“Our decision is based on your depression.”

I can’t say I was surprised, but I was disappointed and saddened to read these words in a rejection letter for the supplemental disability insurance policy I applied for through my workplace. In January of 2023, I went for a routine physical exam with my new primary care doctor, and I screened positive for depression. After discussing my options with her, we decided that a low-dose SSRI in combination with high-quality therapy would be the best path forward.

A diagnosis of depression shocked precisely no one in my world: I’d recently left a toxic job, floridly burned out, and moved my family hundreds of miles further away from my parents and brother to start a new job; two kids in college and two teen boys at home; a marriage that had weathered some hard days; perimenopause creeping in; and not to mention a job that daily reminds me of the brutality and unfairness of life and the devastation of firearm and other forms of interpersonal violence. Oh, and the pandemic. And, oh yeah, the collective sadness of a nation wounded by divisive and hateful political rhetoric. I know I am not the only one who sported a new diagnosis of mild depression in 2023.

After about six weeks on some Prozac, and a few impactful sessions with my terrific therapist, I was feeling considerably better. I felt more engaged in my work and with my patients. I had more energy to accomplish tasks at home. I regained my interest in exercise and cooking and writing. I felt less labile, less tearful, and less anxious. I was sleeping better and worrying less. A few times I even described the difference before January and after around March as “like a switch was flipped”. I was never suicidal, but I certainly had some fleeting feelings of despair (which I believe is part of the human condition and not pathologic), but those dark moments are so few and far between now. I was hitting my stride in my job, loving teaching, operating, writing, speaking. I was doing great! I still am.

So why, when I am doing all I can to take care of myself, am I now ineligible for insurance to provide for myself and my family should some unexpected event limit my capacity to do my job, such as a car accident or fall?

I am not surprised at all.

Though there has been some improvement over the past five years or so, there remains significant stigma around the mental health of physicians. For years, we have been asked to disclose any mental health or substance use disorders (including history of, treated, recovered, or non-active) and these disclosures are routinely used against us to withhold or complicate medical licensing, hospital credentialing, and insurance coverage, particularly life and disability insurance. The great irony is that failing to seek an accurate diagnosis and treatment for mental health concerns and substance use, much like failing to treat diabetes or heart disease, makes me a much more unsafe physician than ignoring my conditions or lying about them. Failing to seek help dramatically increases my risk of needing that same disability insurance.

It’s frustrating that although I feel my best, my proactive approach and my honesty about my depression, have stood in the way of my desire to fully protect my family in the event of a tragedy…which by the way, after my husband’s stroke in July, we are all too familiar with.

Nevertheless, I will persist. 2023 was a year that knocked me down, caught me off guard, and tried to hurt me. But here I am, arguably stronger than I was at the tail end of 2022. In 2024, I am certain we will similarly face adversity. All of the issues that have broken my heart in 2023 will not magically disappear at the stroke of midnight tonight. But I feel strong enough to face them. I have the personal tools for mental fortitude, the family and friends who are squarely in my corner, and every reason to believe that even when I feel like things won’t be ok, indeed, they will actually be ok.

Disclaimer: My viewpoints are not necessarily reflective of my employer, or any local, regional or national organization that I belong to. As a matter of fact, I pretty much just speak for myself. Please keep that in mind.