Reflections: Depression and Anxiety among Pakistani Medical Students
Depression is a mental disorder that presents with low mood, loss of interest or pleasure, feeling of guilt, low-self worth, disturbed sleep or appetite, low energy, poor coordination and tendency to suicide. The elevated rate of depression during medical school doesn’t appear to be a result of medical school alone. Rather, it suggests a positive bias of unknown nature in the selection of students predisposed to depression and anxiety which is associated with sleep complaints and emotional symptoms.
A research conducted in Punjab shows that their prevalence is more common in males by 6.6%, unmarried by 84.6%, according to age highest level of stress is seen in 20-22 yr age group, 1st year students are most stressed than final years and some other variations according to locality and total family income have been noted.
Increased stress causes inability to cope, helplessness, increased psychological pressure, mental tension, low moods, loss of temper and inability to concentrate mostly prior to exams. Some inadequacies in the social activities of the students might play a role in this type of disturbance. Symptoms associated with increased anxiety are constantly feeling on-edge, restless or worried, unexplained sudden shaking or trembling, frequent panic attacks (increased heart rate, short of breath, sweating, nausea or chest pain), irrational thoughts, fears or obsessions, compulsive behaviours or rituals, feeling like your mind’s gone blank, anticipating the worst, trouble concentrating etc.
Academic factors, particularly increased academic workload and fear of failure, increased exam load, vast syllabus, unexpected marks, less time for repeated learning and procrastination, preparation for foreign licensed exams (USMLE,PLAB etc), aiming to get residencies in renowned hospitals of Pakistan (AKUH, SHAUQAT KHANAM, SIUT etc) and getting research published in international and local journals are some major sources of stress for a medical student. Emotional disorders are also associated with students who are not involved in a relationship. For those who are involved, have the option of disclosing their problems, seeking advice and support from their partners.
Prevalence of symptoms of anxiety and depression is linked with sleep complaints, eating disorders and emotional symptoms, and their associations are different for men and women. In women, anxiety is significantly related to waking up because of nightmares and feeling tired in the morning; depressive symptoms include difficulty in getting sufficient sleep at night, nocturnal eating habits and day-time sleepiness. In men, significant symptoms are difficulty in falling asleep at night before the exam and subjective sleep quality suffers.
Many students are on anti-depressants. Large prospective multicenter studies are needed to identify personal and training-related features that influence depression, anxiety and stress among students, proper guidance and counselling by faculties may help to improve the present scenario and explore the relationship between distress and competency. One of best treatments to get rid of anxiety and stress is Self-Help, which includes challenging negative thoughts, writing down your worries, creating an anxiety-free period, trying to learn to accept uncertainty, practicing relaxation techniques, adopting healthy eating habits, getting enough good quality sleep and last but not the least exercising regularly.
A variety of medications, including benzodiazepines and antidepressants, are used in the treatment of anxiety disorders. But medication is most effective when combined with behavioural therapy and anxiety self-help strategies. Medication may sometimes be used in the short-term to relieve severe anxiety symptoms so that other forms of therapy can be pursued.
Anxiety medications can be habit forming and cause unwanted side-effects, so be sure to research your options. It’s important to weigh the benefits and risks so you can make an informed decision about whether anxiety medication is the right treatment for you.
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