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
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
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
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.
Published April, 2010