When the black dog bites

Authors: Catriona Roberts

Publication date: 14 Nov 2012

Doctors may find it difficult to recognise their own depression amid work stress, as Catriona Roberts found out

Depression is a growing problem worldwide. The disorder is responsible for the highest burden of disease in middle and high income countries and is expected to overtake heart disease as the biggest health problem worldwide by 2030.[1] In Britain around one in 10 adults has depression at any one time.[2] [3]

Depression, as well as many other mental health problems, is likewise common among doctors. The medical profession has one of the highest rates of depression, with women being particularly vulnerable.[4] However, many doctors don’t feel able to talk about mental illness to their colleagues.

Experiencing depression as a doctor

I started developing symptoms of depression after a concussion sustained while I was playing sport during year 1 of foundation training. I struggled to get to sleep, only to wake an hour later and every hour after that.

In the morning I felt as if I had an awful hangover; I cried at the prospect of trying to get through yet another day. However, as soon as I saw my colleagues at work I pulled myself together and smiled as if all was fine. I did the same at home, sobbing under my duvet when I went to bed so that no one would know. I didn’t want to burden anyone else with my problems.

But I couldn’t hide my depression from my family, who told me, “You need to rest; try to slow down.” But I couldn’t—there was simply no time to stop and think.

Then one day a colleague who was stressed herself made a snappy remark. I left the ward, locked myself in the toilet, and sat crying until one of my friends came and took me home.

Tackling the problem

I finally realised that this was more than stress, and I gave up trying to hold it all in. I didn’t feel that I was safe working. It was then that I plucked up the courage to knock on the door of the head of education.

“You are like a car stuck in the mud,” he said. “You are spinning your wheels.” I was trying so hard to keep going and “cope.” I was whisked off to see occupational health, who signed me off for the next week with stress.

My depression didn’t get better, though; if anything, it got much worse. At night I had disturbing nightmares and woke up sobbing. I felt so low, worthless, and hopeless. I just tried to make it through each day. I couldn’t even comprehend the future. It was terrifying.

Four weeks later I saw a psychiatrist, who diagnosed severe depression. Unfortunately, I had side effects from the medication and became suicidal. Being depressed actually hurt, and I wanted it to be over; the only thing stopping me was the thought of my family and friends.

Finally, after several months I found a drug treatment that agreed with me. Slowly the dose was increased, and, with invaluable support from a psychotherapist, my symptoms began to improve.

More than a year on my energy has started to come back, and finally I can see some way forwards.

Returning to work

When I went back to work part time, I had some difficult experiences with colleagues. One nurse asked loudly when I arrived at work, “Have you had a nice lie in?” I also had a few difficulties with fellow doctors, who sometimes seemed frustrated that I was working fewer hours when they were run off their feet.

Doctors are not good at coming forward if they have a problem and might not be accepting of colleagues who may be struggling. As doctors it’s almost as though we are expected to be invincible, work hard, and not complain. It is our patients who are ill, not the doctors looking after them.

Don’t get me wrong: my bad experiences when I returned to work were infrequent, but they really didn’t help. Wouldn’t you expect our profession to be the most understanding in these situations?

More support is needed

The modern NHS puts many stressors on doctors. A constant bombardment of information means that there is no time to stop. I believe that I if had properly paused and reflected, then I might have sought help for my depression earlier.

I wish that someone had been honest with me when I started work as a doctor and told me that it’s fine to “not cope”; it doesn’t mean that you are a failure. We’re like ducks on a pond: we all look fine on the surface but below are frantically paddling. I also wish that I had known that the hospital had a counselling service specifically set up to help struggling employees.

Those colleagues who were supportive throughout my illness made the world of difference, and for this I will be eternally grateful. I know I’m not the first doctor to have depression, and I’ll definitely not be the last. We must look after each other, as well as ourselves, so that we can best look after our patients.

Resources

Online

BMA counselling service for doctors—tel 08459 200169; www.bma.org.uk/doctorsfordoctors (BMA members only)
Support 4 Doctors—www.support4doctors.org
Samaritans, 24 hour free support line—0845 790 9090; www.samaritans.org/
Mind (mental health charity)—www.mind.org.uk/help/diagnoses_and_conditions/depression
Doctors Support Network—www.dsn.org.uk/
Depression Alliance—www.depressionalliance.org/
Living Life to the Full: free self help psychotherapy modules—www.llttf.com/

Books

Cantopher T. Depressive Illness: The Curse of the Strong. Sheldon Press, 2012
Harris R. The Confidence Gap. Robinson Publishing, 2011
Williams M, Penman D. Mindfullness:A Practical Guide to Finding Peace in a Frantic World. CD guided meditation. Piatkus, 2011.

Thanks to those who helped me through dark times—I wouldn’t have made it without you.

Competing interests: None declared.