
75% of med students are on antidepressants, stimulants, or both? (2017) - bookofjoe
http://www.idealmedicalcare.org/75-med-students-antidepressants-stimulants/
======
kendallpark
I'm going to reply to several thoughts I've seen in this thread.

1) As u/DevX101 said, "The article is based on a collection of anecdotes from
responses to a Facebook question: '75% of med students and residents are
taking either stimulants or antidepressants or both. True or false?'"

It looks like the 75% number is invented and not actually reflective of survey
results.

2) Med students would be exactly the type of people that would know that
caffeine is technically a stimulant. There are also a decent number of
students with valid prescriptions for ADHD, which they would be on regardless
of medical school.

3) Medical school has always been hard. But the amount information one has to
intake and regurgitate seems to have steadily increased. Meanwhile, medical
school remains four years long. Technology has evolved to help students absorb
more faster. Spaced repetition. Watching lectures at 2x speed. Massive
Q-banks. But you have wonder whether this is sustainable.

Five years of medical school is a bit untenable because of the debt.
Additionally, our education system is not set up to move the preclinical years
to undergrad (which I believe other countries do).

EDIT

4) I suspect depression is seriously underdiagnosed in med students and MORE
students should be taking antidepressants than those currently on them.

~~~
chiefalchemist
> "Medical school has always been hard. But the amount information one has to
> intake and regurgitate seems to have steadily increased. Meanwhile, medical
> school remains four years long..."

It would seem to me the med profession is an ideal place for technology / AI.
Docs aren't magicians and House (the TV doc) is fictional.

Furthermore, it would seem to me that the aggregation of patient data /
symptoms / outcomes would be more beneficial than the single opinion of the
one or two docs that see.

I'm not trying to dismiss the human element or the knowledge / experience of
any single doc, but certainly that shouldn't remain so silo'ed.

<sidebar>

My father had a (severe) stroke almost 18 months ago. He's doing well and
ultimately got good / great care. That said, my sense was most docs favored
their (subjective) optinions over what I presumed would be known best
practices, etc. Mind you, my assessment is subjective. None the less it was a
pattern that existed across multiple shift and med facilities.

</sidebar>

~~~
soared
Doctors 100% take advantage of technology, contrary to many comments here.
There are search engines that are basically google but for everything medicine
related. Your doctor doesn’t know the dosage for most medications, they just
look it up on their website.

~~~
jahewson
> Your doctor doesn’t know the dosage for most medications, they just look it
> up on their website.

And then the local pharmacist corrects it :)

~~~
classichasclass
My second day of internship, I could already identify which inpatient
pharmacist from the beeper number.

------
travisoneill1
Of course they all use stimulants. I don't know how else they could handle the
workload. The scary part is that it continues into residency. There are
surgery residents working 24h+ shifts. We have laws against overworking truck
drivers, but somehow the medical profession gets a pass.

And Johns Hopkins estimates 250K deaths a year from medical errors. I wonder
how many of these are from lack of sleep.

[https://www.forbes.com/sites/leahbinder/2018/11/09/ignored-a...](https://www.forbes.com/sites/leahbinder/2018/11/09/ignored-
as-an-election-issue-deaths-from-medical-errors-have-researchers-
alarmed/#2a778350653d)

~~~
wpietri
A friend runs a residency program and I've talked with them about it a few
times. This is definitely getting better, but the number of hours still seems
high to me. As a developer, I'm strongly against extended hours because I know
how quickly the error rate creeps up. (And I probably wouldn't know that if I
weren't doing TDD and pair programming, because the first thing that goes for
me is ability to notice my poor performance.) My basic question was: shouldn't
doctors work 8 hours and then go home?

The big difference between writing code and doing medicine is that patients
won't stay the same when a doctor leaves for the day. With 8-hour shifts and
40-hour weeks, covering a patient around the clock requires 4-5 people. Those
people will have 21 handoffs during that week. Each one of those handoffs is
an opportunity for information to get lost, for understanding to fade, for
followups not to happen. If people work 12 hours, that's only 4 handoffs. 16
and it's 10. 24 and it's 7.

Obviously, at some point the harm from overwork outweighs the harm from
handoffs. But it's not an easy decision to make. When I'm debugging some
weird, urgent problem, I know how valuable it is to stay with it, to keep all
the state loaded in my head until I figure it out. And hospitals are full of
weird, urgent problems.

~~~
albertgoeswoof
This is really important and an often missed point. The handover can cause
more errors than a fatigued doctor. So you would need to solve this problem at
the same time (eg what if there was a way to change doctors without a
handover)

~~~
ams6110
Nurses have the handoff issues as much as the doctors if not more, and yet
they work strict shifts.

~~~
rscho
Realistically, nursing is a job that is far more structured than is being an
MD. This allows nurses to function much better as a group. That's precisely
the crux of the matter and the (questionable) reason for the hours. Nursing
teams are the stable basis on which the MDs rely on to fight the huge pile of
s* * * work that escapes the standard pathways in which we try to shoehorn
every patient.

------
DevX101
Many of the respondents to this informal poll classified coffee or other
energy drinks as a stimulant, so not surprised by this. 64% of Americans drink
coffee every day.

This would have been more interesting if antidepressant usage were isolated.

~~~
abnry
You dug into the sources? The author of the linked article wrote, "I
discovered that 75% of med students (and new doctors) are now on psychiatric
medications."

That seems to exclude caffeine from coffee.

~~~
DevX101
The article is based on a collection of anecdotes from responses to a Facebook
question: “75% of med students and residents are taking either stimulants or
antidepressants or both. True or false?”

Ctrl-f for 'coffee' to see some sample responses.

------
BucketSort
Med school -> Memorization school. The medical profession needs to figure out
how to use technology more effectively in its processes. I'm convinced that
having doctors spend years doing route memorization hinders their critical
thinking. It also puts a ton of stress on medical students who have to spend
an exorbitant amount of time drilling. Of course, that would harm the medical
industrial complex, so we must make being a doctor as difficult as possible.

~~~
assblaster
Yet another person with no experience in medicine, finally figured out how to
"disrupt" medicine with technology.

You can't practice medicine without knowledge. You can't learn how to practice
medicine without knowledge.

What knowledge is required?

Physics,

inorganic chemistry,

organic chemistry,

mathematics,

microbiology,

cellular biology,

biochemical biology,

molecular biology,

developmental biology,

physiology,

pathophysiology,

human anatomy,

pharmacology,

histology,

gross pathology,

statistical analysis,

internal medicine,

paediatric medicine,

general surgery,

orthopedic surgery,

neurologic surgery,

urologic surgery,

gynecology,

obstetrics,

outpatient medicine,

cardiology,

pulmonology,

nephrology,

hepatology,

radiology,

neurology,

psychiatry,

critical care,

healthcare economics,

medical ethics, et cetera.

If you don't have a knowledge base, you simply can not practice medicine
because you don't understand how things actually work...

Critical thinking without knowledge isn't critical thinking, it's ignorance.

~~~
treis
>If you don't have a knowledge base, you simply can not practice medicine
because you don't understand how things actually work...

Nonsense. Why does a heart surgeon need to know anything about psychiatry?
What does a radiologist need to know about cellular biology?

The equivalent for programming would be forcing someone to understand how
transistors work at the atomic level, CPU architecture, and OS structure
before letting them write a webapp. It's definitely one of the problems in
medicine. There's way too much useless knowledge required leading to a limited
supply of people being able and willing to master it. Plus, it makes it much
more expensive and time consuming to train all of those people.

~~~
ams6110
Knowing about CPU architecture and OS structure helps me to reason about the
application code I write. Do I understand those things as much as someone who
specializes in them? No of course not. But a certain level of baseline
knowledge does have its benefits.

~~~
treis
Baseline? Sure. But that's not what med school is. It's the equivalent of a
masters level course on a dozen different topics.

~~~
ams6110
Medicine is more complicated than computing.

~~~
treis
Is it?

They seem to follow a pretty similar career arc. If you take a typical CS grad
they're going to go through a couple years as a junior dev, couple more as a
more senior one, and then five years or more in they are ready to be in charge
of their own project. That's pretty similar to the intern -> resident ->
attending pattern that doctors follow.

Honestly, the biggest difference between having a career in programming and
being a doctor is the gate keeping. In programming, you can drop out of high
school and 20 years later be an expert in the field. There's a path for
talented people to go from junior -> dev -> senior -> lead -> principle ->
whatever. There's no path like that in medicine. Sure, as a nurse you can go
from LPN -> RN -> NP but that's where it ends. Your only option at that point
is to spend 4 years and hundreds of thousands of dollars. And there's really
no reason for that.

------
bookofjoe
I just sent this article to my psychiatrist, whose practice includes medical
students. His response: "Yep. I believe it, mostly. Would estimate 50-66% but
medical boards suppress self-reporting."

~~~
robertAngst
Doesn't 'everyone' do drugs?

I was introduced to daily caffeine usage by the most religious christian
engineer I worked with at the time. We would drink 2 cups at once to get a
jolt.

I don't think I need to ask about engineering, as many of my coworkers have 4+
cups of coffee a day. I can't imagine how many of them take other
stimulants/anti-depressants, etc...

From professionals to laborers, why would we assume drug usage is any
different?

~~~
Jach
Does any form of Christianity besides Mormonism have a stance against
caffeine? I know many Mormons from professionals to laborers who abstain from
caffeine, nicotine (another common stimulant), and alcohol. (Of course many
others who don't.)

~~~
tenpies
In modern Catholicism, coffee could be sinful if it is disruptive to your life
or connection with God. This is very much the same as alcohol which is
normally fine, but can have a detrimental effect in excess or if addiction
develops.

There is also some folk history that when coffee started to become popular in
Europe, several clergy were concerned about this Islamic drink (coffee having
been introduced to traders by Muslims, who cannot drink alcohol). Since wine
is central to Christian liturgy, they were concerned that Muslims had
developed an alternative to wine and this could be the work of Satan.

This was allegedly put to rest when Pope Clement VIII tasted coffee and deemed
it to be an acceptable Catholic beverage.

------
tomstokes
This 75% number is not from a formal study. The number supposedly comes from
quotes from 3 different psychiatrists who quoted the same 75% number.

The author verified the 75% number by _asking her Facebook followers._

    
    
      Do most med students require psych drugs for day-to-day
      survival? I turned my question over to Facebook: “75% of
      med students and residents are taking either stimulants
      or antidepressants or both. True or false?”
    

She cherry-picked a few Facebook responses to include in the article, but even
some of those don't support the author's claim:

    
    
      but I have no idea if it’s 75%…I don’t know enough of my
      class well enough to have that info, nor do I think anyone
      does…there are usually cliques of up to 25 people, but for
      people to say they know for sure details of 75% of their
      class would be hard for me to believe but maybe…there is a
      lot of it, I agree with that.
    

And

    
    
      Being completely honest 75% seems a bit high, but I wouldn’t
      be that surprised if it were true
    

The author's real point is buried at the bottom: Medical licensing requires
doctors to disclose their psychiatric history and medication use. Admitting
previous psychiatric problems on your licensing form requires a detailed
explanation of the condition and treatment. Doctors know this, so they have a
perverse incentive to hide their treatment or even avoid treatment at all for
fear of risking their careers.

------
nicolashahn
They're both effectively performance-enhancing drugs, and I'm not sure I'm
totally against this. Anti-depressants boost your stress tolerance and
stimulants enhance your focus and productivity. Unless it's been shown that
usage of these damages people permanently in the long term, the net outcome is
a more effective medical industry.

(strong opinion weakly held, tear it apart)

~~~
kace91
I think the problem doesn't lie as much in the use of the drug, but in the
environment that leads to consumption. If we assume strong social stigma
against it, and yet a majority of students end up doing it, it means there is
a very strong pressure to increase performance by whatever means necessary -
that is to say, that students are not in a state where they consider their
workload bearable. That's in a pool of people that have been somewhat
preselected for being high achievers and willing to work a lot.

While medicine is a field where there should be high expectations for students
(given what's at stake), I don't think keeping students and workers around the
very edge of what they can mentally handle is at all healthy or worth it in
the long term. We don't want burnout, we don't want to have them suffer from
stress-related issues, we don't want to increase their chances of making
mistakes at work, and from an ethical viewpoint we don't want them going
through a miserable life even if it's a net win for society (at least I
don't).

~~~
jointpdf
100% agree with this. We see the same mental health epidemic in PhD students.
Clearly, there needs to be a paradigm shift where we can enable people to
achieve high levels of education (and hold them to high standards) without
making it a nonstop do-or-die mission. Mental wellness training should
definitely be part of the curriculum for medical students (and everyone).

------
_sword
I have a number of friends who are presently in medical school who come from a
wide variety of backgrounds. The ~75% number seems highly consistent with my
experiences. Replace "coffee" with "adderall" and it would remain consistent.
Some would say they would take adderall just to get the drive to continue
their studies despite otherwise being stressed, burned out, depressed,
disinterested, etc. as their end goal that they've been working towards for
~10+ years has been becoming a doctor.

------
maxxxxx
I always find it interesting that we go to the medical system to get advice
about staying healthy but the people who live in that system and give advice
live in a profoundly unhealthy system. A lot of doctors don't have first hand
experience how to live a healthy lifestyle.

------
WhitneyLand
Is there typically no screening for doctors during job interviews or at some
interval after getting a job?

Not sure if everyone is aware of this, but in the tech imdustry typically the
more prestigious the company or role is the less likely there is any drug
testing. It’s a bit ironic, just one anecdote: I’m not aware that any of the
top 5 software focused companies require developers or related tech roles to
ever take a test.

On the other hand, it’s very common for a developer or tech role to have to be
screened at companies like AllState Imsurance. I’ve never worked at AllState
and don’t mean to imply they’e worse than average (anyone can google the
requirement). It’s just meant to represent a typical example of large company
IT corporate America for which tech is not the core competency of the
business.

I can see drawing a line between truck drivers and developers (or any role
where it’s easy for a mistake to cost lives). However, if truck drivers are
almost always tested to get a job:

\- Should doctors be as well?

\- Should Waymo developers be tested?

~~~
albertgoeswoof
Drug testing is a infringement of basic human rights, no one should be
routinely drug tested by their employer, under any circumstance.

------
splatt
I've always worried that an ssri would decrease my mental performance. Maybe
worth revisiting. Can the help you learn better / focus more by blunting
depression / stress?

~~~
actualdc1
Not sure about SSRI’s, but bupropion can definitely have positive effects on
your performance.

~~~
rmrfrmrf
Or the opposite. The ramp-up period (4-8 weeks before the brain rebalances its
chemistry in response to the drug) is hell, and cessation of the drug (or
running out without access to a pharmacy) causes near-total loss of cognitive
ability for a few days (with brain zaps to boot).

~~~
PascLeRasc
That's why I'm not using my bupropion. I got a prescription last month to
treat seasonal affective disorder, and my psychiatrist wants me to use it
every winter then cycle off in the spring, but the side effects both coming on
and off seem awful.

~~~
bm1362
Why not just stay on it indefinitely?

------
ineedasername
_" I was told by the psychologist at my med school’s campus assistance
program, that 75%..."_

Okay, this intuitively _sounds_ right. It makes sense that overwork and sleep
deprivation are both triggers for issues like depression and would also drive
those same students to seek stimulants to overcome them.

However! From the title to the contents, this rate is presented as fact. In
reality it's an annecdotal single piece of information combined with some
facebook "me too" chime in. Hardly a quality survey.

Maybe this particular school has a significantly worse problem, or even the
opposite: their rates might represent the lower bound of this issue. So while
this all fits with our preconceptions of med school issues, I'm reluctant to
take the particulars as a true representation of the issue.

~~~
taeric
Thanks for this perspective! There are few things as dangerous to learning as
just accepting things that "sound right."

------
roadkillon101
Dr Wible who wrote the article on med students on medication (antidepressants
and/or stimulants) did a TEDMED talk on "Why doctors kill themselves"
[http://www.idealmedicalcare.org/why-doctors-kill-
themselves/](http://www.idealmedicalcare.org/why-doctors-kill-themselves/)
which refers to the problem with the medical system itself. If the healer is
mentally ill (and most of them are), how can we expect the best medical care?
The fact that med students take medication is just the tip of the iceberg.

------
Tycho
Can someone explain to me why we have very highly paid medical staff working
crazy hours, as opposed to simply having more medical staff working normal
hours and getting paid proportionally less? Is it because we can’t train
enough of these people so we must overwork the existing ones to meet the
demand for healthcare?

(Obviously from the patients’ point of view they’d rather not have any
important medical decisions made by sleep deprived doctors.)

~~~
travisoneill1
Because it's operated like a cartel:

[https://fee.org/articles/the-medical-cartel-is-keeping-
healt...](https://fee.org/articles/the-medical-cartel-is-keeping-health-care-
costs-high/)

I'm surprised this hasn't been solved by lawsuits yet. I have to assume that a
surgery going wrong when the surgeon hasn't slept in 24h is pretty much an
automatic guilty verdict.

~~~
ams6110
Because the actual surgeon is not a resident at the end of a 24 hour shift,
it's a staff doctor on call or a local doctor with privileges at that hospital
or surgery center.

------
tossaccount123
I think the medical field will be one that benefits most from AI. Routine
surgeries will be able to be done by medical robots like those being developed
at Cal Berkeley with human supervision if something unexpected comes up

This will shift the supply and demand equation and lower medical costs and
make life easier for doctors

[https://spectrum.ieee.org/robotics/medical-robots/would-
you-...](https://spectrum.ieee.org/robotics/medical-robots/would-you-trust-a-
robot-surgeon-to-operate-on-you)

~~~
cm2187
Using AI for sugery would terrify me. Some algorithm that does it right 95% of
the time and in 5% of the time would do something completely random and
inexplicable...

~~~
tossaccount123
Anything in the medical field would have to be extensively tested, this isn't
a web app where "move fast and break things" applies

and it would primarily be used with routine surgeries and would default to
human intervention under uncertainty. Most of these surgeries are basically
identical and the AI could improve by sharing data with all surgeries
performed around the world. Not to mention how bad humans are at surgery,
especially when fatigued.

AI is the only way to fix healthcare, a doctor/surgeon can work effectively
only a few hours a day and takes nearly 30 years to educate from childhood. An
AI could do surgery and diagnose patients nearly 24/7, 7 days a week.

~~~
cm2187
I agree that medecine is one of the only domains that didn't industrialize,
remaining an artisanal profession, with a highly skilled, highly paid
professional in front of every customer. But I am more concerned about the
failure modes of AI.

------
great_psy
Here is a study from 2008, where 50% of med students show symptoms of burnout,
and about 10% suicide ideation.

It does not say anything about drug use, but the high stress and depression
the article talks about seems to be confirmed.

[http://annals.org/aim/article-abstract/742530/burnout-
suicid...](http://annals.org/aim/article-abstract/742530/burnout-suicidal-
ideation-among-u-s-medical-students)

------
zwilliamson
I just read "How to Change your Mind" by Michael Pollan. It appears we are
inching closer to freeing psychedelic drugs (psilocybin and LSD for example)
for medical use via psychedelic therapist. Michael goes over a lot of new
research and revisits older research (1950s - 1970s) showing the effectiveness
of these drugs when administered by a professional to help cure depression and
break addictions to substances like alcohol and nicotine.

~~~
markroseman
Best to think of them as a possible way of accelerating a course of
psychotherapy.

~~~
zwilliamson
Yes, they are not a guaranteed solution. But research from Hopkins University
School of Medicine and others show they are more effective than any current
pharmaceutical drugs.

------
Iwan-Zotow
And what remaining 25% are doing? Shrooms? Sniffing glue?

~~~
Havoc
Lie

------
Havoc
Not just medical students. Surprised how many of my friends are on anti-
depressants.

------
iandanforth
Actively modifying and controlling your internal environment is both good and
useful, it's neurochemical nudists who are weird.

------
ck2
and that doctor making critical decisions about you or even worse that surgeon
cutting into you has been on back-to-back shifts for 24+ hours

there are many documentaries about the sheer mess our medical system is in,
yet everyone remains ignorant and allows to burn forever, like guns apparently
you have to be a victim first before you change your mind and give a damn

------
fallingfrog
When an economic system can no longer be sustained except by its members being
on drugs, it’s nearing the end.

------
m0zg
I would also be on Ritalin if I could get it. I tried it a couple of times (my
son took it briefly but stopped because "it made him feel weird"). A single
delayed release pill easily doubles my productivity, improves my memory, and
makes the work far more enjoyable.

~~~
Waterluvian
Something's bizarrely wrong to me that you seem excited about a medication you
borrowed from your kid that he felt side effects so significant that he
discontinued use.

When I was a kid I used it for years until I stopped because it made me feel
weird. For me "Weird" meant antisocial, never hungry, and feeling crestfallen
for hours when it wore off.

I took it again in university until I stopped because by then the
"crestfallen" feeling was replaced consistently by suicidal thoughts.

To each their own, and everyone can experience different effects, but you seem
so very ignorant to what taking Ritalin is actually like. It's not a magic
productivity pill. You pay for every bit of it.

~~~
m0zg
I don't see anything "bizarrely wrong" with observing a quantifiable doubling
of productivity and improvement in enjoyment of life, all from taking a very
small dose.

When (and where) I was growing up ADHD wasn't really a diagnosis you could
get. I strongly suspect I have it, at least the attention deficit part, but
apparently the only way to properly diagnose it is before you're a fully grown
adult, so I'm kind of SOL since I'm in my 40s.

You, on the other hand, seem to be quite judgmental towards people you don't
know. That's what's "bizarrely wrong".

------
the_arun
But why?

~~~
Thriptic
Very high workload with long hours, high performance demands depending on the
stage of training you are in, oscillating shift based schedule, minimal time
off to decompress, cultural pressure and competition.

~~~
lprubin
This has to be a big component of it. Working 16 to 28 hour consecutive
shifts, often over night, where a mistake can potentially be fatal, with very
irregular sleep hours. That has to be a recipe for disaster. After I learned
that was what residents’ schedules were like I was terrified of going to the
hospital.

------
erikb
The difference between med students and other students is that more med
students can afford these medications, I'd say.

~~~
DocSavage
Med students accumulate horrendous debt and don’t actually make real money
until they finish both med school and residency. That’s an 8 year lag in money
making compared to a comp sci grad who goes into tech.

~~~
erikb
That is why mostly people with wealthy parents will attempt med school. You
can trust me, I lived with med students in a living coop for some time. Where
CS students rent an apartment in a 30 story block on the outskirts of town,
med students live almost in the center and rent a whole house together. It's
not even comparable.

And do you think anti depressants get paid by health care? Someone needs to
buy them as well. Most CS students I know are happy when they can afford the
frozen pizza from the super market.

And that's also the main point here. It is a sign of wealth that you can worry
about depression. If you are not, then you are also depressed, probably even
more so, but can't spend time worrying about it because you worry about rent
and food.

~~~
DocSavage
So I'm supposed to trust your anecdote on the wealth of med students based on
you living with med students for some time? I went through med school and have
many friends who went to other med schools. There is a wide range of med
schools and support mechanisms. While it may be true that premeds come from
wealthier backgrounds than CS students in US, that's something that needs
separate sources. If you think CS students are happy when they can afford
frozen pizza, it differs from my memory of CS at Stanford, so there's also a
huge range of affluence among CS students depending on where they go.

Also if someone is diagnosed with clinical depression, insurance will
definitely pay for antidepressants. That diagnosis can be made by student
health.

------
jaked89
The title misses an important detail: _in USA_.

Americans have plenty of reasons to be depressed, but the drugs aren't going
to improve their situation.

