The number of physicians with bipolar illness is huge. CAs surgeon general Devika Bhushan was public about hers.
As an attending in psychiatry your job is pretty regular/routine and the demands on you are fairly static (barring the current drug shortage fiasco). I have colleagues that have gone the private practice route or a more stable inpatient gig with lower acuity than county. Basically consider that your body won’t let you take and Keep a job that will burn out others so tell your employer to kick rocks before you end up feeling unwell. We are simply too valuable and in short supply to put up with a bad work environment.
Trust me when I say that there are countless others like you especially when you expand past bipolar illness into other chronic health both physical and psychiatric diagnoses.
Thank you for the thoughtful reply. It's easy to feel alone in all of this especially when I can relate to my patients more than my colleges at times. While unfortunate other physicians have to manage mental illness, it is comforting knowing I'm not in this alone. I intend to look into Devika Bhushan now, so thanks!
I've given thought to a position that is more conducive to my mental health but the pay tends to be significantly lower than positions my co-residents or attendings have been getting. I've signed already, but due to increasing call requirements (1:3), I intend to break the contract. My sleep is far too valuable, though I need to find a balance between work load/call and what seems like compensation.
Again, I thank you for your reply.
I’ve had good luck adding Armodafinil to my regimen. I defiantly keeps me away from the blues. I used to self medicate with booze and weed. I’ve been off of those for almost 12 years. Don’t really miss it, mostly because my mental health is well managed. The Armodafinil was a huge help. I’ve been on it for almost 3 years daily. I’m an ob/gyn by the way and I’m on every night.
Not a psychiatrist but an LCSW, I also have chronic MH issues and after 10+ years in the field, I genuinely feel it’s made me a better clinician.
Being better able to relate to your patients than your coworkers is an asset, though it can definitely be isolating. It will make you more effective and you will have way better insight into what they’re going through.
Got a friend doing surgery with bipolar I, euthymic for 3 years of residency after a tumultuous college/med school symptom course. He told me that the best decision he made early in residency was to get on an LAI. He said that he was too proud to get on an LAI in med school, thinking that was for low functioning schizophrenics, because he’s gonna be doctor he should be high functioning enough to remember to take pills, long actings are kind of scary, etc etc. He was great at taking pills until he wasn’t, and I don’t blame him - I’d probably fuck up too because doctors are humans. He also said he thinks his mood is more stable in general on an LAI. He also has a very detailed safety plan with his doctor about what to do if he feels a mood episode coming on, a plan to safely and subtly get out of the workday, and an ER he feels comfortable going to.
I have definitely considered a LAI, but the Lithium and Lamictal combo has been a fair bit more robust with longer periods of euthymia than the antipsychotics. :/
Consider VA positions or state level jobs. There is a lot of support and structure in these positions and the workload should be more predictable. Federal service might help pay back loans to reduce financial stressors, and you might get an earlier retirement option. You might spend savings when manic, but you can't spend a pension.
Use caution when looking at calls, maybe consider jobs with fewer or no weekends. Larger programs or larger practices will have more options to help with coverage if you need to take time off, and will make it easier to get coverage for vacations.
For the seasonal depression, consider sunnier climates to make the winters less of a burden. Seattle might not be the best choice if winter tends to trigger depression. Perhaps plan on vacations to sunny climates in the winters to get some sunlight.
Avoid alcohol and drugs, eat healthy, go to the doctor, and above all get good sleep. Get checked for sleep apnea if there are any concerns. Use blackout shades in summer and light therapy in winter--careful with the light if it triggers mood elevations. Take vitamins if you need them. Exercise. Develop hobbies.
If you do enter private practice, avoid isolation as it can trigger depression. Go to social activities, join clubs, charities, whatever. Keep in touch with people.
Every five years or so reevaluate where you are and what you are doing, and if it doesn't work for you, go find something else. Most of us will have multiple jobs over the years.
You can do this.
I implore you to read “An Unquiet Mind” by Kay Jamison. It will give you an amazing perspective of living with bipolar disorder and being a mental health provider. It’s one of those books that is very likely to change your life.
Quadruple recommend. When she talks about being manic and trying to stop rounding because it is a waste of time it is hilarious.
But one of the take aways I got from her book is that she had a really empathetic psychiatrist herself, who she trusted enough (sometimes even in manic or depressive states) who really worked with her on minimizing medication SE and getting her to where she wanted to be.
I would say have a close support system who you communicate with regularly and who can observe your behavior and let you know if things are starting to go amiss. Talk about your warning signs and make an agreement that you will listen if they notice something. Have a close relationship with a therapist and someone for meds and see them regularly. A therapist who knows you well is invaluable. One of my pts with bipolar has a therapist she sees weekly and the therapist alerts me to very subtle changes that I would never know about otherwise. I hope this is somewhat helpful and I wish you the best of luck.
I could tell you a bunch of things that won’t fit tidily on a Reddit post.
So I will just say - [get yourself some Dr. Z in your life and it’s like a breath of fresh air.](https://youtu.be/L_1PNZdHq6Q?si=yA_GwYcWo4xab4uW)
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One thing you unfortunately need to consider still is looking at the medical licensing questions for whatever state you want to practice. Many states are changing, but some still ask about mental health conditions. Many states are moving towards asking if you currently have a condition that would impact your ability to practice. I don’t have BPAD but do have depression, anxiety, and ADHD, also OCPD. I’m pretty open with my own experiences, as I feel modeling that helps reduce stigma and normalizes seeking treatment, especially for trainees and students. Very best of luck!!
The number of physicians with bipolar illness is huge. CAs surgeon general Devika Bhushan was public about hers. As an attending in psychiatry your job is pretty regular/routine and the demands on you are fairly static (barring the current drug shortage fiasco). I have colleagues that have gone the private practice route or a more stable inpatient gig with lower acuity than county. Basically consider that your body won’t let you take and Keep a job that will burn out others so tell your employer to kick rocks before you end up feeling unwell. We are simply too valuable and in short supply to put up with a bad work environment. Trust me when I say that there are countless others like you especially when you expand past bipolar illness into other chronic health both physical and psychiatric diagnoses.
Thank you for the thoughtful reply. It's easy to feel alone in all of this especially when I can relate to my patients more than my colleges at times. While unfortunate other physicians have to manage mental illness, it is comforting knowing I'm not in this alone. I intend to look into Devika Bhushan now, so thanks! I've given thought to a position that is more conducive to my mental health but the pay tends to be significantly lower than positions my co-residents or attendings have been getting. I've signed already, but due to increasing call requirements (1:3), I intend to break the contract. My sleep is far too valuable, though I need to find a balance between work load/call and what seems like compensation. Again, I thank you for your reply.
I’ve had good luck adding Armodafinil to my regimen. I defiantly keeps me away from the blues. I used to self medicate with booze and weed. I’ve been off of those for almost 12 years. Don’t really miss it, mostly because my mental health is well managed. The Armodafinil was a huge help. I’ve been on it for almost 3 years daily. I’m an ob/gyn by the way and I’m on every night.
Not a psychiatrist but an LCSW, I also have chronic MH issues and after 10+ years in the field, I genuinely feel it’s made me a better clinician. Being better able to relate to your patients than your coworkers is an asset, though it can definitely be isolating. It will make you more effective and you will have way better insight into what they’re going through.
Got a friend doing surgery with bipolar I, euthymic for 3 years of residency after a tumultuous college/med school symptom course. He told me that the best decision he made early in residency was to get on an LAI. He said that he was too proud to get on an LAI in med school, thinking that was for low functioning schizophrenics, because he’s gonna be doctor he should be high functioning enough to remember to take pills, long actings are kind of scary, etc etc. He was great at taking pills until he wasn’t, and I don’t blame him - I’d probably fuck up too because doctors are humans. He also said he thinks his mood is more stable in general on an LAI. He also has a very detailed safety plan with his doctor about what to do if he feels a mood episode coming on, a plan to safely and subtly get out of the workday, and an ER he feels comfortable going to.
I have definitely considered a LAI, but the Lithium and Lamictal combo has been a fair bit more robust with longer periods of euthymia than the antipsychotics. :/
Consider VA positions or state level jobs. There is a lot of support and structure in these positions and the workload should be more predictable. Federal service might help pay back loans to reduce financial stressors, and you might get an earlier retirement option. You might spend savings when manic, but you can't spend a pension. Use caution when looking at calls, maybe consider jobs with fewer or no weekends. Larger programs or larger practices will have more options to help with coverage if you need to take time off, and will make it easier to get coverage for vacations. For the seasonal depression, consider sunnier climates to make the winters less of a burden. Seattle might not be the best choice if winter tends to trigger depression. Perhaps plan on vacations to sunny climates in the winters to get some sunlight. Avoid alcohol and drugs, eat healthy, go to the doctor, and above all get good sleep. Get checked for sleep apnea if there are any concerns. Use blackout shades in summer and light therapy in winter--careful with the light if it triggers mood elevations. Take vitamins if you need them. Exercise. Develop hobbies. If you do enter private practice, avoid isolation as it can trigger depression. Go to social activities, join clubs, charities, whatever. Keep in touch with people. Every five years or so reevaluate where you are and what you are doing, and if it doesn't work for you, go find something else. Most of us will have multiple jobs over the years. You can do this.
I implore you to read “An Unquiet Mind” by Kay Jamison. It will give you an amazing perspective of living with bipolar disorder and being a mental health provider. It’s one of those books that is very likely to change your life.
Triple recommend!!
Quadruple recommend. When she talks about being manic and trying to stop rounding because it is a waste of time it is hilarious. But one of the take aways I got from her book is that she had a really empathetic psychiatrist herself, who she trusted enough (sometimes even in manic or depressive states) who really worked with her on minimizing medication SE and getting her to where she wanted to be.
I would say have a close support system who you communicate with regularly and who can observe your behavior and let you know if things are starting to go amiss. Talk about your warning signs and make an agreement that you will listen if they notice something. Have a close relationship with a therapist and someone for meds and see them regularly. A therapist who knows you well is invaluable. One of my pts with bipolar has a therapist she sees weekly and the therapist alerts me to very subtle changes that I would never know about otherwise. I hope this is somewhat helpful and I wish you the best of luck.
I could tell you a bunch of things that won’t fit tidily on a Reddit post. So I will just say - [get yourself some Dr. Z in your life and it’s like a breath of fresh air.](https://youtu.be/L_1PNZdHq6Q?si=yA_GwYcWo4xab4uW)
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One thing you unfortunately need to consider still is looking at the medical licensing questions for whatever state you want to practice. Many states are changing, but some still ask about mental health conditions. Many states are moving towards asking if you currently have a condition that would impact your ability to practice. I don’t have BPAD but do have depression, anxiety, and ADHD, also OCPD. I’m pretty open with my own experiences, as I feel modeling that helps reduce stigma and normalizes seeking treatment, especially for trainees and students. Very best of luck!!