Q: Colleague Recently Dx'd with BP & Has Questions
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Q:  Colleague Recently Dx'd with BP & Has Questions

Good afternoon Dr Phelps:

I am a psychiatrist in [middle eastern country name changed].I am diagnosed with bipolar ii disorder about 10 days ago.I am currently on lithium and very gradually recovering from depression episode..

My question is: during depressive episodes is it safe to continue seeing psychiatric patients? and can seeing depressed patients affect the overall prognosis of the illness?



Dear Doctor

Thank you for excellent English skills. I could not even begin a reply in Arabic!

1. Is it safe to continue to see patients while depressed? As you can imagine, "it depends".  It depends on whether the mood problem might affect your judgment, and your ability to connect with your patients.

I can imagine that if you are very depressed, you might have more difficulty than average avoiding "resonating" with your patients.  As you know, when we see people who are depressed, it is difficult not to be drawn toward the depths of their negative thinking.  One can find oneself feeling and thinking like the patient is thinking.

I cannot speak to your question from my own experience.  My only episode of depression occurred during my residency.  I had not learned at that point how to understand depression from a distance, how to recognize whether I was being drawn into a patient's mood state. But I think that even now, my own mood probably determines how I respond to my patients, to some degree.  When I am feeling tired or down, I am more susceptible to the impact of my patients depression. 

Otherwise, I have not seen any research on this.  There may well be some.  But not specifically addressing the issue of "safety ".  Instead, I think you would just have to imagine, before you start seeing patients again, whether you can be objective when necessary.  I hope that you might be able to get some sense of that just from your daily experience before you go back to the clinic.  (I apologize for the delay in my reply; and hope that perhaps that you are already back there, and finding success in the treatment of your patients). As you know, you should discuss your readiness to return to work with whoever is treating your depression.

2. Can seeing depressed patients affect your own outcome, your prognosis?  This is an important question. Since stress can make mood disorders worse; for which reason treatment recommendations routinely emphasize keeping stress under reasonable control; the question is how much stress seeing depressed patients will cause.  And I suppose that needs to be compared against how much stress you might face if you are not seeing patients, e.g. financial stress and simply the stress of not being able to pursue your profession.

In my practice, most of my patients have depression.  I'm sure you have experienced this as well: the stressful ones are those whom it is difficult to help.  Some patients can clearly improve.  Treating them is not very stressful.  But the ones whose lives are such that they are unlikely ever to improve very much, those are the hard ones.

Of course, in as you also know, sometimes it is difficult to tell who is who -- who can clearly get better, and who will not (or not much).

So here again, "it depends". I hope that you are making headway toward getting back to regular work.  Perhaps there is an idea here which will be of some benefit to you in that process.  I hope so.

Your colleague,
Jim Phelps

Published April, 2010


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