Personal Views Personal views

Coping, but only just

BMJ 2002; 325 doi: (Published 26 October 2002) Cite this as: BMJ 2002;325:977

I gave in—or did I give up?—on 29 November. After three years on different selective serotonin reuptake inhibitors (SSRIs), the depression had returned quickly and unexpectedly. I had been able to reduce the dose of my latest SSRI to one every third or fourth day. I was as content as I had been for many months. Six weeks into the winter period we had the usual round the table discussion at home.

“You can't go any longer like this,” my wife said. “Don't they know at work how bad you feel?”

I had the feeling that I wasn't safe anymore

Were we somehow taught not to show the signs of stress?

“Well, some do …”

I had struggled against taking time off for several years because I felt that I could still cope with all the ups and downs. I also had a fear that I might never return to work if I had a lengthy period away. I had worked continuously in the NHS from 1 August 1970 until 29 November 2002. Apart from a few days off for viral infections, I had been in the front line, 27 years in general practice after vocational training, and the last nine years as a senior partner.

I had all the same symptoms as before—poor sleep, worrying about Monday on Sunday, difficulty in getting myself going in the morning, and wondering whether I would cope to the end of the day. I used to call these “my grey periods,” but I finally recognised about three years ago that they were all pointing to depression. I had had these periods on and off for years, especially at times of increased workload in the winter. I even wondered about seasonal affective disorder.

This time I was exhausted. In some consultations I was giving patients all the advice that I was trying to give to myself. I had helped and counselled teachers, colleagues, and many groups through the “retiring early on medical grounds” route; now I wondered if this was for me. Above all I had the feeling that I wasn't safe anymore. Had I made the right decision? Had I given the right advice? Together my wife and I decided that I should stop work. I phoned my general practitioner to be told that the next appointment was eight days away. I was the patient patient and tried to phone her at surgery, but couldn't catch her. She, like me, was trying to squeeze a quart into a pint pot. Eventually she phoned me. We discussed my problems—increase the SSRIs and we would sort out certificates in due course.

My excellent GP arranged an appointment with our local psychiatrist. He put me on the top dose of SSRIs and said that he would speak to his attached psychologist to organise a course of cognitive behavioural therapy.

“How much of this illness do you think is down to work?” he asked.

“About 95%,” I replied.

“I agree,” he said. Amusing thoughts flashed through my head—“I could sue the NHS!” Under the blue logo of the NHS it should say: “Working for the NHS can seriously damage your health.”

A month went by, with Christmas and the New Year bringing some relief to the gloom. I thought I had some side effects from the medication, so, like other patients, I read the information sheet. Yes, postural hypotension, dry mouth, sweating, and impotence—almost a full house. I felt a little better as I saw my psychiatrist again. “Continue the medication and I'll chase the psychologist as you haven't heard anything.”

Now I was on the opposite side of the job that I had been doing daily, trying to tweak the system for the patient. Ten days later I met the psychologist for the first time. He listened carefully.

“I know I will be telling you how to suck eggs,” he said, “but when do you normally start work … and finish? Do you take a break, completely, from work during the day? Do you take work home at night? What do you do to relax? Did you know that the older you are, the longer it takes to recover when the stress is taken away?”

When I related this to the spouses and partners of my medical colleagues, they all said that this sounded familiar.

How many of us are there, in the NHS, coping, but only just? How many of us feel unsafe at times? Were we somehow taught not to show the signs of stress? Am I just the tip of the iceberg of mental illness in the NHS that is undiagnosed or not admitted? Should I go back to the front line? Should I wait for “an opening”?

I've stepped off the merry-go-round—should I get on again? How can I get on again?

Have I given in or given up? Only time will tell.


  • The author is a general practitioner in Suffolk

    If you would like to submit a personal view please send no more than 850 words to the Editor, BMJ, BMA House, Tavistock Square, London WC1H 9JR or e-maileditor{at}

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