I am a psychiatrist, and I have experienced recurrent severe major depression for most of my adult life. My problems first appeared during adolescence when I began to suffer from anxiety. I experienced my first episode of significantly low mood in my last year of medical school. Nevertheless, I decided to go ahead and train in psychiatry, as it was clear to me this was the specialty that I showed the most talent for as a student. I had a further episode of depression during my training when I failed a professional examination. After that, I began to attend sessions of psychotherapy. Since then, I have undergone both psychodynamic and cognitive behavioral therapy with some benefit—although not enough to prevent further more serious episodes over the past 25 years. My illness has necessitated some long periods off work.
I’ve tried most antidepressants and have now taken medication continually for 2 decades. I’ve never been hospitalized, although I once refused admission, and my current psychiatrist thinks I could well have been an inpatient in recent years if I had not stayed on antidepressants. I had mixed feelings about medication at first. I trained in psychodynamic therapy and found it hard initially to accept that tablets would help. The tricyclic I was first treated with caused adverse effects, which I struggled to cope with. SSRIs were an improvement but were insufficient to keep me well. I’ve been on lithium and now take another combination of drugs, which keeps my mood fairly stable. I still have occasional relapses though, usually in response to life events.
I am certain that both having depression and being a patient have had a significant impact on my career. I understand what it is like to experience severe depression—to feel worthless, hopeless, and even paranoid—and I have had persistent suicidal ideas, although I have never attempted to harm myself. I too have felt the ambivalence about accepting help from professionals that my patients have sometimes expressed about receiving from me. I think all this has caused me to be a more empathic doctor, although I am not suggesting that you have to have experienced these things to help people who are depressed. I am simply saying that I think it can help. I do understand what it is like to visit a psychiatrist, to wait in the waiting room, and to be asked the questions that are so familiar to you in your everyday work. As someone who takes the tablets but who would much rather not have to do so, I’ve learned a great deal about the need to negotiate treatment, to answer questions truthfully, and above all to listen to my patients’ worries and concerns.
I have been perhaps more concerned with the importance of the depressed patient getting access to care (hence my interest in primary care) and the need to really engage people who are depressed. I know how hard it is to commit to attending a session regularly if you have difficulty even getting out of bed and putting your clothes on and you have to tell your manager you need to take every Monday afternoon off. Yet too often the onus for beginning therapy is placed solely on the patient, who has to be “motivated.” I know my first therapist did not always find it easy to persuade me to engage in working with him, but he made a considerable effort to do so, and he succeeded in reaching out to me.
I am now retired from clinical practice, and I’ve written about my experience of depression in a book, which was published in the United Kingdom this year. Quite a few people have told me how brave I am to “come out” and admit that I’ve suffered from mental illness. Yet if I had written about having diabetes or some other physical condition, no one would have described my illness in such terms. Why should it be such a surprise that a person who worked as a psychiatrist for over 30 years and who has spent her life researching and teaching about depression might have first-hand experience of it herself? Probably because, in the health professions, the last thing we usually want anyone (particularly our colleagues) to know is that we too are vulnerable to exactly the same stresses and problems as our patients.
Dr Gask is Emerita Professor of Primary Care Psychiatry, Centre for Primary Care, Manchester, United Kingdom. She is the author of The Other Side of Silence: A Psychiatrist’s Memoir of Depression.