Residents and Depression- needing some input!

Hello- new to the boards, so be kind.

My husband, PGY-2 in Emergency Medicine, is experiencing some difficulties. Our situation is unique in some ways, but that withstanding, we need some advice.

He knows now that alot of his dissatisfaction is actually with emergency medicine. His father is an ER doc and it really is a natural fit for my husbands personality. But, he has decided to switch specialties and is currently being recruited by an internal medicine program in our hometown.

Now- the problem. His depression is out of hand. I can't even make him smile.

He hates what he is doing, dreads going to work (especially nights) and is having a lot of trouble "taking it one day at a time".

I need to know if others have experienced this and what you might do to help.

Thanks for listening to my gripe.

Annie

[Cumberland]

Welcome to the boards. We are generally a kind bunch around here. My husband is an intern in Ob and really hating life right now. I dont think he is clinically depressed- more having issues adjusting to the demands of residency.

I would think though that depression is a very common issue. A resident has virtually no life outside of the hospital, and it can seem like there is no end in sight. Is there an employee assistance program ( or whatever they call it) that you guys can go to together?

This is a great place to vent as well as get great advice. Please keep us posted.

[Phoebe]

Hi Annie- I just posted a message for you in the Intro section. My husband suffers from depression too. The stress of medical training, small children and irregular sleep patterns doesn't help his cause. My husband often attributes his dissatisfaction or unhappiness to situational issues (like residency and fellowship and now his job) when indeed the problem is internal. I have found it hard to cope especially when he gets in "slumps" and becomes hopeless about things he can't control. I don't know if it is like this for your husband, but my husband doesn't like to think he needs help to deal with his problems so most often I just have to wait for his bouts of depression to pass. I have tried the supportive approach and the "get your butt off the couch" reaction. For my husband, exercise is an important stress relief so if I can get him to the gym, he will usually bounce back in a couple days. I know it is hard on you seeing your husband down and not being able to help him. Do you have anyone you can talk too? A support system has been key for me. Will he have time off for the holidays? Maybe getting out-of-town would help.

Jennifer



Jennifer

hi annie-

i can't speak from the perspective of having a spouse who is depressed, but i can speak from the perspective of being clinically depressed while my husband was in residency. i, too, was very resistent to seeking any treatment because i am trained as a social worker, so i thought i should be able to work through it all on my own. i didn't need therapy or medication or whatever...the fact of the matter was, i did need treatment, and i needed my dh to just tell me that he loved me and b/c of that was going to go with me to find some tx. (btw, this is not the approach he took, being in his first year of residency, knowing there was something seriously wrong, but not having the time or the energy left to do anything about it.) luckily, b/c of my training, i checked every book out of the library on the subject (again, trying to fix myself), and finally sought tx with the support of my husband, but i suffered in silence for 7 months before i finally started on the road to recovery.

now that i am healthy i recognize what would have been most helpful to me. i know at the time i probably would have been very resistent to my husband taking the approach that i suggested, but i was so incredibly depressed it was exactly what i needed. your dh may need a totally different approach. the most important thing is to emphasize how much you love him and you support him in his recovery. my husband went with me to all of my doctor's appts which was incredibly helpful. when i wasn't able to vocalize what was going on, he was able to communicate to the dr for me. i am incredible grateful for that gift he gave me.

good luck - hope this helps a little. [/code]

I posted this same message in the Hating Residency thread and thought I would repost it here, since it applies...

Ever since DH has been considering a surgery subspecialty, which will require 4 more additional years of training (9 total) and the moving that would be required, I have been depressed myself. I purchased a book called Medical Marriage by Sotile in hopes of finding some coping skills for both me and DH. Needless to say, both of us have been struck with certain levels of anxiety and depression the last year. So far, the book has made me even more depressed! The facts in the book are harsh and not for the faint at heart.
Here are just a few of the sobering facts quoted in the book:
- doctors and their spouses suffer significantly increased incidences of drug abuse, alcoholism. depression, thoughts of suicide, acts of suicide and psychiatric hospitalizations.
- more than 50% of practicing physicians say they would currently discourage future generations from entering medicine
- 40%women and 27% men med students and residents experience pronounced symptoms of depression or anxiety
- the multiple roles, inflated expectations and sheer stress faced by medical couples are abnormal
- the training of physicians is stressful and teaches residents short-term adaptive behaviors that are in the long run, maladaptive.
Normalizing life as a resident is abnormal. Inhumane periods of sleep deprivation is abnormal and unhealthy. Why physicians will often claim "they can handle it" like they have superhuman physiology often angers me. It's the same thing as an alcoholic pretending they are not at all impaired when they can't even stand up. I see the medical community perpetuating this notion by making residents feel they are "not as smart as their peers", "not as committed to medicine as they should be" "not studying enough" etc. Guilting them into working more, sacrificing more and competing more vicously with their peers.
Yes, the 80 hour work week is much better, when the rules are followed. Things are changing slowly but in my book especially when it comes to surgery, not nearly enough.
Yes, I am proud of my DH. I look forward to the life, security and opportunity that being married to a physician provides. Yes, I wish I could have gone to medical school as I hoped long ago when I had more energy to be a force of change. Knowing what I know now, not a chance. I am trying SO HARD to remain upbeat in all this but the truth is, I feel trapped in a powerless state of anxiety BECAUSE of residency. My DH is changing right before my very eyes and I am not so sure I am capable of keeping him level-headed.
Everyone suffers during residency, some more than others. Every physician needs a support system to make sure they are keeping their head safely above water. Depression is obviously common and should be watched out for. They need to understand that what they go through is totally NORMAL. I wish the entire medical community would stop pretending and at LEAST take better care of their "children" in training and provide them with the coping skills, therapy and attention they deserve!
Arrrgggghhhh......
I guess I will report back when I am finished reading the book and have better "tools" to deal with our life.

[PrincessFiona]

Annie,

Do you think he is switching to Internal Medicine because he is feeling unhappy/dissatisfied? Has he figured out what he doesn't like about ER and talked to people in IM to find out more about the practice of internal med?

My husband didn't suffer from depression during residency/fellowship but I remember the burnout, the exhaustion, the 'why did I study medicine', the "our lives will be better when..." He was pretty unwilling to talk with someone even about his burnout.

Can you sit down and talk to your husband about how worried you are? Maybe it would help him to realize how far he is in residency (and in the whole medical training journey in general). If memory serves, ER is a 3 year residency, so if he sticks it out in ER he'll be done in a year adn will be free to choose a good job and start earning enough to begin paying on those pesky student loans

This must be so stressful for you. How are you managing?

kris

[DCJenn]

Oh, boy-

Yes, indeed there have been some whoppers of depressive bouts in this household. and not just in our household, but in others. I dont' know if it's the Army or what, but they seem to be really on top of their residents and I know of three different people that were essentially sent by their commanding officers to psych. Like, "you will not continue until you get some help." (which is great because as we all know, these doctor types usually aren't that great at admitting they need any kind of assistance) My husband probably wasn't diagnosable but he did sink to some pretty serious lows.

It's a horrible thing to watch someone you love go through, isn't?

Jenn

and I also read that Medical Marriage book, and while I found that it had some valid points, I think it's more geared to the generation of physicians in their late 40's and older. The statistics and sociologists suggest that the younger generations are not willing to make the same sacrifices that the older docs did. (and not just in medicine but across the professional spectrum, which is hopefully, albeit slowly, changing the buisness world.

I agree with Jenn about the limitations of the Medical Marriage book. In addition to the limitations Jenn raised, remain cognizant of the fact that the authors are creating case studies of some of the "train wrecks" they've seen in years of private practice. I have no doubt they've seen and helped many clients, but the case studies seemed to be amalgams of hundreds of patients narrowed down to discrete "archetypes" of dysfunction. Also, these therapists, by virtue of their practice, spend the majority of their time seeing the most troubled relationships. I'm not, however, suggesting that most people are completely immune to all of the issues presented. Perhaps because of some of these limitations, I was left thinking that there wasn't enough practical information on making relationships stronger. I'm sure that was the intent of the entire book, but I think it was obscured somewhat by the jargon and the cases presented.

Welcome to the board. I hope things start to look up for you.

Welcome, Annie. I can commiserate somewhat because my husband is an ER physician as well. While he never went through a depression, he has gone through a few dark periods. Emergency Medicine can be very draining with all of the trama ER docs see on a daily basis. DH reached his lowest point in 2nd year when he had to tell a husband that his 25 year old pregnant wife and unborn child were both killed in a car accident only 2 days before Christmas. My husband was so upset that he was actually sent home early from his shift....something they never do in the ER! He's also been feeling a little down this week because he had a patient who was in a tragic accident while on the job and died. He spent 3 1/2 hours trying to save this guy's life, but he was injured so severely that he didn't have a chance. He had to tell his wife that her husband and father to her 3 kids was gone. I used to hate telling people they weren't hired for a job...I couldn't even imagine what it is like to tell someone they have lost a loved one.

The night shifts can be difficult on many ER docs (as well as doctors in other specialties). There was a study I read a few years ago that said some people are just not wired to be awake at night. Luckily DH has no problem working an overnight shift, but I can tell you now that there is no way I could ever work overnight! After an overnight shift, I would encourage your husband to spend about an hour outside in the sunshine (I realize this might not be that easy where you live) instead of going straight to bed. Studies show that this does wonders to people's moods and their sleep cycles.

I hope that your husband will find happiness in IM. It takes a lot of faith and courage to switch specialties halfway through residency. One of our friends switched out of Emergency Medicine at the end of his second year of residency and is happy in his current specialty. The switch meant an extra year of residency, but the tradeoff is that he is now in a specialty in which he feels comfortable.

My only advice is to talk with your husband to see what it is that he doesn't like about Emergency Medicine. Is it the types of patients he sees, the other doctors he works with, the schedule, where you currently live, or is it that he is having second thoughts about being a doctor? Does he feel like he is a disappointment to his father? One girl we knew during residency quit after intern year to pursue her dream of owning a bar. Her parents were both physicians and it was always expected that she would become one as well....whether she wanted to or not. I think it is important to find out what is at the root of the problem as soon as possible. I'm sorry I couldn't be of more help, but I hope that you can work through this difficult time.

Erica

Hi Annie,
My BF (well, ex-BF now) and I both suffer from mild-moderate depression as a result of his first year as an intern. He hates the long hours and intensity of the 100 hours (80 hour rule doesn't apply most rotations for him) at the hospital, and he has no time for an outlet. Exercise is a great stress reliever for both of us, but he rarely has time to workout (at home or otherwise). He's not sought psyche help (I have done so on my own), but I think most residents could use someone to talk with outside of work and home. I really wish the residency programs mandated periodic evaulations of mental health, b/c these years are so stressful -- just making sure there's not a problem would be reassuring for everyone who loves their medical SO, sibling, child, whatever the relationship. Just my opinion, though.

My BF and I broke up 2 weeks ago. It seems that those of you who were married during the training years are the ones that made it through (not as easy an out when married), so I think you have a significant advantage. I can't speak from experience as a wife, but as someone that has seen their loved one go through the residency depression, I would suggest trying to get him to talk to a therapist. It's helped me see things more clearly about how things spun out of control. And he wouldn't have to worry about what he says if it's a professional stranger. They give some wonderful advise.

Well, that's my two cents and is based on nothing but my uneducated opinion. I hope things get better for you and your hubby! Good luck and hang in there.

Stephanie