Do depressed doctors go to doctors? Do they even seek help? What do depressed doctors do when they’re not helping you? Doctors have affairs. They drink alcohol and smoke pot. They steal prescription medications. They binge-eat crap, scream, and exercise obsessively. Depressed doctors contemplate suicide. They hide their feelings to prevent being punished by licensing boards or mistreated by “Physician Health Programs.” Fact: depression is an occupational hazard in medicine. Chances are your own doctor may be depressed now.
Recently 220 physicians responded to my survey, “Have you ever been depressed as a physician?” Two hundred (90%) stated yes. Yet when asked what treatment they pursued only 33% chose professional help. Many just ignore their feelings or fall into self-destructive behaviors. In their own words, here’s what doctors disclosed to me (published with permission).
“Currently struggling immensely and realizing it is all due to the pressure of the assembly line I work in! Made worse by being made to feel like shit for standing up for what I believe in. It’s fascinating that wanting to care for patients, know them, love them, be thorough for them is viewed as incompetence! Anyway I digress. I abuse my son’s Adderall to try to be more efficient and survive on little sleep! Abuse 5 hour energy for the same reason! I self prescribe Cymbalta. I rescue too many pets trying to think that caring for them will help me. I drink to escape when I can on the weekends and I am not on call. I have tried an 8-week mindfulness based meditation class. Wow I could go on and on! Have to take my internal med board recert Monday and then make some major changes. Currently on an escalating path of self destruction. More than you wanted to know I am sure!!! Thanks for all you do! Trying to hang on! A few others I just feel like I need to confess to someone… Research how much of certain meds to kill myself, save up old Meds just in case, fantasize about getting a self-limited illness such as appendicitis so I can get some time away from the office to catch up … Sorry once started needed to get these off my chest as no one knows …I hide it so I am confessing to myself! Try to pretend like I am a good mom and a put together doctor! lol.” ~ Caroline
“I sought therapy while in med school….later on, meds and therapy. Honestly, I can’t remember how depressed I was in medical school and residency..let’s see…it’s such a blur!! I worked SO much, and was SO tired, (this was in the 1980s, and I am a woman) We were treated like dirt, male docs were always making sexual remarks, and making comments about us. Had an affair (he was married) with an ER doc when I was a 3rd or 4th year medical student (I guess that’s a form of therapy, yea, right)…. In residency, I worked such long hours….and despite being married (to another MD), I had another affair (again, treating depression??)…changed programs, got a divorce,….. Making me look back, it’s a wonder I made it!! Geez, such poor choices..was it youth or depression?? You are free to use this information…maybe it will help others. When depressed, we find lots of way to get through day to day…and they AIN’T ALL HEALTHY!” ~ Victoria
“I was told by the psychologist at my med school’s campus assistance program, that 75% of the class of 175 people were on anti-depressants. He wasn’t joking. How broken is the system, that doctors have to be pushed into illness in order to be trained to do their job? And then we wonder why so many of us get detached—detached from patients, family, but most importantly, ourselves. I am a psychiatrist. It is only through my personal work on myself that I have been able to stay in my own reality, observing compassion for myself, and then bring that compassion and reality to my patients. That’s what I should have been taught by my mentors in school. That’s what we all should have been taught. Because what is a doctor but the ultimate public servant? We are tasked with caring for others as a profession. How can we possibly achieve that when our own beginning in the work, is characterized by detachment, dissociation, and despair? I’m passionate about medical education. Whatever I can do to help, please do let me know.” ~ Jaya
“During residency took med prescribed by family doc. In practice took meds from sample closet (Celexa, Lexapro), self medicated with food, Binge eating disorder. I see my family doc now and a psychologist (self pay). I use Seasonal Affective Disorder as the reason for my med now and not depression although I am not afraid of medical boards anymore. I also see psychologist self pay so that it is not in my chart.” ~ Laura
“I experienced PTSD, complicated grief and am leaving medicine. I abused alcohol for awhile, sought help (am now alcohol free 2 months!) and have had a negative experience with a ‘healthcare professional’ treatment center AND the Physician Health Program. It is really sad how the other doctors in my group therapy and Caduceus meetings suffer at the hands of the PHP. Their stories break my heart. I am glad to be able to walk away and start fresh!” ~ Max
“I’ve tried everything including PHP self-referral (with the noose around my neck). Far and away the most destructive action was PHP referral.” ~ Tony
“About 18 months after graduating from residency and taking what I thought was my dream position as a new faculty member doing hospital medicine, I slipped into a suicidal depression and ended up doing ECT as a last resort. I thought that was the worst things would ever get, but when I found out I my husband was having an affair while I was working my ass off doing 80-hour weeks of call and hospital medicine, I was caught completely off guard and made a horrible, horrible decision to quit trying. I overdosed on a combination of Tylenol, Clonazepam and a bottle of wine. I was taken to the hospital where I work, and someone decided to call my CMO, who got the PHP involved. From there, I lost all my pride, almost lost my license, have had to continuously hang my head in shame every time I apply for a license, privileges, participation with an insurance plan and disclose my ‘dirty little secret.’ Oh, and I paid them over $7000 of hush money. All so they could call me once a month to ensure that I was doing all the things I would have been doing anyway: seeing my psychiatrist, my therapist, my couples therapist, etc. Geez, Pam. That just turned into a PHP rant. Sorry, I’ve just been doing licensure applications for a new state and new job interviews, and it’s bringing a bunch of anger up. We’re moving to California when my youngest graduates from college, and it’s turning my job search into a huge trigger-y mess! I ran into an article the other day about PHP and physician suicide the other day, and you were mentioned, so I’ve actually had you on my mind. I’ve thought long and hard about trying to write a book about my experience with the PHP, but I’m still not sure I have the distance and detachment I need from it to do it. I think it’s important that people understand what a scam this is, but maybe it’s a retirement project?” ~ Carmen
“I have had serious depression since med school. I self medicated and abused alcohol for a lot of years until I figured that out. I have self prescribed antidepressants and also have psychiatrist and therapist. I try to follow the psychiatrists instructions but at times I will crash and they are not available so I try something myself and then tell them what I did at the next visit. I can’t go 3 months not being able to function well waiting for an appointment.” ~ Patrick
“I have eaten, exercised, quit, thrown hay bales, thrown my pager, yelled, done counseling, seen psychiatrists, been hospitalized having detailed suicide plan down to supplies and practice, committed to not dying by suicide, played saxophone, gone to more counseling, meditated, cooked, eaten, drank Diet Coke, drank alcohol despite a strong family history of alcoholism and a general terror of alcohol consumption, drank Coke, and finally trying to learn how to love myself again…which is pretty tough when you have been told you’re worthless by the world including the people you respect most (physicians) for 45 years. Oh, I have self prescribed but only when I didn’t have time to see my provider, which is to say my FP NP, FP MD or Psych MD depending on the year although honestly an FP NP will do pretty much whatever her physician patient requests so I’m not sure that’s any different than self prescribing. I do have some ‘illegal’ Xanax for crisis situations that were prescribed to my daughter. Oh, and I did overdose once on Ativan without suicidal intention but with a ‘I need to be unconscious for a while intention’ but that was prescribed to me… thus the illegal Xanax because physicians pretty much don’t trust me with benzodiazepines now because I might overdose although metoprolol is in my prescribed list, like that makes any sense. It’s pretty hard to die by Benzo overdose.” ~ Ellen
“Isn’t depression part of being a physician? It starts in medical school when you have to learn how to study all over again, because the old ways you studied to get A’s as an undergrad don’t work anymore. You are made to feel small at every turn. It continues through your board exams (constantly feeling you failed, even if you didn’t), and well into your residency, when you quickly discover you don’t know anything and are often reminded of that fact by less-than-sensitive attending physicians. You learn quickly to hide your feelings, because being a doctor, by its very nature, implies tremendous self-sacrifice. It implies putting your own needs on the back burner for many years in pursuit of medical knowledge. This, in itself, is rather depressing, don’t you think? But legitimate clinical depression can creep in too. And often does. During my internship, I found out that at least 75% of my fellow residents were on SSRIs or other antidepressants, just ‘to get through it,’ because it was so horrible. Depression, or a constantly depressed state, is more or less the norm in medical school and throughout one’s residency. It’s truly a wonder that more doctors don’t die by suicide as they go through this lengthy, rigorous, and often heartless process. Well, the height of my depression occurred after medical school and after my residency when I was working primary care. I decided the only way to preserve my own mental health was to get out, which I did. I quit my job. And I quit a subsequent job as well. You have to take control of your own situation as a physician, because in the world of corporate medicine today, they will literally work you to death. There is little or no consideration for the feelings or the health of physicians, many of whom have to work when they are sick themselves—or face criticism or retribution. It is a truly heartless system where the only thing that matters is making money. But the money is not being made by the physicians, at least not the primary care physicians (maybe the cardiologists, orthopedic surgeons, radiologists, and neurosurgeons). The money is being made largely by the business people, the managed care and pharmaceutical industry executives and other third-party players. And if you’re a woman working in medicine today, you have yet another reason to be depressed—sexism in medicine. Women consistently earn less than men in medicine, and also have more trouble advancing professionally compared to men.” ~ Joel
“I was depressed clinically. I saw my family doctor and tried some antidepressants. They were not that helpful. I did not seek specialist care until I had been sick for a long time. Treated myself with ethanol, 2 to 6 ounces per day. Crashed. Hospital thought the best way to deal with this was to fire me.” ~ Ron
“Pamela, Yes I’ve been depressed as a doctor—ever since my postpartum depression as a third year med student. First, I did nothing and withdrew from friends, family, and interests. I’ve had moments of what I’d call my best Facebook self and became a strict bedtime adhering good diet eating runner/gym goer for a spell (and looked damn good in a pair of jeans) until I could see that plan didn’t help me feel like I stole my life back from the gaping mouth of medicine. I self prescribed antidepressants and even bought them through a drug wholesaler to hide my shame of my illness for fear no one would trust the judgment of a depressed doctor. I sought help from primary care docs, psychiatrists, psychologists and several therapists and life/ career coaches and I can never seem to be “ok” with depression. It’s hard to sort out. I’ve never been fired or dismissed from work. I’ve never been out for long periods because of it and I’ve never been hospitalized or suicidal. Like a functional drunk, I’m functionally depressed. I have good days and good weeks and I also have horrible mind numbing days that all run together for months on end and I look back and cannot fathom how I was surviving not to mention caring for others. I’ve been cynical , angry, optimistic, aggressive, passive and passive aggressive. I had periods where I drank everyday and even considered drinking before work but never did. I’ve numbed my mind with pot in Colorado and Seattle. I’ve had affairs and even fucked a guy in my office while on call. True story. So yeah. I’ve spent a life and a career trying to simultaneously handle and avoid this ever present shadow of depression. Which might I add I never experienced prior to med school.” ~ Laurel
“During my fellowship training I was treated for depression/OCD because of the extremely difficult work environment there. I was illegally terminated from said fellowship (per EEOC Decision), and have had periods of homelessness and unemployment and underemployment since then. The past five years have been even more trying than my four years of medical school. My journey through medicine has taken so much from me in every way.” ~ Sara
“[To treat my depression] I quit what I had always hoped would be my ‘forever job,’ where I would work until I retired for my small town critical access hospital. After years of boorish mistreatment, and watching them fire a 20-year veteran of the local medical community, I realized that I had to take control. I quit, and am, unfortunately, in the middle of legal action against the administration, as they couldn’t even let me resign in peace. If I could walk away without further financial insult, I would have washed my hands of it. In addition to the MD they fired, they had 3 MDs (including me) and a PA resign in a three month period. I will admit, though, that I was trying to figure out a ‘way out’ that would have gotten my family my life insurance, until I realized that I was in control and walking away jobless with my family intact was better than my family without me. Reading your blog helped immensely in that aspect.” ~ Michelle
“For years I tried to heal myself while employing the common coping mechanisms of intellectuals (workaholism, intellectualizing, OCD behaviors, obsessive exercising, etc.) in addition to repeating self-destructive patterns in relationships. Then I finally waved the white flag: My healing & recovery has included: Individual professional & church-based counseling, Christ-centered support groups, persistent personal prayer & dedicated Bible study, exploration of generational roots of my issues, and creative writing in the forms of journaling, poetry & prose (including memoir and a future book).” ~ Nadine
“I am thoroughly disgusted and somewhat depressed, as a direct result of my experiences in medicine. Thank God for sobriety and having some tools in the toolbox of life. I have realized recently that the environment of practicing medicine with corporate contamination and yes..bullying, is really the only truly dark spot in my life. I am allowing it to rob joy from a sober, happy, and otherwise pretty healthy life. For that, I am responsible. I am actively in the initial stages of planning my exit to something similar to what you promote. The only snippets of joy found in a typical workday are the times when I say to hell with metrics, throughput time, and the high pressure move ‘em in, move ‘em out mentality, and sit with a patient that truly needs me. These folks are often the ones that are terminal, dying, or the ones that have been shunted through the assembly-line system like cattle with little or no true explanation of what is happening and what their choices are. I have deep gratitude for these folks allowing me to work together with them. I feel blessed, even in the sad instances because I am doing what I was trained to do, what I am good at, and what satisfies the soul. It goes against the grain of corporate medicine on every level. I hate my job with exception of those few moments I can carve out with a few patients.” ~ Rick
“Yes, I have been depressed. To tell u the truth seeking professional help is taboo… ur looked upon as weak so I try my best to deal with it myself. I’m considering quitting.”. ~ Robin
“I’ve had 25 years therapy (psychoanalysis), brief trial self dispensed Bupropion and Fluoxetine (not much benefit but the Wellbutrin helped me fight my way through a deposition). Overeating and wishing it all would end. Never went to a physician for help always afraid of being judged and excluded or reported in some way even though I was able to carry on my duties. Always sought treatment from non-physician providers and always paid out of pocket. Being in psychiatry made it ok to be in psychoanalysis back in the day. Thank you for all you do you are a life saver.” ~ Denise
“I have been actively suicidal over the past 7 years more times than I can count. In a strange way it has become one of the few comforting constant areas / states where I feel I exert some degree of control and autonomy. What I think I experience when it comes to my profession goes beyond ‘Clinical Depression.’ It’s the depletion of one’s humanity. What I see from the mirror staring back as I cross into my 40’s is many times unrecognizable to me.” ~ Mike
“I tried to do the work-life balancing thing, making sure to do fun stuff on my off days so that I could unwind. Most of the time, since I have limited free time, all I did was to eat out, which led to it being self-destructive. I also talk to close friends at times about how things are going, but, most of the time they can’t really relate or most of the time our free times don’t match. I’m usually free after lunch when I get out after a 28-hour shift, while my friend is in the middle of her workday. I’m usually asleep when she gets off work and so we don’t get to talk much. Eating out too much made me continue to gain weight and I totally have lost self-control. My mind, when tired, wants to eat even though my body is just begging for good quality sleep. I don’t know why, but I feel that I was just wasting time sleeping when I should be doing something else. However, I usually end up binge eating because my mind is too tired to think of other things to do than eating and sleeping. The cycle goes on and on up to this day. I’m really frustrated at myself for this bad habit.” ~ Abigail
“After years of bullying, I gained weight, cried, lost relationships, friends, isolated myself—changed jobs—I was depressed and feel like it cost me years of life and joy. Thought about dying. Still have PTSD—despite enjoying the roll of medicine, I am exhausted by the demands and the perceived professional competition, the back stabbing. It’s better now that Im older. Still Everyday is count down to retirement—a long marathon—paying back thousands of med school bills and knowing I can’t get the time back nor can I quit as I am captive by bills.” ~ Lydia
“Medical school into residency, I ignored [my depression] for awhile, started on small dose SSRI from my family doctor, intermittently thinking about driving my car off the interstate on the way home from work, more psych appointments, more meds, feeling better through med school graduation, intern year had ups and downs, venting via text to high school friend (also with depression) on the shitty days, so far I’ve had fewer depressive times as a second year resident.” ~ Jennifer
“For self-care when I start to feel myself slipping I pick 3-4 of the things on my Rose Anti-depression Plan 1) Go to bed by 11:00 every night. 2) Begin each day with 15 minutes of stretching along to worship music. 3) Exercise 150 minutes per week or 20 minutes per day. 4) Eat 18 servings of vegetables per week. 5) Keep sweets to a minimum. 6) Use the sun lamp 15-30 minutes per day. 7) Keep gratitude journal. 8) Have regular devotional time. 9) Have friends over for meals. 10) Engage in art/music (quilt, drawing, watercolor, guitar, etc.) 11) Finish tasks and minimize distractions/interruptions. 12) Read books. 13) Spend quality time with family. 14) Consider other ways to simplify life. 15) Consider counseling. 16) Consider medication. ~ Rose
After collecting all these stories, I’ve had some revelations about my own responses as a depressed doctor. So I’ll add my story to the mix.
“First year of med school was by far the worst year of my life. I cried constantly. Cried myself to sleep most nights (one morning my eyes were actually sealed shut from crying!). Called my physician parents for help. Not helpful. Mom (a psychiatrist) mailed me antidepressants (Trazadone). Didn’t help. I kept crying. I stopped eating sugar. I made it through med school on NO caffeine! I became a strict vegan (then would sneak to the store at midnight to eat string cheese). Like Caroline, I rescued ‘too many pets trying to think that caring for them will help me.’ Had an apartment full of strays. Quit med school. Then realized I had no money to leave (and my tuition was paid) so my anatomy partner convinced me to stay and ‘to keep taking tests and see what happens.’ I graduated. He died by suicide. Had sex with my best friend in med school’s boyfriend! Years later, he died by suicide. After his funeral, I apologized (for both of us). She understood. Threw myself into my patients’ pain to distract myself (note: I was always at my best with patients) yet ended up suicidal due to complete disgust with assembly-line medicine. I prayed, journaled, meditated, went to random psychics on the side of the road, energy healers, shamans, massage therapists, and all kinds of counselors. Rare binge-eating then attended Overeater’s Anonymous (even though I’m not an overeater). Slept A LOT. My mom gave me Prozac. Didn’t help. I never saw a psychiatrist because I figured the profession that wounded me wouldn’t be able to fix me. I never drank alcohol (yuck!) or treated my depression with illicit drugs. Instead, I did lots of art projects around the house. A mosaic mural covering every square inch of my bathroom that took nine months. Intricate 3D stained glass in doors and windows. Obsessive knitting. Creative writing. Got divorced after my husband had an affair. Had to sell the house with all my art. Quit a ton of assembly-line jobs until I FINALLY had the courage to open my own ideal clinic in 2005. Since then I’m no longer depressed!!!! Go figure . . .” ~ Pamela
Bottom line for me is occupationally-induced depression and suicidal thoughts can not be cured by staying in a crappy job while doing a beautiful bathroom mosaic, rescuing stray animals, having affairs, obsessively knitting, or numbing the pain with Trazadone or Prozac. These are COPING mechanisms for a dehumanizing medical education and terrible working conditions. There is nothing intrinsically wrong with me. My depression resolved when I extricated myself from assembly-line medicine and became the doctor I had always dreamed of. (Incidentally, I’ve spent more in various therapies to recover from the trauma of my medical education than I did on med school tuition!)
Have you been depressed? What did you do? Leave your (anonymous) comment below.
VIEW FILM TRAILER Do No Harm (on doc depression/suicide)
Pamela Wible, M.D., is author of Physician Suicide Letters—Answered. View her TEDMED Why doctors kill themselves and feel free to contact Dr. Wible here.