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How a stroke made me face up to my depression

It took a minor stroke before I was able to take much-needed leave from work. But it wasn’t the stroke I needed to most recover from – it was the severe depression I had that was many times worse. The stroke afforded me the time and space I had wanted, and needed, in order to recover.

– Geoff Toogood

 

In 2013, I faced major stresses at work and my marriage was ending. It got the best of me. I had experienced moderate depression a few years prior – moderate enough that I could work through it – but this time it was a lot more severe. I was so depressed and stressed that I had suicidal thoughts. I confided in some people at work; I told them I was suicidal. I told them I wanted to take leave. But it was the stroke symptoms that allowed me to get the leave more easily approved. I took about a month off. As a result, I had to make the decision to step down as head of my department for a while.

The culture of the health industry doesn’t offer the best support for health professionals experiencing mental health issues. That was certainly my experience anyway. Some health professionals frown upon taking sick leave. There’s a perception of weakness. beyondblue research actually confirms that perception from people in our industry.

According to a beyondblue survey of Australian doctors, approximately 40 per cent of doctors felt that medical professionals with a history of mental health disorders were perceived as less competent than their peers. Almost 59 per cent of doctors experiencing depression find it is embarrassing for them. Even more worryingly, almost 50 per cent of doctors feel those with mental health disorders could face setbacks in their career progression.

Additionally, beyondblue’s research showed that one in five medical students and one in 10 doctors had suicidal thoughts in the past year. It’s not difficult to see the significant issue of the health industry dealing with, or in some ways failing to deal with, mental health issues. Though it’s positive to learn from the research that doctors show great resilience, personally and professionally, to the negative impacts of mental health.

My road to recovery was gradual. It took me a while to summon up the courage to see my GP. Instead of booking an appointment I used natural remedies, such as taking B vitamins, as a way of self-medicating. It made little difference. What I needed was counselling and medication: professional help.

Admitting to myself that I had a serious illness and seeking help was a major turning point. Part of my self-admission came after a long-time friend texted me saying ‘I’m concerned about you’, and provided me with the beyondblue Support Service number. Having a friend recognise and voice the seriousness of my situation also reinforced my need to seek help.

I finally called my GP. She took control and told me what we needed to do so I could start to recover. Following her advice and treatment plan was pivotal. A compassionate doctor will understand exactly what you’re experiencing, as an individual and as an industry peer. Now I’m well and back working as a senior cardiologist at The Alfred and Peninsula Health.

I really feel for today’s junior doctors. I think pressures on them have increased since I was in their position. The health system has changed, which has increased pressure to get more things done in less time.

There are also so many challenges that haven’t changed: the pressure high achievers put on themselves to perform continuously at a high level; and the pressure to keep up with peers, whether it’s managing high workloads or giving accurate diagnoses the first time, every time.

The stress of the high workload for junior doctors can’t be ignored. You’re working 50- to 60-hour weeks and then studying for 20 or more hours. Exam study adds to the intensity. You always have that uncertainty of passing, which everyone goes through.

Throw in the unsociable working hours, as well as job instability due to short contracts and frequent rotations, and it’s easy to see the impact on young doctor’s mental health.

Still, even when doctors aren’t well, we often put our own health second.  You tell yourself to always put patients first. But we need to fit our own oxygen mask first. If we don’t look after ourselves, our patients won’t have a doctor to look after them. A doctor needs to be well to provide high-class care to their patients.

Here is what I’d advise young doctors do to stay well:

  • Look after yourself by doing what you can to develop work-life balance. This could mean making extra effort to catch up with family and friends, establishing an end-of-day routine to unwind, or planning a holiday;
  • Develop interests and passions outside work. I’ve taken up ocean swimming. What I love about swimming is the need for minimal equipment, getting time to myself so I can practice mindfulness, and I always feel great afterwards;
  • Realise that you’re more than a doctor, you’re human. Yes, we too can be ill, and we need to follow the advice we give our patients about self-care;
  • If you’re struggling, seek help early;
  • Make sure you have your own health professionals, especially a GP, that you trust and can be open with;
  • If you see a colleague struggling, reach out to them. Offer to catch up over coffee or just offer support. When hospital culture is positive, it can feel like you’re working in a small town or community so you notice and react if someone isn’t well. beyondblue has a range of resources to help you have these conversations;
  • Show leadership at work by not tolerating poor behaviour towards mental health issues;

As a beyondblue speaker, I’m proud that our education and research tools have helped break down stigma surrounding mental health conditions. There are also other great resources such as ‘Keeping Your Grass Greener: A wellbeing guide for medical students’.

I definitely encourage doctors who might be experiencing mental health issues to talk to someone. It might even be best to speak to a trustworthy friend outside of the workplace to ensure confidentiality. If you need to speak confidentially to a professional, your state Doctors Health Service and employee assistance programs can provide support. beyondblue has several confidential support options for doctors. The Support Service provides free impartial, solutions-focused counselling from mental health professionals by phone 24/7 on 1300 22 4636, online at www.beyondblue.org.au/get-support or via webchat from 3pm to midnight AEDT.

Sharing my experience of depression with other medical professionals has shown two sides of the industry. I have doctors approach me at conferences to thank me, and to share their own mental health issues. Unsurprisingly, they often tell me they haven’t spoken to anyone else about their struggles. That in itself speaks volumes about the relationship between mental illness and our profession.

When senior executives from our industry attend and engage with my beyondblue advocacy talks – including Grand Rounds – that’s when change and improvements most often happen. Support from the top is imperative. Leaders must walk the positive talk.

beyondblue provides organisations free practical information and resources about how to create mentally healthy workplaces. The Heads Up website is developed by beyondblue in collaboration with the Mentally Healthy Workplace Alliance. Heads Up has specific resources for doctors and medical students to support their mental health at work. To learn more, visit http://www.headsup.org.au/doctors.

Dr Geoff Toogood has been working in medicine for 30 years, specialising as a cardiologist for the past 20 years. He works at The Alfred Hospital and Peninsula Health, at which he has held director roles.

This blog was originally published on www.onthwards.org.  Read the original article here.

onthewards is a website dedicated to delivering practical, high quality free open access education for medical students and junior doctors.

 

For more information about health issues for doctors, access a range of online resources from Doctors’ Health Advisory Services Pty Ltd.

Or phone:

NSW and ACT … 02 9437 6552

NT and SA … 08 8366 0250

Queensland … 07 3833 4352

Tasmania and Victoria … 03 9495 6011

WA … 08 9321 3098

New Zealand … 0800 471 2654

Lifeline on 13 11 14

beyondblue on 1300 224 636

 

What links anxiety, depression and insomnia

Good sleep is essential for our mental well-being. Just one night of disturbed sleep can leave us feeling cranky, flat, worried, or sad the next day. So it’s no surprise sleeping problems, like difficulty falling asleep, not getting enough sleep, or regularly disrupted sleep patterns, are associated with anxiety and depression.

Anxiety and depression, which can range from persistent worry and sadness to a diagnosed mental illness, are common and harmful.

Understanding the many interacting factors likely to cause and maintain these experiences is important, especially for developing effective prevention and treatment interventions. And there is growing recognition sleep problems may be a key factor.

Which problem comes first?

The majority of evidence suggests the relationship between sleep problems and anxiety and depression is strong and goes both ways.

This means sleep problems can lead to anxiety and depression, and vice versa. For example, worrying and feeling tense during bedtime can make it difficult to fall asleep, but having trouble falling asleep, and in turn not getting enough sleep, can also result in more anxiety.

Sleep disturbance, particularly insomnia, has been shown to follow anxiety and precede depression in some people, but it is also a common symptom of both disorders.

Trying to tease apart which problem comes first, in whom, and under what circumstances, is difficult. It may depend on when in life the problems occur. Emerging evidence shows sleep problems in adolescence might predict depression (and not the other way around). However, this pattern is not as strong in adults.

The specific type of sleep problem occurring may be of importance. For example, anxiety but not depression has been shown to predict excessive daytime sleepiness. Depression and anxiety also commonly occur together, which complicates the relationship.

Although the exact mechanisms that govern the sleep, anxiety and depression link are unclear, there is overlap in some of the underlying processes that are more generally related to sleep and emotions.

Some aspects of sleep, like the variability of a person’s sleep patterns and their impact on functioning and health, are still relatively unexplored. More research could help further our understanding of these mechanisms.

Sleep interventions

Disentangling which problems come first, and under what circumstances, is difficult.
masha krasnova shabaeva/Flickr, CC BY

The good news is we have effective interventions for many sleep problems, like cognitive behaviour therapy for insomnia (CBT-I).

So there is the possibility that targeting sleep problems in people who are at risk of experiencing them – like teenagers, new mothers and people at risk for anxiety – will not only improve sleep but also lower their risk of developing anxiety and depression.

Online interventions have the potential to increase cost-effectiveness and accessibility of sleep programs. A recent study found a six-week online CBT-I program significantly improved both insomnia and depression symptoms. The program included sleep education and improving sleep thoughts and behaviours, and participants kept sleep diaries so they could receive feedback specific to their sleep patterns.

We’re conducting some research to improve and even prevent physical and mental health problems early in life by targeting sleep problems. Using smart phone and activity tracker technology will also help tailor mental health interventions in the future.

General improvements to sleep might be beneficial for a person with anxiety, depression, or both. Targeting one or more features common to two or more mental disorders, like sleep disturbance, is known as a “transdiagnostic” approach.

Interventions that target transdiagnostic risk factors for anxiety and depression, like excessive rumination, have already shown some success.

A good foundation

For many people, treating sleep problems before treating symptoms of anxiety and depression is less stigmatising and might encourage people to seek further help. Addressing sleep first can develop a good foundation for further treatment.

For example, people with a depressive disorder are less likely to respond to treatment and more likely to relapse if they have a sleep problem like insomnia.

Many of the skills learned in a sleep intervention, such as techniques for relaxation and reducing worry, can also be used to help with daytime symptoms of both anxiety and depression. And this is not to mention the physical benefits of getting a good night’s sleep!

If you’re concerned about your sleep or mental health, speak to a health care professional such as your GP. There are already a number of effective treatments for sleeping problems, depression and anxiety, and when one is treated, the other is likely to improve.

And with research in this area expanding, it’s only a matter of time before we find more ways to use sleep improvement interventions as a key tool to enhance our mental health.


Professor Emeritus John Trinder contributed to this article.

Joanna Waloszek, Postdoctoral Research Fellow in Psychology, University of Melbourne and Monika Raniti, Master of Psychology (Clinical)/PhD Candidate, University of Melbourne

This article was originally published on The Conversation. Read the original article.