Mental Health

Physician, heal thyself: Doctors speak about their depression

Following the suicide of Dr Bongani Mayosi, doctors have come out to raise the seriousness of depression in their line of duty

05 August 2018 - 00:00 By Shanthini Naidoo

As caregivers, doctors tend to ignore their own well-being. Most doctors who have suffered depression and undergone therapy believe they have become better in their work and relationships.
What Dr Alastair McAlpine said:
At the age of 21, halfway through my medical training, I found myself in a psychiatric hospital for depression and substance abuse.
It's hard to say which caused which but in a short period I had gone from being an upbeat guy with a loving family, great friends and a promising career to a hopelessly lost soul, stuck in a dark hole from which absolutely no light was visible. I don't think there is a lonelier place than that hole.It took many months of hard work, professional psychiatric help, counselling, medication, group therapy, and time, but with the support of friends and family I was able to begin to see the light again.
I learnt that I wasn't weak, just sick. I was incredibly lucky I had the resources available to me that I did - because, the truth is, there was no way I could have recovered alone.
In time, I was able, with professional support, to come off my medication. I continued therapy and support programmes for many years. I also began running. I went back to medical school and graduated, despite being told that I would never make it.
I truly believe that my experience has enabled me to be a better, more caring physician to my patients. When you've been in the same desolate place, you're better able to empathise with those who are struggling. Depression, nevertheless, is not something I would wish on my worst enemy.
Doctors in SA are pushed too hard. No question. We see and do things daily that would give regular folk nightmares. We work ridiculously long hours, our goodwill is exploited by our employers, and we are unsupported by our regulatory bodies.
The high incidence of suicide and mental illness is testament to this. I was lucky I was able to survive it, but we need to find a kinder, better way. Our lives, literally, depend on it. — Dr McAlpine is a palliative care physicianWhat Dr Sindi van Zyl said:
I was admitted to Life Poortview Psychiatric Hospital on my 37th birthday. It was the best day of my life.
The months leading up to my mental breakdown had been harrowing. I’m a very happy and bubbly person — the life of the party. But I lost all interest in having fun. I was always sleeping. I lost 13kg. I knew that something was wrong.I didn’t want to do anything. My daughter was five years old. She would come to the bedroom and pry my eyelids open.
I would make promises to her that I wouldn’t keep and she stopped trusting me. Major depression may also result in hating loud sounds or noise. My husband bought me earplugs. Nothing worked.
Everything was too noisy. The worst part was the inability to make decisions. A simple task, like choosing what to wear to work in the morning, became a burden. I would sit on the bed looking at my clothes and cry.
After a while, I recognised my symptoms as those of major depression. I told a few friends but I guess because I was on autopilot nobody believed me. Autopilot is acting normal on the outside and falling apart inside. I had mastered the act. Eventually on April 1 2013, my body gave up. I woke up and I was unable to function.
My son was 16 months old.
He was awake because he needed a nappy change. In my mind I knew that I had to get up, walk to his room and change his nappy. My body refused to budge. I lay there crying and eventually I called Dr Natasha Davies — a colleague and friend. I told her what I was going through.
She listened, and advised me to call my GP. Dr Marlin McKay was at the house within two hours. He diagnosed me almost immediately. Two days later I was at Life Poortview. It was the best three weeks of my life. Therapy was amazing.
I was started on antidepressants and stayed on them until 2016. I am back to normal and doing better than ever before. My diagnosis has helped me to become a better clinician. And I use my story to help others. — Dr Van Zyl is a general practitionerWhat Dr Hermann Reuter said:
Throughout my adult years I had difficulties sleeping. I would wake at 3am and be unable to get out of bed or occupy myself constructively. My brain would fill with morbid thoughts. Thoughts of taking my life recurred. Life did not seem worth living. I was plagued by fatigue, poor concentration and irritability. I began overeating.
I discussed my symptoms with my brother, who is a physician. He prescribed antidepressants. My wife got me to join the gym.I lost some weight but my low mood and insomnia continued. Daytime tiredness was really a problem now - nodding off at red traffic lights, falling asleep while doing homework with my daughter. At night my thoughts would repeatedly return to suicide.
I saw a psychiatrist. She changed the antidepressant. She referred me to a psychologist, recommended a mood diary and suggested practising mindfulness. I heeded her advice. My symptoms remained unchanged.
My medical aid does not pay for antidepressant medication, adding insult to injury. I was not so much bothered by the financial burden as that it demonstrated the medical fraternity's contempt for depression.
After changing to a third antidepressant, things improved. If I woke up with suicidal ideas, I could now steer my thoughts away and fall asleep again. I awoke in the morning feeling rested. My concentration improved and I was able to experience joy again.
I am still amazed by how the right medicine, with a slightly different pharmacological mechanism, could change my thinking patterns within two days.
Many aspects of my life remain unchanged - my job, my family, my ambitious personality that expects too much of me. But they no longer drive me to despair. I am fine.
— Reuter is a medical doctor who pioneered Aids treatment for MSF in Lusikisiki in the Eastern Cape. He now runs a rural site for a UCT mental health facility in George.THE FOUR MOST COMMON TYPES OF DEPRESSION
Major depression
● A dark mood is all-consuming, with loss of interest in activities, even ones usually pleasurable. One may have trouble sleeping, changes in appetite or weight, loss of energy, and feel worthless. Thoughts of death or suicide may occur. Treated with psychotherapy and medication.
Persistent depressive disorder
● A low mood that has lasted for at least two years but may not reach the intensity of major depression. Sufferers feel low or joyless. Other symptoms include appetite and sleep changes, low energy, low selfesteem and hopelessness.
Bipolar disorder
● Episodes of depression with periods of unusually high energy or activity. Manic symptoms include: grandiose ideas, unrealistically high self-esteem, less need for sleep, thoughts and activity at higher speed, and ramped-up pursuit of pleasure including sex sprees, overspending and risk-taking. Medication can be very effective.
Seasonal affective disorder
● A mood change that emerges as daylight hours get shorter in autumn. Treatment includes light therapy.
Perinatal depression
• Includes episodes that occur during pregnancy or in the first 12 months after delivery (also known as postpartum depression). It affects up to one in seven women who give birth and can have devastating effects. Treatment includes counselling and medication.
Premenstrual dysphoric disorder
• A severe form of premenstrual syndrome, or PMS. Selective serotonin reuptake inhibitors may reduce symptoms...

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