Tips to fight depression during medical residency

Even though I love my job, I’ve been feeling a little burned out lately. I think it comes from being stretched too thin, which is something I’ve coped with off an on ever since med school.

As the saying goes, there are never enough hours in the day, and sometimes that really gets to me. While my practice is incredibly important, I also place a lot of value on my family. When I don’t get to spend much time with my husband and two children, I don’t just feel upset … I feel guilty, too, and those feelings wear on me every day.

In an effort to find creative ways to aid the situation, I was doing some research online when I came across this article by Christine S. Moyer from the American Medical News, which talks about an interesting study regarding depression in residency.

That got me to thinking back on my own experience in residency. It was one of the most overwhelming, stressful times of my life! There were literally times when I felt like it wouldn’t end. But it did, and even though I still struggle with feelings of burnout and blues, I sometimes wish I could go back to myself in residency and say, “Everything’s going to be ok!”

In reflecting on my own experience with residency, I’ve decided to dedicate this post to current residents who are dealing with burnout and depression in residency and too much stress in general. We’ll look at the facts, and I’ll share my own tips for coping towards the end.

But anyway, back to the study. Along with other researchers, Srijan Sen, MD, PhD surveyed 740 doctors entering 13 different residency programs between 2007 and 2008. The findings were pretty astounding: though fewer than 4% of doctors had major depression when they entered residency, about 25% did by the end of their first year. 

Those are scary numbers, and I can’t help but think to myself … if 25% are experiencing depression in residency by the end of their first year, how many are experiencing it by the end of their third year?

It really is a serious issue, and major depression in residency can be threatening not only to oneself, but to others as well. In order for patients to receive the best care possible, doctors need to be well cared for, too … especially when it comes to self-care.

Below are a few of the things that helped me through rough times during residency, and they continue to help me today. Though major depression is something that needs professional attention (see #4), there are always things you can to do make yourself feel better. Here are my tried and true:

1. Depression in residency? Talk about it. In my opinion, one of the worst things you can do when you’re having a hard time in residency is to keep your mouth shut. While it’s good to remain professional (no one appreciates a colleague who’s constantly bemoaning his or her job), it’s also important to find someone you can vent to in a healthy way.

Whether that’s a close friend, your significant other or a trusted family member, find someone who cares and will listen. I think it’s especially important for those of us in medicine. As doctors, we’re always supposed to act like we have everything under control, but the fact is, we don’t. We’re human, just like our patients.

2. Get some fresh air and exercise. I really wish I’d discovered the benefits of exercise during residency… it would have been a great stress reliever. To be honest, I didn’t really start making time for exercise until my patients began asking me what kind of exercise I was doing. That made me decide to get active.

About a year ago, I was invited to play on a women’s soccer team. Though I had no prior experience with the sport, I love it now! It’s definitely made an improvement on my morale, which has been a bit lower than usual. Plus, I find I have lots of extra energy throughout the day (and something to look forward to!).

For busy residents, working out for 30 minutes a day might not be manageable. But even if you can squeeze in just 5 or 10 minutes 3 times a week, you’ll get your blood pumping, which can do wonders for your mood. Don’t feel like you have to start running marathons just because you want to take up exercise. Even doing just a little is way better than doing nothing.

3. Take the time to eat right. If you stick with it and stay disciplined, you’d be amazed at what a healthy diet can do for your mood. When you’re stressed and pressed for time, it’s more than easy to fall back on vending machines and fast food. I like fruit (it’s portable, delicious and gives me a great energy boost), and when I can swing it, I make lunches in advance.

4. If you’re experiencing depression in residency, don’t be afraid to ask for help. Depression in residency varies. Sometimes, it’s something you can take control of with yourself and the support of loved ones, and other times, waiting to ask for help is the worst thing you can do. Taking that first step to seek help (whether that means counseling, antidepressants or a combination of the two) is always the hardest, but once you do, you’ll wonder why you waited. Check around your program for resources — many have services geared specifically for residents.

Finally, if you’re stressed about work/life issues or looming career decisions, I strongly recommend check out both the Life, Money & Career Priorities and Job Transition stages in the Adventures in Medicine Resource Library.

Adriana Tobar is a family physician and resident advisor for Adventures in Medicine.

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  • http://profile.yahoo.com/LOCQNLXPQYL7Y6472CN6AIES3U Olga

    I agree, residency is the most stressful time in my life. I am a third year resident now and they make us to to take a board exam during our residency without a time off. In my program we lost 6 resident for the last 3 years. I remember my self as a first year resident, I was severely depressed and started SSRI. My advisor told me recently that I should not forget that I am still a resident and they have all power to do what ever they want. I couldn’t believe it….They made me work 5 weeks with 1 day off only in this period and almost every day I was on some call: Ob, hospital, clinic call or both. It is burning… I feel sad that people finish medical school, got all these student loans and not able to complete the residency.

    • http://adrianatobar.myopenid.com/ Adriana Tobar

      Hi Olga,

       

      I completely understand
      where you’re coming from. Hang in there — you’re in the final push, and almost
      done!

       

      I’m going to echo some
      of the other comments, too: mindfulness can be an incredible tactic for
      managing stress, anxiety and feelings of burnout. While it can be a slippery
      concept to understand at first, it becomes easier in time to understand and
      practice.

       

      Wishing you all the
      best,

       

      Adriana Tobar, MD

      Resident Advisor

      Adventures in Medicine

      http://www.adventuresinmedicine.net

  • Diane Sanford

    My daughter is a second year med student and while she’s not clinically depressed, med school has been a negative influence on her mood. As a Ph.D. psychologist, I never understood the trauma and unending hours of work physicians experience in their training. I don’t believe it has to be this way and think that it actually interferes with compassion and practicing patient-centered care.

    A couple of weeks ago, I spoke to the AMWA student chapter at the University of Missouri (Columbia), my daughter included, about using “mindfulness” to manage stress and worry. Like Dr. Tobar recommends in her post above, exercise and eating right go a long way, and adequate sleep when you can. Mindfulness works well because it doesn’t require that you take time away from what you’re doing, but that you practice awareness of what you’re doing with an attitude of acceptance and non-judgement. You can do this when you’re showering, walking or eating by paying attention to sensory experience and not the constant stream of thoughts our minds create.

    Evidence-based research supports that mindfulness helps improve mood, reduce distress from chronic health conditions, diminish depression and anxiety, and alleviate stress. To learn more, check out http://www.livingselfcare.com today’s post.

    • http://adrianatobar.myopenid.com/ Adriana Tobar

      Hi Diane,

      Thanks for your
      feedback! I’ve recently become interested in the concept of mindfulness, too. I
      think it can be a really powerful tool to keep us calm and in tune with
      ourselves, rather than just reacting all the time.

      For anyone interested
      in a primer on mindfulness (and self compassion), a great book on the subject
      is “Self Compassion” by Dr. Kristin Neff.

      I’m curious — did you
      find it was hard to grasp the concept of mindfulness at first? Has it gotten
      easier for you over time?

      All the best,

      Adriana Tobar, MD

      Resident Advisor

      Adventures in Medicine

      http://www.adventuresinmedicine.net

       

  • http://www.thehappymd.com/ Dike Drummond MD

    Thanks for posting this article Adriana … and in my experience Depression in residency is almost always a consequence of untreated burnout.

    You mention just a few of the methods of dealing with burnout/depression. Here are a few more.

    - Work-life balance and boundaries between medicine and the rest of your life
    - Mindfulness and the ability to release negative emotions when they arise
    - Narrative medicine – journaling and other writing techniques – to support processing the emotions of the job
    - Support groups to discuss/vent and support each other through this stressful time

    Burnout is a well understood work hazard for residents … it is staggering to me that most residencies don’t teach prevention … staggering.

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

    • http://adrianatobar.myopenid.com/ Adriana Tobar

      Hi Dike,

      You bring up so many great points!

      Like I mentioned to another commenter, mindfulness is indeed a great tool (once you get used to it). For beginners, I think it can feel a little foreign/forced, and it takes practice. What are your thoughts? Do you think it can be a slippery concept?

      Journaling is great to purge all that mental clutter. It’s amazing how much relief comes from just getting things down on paper.

      And I agree — there’s so much missing from training in residency. Not only in terms of work-life balance and burnout prevention techniques, but also in terms of business of medicine training. There’s so much more to medicine than the clinical side of things.

      Love your website and your mission! Keep it up.

      All the best,

      Adriana Tobar, MD
      Resident Advisor
      Adventures in Medicine
      http://www.adventuresinmedicine.net

      • http://www.thehappymd.com/ Dike Drummond MD

         Adriana — let’s face it, ALL of this is foreign to doctors. Mindfulness has dozens of “flavors” so that anyone can begin to practice it immediately. The key is having a teacher that knows multiple forms and ways to teach it … as opposed to “everyone sit here and breath with your eyes closed for the next hour”. That is what I call the “my way or the highway school of mindfulness instruction” and it is a turn off to many.

        They key is this in my mind. EVERYONE would do better with a personal Burnout Prevention Matrix. This is a personalized plan combining whatever techniques work best for YOU to maintain your mind/body/spirit energies under the inevitable onslaught of practice burnout. That is why it is so important that all physicians have access to the research proven tools AND that med schools and residencies begin to incorporate burnout prevention/physician wellness in the standing curriculum.

        My four cents,

        Dike
        Dike Drummond MD
        http://www.thehappymd.com

  • Diane Sanford

    It’s definitely gotten easier over time. At first I understood it intellectually, but when I started to experience the difference between being present to the moment I was in and when I wasn’t, it became much clearer. I catch my mind straying much easier and am able to bring it back to the moment I’m in more quickly. But stress including sleep deprivation, not eating on a regular basis, fear, extreme pressure and many of the experiences med students and residents experience daily which tax our bodies and minds, make it much more difficult to remain mindful.

    I recommend “The Mindfulness Solution” by Ronald Siegel, PsyD because it’s a humorous, entertaining narrative about his own restless mind and clear, concise scripts for how to practice mindfulness personally and with patients.

  • http://www.aces-counseling.com/ DUI evaluation

    Med students and doctors have really demanding jobs. It is hard to work around the clock for others when you are too down to give positive energy. Too much work and no play is not healthy. Great tips! This should help others too, not just med residents.

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