
Physicians are at higher risk for suicidal behavior. On average, the United States loses the equivalent of at least one entire medical school class each year to suicide. If you are having such thoughts this is not because there is something wrong with you as a person. It is not because you don’t have what it takes to complete residency and be a good physician. Please read the information below and let someone know the distress and the thoughts you are having.
There are multiple pathways to thinking about suicide and one of the most frequent is correlated to depression. Unremitting depression is a major risk factor for developing suicidal thoughts and eventually acting on them. Many theories describe the emergence of suicidal thinking. According to one explanation, cognitive narrowing, a person becomes increasingly focused on the distressing situations, emotions and thoughts they are experiencing. The person begins to view “for now” situations, emotions and thoughts as “forever.” The person becomes unable to notice the positives in their life and the caring relationships in their support system. As a result, suicide creeps into the person’s thinking, appearing to be a logical choice for dealing with the person’s faulty assessment of their situation. Physicians as a group are at
higher risk for suicide and we speculate that this may be related to the confidence physicians develop in their own thinking and problem-solving through their training so that when they conclude, through distortions of cognitive narrowing, that suicide is a logical option they become more at risk for acting on it rather than asking for help.
IF YOU ARE HAVING THOUGHTS OF SUICIDE
Tell someone now.
Let others help you get to the help you need to get through this safely.
During the weekday contact the Department of Psychiatry and Behavioral Health at the Marshfield Clinic (387-5744) and ask to talk with the triage clinician due to concern for suicidal thinking.
After hours contact the on call clinician through the Department of Psychiatry and Behavioral Health at the Marshfield Clinic via the clinic switchboard (387-5511)
Any time: tell a friend, program director, program coordinator, page a RWBC member, call your clergy person, crisis line. Keep trying until to reach someone.
Do not isolate at home. Seek others out and ask to spend time with them, spend the night at a friend’s home and explain why.
Have a friend take your medications, firearms, sharp instruments (knives, razors, etc.) and keep them for you temporarily.
Alcohol use greatly increases the risk for suicidal thinking and behavior. Remove it from your home for now. Ease of medication access greatly increases risk for suicidal behavior. Give your supplies to a trusted person to hold for you.
Please, let us help you through this difficult time.
The National Academy of Medicine (in the spring of 2018) constructed a Knowledge Hub on Clinician Wellbeing. It is comprehensive in scope and well organized to help you quickly find tools and resources related to wellbeing and burnout. ACGME identifies the NAM Knowledge Hub as the go to national resource for medical education on this topic and we encourage you to explore it. http://nam.edu/clinicianwellbeing/about/
MedlinePlus Depression Information