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I suspect that I'm having a depressive relapse after a month or two of genuine euthymia. No surprise that coincides with a return to work and exam grind. My workload is probably 3-10 times what it was on my first rotation. I used to get bored during my shifts. Now I barely have a moment to park my ass, and the other doctors and I have to draw straws to decide who gets to have lunch first. I used to have the time to (at least in theory) revise my notes during working hours or browse the internet. Right now my phone is helpfully noting that I've reduced my screen time by a remarkable margin.
Is this going to get better? Hah. Haha. Hahahaha. This is going to be my life for the next 5 months, no relief from the pain. I am under-medicated for my ADHD. I have worsening migraines. I leave work wanting nothing more than to crawl into bed and stay there.
What clinched the self-diagnosis was sighing. Literal, audible sighing. The last time I was properly depressed, a junior colleague clocked this tell before I did, which surprised me, since I thought I was hiding things well. The literature, predictably, confirms a correlation. (The body keeps the score and occasionally narrates it out loud.) I caught myself doing it yesterday. Then an intern asked me why I was sighing.
@ToaKraka was kind enough to link to the PHQ-9 screening questionnaire lower in the thread. One glance at it made me wince, I didn't have to add up the numbers to know it didn't look good for me.
The good news is that Paper B pressure lifts next week, possibly forever if I pass. I have never failed an exam in my life. That fact is a load-bearing pillar of my self-esteem, and I am aware of how that sentence sounds coming from a psychiatry resident. I'm willing to risk the burnout. The exam has to be cleared eventually, deferring wouldn't buy me study time anyway, and a pass earns me twelve to eighteen months of academic reprieve. The workload stays the same. This is the only consideration keeping me from filing the current monomaniacal focus under "obviously irrational."
Apparently, around 20% of psychiatry residents experience burnout or depression. Lovely. Glad to have good company. I know the pharmacological management of depression like the back of my hand.
Before anyone panics, I'm going to talk to my GP, and warn her that I might need to see a psychiatrist. The last time I did this was slightly awkward, given that I knew precisely what she would suggest before she said it, and she was kind enough to treat me like a fellow professional and go off my self-assessment. I know precisely what to do if it gets too bad to bear.
Let's hope it's just exam stress. Being fully honest, that's not likely to be the case. But it'll help, on the margin. But tripling my stimulant dose?* Proper migraine prophylaxis? More optimism on that front. And I know the NICE referral pathways well enough to demand that I get something more immediate and robust than another course of Standard Antidepressant.
*What a fucking joke. The ADHD assessment and treatment pathway is designed to weed out 90% of people with ADHD before they see an actual psychiatrist. At least if you don't spend a third of a month's wages on a private assessment and consultation. I fell off that wagon because of... depression and ADHD. Getting back on it will be either time consuming or expensive, and I'll take the latter any day of the week.
Oh well. At least I'm not a gynecologist. Gotta look at the bright side of things.
In retrospect you ever think you’d have chosen a different career path entirely? The front lines of health and medicine always had zero appeal to me. I definitely have my preferred path I would’ve chosen, except for the fact that the industry hadn’t matured and established such that there was a viable and well defined path at the time I’d have come of age to first begin pursuing it in higher education.
When I was in the later years of grade school and throughout junior high and early high school, I was in gifted and AP programs and high achieving courses for a time and I’d always been administered tests that I had no doubt were designed to have you fail; they were enormously difficult. Comprehensible and I could and did do them but the amount of work was enormous. I think perhaps like you albeit at a younger age I just wasn’t mentally prepared for it; and having the right attitude and perspective is a huge part in being able to make it in various disciplines and when you’re up against challenges. Back then I just wanted to go play with my toys and video games by myself and be left alone. By the time I was in high school I deliberately underplayed things to coast by so I didn’t have to get recognized by everyone else. If blowhards want to excel and look good by performing better than you, let them. The brightest stars burn out the quickest and have the shortest lives. If you looked at my report card around that time I had everything. A’s, B’s, F’s and D’s; just enough to squeeze by. My mental health was better because of it but those who knew me didn’t like what I was doing at all.
Is it possible for you to pivot to a psychiatric modality that’s less straining on you mentally? When I read the DSM-IV several years ago, that alone was enough to give me a mental illness. How do you feel about the people who say psychiatry is a fraudulent, applied science in the first place?
Not really. I entered med school because that was the default expectation, and I couldn't think of better alternatives (I was nudged, not forced into it). I discovered I genuinely like psychiatry as a subject, whereas I genuinely loathe most other branches, particularly internal medicine or surgery. Not for me.
In hindsight, I discovered I do like programming a little. But I found this out too late, and I wouldn't have been brave enough to choose that after high school. It possibly would have been a bad choice for me.
I don't know about mental fortitude on my end dawg. My ADHD diagnosis is not fake. It just didn't exist then, nor did I receive any medication. It's not like I manifested a work-ethic and appreciation for higher education of my own volition, I just found out that the drugs solved problems that nothing else could.
Yes, but you need to remember that I'm a psychiatry resident. I don't get to choose what I do or where I go for the next 2 or 3 years. This placement is unusually awful, and I can't just tell them they need to send me elsewhere. I am optimistic that after 5 months, I'll be somewhere much, much quieter.
I expect that if/when I'm more senior, and as @Throwaway05 suggests, more experienced, it won't be so bad. I have a decent idea of what I'd like to do (General Adult psychiatry, probably). That is a long time away. The British system is retarded.
I've only read the V. And the ICD-10 and 11. Sorry for being a poser. Don't worry, memorizing them gave me mental illnesses too, or at least made my existing ones worse.
I diagnose them with moderate to severe intellectual disability. Or I would, if I could. Instead, I ignore them, and feel glad about the fact that 99% of people don't have such awful takes. There's plenty of room for critique of psychiatry, which I have done myself, but it's not a fraud. I treat sensible criticism with respect.
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