Archive for the ‘depression’ Category

While reading over some articles I found one about physician suicide – which is of course an issue close to my heart. From there I started looking at other articles talking about physician suicide. This is gives me some relief as I am not alone but at the same time scares me as I fit some of the descriptions of a successful physician suicide “to the T”. In a career dedicated to helping others, it seems we fail at helping ourselves as evidenced by “the overall physician suicide rate cited by most studies has been between 28 and 40 per 100,000, compared with the overall rate in the general population of 12.3 per 100,000”  which is 2-3 times the rate of the normal population! In an era of physician shortage, about 400 physicians successfully complete suide each year which “would take the equivalent of 1 to 2 average-sized graduating classes of medical school to replace.”

I wondered if any specialities would be a highest risk – you would think oncology – with so much death and sorrow, or maybe neurosurgery – which are overworked and in constant high stress situations. In my situation, one of my worse clinical rotations was the medical ICU as I started feeling down, thinking very negative and was having trouble with dealing with other people being happy/content. I soon realized that we were averaging a death a day and it was taking a toll on everyone.  The answer suprised me – “there has been multiple studies since the 1960s trying to breakdown this in specialities, and they tend to point to psychiatrists as having the highest suicide risk – although studies done later have found no difference in specialities.” Although maybe dealing with constant mental illness, depression, and anxiety starts to effect oneself.

The risk factors for physician suicide are a lot like the general population – which upset me because I fit so many. For example, rates are found to be “higher among physicians who are divorced, widowed, or never married,” and having been recently divorced…  Another statement describes the personality qualities of a physician who completes suicide “as driven, competitive, compulsive, individualistic, ambitious, and often a graduate of a high-prestige school,” – I don’t think I am too competetive – but of course I am individualist(do autistic people have a choice in this regard?) and driven(which has gotten me to where I am). Another study showed personality factors “including self-destructive tendency, depression, and guilty self-concept” – which basically describe my mindset for the past 20 years – using these attributes psychiatrists were able to review a past medical class and pinpointed the 8 successful suicides without prior knowledge of the class! A 1980s study linked suicides to “having slightly more difficult or emotionally draining patients than other physicians, both throughout their careers and in the final 2 years of their lives” which is not too suprirising.

One of the other reasons possible for such a high success rate in physicians may be our knowledge of drugs and lethality, this has resulted in a “higher completion to attempt ratio”, especially in females. I can appreciate this as I think of my previous attempts when I was a teenager – how unlikely my change of suceeding would be with the methods I had used..


Miller, et al. The Painful Truth: Physicians Are Not Invincible, “Southern Medical Journal”, 2000

Facts About Physician Depression and Suicide, American Foundation for Suicide Prevention

Andrew, L, et al. Physician Suicide,, 2012



Posted: September 2, 2011 in depression
Tags: ,

This is a very similar post to my previous post about Ritalin, but this issue dominates my life.

Also, I originally thought this would be a space about my experiences in medicine and how autism effects my views but I seem to be on a mental illness kick. Considering not many people read this and it helps me a little to get things in physical writing, I will continue to write whatever I feel at that time.

I am laying in bed alone, I feel hopeless and overwhelmed. A vast empty abyss is growing in me. During the day I am having trouble returning the small talk normal people require because my focus is set inward. Doesn’t inward focus sound good? Well for me it’s a toxin. I turn my intelligence and ability to spot weakness on myself. I tear myself up over little things, I don’t let anything slip by. My emotions are very fragile during this, for example, I almost cried when someone wouldn’t sit with me.

It’s only been a week since I stopped taking ritalin because I was feeling stable. This quite a quick decline, sometimes I can last a month. I am at the bottom, I fall asleep planning little details of my suicide. I plan item lists, locations, and imagine how it would feel. This relaxes me enough to sleep.

Sleep..all I want to do is sleep. If I allow myself I’d sleep 18 hours a day. Dreams are so much better than reality, I get to feel the rush of serotonin in my dreams. I actually get to have good feelings in them as to opposed to the negativity that dominates my life.

I suppose I will take a Ritalin this morning as I feel my interpersonal relationships at work crumble. I am purposely distancing myself and reducing how much I talk. I lack the urge to “mirror” their facial expressions.

I just dread that high, speedy feeling. I am not looking forward to feeling my thoughts race and feeling anxious. It’s so much more comfortable for me to be slowed down and depressed.

It is the third year of my medical school and I am in a psychiatric ER, against my will, and on the phone with my course director who states the dean promises that they will treat this incident just like any other acute illness requiring hospitalization.

How did I get there? I think it was a perfect storm. Sure, almost every month I have times where I am actively planning every little detail of my death, but this time was different. It was Ramadan thus I was fasting from food/liquid and because of this I had not taken my Ritalin for 2 weeks or so. At first it wasn’t going so bad but suddenly, or so it seems to me, I started crying at the slightest thing. People would make tiny criticisms and I’d just fall apart.

It was also the anniversary of my grandmothers death, who you know was very close to me. I could feel the fear and apprehension of actually having to face it start to mount.

My wife was also pregnant and in her last weeks. I did not feel prepared, I did not feel like I should be a father.

Ritalin my enemy

Posted: August 18, 2011 in depression
Tags: , ,

My heart is pounding against my chest, I feel the tremendous force of its impact against me and it’s uncomfortable. My mouth is dry and tacky reminding me of when I fast from liquids. My eyes are darting around and it’s hard to focus on anything for too long.

My mind follows this pattern, skipping thoughts and subjects at a rapid pace. I barely can keep with the speed of my thoughts, I wonder If this is what mania or ADHD feels like? It’s hard for me to talk to people as my mind wants to go faster and faster.

I have a deep pit in the bottom of my stomach. My body and mind are telling me I did something really horrible, like run someone over, and I’ll be caught. I try to review my life, and I can’t find a real event that causes this.

This is why I have a love/hate relationship with Ritalin. Whereas it helps reduce my suicidal thoughts and helps give me emotional stability it comes at a cost.

I also hate how it works. I hate how I can be planning my “end”, take the medication, and an hour later I am hopping all over the place. But of course it works, it’s based on amphetamine. Wouldn’t even a normal happy person feel better with such a stimulant? SSRIs, like prozac, take 4-6 weeks to take effect, so isn’t it wrong to have my mood elevated in 30 minutes?

It feels dirty, like an illegal high. Like I am doing something wrong that I shouldn’t be doing.

Can’t I get thru this by my intelligence alone? I have gotten in and completed an ivy league education and medical school with moderate effort, so can’t I overcome this problem with my mind alone? If I am so smart why can’t I apply it to this situation and overcome it?

“Compare it to a diabetic who needs insulin, are they weak for needing medicine?” is what I’d tell a patient who thinks antidepressants are for the weak. But this is different. Ritalin is an instant up with a noticeable downslope. It comes out of the system in hours. It’s abused so that people will feel better. No one takes Prozac without prescription for fun!

The abyss

Posted: August 6, 2011 in depression
Tags: , ,

I sit on the couch, all of my muscles feel exhausted even though I have over slept by 4 hours. My thoughts form slowly, my mind working at sluggish speeds. Even though it is just the beginning of the day I feel like I have run a marathon and then had to take a 2 hours calculus test. It is almost like I am drugged, dragging myself thru a fog.

In addition to this exhaustion I am have no interest in common things. I can’t find myself caring about anything, I am not drawn to music or hobbies. Thinking about playing guitar, or even going outside seem like unobtainable goals.

But worst of all is the feeling of being alone. I feel unattached to anyone. No connections to the outside world. I float along thru the mass of humans with no attachment to the masses. It feels like a dark abyss, large and empty. Surrounded by a gulf of darkness. My body remains untouched, my skin isolated from the electricity of humanity.

My mind tells me to escape. To do anything possible to leave my current situation. I am like an animal who is caught in a cage, my vision is narrow and I can only think of the immediate present. I am unable to visualize the future and the consequences.

Shock therapy, aka electro convulsive therapy (ECT) is much more humane now then it was in the 1950-1960s and very different from how they portray it on TV. Although the objective of causing a generalized tonic-clonic seizure remains,  a combination of general anaesthesia and a muscle paralytic agent makes the procedure painless and reduces fractures to basically zero. So here is my “one flys over the cuckoos nest”

It’s a day off from my crappy minimum wage job and I am being driven to the hospital by my parents, as you are not supposed to drive after general anaesthesia. I wait in line outside the “therapy room” with others like me, lots of them much older or on the surface much more disabled. Finally, the wait is over and it is my turn.  I am led to the therapy room by an older nurse, one who still wears the old nursing hat with the matching folded cap. The ECT machine is imposing in the room, large, antique looking, steely gray with a bunch of dials and gauges. I lay down on the cold OR table still wearing my street clothes and look up at the sterile white ceiling. I feel the fear and apprehension building even though I have done this many times before, but I try to ignore it. I try to concentrate on the patterns on the ceiling and ignore the screaming anxiety in my head. The IV is started, my head is strapped with an old leather belt-like device (bipolar ECT), my body strapped down by much thicker leather straps, and the drugs are pushed.

“Count back from 100…”, the anesthesiologist says. I start to feel drowsy but then right before I nod off the paralytic agent takes effect.  I feel my legs go numb then limp, then the worst happens. I feel my diaphragm start to slowly give up and this causes me intense panic. It feels like the worst asthma attack I have ever had, I can’t move enough air, my eyes become wide with fear. I begin a losing fight against the medication’s effect, using every ounce of strength and determination I have to keep my diaphragm moving up and down… And then…. I black out.

I wake up with three large leather straps across my body. I have no idea what is going on, where I am, or who I am. I feel intense fear, an overwhelming urge to escape to a safe place to figure things out. I start fighting against the straps, trying to tear myself out, but I am secured tightly.  A nurse I have never seen before comes over and asks “Whats your name? Where are you? What just happened?” I am unable to answer any of these questions and I become very angry. She tells me my name, and when she does all I feel is a twinge of deja-vu, like “I swear I’ve heard that name before”. This process, asking me the 3 questions then telling me the answers occurs every set period of time until I am able to answer all three without her prompting me. I have no idea how long this takes as my sense of time is destroyed.

They lead me to the cafeteria and offer me juice and crackers. The anaesthesia has made me very nauseous, or maybe it was the grand-mal seizure? Either way I have no urge to eat. I feel…flat…nothing..a blank slate and my face reflects the same emptiness. I have no negative thoughts or positive thoughts, I am just..level. My parents meet me and start talking about random life topics. I am unable to keep up with the pace of the conversation, my brain feels like its going thru a thick fog.. On the drive home the feeling of deja-vu occurs over and over again.. “oh I think I’ve seen that car before” “Oh I think I’ve seen that house before..”

I underwent over 100 of these procedures, and only stopped because I had a heart arrhythmia under anaesthesia. They did not make me happy, nor did they make me “normal”. They do not end a behavior because of “pain” (as there is none) or negative reinforcement (again, as there is none) but it did help reduce my intense urge to kill myself. If one was suicidal, and 10 was perfectly happy, it made me a 5 with the inability to go to a 4 or even a 6. Others around me say I became very forgetful, that during this period I was not as sharp or as quick as I normally was. One person told me I was a “zombie version” of my former self. Also, the 1.5 year period I was receiving these is completely wiped from my mind still.. My memories from this time are purely people telling me later what I did or what happened. Yet, despite these side effects I feel that ECT helped save my life. It helped me get thru one of my roughest depression phases and hence able to go on with life and for that I am thankful.

Does grief affect someone with autism differently than neurotypicals (those without autism)?

I went to assess a pt who was in end of life and met the pt’s daughter in the hall. She was shaking and saying her mother hadn’t breathed in over a minute. While the nurse tried to calm her down I listened for breath and lung sounds, which there were none. I informed the daughter and she started crying. I started feeling the strong sense of composure and cold detached logic, which I pride myself on, collapse. The wall around my emotions I had been building since my grandmother’s death 3 years ago just gave way and I felt the daughter’s grief affect me on a personal level. As I saw the daughter cry I began identifying with her pain and knowing how deep it runs which tore me apart inside. I felt tears start to well up in my eyes, I tried to say my condolences, hugged her (which I did even though it causes me physical pain because I know neurotypicals need it in times of grief) and quickly escaped the room.

It all seems odd to end up this way as I have spent countless hours focusing on my death, planning it, trying to predict it’s after effects. I looked at death in a logical way, as in an event that is expected end point of any life. Yet I was not prepared for my grandmother’s death and it ended up changing me forever. After the event I didn’t really talk and I started sleeping the days away. I had typical grieving reactions such as thinking I heard her voice or seeing her out of the corner of my eye. I cried for months and found it very hard to not wake up thinking of her. I couldn’t even watch TV shows or commercials that contained grieving people or I would become very upset.

Fast forward 3 years later, and things have become like what Johnny Cash said regarding his brother’s death “I kept talking but everyone stopped listening, so I stopped talking about him”. In this time period, it feels like I have built a wall, a defense system against tragic events effecting me personally. While this may seem cold, it is required if you are a doctor in a field with death being a normal expected event, for example: In my ICU rotation we had someone die around once a day and if I had opened myself up to the experiences of the family because I would have not made it thru. I thought the barriers I had formed over the years were near complete as I had gone thru patient deaths unscathed. Yet, when this patient’s daughter, who I have known only for 6 months, started grieving my defenses completely failed.

I suppose I should have predicted this, for the wall itself is in part a charade. If I was completely healed from my loved one’s death, couldn’t I bring myself to visit her grave? Couldn’t I think of her and things we did without crying? Would I avoid talking about her for fear of the emotional response it will bring?

So I would say yes, in this case an autistic man grieves like any other man.