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ER Goddess

ER Goddess

Overcoming Depression is a Journey, Not Just Flipping a Light Switch

Simons, Sandra Scott MD

doi: 10.1097/01.EEM.0000581468.42246.82
    depression, burnout, physician suicide
    depression, burnout, physician suicide:
    depression, burnout, physician suicide

    I had days when I hurt enough to think, “I understand why doctors kill themselves.” I was in the depths of depression.

    Plenty of doctors reach that point, shown by the alarming rate of physician suicide, but we don't talk about it. Our silence isn't helping us or anyone else. Let's do better in honor of National Physician Suicide Awareness (NPSA) Day on Sept. 17.

    For every person who dies by suicide, 280 people decide not to go through with it, yet we don't hear their stories of survival. (Active Minds. We should balance the tragic stories of physician suicide with encouraging ones of the 280 others who have found ways to cope. Not sharing journeys like mine maintains the taboo that is the enemy of hope and healing. The best thing we can do for NPSA Day is to defy labels and stigmas and talk candidly about our mental health.

    For starters, let's be honest about feeling overwhelmed. The moral injury physicians experience will always find chinks in our armor and creep into our psyche. I didn't fully grasp how toxic medicine was to my psyche until two years ago when I had five months off between jobs. When I went back to work, the contrast between my states of mental health was sobering.

    Frazzled and Depleted

    I love my new job, but being in the trenches of the ED erodes my capacity to deal with mishaps that I might otherwise take in stride, like surprise last-minute homework projects, overflowing toilets, malfunctioning Xboxes, and the impossible task of getting two kids to two simultaneous practices on opposite sides of town. Many days I feel frazzled and depleted, as most physicians do given the increasingly lofty demands of the job. It has a name—caregiver fatigue, and it has as much to do with the profession as anything innate in me. Physicians should acknowledge it and seek help without shame.

    Let's also be frank about the hellacious effect of shift work. Honestly, after 13 years of full-time nights, it's no wonder I'm in therapy. The sleep deprivation, the opposite schedule from family and friends, and the need to be on when our circadian rhythm has other ideas are underrated threats to our wellness. Even though my life circumstances had improved after five months off, my happiness plummeted as soon as I resumed my Sunday-Monday-Tuesday night shifts.

    I'd worked that schedule for six years, but it wasn't until I experienced the same level of misery at a great new job that I finally realized that no amount of self-kindness or reframing could make up for that schedule's physical and mental repercussions. Rather than shutting up and powering through as our antiquated culture of bravado encourages, I asked for a schedule change. With the help of an understanding medical director and some custody schedule adjustments, I achieved a scheduling coup of working just two nights a week. Fewer hours mean less money and a part-time status without benefits, but my sanity is worth it. If we don't speak up and address threats to our own wellness, no one else will.

    Steps Backward

    Let's also talk unabashedly about antidepressants. I've been taking one daily for eight years, and it is life-changing. It was wondrous how crusty old gomers almost immediately became cute little old men again. It's also striking how differently I feel when I forget to take it. Years ago, I remember inexplicably bursting into tears while doing the dishes and hearing U2's “Stuck in a Moment” on the radio; I couldn't figure out why, but then it dawned on me: I hadn't taken my Wellbutrin in two days. Since I was in a better place, I thought I could wean myself off the Wellbutrin. Nope. Pull yourself up is no longer an acceptable approach to mental health. None of us should have to worry about judgment or stigma from starting or continuing medications that help us.

    Finally, let's talk about psychotherapy like the valuable resource it is, not like a four-letter word. Too many scoff at therapy or delay even considering it until they're in crisis. It shouldn't take a catastrophe to talk to a therapist. Like diet and exercise, mental health maintenance is an integral part of wellness. If more of us speak candidly about seeing therapists the same way we talk about the race we're training for or the latest diet we're trying, we could fight stigma and encourage others. Therapy is a safe space to talk through whatever troubles me. Sometimes I need someone objective to help me get out of my head, put my stressors in perspective, and see healthier options for dealing with them. Going to therapy means I'm strong, not weak. Psychotherapy every few weeks is a way I push back and take a stand for my own mental health.

    Even with antidepressants and therapy, overcoming the darkness of depression is a journey, not just flipping a light switch. We don't hear about the bad days and steps backward on that journey because people don't talk about their personal battles. I remember eating half a dozen cupcakes in a moment of sadness or frustration and then beating myself up, self-critically blind to all the steps forward I'd made and only seeing my sugary screw-up. I wasn't giving myself credit for the small breakthrough of not eating a dozen cupcakes, which I'd been known to do. No one talks about these seemingly inconsequential steps, but taking them day after day is what eventually gets us to a better place. We need to be real about all our steps and stumbles so we can create a realistic map of the journey through depression for everyone struggling.

    If you've stumbled or even had a full-on face plant, I urge you to share as a way of debunking the myth that good physicians are happy and perfect all the time. Reach out, seek help, call a therapist. Let's be real about our mental health struggles on NPSA Day and every day.

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    Dr. Simonsis an emergency physician in Richmond, VA, and a mother of two. Follow her on Twitter@ERGoddessMD, and read her past columns at

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