Dr. Andy

Reflections on medicine and biology among other things

Thursday, September 22, 2005

Depressed medical students

An interesting article on depression among medical students in last week's NEJM (free full text).
Others have suggested that although the rate of depression among students entering medical school is similar to that among other people of similar ages, the prevalence increases disproportionately over the course of medical school.
I think there are several contributing factors, including:

1. Hard work, much of it not very rewarding (i.e. memorizing biochemical pathways or printing out lab results)
2. Sleep deprivation
3. Disillusionment. Medicine is a funny sort of career. Most people have no real idea what they are getting into when they decide to go to medical school. They work very hard to get good grades in hard classes and good MCAT scores as undergrads, then show up for 2 even harder years which have no relation to what they'll actually do. Then 3rd year, they start "clinical" work, but it is largely focused on inpatients who are generally old, sick and depressing (most people have no idea what a high percentage of medical care goest to the old/sick). They spend most of their time with even more tired (and often bitter) residents. They don't stay in one place long enough to bond, and are separated from all their classmates. Most people are able to find a specialty the can tolerate (or actually like) but if, say, you are destined to be an anesthesiologist and you do medicine and pediatrics as your first rotations, things can look a little bleak.
4. Learning to live independently. I think studies say undergrads spend 25-30 hours per week on school (granted pre-meds probably spend a bit more than average), and live in dorms with janitors and have meal plans. Even then they have trouble getting their laundry done. Now as a medical student you are working 2-3x as many hours and also having to be more responsible for things like buying groceries and paying the rent.

It is no wonder so many medical students are depressed. Of course, in many ways what comes next, residency, is worse.


At 6:06 PM, Blogger Barbados Butterfly said...

I agree. Sleep deprivation can have tremendous effects; of course, once you get to the point that you're not getting enough sleep you're not getting enough relaxation or time for loved ones. I usually find that time for regular meals, oral fluids and toilet breaks also fall by the wayside. As a surgical registrar I get two full days away from the hospital every three weeks. I often spend much of these sleeping. It's hard to maintain relationships. It's just hard, period. :(
In addition to the points that you mention I've noticed that a lot of depressed medicos (and, I guess medicos in general) tend to be quite introspective and obsessive type A personalities. When things go wrong (or when things aren't going right all the time) the frequent introspection and obsessions don't help. As I went through medical school there were many students with mental health problems and I do wonder if medicine attracts people who are predisposed to depression.
Another feature that I think is a problem (which you touched on) was the motivation of people to become doctors. In our first year of med school we were asked to tell our class why we wanted to become doctors. One young man said, quite seriously, "I want to become a doctor so that people will look up to me." I haven't seen this doctor for a few years and don't know if he achieved his aim. I think it likely that he didn't get the adulation he desired after graduation and have often wondered what happened to him after realisation set in.

At 12:10 AM, Blogger BotanicalGirl said...

All of these apply to graduate school, especially PhD programs, as well.

Hard work without reward or acknowledgement. Disillusionment/not knowing what you're getting yourself into. Learning to be independent. Knowing there is a lot more scutwork ahead (postdocs, adjunct teaching etc)

I know so many grad students (myself included) currently taking antidepressants.

I know that med students get it worse in terms of sleep deprivation and having their egos slammed however.

At 7:16 PM, Anonymous jb said...

Someone out there please educate this middle aged surgeon: is this phenomenon depression (a disease that can be treated with medication, psychotherapy, or other medical interventions [ECT even?]), or is this a fancy way of describing disillusionment, unhappiness, buyers' remorse? Reading the description of the "depressed" med students, I sense that their "depression" would abate if a magic wand would somehow transform them into debt-free, 40 hour/week well paid government clerks with lots of friends and a steady significant other. That is not my concept of disease.

I'm serious about this. Are we trying to medicalize the expected normal stresses of life? Is it healthy to be taking Prozac because you are in debt, or no longer working with the resident you really liked last month? Someone please explain.

Thank you.

At 7:32 PM, Anonymous Anonymous said...

I agree too, medical students have the highest risk of getting depressed comparing to other undergraduates courses.
I have failed my first sitting of my first year exams and feel extremly depressed and no motivation, but life has to carry on. Just hope God will help me this time.

At 11:38 AM, Anonymous viagra online said...

What a shity career, they are condemned to hear the complains of a bunch of old farts fro ever... fail.

At 6:11 PM, Anonymous Anonymous said...

The disease of depression can be developed by some incorrect decisions over time; however, it is more likely that the incorrect decisions leading to negative thoughts and ideas are due to the depression. Decisions are affected by the depression. Magically curing debt, having a 40 hour/week well paid government clerk job with lots of friends and a steady significant other usually doesn't cure people who truly have the disease. They are still unhappy and unable to get out of that hole even if everything seems fine in their lives. The other side of it is that the people that do not have their lives set with the previously listed luxuries of a "perfect life", who truly have the disease of depression, cannot get to this point because of their depression. It is a life altering illness and it isn't about what you have around you, it is about what is going on in your mind.

At 2:21 AM, Anonymous tips malam pertama said...

that's is why i don't want to be a med grad dr.. very hard life

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