Not too long ago, a young man came into my office for the first time. We'll call him John. After taking a thorough medical history, I asked him what brought him in that day.
"Well I'm trying to figure out if I'm depressed," John said. "Do you have a measurement tool for that?"
We do, actually — in our office we use the PHQ 9 to diagnose and quantify the severity of depression. While the tool certainly has its flaws, it does allow us to track a patient's symptoms over time. I went through the questionnaire with him and he scored a 4-5 (it was difficult for him to answer the questions). The tool would consider this to be no depression or very mild depression. However, anytime somebody is not sure if they're depressed, I want to find out what is actually going on.
It turns out that John was a young medical student who had moved from another part of the country to attend medical school. He lived alone and worked long hours like most of us do. He had difficulty making new friendships in medical school and had no romantic life to speak of.
"I just don't feel like myself," he said. "I'm tired all the time and I feel lonely. I used to date and now I can't remember when was the last time I went on a date. All I really do is work, and I really never do anything for fun. I don't talk to my family much because I'm always working and they don't really understand what I'm going through anyway. I used to exercise regularly, but I don’t do that anymore either. I heard that like 50% of medical students are on antidepressants. I just have two questions. Do you think I need an SSRI, and does it ever get better?"
I told John that, while what he was experiencing was very common, it was important to make some interventions to ensure that things don't deteriorate.
"There's no pill for what you're going through. Looking to a pill to address very real causes of feeling down and alone is not what I recommend."
I gave him some reading material to go over, and also discussed some ideas of how he could socialize a bit more even with his busy schedule. I suggested he get at least a little bit of physical activity, even if it meant just walking for twenty minutes a couple times per week.
We discussed implementing some mindfulness practice as well as other forms of meditation, and made a follow-up appointment for one month later.
In the Medical World, Most of Us Have Been John
Does John sound familiar to you? Most of us have felt like him at some point in our training or careers. We're not necessarily severely depressed or suicidal, but there are warning signs that we need to do something to improve our situation. When you get to that point where you “don’t feel like yourself,” you are definitely going down a risky path.
Psychological distress is quite a bit different than physical distress. If you’re not sure if some part of your body hurts or not, you can at least be sure that the pain is not severe. However, when it comes to psychological distress, if you’re thinking that you might be depressed, then something is definitely already not quite right. While much has been said about the prevalence of burnout among physicians, and medical student depression, the question is: What about people who do not quite meet the criteria — people who are “subclinical,” if you will?
I think that John’s story represents the rule rather than the exception. At some point in our training, most of us will have a period where we feel like we are losing ourselves. For some of us, that feeling will last for years. Is it any wonder why some people go on to develop full-blown depression and even suicidality?
In my opinion, asking the question, “Does it ever get better?” is a red flag. It is a sure sign that you are very unhappy with the way things are, and it’s probably already time to take serious steps to remedy the situation. This may include seeking professional counseling or psychiatry, or it may simply mean seeking out a mentor to help guide you. Of course, if you are at the point where you are wondering if your life is even worth anything or you spend a significant amount of time hating your life, it is definitely time for professional help.