I had my first depressive episode when I was 19, during second year at medical school. First year had gone well, I had moved into a flat with very good friends at the start of second year, I had a lovely boyfriend and life should have been good. I remember feeling anxious most of the time, waking up at 4am and not getting back to sleep, difficulty concentrating in lectures and being irritable with my flatmates and boyfriend. I developed symptoms of IBS and became almost convinced that I had bowel cancer and would be dead within six months; despite this I didn’t see a doctor about it and am still not sure if this was because I was too scared or because part of me knew that it was not rational.
I had heard other students talking about depression and wondered if I may have it, but discounted this because one friend had said that depression was, “when you haven’t had a good day in two weeks,” and I did have some good days. I assumed that it was normal for medical students to be anxious and that feeling miserable was understandable as life is difficult.
After about seven months my mood started to improve although I think I only had short spells of being completely well over the next few years. In third year I learned more about depression from psychiatry lectures and realised that this was what had been wrong the previous year but because I had become so used to feeling low I decided that I had mild depression and didn’t need to do much about it. Looking back I definitely fitted the criteria for moderate to severe depression. Despite being aware that my low mood due to an illness I minimised my symptoms and although I would have encouraged anyone else in my situation to get help I thought I shouldn’t take up other people’s time and, “just got on with it.”
I first asked for help when I was an FY2, aged 25. I was working in A+E at the time. I enjoyed the job but I think the frequent night shifts and the stress of applying for specialty training caused me to become unwell. I was more depressed than I had ever been previously; the anxiety was replaced by a feeling of detachment and emptiness and my concentration was so poor that I struggled to do simple tasks at work. I was sent home one day by colleagues who told me I had to see a doctor about my mental health. They had been worried by my slow thinking, to the point where they checked my blood glucose as they thought I was physically unwell and confused. They didn’t realise that earlier in the shift I had been planning to take an overdose of insulin and had got as far as getting the drug cupboard keys from one of the nurses, but didn’t do so as I couldn’t collect my thoughts enough to work out how I would find a place where I wouldn’t be disturbed. Later that day I went to my GP, who was very kind to me and prescribed an SSRI.
My mood improved surprisingly quickly when I started the medication. I got back to work after a few weeks although I think that was too quick; I spent much of the first week back wishing I was at home in bed. I did start enjoying work again and my colleagues were very supportive. A couple of months later I found I was becoming very irritable and friends said I was overtalkative and hyperactive. My GP referred me to a psychiatrist as she thought I was hypomanic but I had calmed down by the time I was seen and he recommended that I stay on the SSRI.
Over the next three years my mood fluctuated, tending to be low in the autumn and winter although I remember some short depressive episodes over the summer months. I also had periods of feeling low but being irritable to the point of shouting at people at work, swearing a lot (not usual for me), spending excessive amounts of money on eBay and driving erratically. Somehow I managed to stay calm and cheerful most of the time at work especially when talking to patients. I was referred back to psychiatry by my GP and was diagnosed with bipolar 2 three years ago when I was 28.
I’ve been much better on mood stabilisers and in the past few months seem to have found a combination that works well for me. I’m also having psychotherapy, which has helped me to find strategies that I can use to deal with mood changes as well as looking at how my childhood experiences have influenced how I feel and behave which has allowed me to become more accepting of myself.
I regret not getting help much earlier. Although I managed to get through medical school, passing exams and enjoying clinical attachments to some extent, I would have enjoyed my days as a medical student much more if I’d understood what was wrong and had some treatment. I really enjoy my job now. I haven’t needed a lot of time off over the years and haven’t had to extend my training programme so far. My colleagues have been very supportive although I know this is not the case for everyone, even in medicine where we should all know better. I am happy to talk about my illness at work and that usually makes it easier for colleagues to let me know if they are worried about me or think that I am too unwell to be at work. I had a depressive/mixed episode towards the end of last year but as I had such good support I managed to stay at work with some changes to my working pattern. I do worry about the future, particularly what would happen if I became too unwell to work or if my health problems affected patient care. These things haven’t happened so far though. Work is going well and I’ll be looking for a consultant post in a couple of years. I’m also happily married (to the aforementioned lovely boyfriend) and have a child. Life is good.