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Chitchat Excellent article on depression suffered by a doctor.

scroobal

Alfrescian
Loyal
Excellent article by a victim who is a daughter.

http://themiddleground.sg/2017/05/11/im-a-doctor-and-this-is-how-i-got-depressed/
I’m a doctor, and this is how I got depressed
May 11, 2017 05.00PM | The Middle Ground linkedin

by George Khoo

I saw the signs a couple of months before my daughter’s wedding. The year running up to this point had been rough. I was feeling upset, tired, irritable and angry almost every day. I teared up easily and was constantly thinking negative thoughts, sometimes even suicidal ones.

Even though I was so tired most days, I wasn’t able to sleep properly, often waking up in the wee hours of the morning. How I felt added to my fatigue, frustration, hopelessness, guilt and feelings of worthlessness.

While the truth that I was clinically depressed started to sink in, I was probably still in denial and hoped that with time, rest and exercise, things would improve. However, it just got worse and the low moods and negative thoughts persisted.

Part of the reason for not seeking help early was because I’m from the medical profession. I felt that admitting that I needed help would not reflect well on me – a healthcare provider who’s not even able to care for himself.

How did it get this bad?

It wasn’t the volume of work that affected me most but the issues in my relationships. I have always tried to live peacefully with my fellow man and it’s not in my nature to confront others. However, the leadership roles I’ve taken up at work and in my church have increasingly put me into situations that require confrontation.

I had patients that year that I expected would be grateful to me but turned around to question me on the wisdom of the recommendations I had made with their best interests at heart. I had a colleague who was pushing me to pursue something I was not comfortable with. And I had to confront people who had made wrong choices and required disciplinary action. Meanwhile, in church, a man told me to my face that he wanted me to step down as a church leader.

The worst was when a leader at work, unhappy with a policy I was trying to revise, accused me of being more interested in systems and policies than in caring for patients. I had spent sleepless nights worrying for my patients and trying to get them good healthcare and while what the leader said was absurd, it really hurt to hear him say that to me.

All of this played into my feelings of worthlessness and frustration, causing me to feel even more irritable and upset than I already was.

An unusual sense of loss

At some point, however, I realised that these were not the only causes for what I was feeling. It dawned on me that a big factor was the prospect of ‘losing’ my precious daughter once she gets married. That year, we must have attended close to 10 other weddings and I dreaded going to them because they just reminded me that soon, I was to give away my own daughter. Each wedding became more and more difficult to attend and the worst was the one two weeks before her wedding. I teared throughout the wedding thinking of what it was going to be like on that day!

I was unable to make sense of how depressed this made me feel until I read Unmasking Male Depression by Archibald D. Hart:

“Then there was the time when my first daughter was going to be married. I found myself quite depressed a few months before the wedding. Finally, it dawned on me that my little girl was saying goodbye to me in favour of a young man who was not part of me. Like it or not, being excited for my daughter was not enough to overcome my sense of sadness. I was facing a loss that could never be replaced. There were those who said to me, “You’re not losing a daughter but gaining a son-in-law.” What a ridiculous idea! What I was losing could not be counterbalanced by what I was gaining. Every father of a daughter knows that a son-in-law does not equal a daughter!”

Coming across that passage was like hitting the jackpot (not that I play). Finally, someone understood how I was feeling – he had been through the same thing and knew how I felt.

Getting help

I finally plucked up the courage to make an appointment with a psychiatrist to confirm my own suspicion. I needed to know for sure, to be fair to my family and my loved ones. In any case, I had reached a point where not much else mattered and I wasn’t bothered about the stigma associated with taking anti-depressants

I had reached a point where not much else mattered and I wasn’t bothered about the stigma associated with taking anti-depressants
I was put on Lexapro (escitalopram) and during my review, three and half months after my first appointment, my psychiatrist doubled my dosage. I was definitely feeling better in terms of having less frequent thoughts of hopelessness and a stop to the suicidal thoughts but I was not “walking on clouds”. About a week later, I distinctly remember waking up one morning and thinking: “Oh, this is what it feels to be normal?” That morning, after many months of feeling down, moody and negative, I felt that burden lift. My medication was working well.

The other thing that helped me greatly was reading the Bible and other Christian literature on depression and burnout. I found them to be great in creating self-awareness and for self-therapy.


“I believe that I shall look upon the goodness of the Lord in the land of the living! Wait for the Lord; be strong, and let your heart take courage; wait for the Lord!” – Psalm 27:13-14

“Despite being a dedicated gospel-hearted Christian who preached grace, the truth is that I was dangerously close to living a gospel of works, not grace.” – Christopher Ash, Zeal without Burnout

“The surprising truth is that the person who pauses long enough to refresh his soul along the way actually becomes more alert, more alive, more efficient.” – W. Phillip Keller, Strength of Soul

The other main factor on my road to recovery was the tremendous support given to me by my beloved wife and family. At the end of our family holiday, six weeks before my daughter’s wedding, I decided to be open with them at the airport while waiting for our flight back to Singapore. I am thankful that they took it very well and were very encouraging.

My wife, who knew my struggles all throughout, was a pillar of strength when my whole world was crumbling emotionally. She is not only my best confidante and my best friend, she also makes me laugh and reminded me to rest. She was ever patient with me when I was negative and moody and even scratches my back to help me sleep! God gave her the strength and grace to put up with me.

It’s been a two and a half year journey and while my psychiatrist has encouraged me to try weaning off the Lexapro, I realise that as long as I am in my current role, in church and at work, it would not be possible. I have tried weaning it off but have had to go back on my medication rather quickly. Nonetheless, my dosage has halved and my recovery has been steady.

Having been through the worst periods has helped me to be more disciplined about taking regular breaks. Now, I take a week off every three to four months and am intentional about observing the weekly Sabbath as a time of rest from work. As the writer Christopher Ash puts it in Zeal without Burnout, “God needs no day off. But I am not God, and I do.”

Stigma

I have chosen to be open about the fact that I am still on anti-depressants because there is a need to remove the stigma associated with it. In Singapore and in this part of the world, to be on anti-depressants is still very much taboo. Thankfully, I work in a Christian organization that fully understands and supports my stand. However, other employers may not be as understanding and that is probably one of the main reasons why people do not speak up – the fear of losing their jobs or not getting one should they be honest.

While it is probably too idealistic to expect no discrimination at all, I hope that we can help employers be open to accepting applicants with a history of mental illness but are stable on medication. They should be at least considered in the same way as those with other chronic illnesses such as hypertension or diabetes. As long as they are capable of performing the tasks and do not pose a danger to themselves or others, they should be given equal opportunities.

“The lines have fallen for me in pleasant places; indeed, I have a beautiful inheritance.“ – Psalm 16:6

Dr George Khoo is a general practitioner in his late 50’s and serves as the Medical Advisor for a Christian organisation. George is married to Mabel and has two grown up children, both happily married. George and Mabel have a newborn grandchild and are expecting a second within the next few weeks.
 

nayr69sg

Super Moderator
Staff member
SuperMod
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.
 
Last edited:

numero uno

Alfrescian
Loyal
Excellent article by a victim who is a daughter.

http://themiddleground.sg/2017/05/11/im-a-doctor-and-this-is-how-i-got-depressed/
I’m a doctor, and this is how I got depressed
May 11, 2017 05.00PM | The Middle Ground linkedin

by George Khoo

I saw the signs a couple of months before my daughter’s wedding. The year running up to this point had been rough. I was feeling upset, tired, irritable and angry almost every day. I teared up easily and was constantly thinking negative thoughts, sometimes even suicidal ones.

Even though I was so tired most days, I wasn’t able to sleep properly, often waking up in the wee hours of the morning. How I felt added to my fatigue, frustration, hopelessness, guilt and feelings of worthlessness.

While the truth that I was clinically depressed started to sink in, I was probably still in denial and hoped that with time, rest and exercise, things would improve. However, it just got worse and the low moods and negative thoughts persisted.

Part of the reason for not seeking help early was because I’m from the medical profession. I felt that admitting that I needed help would not reflect well on me – a healthcare provider who’s not even able to care for himself.

How did it get this bad?

It wasn’t the volume of work that affected me most but the issues in my relationships. I have always tried to live peacefully with my fellow man and it’s not in my nature to confront others. However, the leadership roles I’ve taken up at work and in my church have increasingly put me into situations that require confrontation.

I had patients that year that I expected would be grateful to me but turned around to question me on the wisdom of the recommendations I had made with their best interests at heart. I had a colleague who was pushing me to pursue something I was not comfortable with. And I had to confront people who had made wrong choices and required disciplinary action. Meanwhile, in church, a man told me to my face that he wanted me to step down as a church leader.

The worst was when a leader at work, unhappy with a policy I was trying to revise, accused me of being more interested in systems and policies than in caring for patients. I had spent sleepless nights worrying for my patients and trying to get them good healthcare and while what the leader said was absurd, it really hurt to hear him say that to me.

All of this played into my feelings of worthlessness and frustration, causing me to feel even more irritable and upset than I already was.

An unusual sense of loss

At some point, however, I realised that these were not the only causes for what I was feeling. It dawned on me that a big factor was the prospect of ‘losing’ my precious daughter once she gets married. That year, we must have attended close to 10 other weddings and I dreaded going to them because they just reminded me that soon, I was to give away my own daughter. Each wedding became more and more difficult to attend and the worst was the one two weeks before her wedding. I teared throughout the wedding thinking of what it was going to be like on that day!

I was unable to make sense of how depressed this made me feel until I read Unmasking Male Depression by Archibald D. Hart:

“Then there was the time when my first daughter was going to be married. I found myself quite depressed a few months before the wedding. Finally, it dawned on me that my little girl was saying goodbye to me in favour of a young man who was not part of me. Like it or not, being excited for my daughter was not enough to overcome my sense of sadness. I was facing a loss that could never be replaced. There were those who said to me, “You’re not losing a daughter but gaining a son-in-law.” What a ridiculous idea! What I was losing could not be counterbalanced by what I was gaining. Every father of a daughter knows that a son-in-law does not equal a daughter!”

Coming across that passage was like hitting the jackpot (not that I play). Finally, someone understood how I was feeling – he had been through the same thing and knew how I felt.

Getting help

I finally plucked up the courage to make an appointment with a psychiatrist to confirm my own suspicion. I needed to know for sure, to be fair to my family and my loved ones. In any case, I had reached a point where not much else mattered and I wasn’t bothered about the stigma associated with taking anti-depressants

I had reached a point where not much else mattered and I wasn’t bothered about the stigma associated with taking anti-depressants
I was put on Lexapro (escitalopram) and during my review, three and half months after my first appointment, my psychiatrist doubled my dosage. I was definitely feeling better in terms of having less frequent thoughts of hopelessness and a stop to the suicidal thoughts but I was not “walking on clouds”. About a week later, I distinctly remember waking up one morning and thinking: “Oh, this is what it feels to be normal?” That morning, after many months of feeling down, moody and negative, I felt that burden lift. My medication was working well.

The other thing that helped me greatly was reading the Bible and other Christian literature on depression and burnout. I found them to be great in creating self-awareness and for self-therapy.


“I believe that I shall look upon the goodness of the Lord in the land of the living! Wait for the Lord; be strong, and let your heart take courage; wait for the Lord!” – Psalm 27:13-14

“Despite being a dedicated gospel-hearted Christian who preached grace, the truth is that I was dangerously close to living a gospel of works, not grace.” – Christopher Ash, Zeal without Burnout

“The surprising truth is that the person who pauses long enough to refresh his soul along the way actually becomes more alert, more alive, more efficient.” – W. Phillip Keller, Strength of Soul

The other main factor on my road to recovery was the tremendous support given to me by my beloved wife and family. At the end of our family holiday, six weeks before my daughter’s wedding, I decided to be open with them at the airport while waiting for our flight back to Singapore. I am thankful that they took it very well and were very encouraging.

My wife, who knew my struggles all throughout, was a pillar of strength when my whole world was crumbling emotionally. She is not only my best confidante and my best friend, she also makes me laugh and reminded me to rest. She was ever patient with me when I was negative and moody and even scratches my back to help me sleep! God gave her the strength and grace to put up with me.

It’s been a two and a half year journey and while my psychiatrist has encouraged me to try weaning off the Lexapro, I realise that as long as I am in my current role, in church and at work, it would not be possible. I have tried weaning it off but have had to go back on my medication rather quickly. Nonetheless, my dosage has halved and my recovery has been steady.

Having been through the worst periods has helped me to be more disciplined about taking regular breaks. Now, I take a week off every three to four months and am intentional about observing the weekly Sabbath as a time of rest from work. As the writer Christopher Ash puts it in Zeal without Burnout, “God needs no day off. But I am not God, and I do.”

Stigma

I have chosen to be open about the fact that I am still on anti-depressants because there is a need to remove the stigma associated with it. In Singapore and in this part of the world, to be on anti-depressants is still very much taboo. Thankfully, I work in a Christian organization that fully understands and supports my stand. However, other employers may not be as understanding and that is probably one of the main reasons why people do not speak up – the fear of losing their jobs or not getting one should they be honest.

While it is probably too idealistic to expect no discrimination at all, I hope that we can help employers be open to accepting applicants with a history of mental illness but are stable on medication. They should be at least considered in the same way as those with other chronic illnesses such as hypertension or diabetes. As long as they are capable of performing the tasks and do not pose a danger to themselves or others, they should be given equal opportunities.

“The lines have fallen for me in pleasant places; indeed, I have a beautiful inheritance.“ – Psalm 16:6

Dr George Khoo is a general practitioner in his late 50’s and serves as the Medical Advisor for a Christian organisation. George is married to Mabel and has two grown up children, both happily married. George and Mabel have a newborn grandchild and are expecting a second within the next few weeks.

Don't understand what this childish GP doctor is whining about. Seems he has delusions of grandeur and get depression because his church member told him to get lost and his patients and colleagues also probably told him off the same. no smoke without fire. He probably is arrogant and pompous shits who gets told off by people whom he try to pontificate on.
. He seems more concerned about the loss of his face or social status. Grow up please. there are far far more important issues in life that his position as a church elder or his loss of power. if you get depressed because of illness or loss of job or divorce or death of a spouse I understand. but not in this case. Others are not as fortunate as him. He struck as a pampered pompous self deluded Xtian GP who thinks the whole world revolves around him and got a rude shock when told to fark off by his church member. This is reflected in the way he wrote and the way he talks in his article. I have seen alot of these pompous church elders or small time GPs who like to talk down and behave as if they are some big shots( and these to non christians too!!!!). he can cry like a baby for all I care. he should go and do some charity work in third world countries or donate his pay to welfare secular organisations instead of whining here. pretty immature I say
 
Last edited:

nayr69sg

Super Moderator
Staff member
SuperMod
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

High Order Twit / Low SES subject
Admin
Asset
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.
.

I thought Lorazepam had been phased out and replaced with a newer generation of drugs such as Zopiclone which has fewer side effects.
 

nayr69sg

Super Moderator
Staff member
SuperMod
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.
 

nayr69sg

Super Moderator
Staff member
SuperMod
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 .
 

Leongsam

High Order Twit / Low SES subject
Admin
Asset
It is a hazard of the job. There are many doctors with mental health problems. You can read about it. Well studied.

There is no stigma in NZ. Many leading figures have admitted to seeking help including sports stars and celebrities.

I have been feeling pretty down in the dumps over the last couple of years too. I've found my cycling to help tremendously. It generates a feel good factor which can last till the next big ride.

I have to say that I am struggling with finding real purpose in life after a series of disappointments. Perhaps some happy pills will sort things out. :smile: I've hesitated because there are so many articles that allude to the fact that SSRIs performed no better than placebos in controlled studies.
 

Leongsam

High Order Twit / Low SES subject
Admin
Asset
Anyone who is feeling down should avoid watching the documentary series "24 hours at A & E" produced by the BBC. It depresses the hell out of me. It took me a few days to feel normal again.
 

zhihau

Super Moderator
SuperMod
Asset
Anyone who is feeling down should avoid watching the documentary series "24 hours at A & E" produced by the BBC. It depresses the hell out of me. It took me a few days to feel normal again.

Try meditation, the simplest of it all.
All you need to do is focus on your breathing. Breathing in, focus on how the air passing the nasal cavity and into the lungs, notice how deep the air enters your lungs. Breathing out, notice how the air escapes your lungs, how moist it is in the nasal cavity. Do it till you're completely at ease. You'll notice how wonderful breathing is :smile::smile::smile:
 

Leongsam

High Order Twit / Low SES subject
Admin
Asset
This is probably one of the most common and worst advice given to depressive patients by naysayers suffering from depression and that is telling them to get over it. Depression and mental issues is illogical by nature.


Yeah I used to wonder why those fucking children of millionaires ended up overdosing or hanging themselves when they had everything in life.

Turns out a life with zero challenges to overcome sends you to the nut house pretty quickly.
 

nayr69sg

Super Moderator
Staff member
SuperMod
Perhaps some happy pills will sort things out. :smile: I've hesitated because there are so many articles that allude to the fact that SSRIs performed no better than placebos in controlled studies.

I used to think so too. 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.
 

nayr69sg

Super Moderator
Staff member
SuperMod
Anyone who is feeling down should avoid watching the documentary series "24 hours at A & E" produced by the BBC. It depresses the hell out of me. It took me a few days to feel normal again.

Imagine working there!
 

Satyr

Alfrescian
Loyal
Yeah I used to wonder why those fucking children of millionaires ended up overdosing or hanging themselves when they had everything in life.

Turns out a life with zero challenges to overcome sends you to the nut house pretty quickly.

When every problem can be solved by money, you will keep pushing boundaries until you go just one step too far.
 

scroobal

Alfrescian
Loyal
I think his expectations of himself is far too high and thus the issues he is facing.

Don't understand what this childish GP doctor is whining about. Seems he has delusions of grandeur and get depression because his church member told him to get lost and his patients and colleagues also probably told him off the same. no smoke without fire. He probably is arrogant and pompous shits who gets told off by people whom he try to pontificate on.
. He seems more concerned about the loss of his face or social status. Grow up please. there are far far more important issues in life that his position as a church elder or his loss of power. if you get depressed because of illness or loss of job or divorce or death of a spouse I understand. but not in this case. Others are not as fortunate as him. He struck as a pampered pompous self deluded Xtian GP who thinks the whole world revolves around him and got a rude shock when told to fark off by his church member. This is reflected in the way he wrote and the way he talks in his article. I have seen alot of these pompous church elders or small time GPs who like to talk down and behave as if they are some big shots( and these to non christians too!!!!). he can cry like a baby for all I care. he should go and do some charity work in third world countries or donate his pay to welfare secular organisations instead of whining here. pretty immature I say
 

scroobal

Alfrescian
Loyal
Thanks for the candid sharing bro.

Asian males in particular find it very hard to come forward. Frankly I have seen and heard of such issues across many professions. The only one spared seems to Insurance sales folks, car dealers and grassroots leaders. We know of one ex-cabinet who killed himself. I know of Professors, Superscale officers who took their life. I have also come across people who took year off from work to calm themselves. The last thing on their mind is seeking professional help.

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.
 

scroobal

Alfrescian
Loyal
I cycle for the same reason but believe me the family and friends think I am into my 2nd childhood with no care in the World. It puts me in a bubble from Friday night. In a way, it is escapism and the recharging of the mental batteries.

There is no stigma in NZ. Many leading figures have admitted to seeking help including sports stars and celebrities.

I have been feeling pretty down in the dumps over the last couple of years too. I've found my cycling to help tremendously. It generates a feel good factor which can last till the next big ride.

I have to say that I am struggling with finding real purpose in life after a series of disappointments. Perhaps some happy pills will sort things out. :smile: I've hesitated because there are so many articles that allude to the fact that SSRIs performed no better than placebos in controlled studies.
 
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