Sunday, May 18, 2014

After the depression, now comes the anxiety

After seventeen years, with twelve years on medication, I thought I had my depression under control. I would assume I could just take my drugs every night and that would be it until I die. I might not be totally elated or delirious with happiness but at least I would be stable and not moribund all the time.

In recent months, a new dark cloud has been raining down on me. I can't remember when the situation started but I noticed I have been suffering from anxiety symptoms. The main feeling is my heart racing but other symptoms have been occurring. There has been chest discomfort, difficulty breathing and the aching of my arm muscles. I used to suffer these intermittently when I was depressed but the physical complaints usually came with the feeling of being sad. Now I feel anxious and scared.

Some of these symptoms have been low lying throughout the whole day but they become more prominent when I go to work and just before I see patients. There is no logical reason for this relationship. Like 90% of people, work is just inevitable part of life to pay the bills. All of us don't want to go to work but I don't actively despise it, trying to use as much sick leave to avoid going into the clinic.

Neither have I had any major problems with my patients. Most of the people that consult me can be handled quite easily. I do have problems with explaining things to some of my patients, due to insufficient Cantonese skills, but I can get by. As with any other doctor, I have patients who are difficult or are dissatisfied with the level of care. I do get disappointed with patients who don't take my advice about medical care but I have to remind themselves it is their decision, their own health they are risking and not to take it personally.

"Is it the added pressure of being a higher trainee in family medicine?" I have asked myself. I had to see more patients per session but I can still see all of my consultations in time. I have been putting off a number of issues that I need to sort out, including applying for a postgraduate diploma course in dermatology and starting my clinical audit. I do suffer those anxiety symptoms I have been writing about when I think about doing these tasks but I eventually get round to doing it, even if it is slowly.

The anxiety symptoms do abate when I get to see patients, as I think I distract myself from the symptoms just by focussing on doing something else. Yet I'm at loggerheads why I still suffer from these symptoms.

It got worse when I came back from holiday. My USA trip was 19 days - the longest period I have been away since I started working. I had given myself one day to recover from jet lag, then I went back into work the next day. I was fine with the first day back at work. When it came to the second day, with being on night clinic duty, I was starting to have anxiety symptoms and I honestly thought I was having a panic attack. At one point I thought I was going to freak out and pass out. However I managed to get to the end of the day in one piece mentally

The most worrying thing is not knowing why this is happening. Like most patients, I do want to know why this is happening to me. Most doctors will tell you what you don't want to hear - the truth - that we simply don't know. I know my anxiety symptoms are depression related and psychosomatic. I know I'm not entirely happy with work, dreading waking up, waking up later and later, always looking forward to 5 p.m. and Saturdays but we all deal with that. I have been thinking about going part-time or emigrating after I have finished my training. Yet I don't know if my depression / anxiety would improve by doing this.

For now, I just have to tell myself it is psychosomatic and focus on something different.

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