I'm in the middle of my second year of medical school and i feel like i'm emotionally drowning. I have a lot of family support, my grades are fine, I'm in a wonderful relationship, and I am so grateful for all of these things. My blood sugars are stable and my health is great except for a recurring yeast infection over the past month. Despite all this I cry all the time (almost daily for the past 2-3 months) and have anxiety episodes I can't seem to control. I've been tested for thyroid disorders and I am in range. I realize this is a specific situation but any insight would help? I need to get out of this rut and i can't figure out where to start.
Hannah, here is what I hear you say. I am doing great, my diabetes is controlled, my life is on track, I am in medical school, I have a great relationship and wonderful support. But then you say you are anxious. And you say you are crying, perhaps being depressed. Donât you know that lots of us go through this stuff? Life is stressful, even more so when you have diabetes and try to do things like going to medical school. It is ok. You arenât failing. In fact you are incredibly successful. But you shouldnât think that you are some superwoman, you are after all human. I would suggest to you that you need to open up about these feelings of anxiety and even depression to someone you can trust. Sometimes even friends and family that want to help are not the ârightâ help. It is ok to turn to a counselor to work through these feelings.
Yep, I think you are right. Thank you for your reply. Your perspective helps. I love that you say sometimes friends and family arenât the ârightâ help. I think Iâm learning that. I really do appreciate it. Thank You.
The reason friends and family arenât necessarily the ones who can help is that they themselves are emotionally invested to some degree in your situation. Thatâs why a third party (especially a trained one) can see things more objectively than people close to you. Also they are trained in specific methods and techniques for dealing with this stuff and devising coping strategies. I completely second Brianâs suggestion.
I had a similar experience while I was in law school⌠As the semester wore on, I would start feeling overwhelmed and having anxiety attacks. In my case, I was doing so many things - going to class, interning, volunteering at a legal clinic, etc. that I wasnât taking enough time for my own self-care. I found it helped to reassess my commitments and ease back on some of the lesser priorities so I could build some blocks of âmeâ time in my schedule - and then use them for what I wanted to decompress, be it watching an old movie, reading a non-law book, or even taking an hour or two to zone out and have some peace and quiet before returning to juggling 50 different priorities or running to see what emergency needed to be dealt with next.
Hey, itâs amazing to hear about diabetics getting medical degrees! We need more of those As for the stress, what I can tell you is this: I just finished a PhD, was diagnosed diabetic in the last year while I was working on my dissertation, andâŚit was the worst period of my life. I think about managing my diabetes a lot, and graduate school demands all the time in the world to do right. On top of that, trying to maintain a relationship with my wife, with family, have some kind of social life, finding free time⌠itâs never ending, and absolutely grinding.
All I can say is this: it will get better. For me, it got better immediately after I got my degree and didnât have the dissertation hanging over my head anymore. And my wife called me âDr. David,â which was pretty cool! Anyhow, Iâm just rambling, but what I really wanted to say was this: as far as I know, feeling emotional and overwhelmed in medical or graduate school is completely, absolutely normal.
Hey Hannah,
I totally feel ya! I am in Grad School, and while itâs fine, my grades are fine, my research is humming along, and everything seems great in my life, the little things seem to pile up and I get to be an anxiety-ridden train wreck. I think it has a lot to do with âimposter syndromeâ for me, because everything is so new and different, and I canât imagine that I am good enough, smart enough, or that they even let me walk in the door some days!
I want to our campus counseling office and it helped immensely, and I schedule self-care time.
I echo the friends and family not understanding thing, too. Iâm first-generation (No one in my family has been past an Associates degree) so they canât understand. I love them, and they encourage me, but it doesnât work like a trained professional does.
Youâre singing my song! I still expect the University to call and say âhey, you know that fancy degree we gave you? There was a clerical error, and we never even meant to admit you, far less give you a doctorate.â
I found counseling to be very useful as well, although for me it was employee-assistance provided âcouplesâ therapy that ended up helping both my wife relationship with my wife and my base-level anxiety. Graduate school is just brutal. Iâm very grateful that they wonât let me ever go back at this point (although a postdoctoral fellowship turns out to be almost as stressful as grad schoolâŚ).
I earned my MD in 1992, and still struggle with âimposter syndromeâ at times⌠I think this is only natural and means you arenât a complete narcissist.
To the OP: sounds like the neurotransmitters that mediate depression and anxiety have all been tapped out by the constant study, exam stress, and sleep deprivation. In addition to psychotherapy, Iâd consider treatment with an SSRI or SNRI. Good luck, and hang in there!
This too! I will toss out the suggestion to try one over Semester break if one is determined to be needed (which is still so far away). I canât take anything (except Xanax) because of the possibility of side effects, which would have been bad news to find out during school. YMMV
In your opinion are there any non-prescription alternatives that are worthwhile to ssri/snri options? Do any of the OTC stuff like sam-e, folinic acid, St. Johnâs wort, magnesium supplements, cortisol manager, etc have anything to offer or are they all gimmicks?
Please donât take offense, but Iâm not a fan of leaping to pharmaceuticals for anxiety and depression. Many of these drugs can have very side effects and dull you out emotionally and leave you dependent on them. Getting off them can be a challenge in itself. Iâd encourage exploring some counseling first.
Iâll be perfectly honest: I think the vast majority are gimmicks (and thatâs putting it nicely). At best, a handful of them may compliment or augment the effects of a prescription antidepressant/anxiolytic.
And what many people do not realize is that the interactions of these non-prescription âalternativesâ with the other medications and/or disease processes someone taking them may have are either not known or poorly understood because there is little to no regulation of these âalternativesâ resulting in the exact composition of these âalternativesâ varying from batch to batch.
Additionally, St. Johnâs wort has monoamine oxidase inhibition (MAOI) properties. MAOIs are a class of medication that is rarely used these days (and only in cases where everything else fails) because of the very serious (and sometimes fatal) interactions with numerous other medications (including those used for general anesthesia) and tyramine-containing foods.
âAlternativeâ or âherbalâ substances are not any more ânaturalâ than prescription medications: all of these substances are comprised of combinations of elements, all of which are on the Periodic Table of the Elements. Whenever I come across a patient who eschews prescription medications in favor of something ânaturalâ, I am fond of saying âStrychnine is ânaturalâ. Would you take that?â
I understand what youâre saying⌠but unfortunately for some patients (e.g. Airplane pilots) prescription psychotropic meds arenât an option no matter how attractive that option might be.
When I think about ânaturalâ things, I think about food or other unprocessed substances, not pills or extracts (which are highly processed no matter what theyâre made of).
This is an unfortunate reality for people in certain professions who truly require pharmaceuticals to regulate their neurotransmitters. When prescribed responsibly and correctly, most of these medications (with some obvious exceptions such as benzodiazepines) are either side-effect free or cause only mild, transient side effects. If anything other than this occurs, then the medication should be discontinued and, if appropriate and indicated, another tried.
If taking a psychotropic medication is not possible for whatever reason, good nutrition, adequate hydration, sound sleep hygiene, regular exercise, and a daily multivitamin can help (even when medication is taken). It makes sense to cover all the bases.
And the ultimate irony is that these people are deemed to be in such safety sensitive positions that we donât let them take psych meds and therefore a disproportionate number of them are doing their jobs with untreated or inappropriately self treated psychiatric problems (speaking from experience here if you hadnât realized;)
As for the stress, what I can tell you is this: I just finished a PhD, was diagnosed diabetic in the last year while I was working on my dissertation, andâŚit was the worst period of my life. I think about managing my diabetes a lot, and graduate school demands all the time in the world to do right. On top of that, trying to maintain a relationship with my wife, with family, have some kind of social life, finding free time⌠itâs never ending, and absolutely grinding.