Situational Depression?

Sad, tired, and vulnerable, I plopped into my usual seat in my therapist’s office. As a third-year medical resident, I felt like a poster child for imposter syndrome. For months, my mood had been low, I was not enjoying life, and I was struggling.

My therapist gently commented, “I think it’s time for meds, Pam.”

Internally, I thrashed and resisted, struggling to reconcile what starting meds would mean. Did I have depression? How could that be, as I was highly functional? No one would guess by looking at me how I felt! Would depression from now on be part of my past medical history and on the problem list in my chart? What happened to happy, stable Pam?

My physician prescribed me an SSRI—the most common class of antidepressants. To my utter shock, my mood improved. I cried less often, and the dark chasm of depression faded away. I could have cried with gratitude. I continued various antidepressants for the duration of my residency, two pregnancies, and up to today. My attempts to wean off medication have led back to relapsing depression and restarting SSRIs.

Now, as an attending physician, I mentor medical residents and other medical providers. Inevitably, many of them feel similarly to how I felt sitting in my therapist’s office all those years ago. Being a primary care provider is extraordinarily challenging, particularly working in the chaos of a community health center. Several years ago, I concluded that staying silent about my experience perpetuates harm. Being open helps validate my mentees’ feelings, so now I share my story.

While offering emotional support to depressed residents and colleagues, I gently broach the idea of starting meds, as my therapist did so long ago. They, too, respond with resistance, commenting correctly that their depression is situational. Before residency, they felt well; it was just the time demands and emotional stress of residency that had triggered their low mood. Why should medication be the solution when the system was culpable?

I agree a hundred percent. But what if the situation triggering your depression is your work environment, which will be present for the rest of your career—the career that includes a loan repayment program, the career for which you delayed gratification and life milestones, the career for which you studied and tested and worked and gave your heart and soul.

Although the depression is situational, I fear that medication is part of the solution—until our health care system is reformed.

Pamela Adelstein
Newton, Massachusetts