Is depression more prevalent in medical students?

It appears so.

Chris Rangel points to a study showing that 21.2 percent of medical students (that’s more than 1 in 5), suffer from depression, compared to 10 percent in the general population.

Depression seems to hit its peak during the second year of medical school, and then gradually improves. In general, the rates of depression for students were generally higher than in residency.

Indeed, the second year of medical school is indeed the bleakest, but when clinical rotations start in the third year, it does get immeasurably better.

To help, Dr. Rangel links to a study from The Lancet, comparing the efficacy and tolerability of various antidepressant options. My preferred prescribing choice, Celexa, seems to fare pretty well, although Zoloft and Lexapro appears to top the list.

That said, it’s still somewhat troubling that so many of our future doctors suffer from depression. Just wait until they experience what’s awaiting them in the real world.

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  • Anonymous

    As a current 2nd year medical student I have to agree with this article. Personally I had to start taking an antidepressant this year and I know many of my classmates who are, or should be, on these medicines as well. Maybe someday soon the medical schools will start to pay attention to this trend and consider new, innovative and more enjoyable methods of crammin 120+ credit hours into the first 2 years of medical school.

  • maribella-ella

    For any med students who are reading this (or others), here is a link to a free mental health screen that my Medical School sends to students: https://www.mentalhealthscreening.org/screening/welcome.asp

  • Anonymous

    Concerning graduate and professional students (i.e. medical, law, and business schools):

    “Nearly half of all survey respondents (45%) reported an emotional or stress-related problem that significantly impacted their academic performance or well-being. 67% reported that they have felt hopeless at times, 95% have felt overwhelmed, and 54% have felt so depressed that it was difficult to function. 10% reported that they had seriously considered suicide, and ~1 in 200 respondents reported that they had attempted suicide at least once in the last 12 months.”

    54% (that’s 1 in 2). If the medical student’s portion is only 21.2%…

    Regarding antidepressants:

    “In a study, published today (1 December 2008) in the Journal of Consulting and Clinical Psychology, MBCT proved as effective as maintenance anti-depressants in preventing a relapse and more effective in enhancing peoples’ quality of life. The study also showed MBCT to be as cost-effective as prescription drugs in helping people with a history of depression stay well in the longer-term.”

    I wonder why MBCT isn’t at the top of the list?

  • Anonymous

    As a 3rd year, I was a lot happier 2nd year.

  • JorgeRB

    As a soon to be first year medical student, I wonder if, in this case, knowing what’s ahead will allow me to mentally prepare for the ups and apparently many downs of medical school? Am I inevitably doomed to become depressed?

  • Rishi

    I, like JorgerB, will be starting medical school soon (this July) and am a bit skeptical as to the causes of depression. We all know medical school is difficult. The inconceivable amount of information coupled with the long hours of studying is undoubtedly enough to spur on depression; however, I wonder how those students who “breeze” through medical seem to do it. I think at this point, those who’ve mastered time management and follow good habits (eating right, exercising regularly, etc.) should have minimal difficulty coping with the stress.

    …at least I hope I’m right. :-D

  • KT

    JorgeRB, Rishi,

    As a current second year, I don’t think that the stress is the long hours of studying. You’ll find out very quickly that medical school is only crammable if you are that special, rare breed that can swallow half a textbook in three days. There will be someone in your class that can do this. You should ignore them; that’s not a solution for the rest of us.

    I think it has more to do with all the responsibility that suddenly drops on your head in 2nd year. The boards are months away. My standardized patient physical diagnosis exam is next month. In the meantime, I’m studying for next week’s exam. I came back from the hospital today with the growing realization that while I know all the motions of a physical exam, I know nothing about its practical applications to diagnosis — and starting in July, will be expected to have mastered that ability. And passed the boards. And presumably started lining up a specialty. And my loans are piling up. And my friends from college are all making decent salaries, and discussing kids, and live in real apartments.

    We all feel poor, and pressured, and we’re starting to have the you-will-kill-people-if-you-do-not-memorize-this-by-tomorrow meme thrown at us hard. It has a counterpart, the everything-but-perfection-is-a-huge-malpractice-suit. A newer one is the doctors-are-evil-and-make-too-much-money meme (I call it the NYTimes Well Blog symptom). None of these make us feel good.

    That’s where I think the depression comes from. I don’t think it’s time management.

    FWIW, I sleep eight hours a night, study 2-4 hours a day outside of class, exercise 5 days a week and have mandatory dinner with my husband. My depression, oddly enough, was first year.

  • Anonymous

    Depression?

    Or adjustment disorder with depressed mood?

  • Anonymous

    Real World huh.

  • Jeff

    Third year is far bleaker than 2nd. In 2nd year, if you wanted to enjoy an afternoon of sunshine and play you could just duck out of class. The story of third year is barely ever seeing the light of day, having to constantly acquaint yourself with a new team who rarely cares about you, and suddenly realizing just how much more you need to know.

    Second year was a breeze.

  • Anonymous

    To the med students here. Someone mentioned physical diagnosis. Do they still use Cope’s “Early Diagnosis of the Acute Abdomen”?

    I mean the original book goes back to the 1920′s, but it’s been updated frequently, and the basics remain unchanged.

    The only reason I asked. In private practice now, don’t see med students that often.

    A couple years ago, I mentioned the book to some senior med students and got a blank look. They’d never heard of it. Not sure if that was a function of a particular group of med students, or if the book has gone by the wayside.

    Even with decades of revisions and more technology that needs to be covered, the book is fairly small and tells you what you need, at least for the belly.

  • Anonymous

    Can’t speak for all students, but my school is split down the middle between Schwartz’s Physical Diagnosis (mostly because it comes with a decent DVD) and a book by Degowin. Both of which attempt to cover the full physical exam. They’ve never recommended a book that covers only a bit of it.

  • Anonymous

    I was a degowin fan.

    But did Cope go by the wayside for abdominal pain, or did I just get a unique set of medical students.

  • Doctor with Depression

    Depression is a huge problem with medical students, residents and yes, even attending physicians. The problems are so many, I don’t even know where to begin.

    First, to the med student who thinks time management and exercise are the answer. You are overlooking what is at the core of depression. Feelings of guilt, hopelessness, worthlessness…while exercise and good sleep can give you a nice little burst of endorphins and make it easier to cope with these feelings, the feelings of low self-esteem don’t just go away. You’ll learn that a hallmark of depression is difficulty sleeping, especially staying asleep. It’s a vicious cycle. I hope you don’t experience it. But hopefully, you will change your attitude about depression and not see it as “the patient just isn’t exercising and sleeping”. Now, on the other hand…patients need to take an active role in their care (just like any chronic disease) and start doing all the things you mentioned. They do help.

    Second, stop punishing doctors for seeking help. Again, we must be perfect, right? Every time I have to fill out an application for credentials, licensure, etc. they want to know if I have seen a psychiatrist. I also broke my ankle and had surgery but no one asks about that. Am I somehow flawed? And yet, still no one has questioned my competence or character…so stop asking abdout my antidepressant. Let me have my privacy. It discourages us from seeking help.

    Third, my opinion on where depression (probably adjustment disorder with depressed mood) comes from with physicians. We are used to making people happy and proud. We are used to doing well. We have learned to derive our happiness from making other people happy. As physicians, you can’t make everyone happy. And some days, you can’t make anyone happy. Patients aren’t happy with you (you took too long, you didn’t explain things well enough, you didn’t listen to everything they said, you were running late), patients’ families aren’t happy with you, nurses are frustrated with you, consultants don’t want to see your patient or treat you like you’re stupid, admin isn’t happy with you because you forgot to document the severity of malnutrition…..and the list goes on and on and on. Sometimes none of these things happen, sometimes they all happen on the same day. Hopefully you have enough self-esteem to know that you are doing your best and that is all you can do. Until you get sued, then you should have done better…

    - From a doctor with depression

  • Anonymous

    I’m a 4th year med student, on my second career. Personally, I found the first 2 years depressing, although I don’t know if I was personally depressed (I had friends that were).

    Med school is tough not because of time management and long hours. For me it was tough because I was always reminded of how I was being reduced to a number – score on an exam, an evaluation, a grade – that would potentially play a huge role in where I would end up for residency.

    This is a huge problem even before getting into med school. We all say to ourselves “we need young docs who understand the importance of bedside manners, who communicate well, who have humanity.” And yet what we do is select for students who are motivated to nurture polished resumes and high test scores. And in med school, the struggle to be perfect, top of the class, even intensifies. I don’t know how this translates into patient care skills. I doubt it does.

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