Content warning: suicide, mental illness

I was first diagnosed with depression aged 21. After a period on antidepressants, I had improved and was able to come off them.

Depression crept up on me again during my first year of GP training. Work felt slowly more and more difficult. I couldn’t make clinical decisions as uncertainty and risk made me feel very anxious. I began leaving work late as I spent long periods worrying about my decisions and agonising over test results and patient letters. I couldn’t sleep due to fears about work. I felt devastated about any mistakes or missteps I made, and I felt like I would never improve as a trainee. I was tearful and very low in mood.

I approached my own GP to see what options were available to treat my depression. We tried one medication, followed by a combination when I did not improve. It felt terrible to be in work, and I felt a crushing fear of disappointing others or failing in training. On my last day in work, my clinical supervisor said she did not think I’d be able to complete a quality improvement project in the rotation. I went home and cried for four hours.

It can be hard to remember what being sick with depression is like once you are recovering. I kept a journal, and my entries at this time are stark and sad. I wrote ‘I feel so low all the time. Life is just drowning me. I worry things won’t get better. I worry I will kill myself.’ My suicidal ideation escalated until I felt unsafe being alone. I sharpened all my knives.

I was very tearful, writing: ‘I feel such sudden, crushing sadness sometimes and I spontaneously start crying. It feels like suddenly remembering someone I love has died or that the world is ending.’

I went off sick and contacted a private psychiatrist and an advisor through Practitioner Health, ultimately accessing CBT through Practitioner Health too.

My psychiatrist increased the dose of the antidepressant started by my GP, and when that was ineffective I was switched onto clomipramine. After two weeks I started to feel better. I was crying less and my sleep improved. My suicidal ideation slowly eased off over the next few weeks until it had completely resolved. The techniques taught to me in CBT helped me restructure my negative thoughts and identify the cycles of unproductive behaviours they were triggering.

I am now feeling better, with a plan for returning to work with adaptations and a phased return. I am aware I may get sick again, and I am aware work has previously exacerbated my depression. I hope to find a way to work as a GP trainee and have it feel sustainable for me emotionally. If I find I cannot, then I will change career. I will not risk my life for this job.

A month after what I wrote about feeling crushing sadness, I wrote this in my journal: ‘The darkness does recede. If you can wait, it passes.’ I found it helpful in my worst moments to remember the treatment algorithm for depression, and remind myself that until I had tried literally everything, I had reason to hope that I would find something that would make me better.