How Should I Deal With Depression in Medical School?

Sara Cohen, MD

Disclosures

August 31, 2011

Question

I've been feeling depressed lately. Is this common in medical school? What should I do?

Response from Sara Cohen, MD
Fellow, Department of Physical Medicine and Rehabilitation, Harvard University; Fellow, Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, Massachusetts

Medical training can be very stressful. Many students come to medical school as the top student in their college class and are shocked to find themselves in the middle of the pack...or worse, barely scraping by. The preclinical years require constant studying, which can sometimes result in social isolation. The clinical years are not any better, between the long hours, lack of sleep, and standing in place for hours at a time holding a retractor. Many attending physicians still subscribe to "pimping," or asking medical students difficult questions in front of their peers and humiliating them if they are unable to answer correctly.

It's no wonder that an estimated 15%-30% of medical students and residents suffer from depression. Even more frightening, 11% of medical students have reported suicidal ideation within the past year, which is the leading cause of death in this population after accidents.

Moreover, nearly half of medical students have symptoms of "burnout", which includes emotional exhaustion, detachment, and a low sense of accomplishment. Burnout affects patient care too: studies suggest that students with burnout are more likely to lie about a patient's laboratory tests or develop less altruistic attitudes toward their patients.

Depression is a sensitive topic among medical trainees. Students avoid reporting their symptoms for fear of appearing weak in front of their peers, or because they worry how a mental health record might affect their career. At the same time, trainees have both knowledge and access to medical resources that can facilitate suicide. There are many stories about physicians using medical supplies from their hospitals to commit suicide.

If you are a medical student or a resident who is feeling depressed, remember that you are not alone, even if you think you are. I was always amazed at the coping skills of my medical school classmates, until some late-night discussions on-call when I discovered that a surprising number of them were visiting mental health clinics and taking antidepressants. Medical students and residents are expected to hide their weaknesses, which discourages them from sharing symptoms they might be having. However, you should know that no matter how unhappy you think you are, there are several other people in your class who feel the same way.

There are ways you can prevent or combat burnout on your own. Social support from peers, friends, family, and significant others is crucial to maintaining good mental health. Physical exercise often gets neglected during medical training but can be very effective in improving mood. Finally, you can look into stress-reducing measures such as meditation, yoga, relaxation techniques, and hobbies. These strategies don't work for everyone, but they are all safe and easy ways to reduce burnout. If you have serious depression, however, these interventions might not help. You may need professional treatment, especially if this is not your first episode or if you have a family history of depression.

The most important thing for a depressed medical student to do is to seek treatment! Although there are instances of discrimination against physicians who seek mental health treatment, untreated major depression can have much worse effects on your ability to care for patients and on your career.

Seeking psychiatric help is by no means rare among medical trainees either. My medical school had a psychiatrist who focused primarily on providing therapy to physicians and was well versed in the issues that commonly affect medical students.

Depression is such a common problem and the results of untreated depression can be tragic, so if you feel you are having symptoms of serious depression it is crucial that you seek professional treatment as soon as possible.

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