This Doctor Can: When depression strikes

Following his own experience of mental illness, Dr Rob Wright speaks directly to those who might be going through the same thing.

You have probably felt like this before but this time it is lasting longer, as if there is no end in sight. Everyday life feels hard work, like walking through mud, and thinking is slowed down. Making decisions can be impossibly difficult and overcoming inertia a constant battle. Your confidence in your ability to work well has been replaced by crippling self-doubt. Repeatedly questioning your own actions and decisions, anxiety that you may be missing things verging on hypervigilance.

When you went to bed it felt like your mood might be lightening, at 4am the bleakness has returned and you are ruminating on the same problems that you never find a solution to.

At work you are desperately trying to maintain the façade that all is well, but everything is starting to become a struggle and you are exhausted. At home you want to switch off and sleep, you are not interacting with family and friends, feeling you have little positive to contribute. You may find yourself overwhelmed by a sense of hopelessness, worthlessness, feeling that you have let everyone down, and tears start to well in your eyes.

Remember:

  • This will pass.
  • You will regain your normal self
  • You are not the only one who feels like this
  • This is a state from which you can completely recover
  • There is no shame in seeking help
  • It helps to talk.

You have thought about your own death. It might seem that it provides an answer to insoluble problems. Fix the thought as firmly as you can in your consciousness that your death is not an answer and for your loved ones would be a catastrophe.

You need to talk to someone.

It is not easy to say “I suffered an episode of depression” in the same tone that one would use for a physical illness. And it should be, which is why I am writing this.

Dr Robert Wright, RCP censor

My story

Last year I went through a prolonged period of low mood. I am fortunate to work with very supportive colleagues and we have a strong team approach to work. But I had had a difficult experience with another part of the organisation which left me feeling betrayed and humiliated. At the same time a close family member was seriously unwell. I was under a significant amount of stress and shared this with my clinical director and close colleagues.

The drop in my mood became more severe and was associated with poor sleep, marked diurnal variation, loss of enjoyment, and on some days my cognition felt slow. If I had a morning clinic, I would dictate in the late afternoon so that I could review my decisions. I made an appointment to see my GP but cancelled it because we had our summer holiday coming up. I persuaded myself that the holiday might fix things.

But things did not improve — poor sleep, daytime somnolence, loss of appetite, loss of enjoyment. When I returned to work, I felt stressed and uncomfortable. After 3 days, I decided that I was no longer sure I could rely on my judgement and called in sick. I made appointments to see my GP and Occupational Health. It was definitely the right thing to leave the workplace and it relieved the pressure of daily self-review.

My GP was very good at looking after a medical colleague and made helpful suggestions. My occupational health physician was very understanding and at no time did I feel criticised. They arranged counselling (this took about 6 weeks for an appointment) and suggested the BMA helpline, which I had been unaware of. I arranged to see a clinical psychologist privately and gradually things fell back into place.

After about 10 weeks I felt ready to return to work, which was done in a phased fashion, and I did not resume on-call duties for 6 weeks. I was feeling well, and it was a marvellous experience to be welcomed back by so many colleagues. I was mentored, but did not feel that I had lost any skills and even the return to out-of-hours activity was bearable.

Although I did not feel stigmatised by colleagues who knew, it is not easy to say “I suffered an episode of depression” in the same tone that one would use for a physical illness. And it should be, which is why I am writing this.

Taking steps to recovery

It feels impossibly difficult to talk about how you are feeling. But this is the most important step in making you better. You may find it easiest to talk to a family member or a friend, or your GP, a colleague at work, your educational or clinical supervisor, your occupational health department, a psychologist or a counsellor. Early last year I accessed counselling over the telephone (BMA) which was very helpful. For me, it was important to meet a therapist outside of my organisation and being referred to a clinical psychologist was particularly helpful. As part of the RCP initiative “It’s good to talk”, we have highlighted the many different organisations who are looking to help you.

Summon the courage to make the admission that you are asking for help. Remember this is not just for you, it’s also for everyone who cares about you and for everyone you care about and care for.

Things I have learned:

  • You are stronger by recognising and acknowledging how you feel.
  • You are being kinder to your family, friends, colleagues and patients by doing this.
  • It is better to seek help sooner.
  • If you feel your cognition is impaired, you have a duty to seek help and should discuss this with your line manager for the protection of yourself and your patients.
  • Rumination does not work – although you are a problem solver, some of what you are feeling is not amenable to logic, and you are not failing because you cannot work out an answer.
  • There are more people out there who want to help you than you can imagine but none more than your loved ones and friends.
  • But not everyone you meet will help.
  • Antidepressants are not ‘magic happy pills’ but can make a big difference.
  • Learn about mindfulness and embrace it.
  • Attending occupational health is not a punishment.
  • You need to work on keeping well.

Do things that you enjoy even when you don’t feel like it:

  • Be with family and friends.
  • Stick with your hobbies and interests.
  • Exercise regularly.
  • See daylight.
  • Eat well.
  • Take great care with alcohol or other ‘crutches’.
  • Create something.
  • Complete even the smallest task, congratulate yourself and plan the next one.

Give yourself a chance — the first step is always the most difficult.

Dr Rob Wright is currently working with the RCP to create a resource for physicians in need of mental health support.

Would you like to share your experience of becoming a doctor? Get in touch on Twitter via @thisdoctorcan.