The musings of a fourth year English medical student

Monday, 19 September 2016

MENTAL HEALTH: A GREY AREA





I'm currently on GP placement and am really enjoying it. Like all specialities it isn't perfect, but it is definitely on my list of potential specialities I would pursue.

One thing in particular surprised me about general practice: everyday I am seeing patients being reviewed for anti-depressants. I didn't appreciate how common it was. My heart goes out to the lovely new Mums who are finding it so hard, or the sweet old man who lives on his own and feels isolated. It's sad that as doctors we can't prescribe money, support or companionship. A lot of a patient's problem is social, and that is an area we have no control over. 

Today I had a tutorial on mental health in primary care. In all honesty, I don't know how you can distinguish depression and anxiety from the bad days and scary moments we all feel. What quantity of time is necessary for low mood to persist before it is called depression? If someone has lost a family member, is it just the natural grieving process or something more? We then carried on to discuss the guidelines on prescribing. It is recommended to carry on taking anti-depressants for 6-9 months after a patient has noticed an improvement, in order to prevent relapse. But what is relapse? 

Having suffered with depression, I tried to apply the guidance to my own case. NICE suggests that patients like myself who have a history of mental health problems should consider trying an anti-depressant. It also says that people with long-term depression (2 years +) may even be on SSRIs indefinitely. However, I also get incredibly nervous around consultants and sometimes feel like crying when I am around them. Is that anxiety or is that normal?

Recently I cannot decide if I still have depression or not. I have found some days of placement very challenging and I have been holding back tears at times when I have listened to patients' stories. But is that just part of being on a medical placement? Is that typical of having a bad day? 

Another symptom of depression is disturbed sleep and waking up in the early hours of the morning. I have recently been finding myself doing exactly this, and since my teens I have never slept that well. But then again, you could argue I have recently moved house so am in an unfamiliar environment, and the stress from my course could very well keep me up at night worrying. 

Mental health is definitely a grey area. We don't know what really causes it, how exactly the medications work, and we don't have a cure. However, as long as we keep the discussion open and allow people to know it's okay not to be okay. And however horrendous you feel, you will feel happy again. 
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2 comments

  1. I think your honesty is so refreshing here and agree with your last point - talking and keeping the discussion open is vital. You clearly have a great understanding of that, and I think I'd love it if you were my Dr! xxx

    Sam // What I Know Now

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