nayr69sg, a Singaporean medical doctor now practicing in
Canada, made the following posts on another forum, discussing about
medical doctors suffering from depression.
I take Cipralex (escitalopram) and Wellbutrin (Bupropion) daily
and Ativan (lorazepam) prn. I also see my counselor at least once a
month. It is covered under the Physician and Family Support
Program(PFSP) provided with my Alberta Medical Association
Membership. I will continue to do so as long as I work as a Family
Physician. Dealing with all kinds of different people almost daily
with all kinds of self perceived ideas, paranoias and beliefs
definitely gets one depressed.
There is no stigma here in Alberta. In fact I would say that if
you have an existing mental illness it is advantageous as people
have to be more supportive and understanding of you make
mistakes.
Singapore Medical Association membership basically gives
nothing. Maybe the UOB Visa Card that's about it.
Alberta Medical Association membership covers 80% of my
malpractice insurance, CME benefits (includes buying of electronics
eg laptops computers hand phones printers etc) up to $3000+,
maternity or paternity benefits etc
Definitely way better than crappy SMA.
Many Singaporeans hate doctors. This is why medical profession
is favourite punching bag profession for straits times
reporters.
Singaporeans also look down on teachers.
Basically if you are in a vocation likely they look down on you.
Doctors cos they still paid pretty ok in Singapore they hate
them.
Singaporeans respect $$$. Lawyer, banker, rich businessman,
accountant, CEO you know lah that list of top earners Ministars peg
their pay on. Doctors are not on that list.
Leongsam : I thought Lorazepam had been phased out and
replaced with a newer generation of drugs such as Zopiclone which
has fewer side effects.
Zopiclone is used as a sleep aid for insomnia.
Lorazepam is used more as a short acting anxiolytic. Eg for
people with panic attacks, phobias, alcohol withdrawal or sudden
rage it is used sublingually (at least here in Canada) and works
fast and has a shorter half life. It is not used as a sleep
aid.
Nevertheless it is still a benzodiazepine (BDZ) and has risk of
tolerance and dependence. I prescribe BDZs very carefully. And
never for insomnia eg Valium (diazepam).
Even Zopiclone can have risk of tolerance and dependence. Use of
it less than 4 times a week lessens that risk.
In Canada prescribing of BDZs and Zopiclone is pretty liberal.
Same with opioids like Oxycodone. They prescribe Oxycodone for
things like toothache and simple headache! Canada is world number 2
in use of Opioids.
I have to say though that prior to seeking help myself and going
on SSRIs I also had bias against mental health and did not believe
in the medications. Part of Singapore culture.
But after taking Cipralex I found that it made me less reactive
and I did not dwell on unpleasant encounters as much as I used to.
So it does work.
It is a hazard of the job. There are many doctors with mental
health problems. You can read about it. Well studied.
Usually people seek help when things get really really really
bad. Same with drug addicts. When you are still functioning well no
one will seek help. For things to get better with mental health
usually things first have to get a lot worse .
Previous editor of NEJM also tried to debunk SSRIs.
But from personal experience the results I had is the same as
what my patients on the same meds have.
So now I think there is some benefit. Medication alone cannot do
it all though. Exercise is important. I have a Concept 2 rower at
home which I use daily.
Counselling is good as well. Having a totally non biased person
to talk to.
Leongsam : I have been doing some reading on anti depressants
and was surprised to find that Bupropion is actually a sex
enhancer! Sounds too good to be true. SSRIs are notorious for
killing libido but this pill seems to have the opposite effect! It
is currently being prescribed to smokers in NZ (under the trade
name Zyban) to help them quit the habit and is being advertised
regularly for this purpose. NZ aims to become a smoke free nation
by 2025 and the publicity is being funded by the tax payer. The
drug is subsidized too.
The old folks featured are the ones that ended up in hospital
via A & E. They've usually had a fall, a stroke or a heart
attack and are connected to a myriad of wires, probes and drips but
of course it is all to no avail. It is very unlikely they will be
discharged alive and well. They usually leave in a box.
No lah. Nowadays with technology we tend to keep them alive much
longer. Fall....fix the fracture and get them to rehab units.
Stroke, stabilize and rehab. heart attack - if they don't die in
the first 24h they usually live with a stent.
These cases are not the depressing ones. Those dying of cancer
who keep going to A&E are the ones more depressing. They are
going to die. A matter of when. But keep going to ED when there is
nothing much anyone can do.
Also the ones with dementia who the family have abandoned.
Or in Singapore where the family wants to go on holiday and
cannot find someone to take care of bedridden grandpa, so cook up
some story send to ED and then go off on holiday nobody contactable
for 2 weeks.
It is also depressing for health care professionals because in
the training/school phase they are taught all these ideals of the
profession. What is "right" and what is "wrong". Only to find that
in the real practice we basically should just do whatever the
patient deems is "right". Many take a while to grapple with this.
If they get there faster they adapt better. If they hold out to the
principles and ideals they suffer more. So I blame the stupid
academicians.
