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Question. I am a mental health professional. However, I also find myself searching for information to console me personally. I have been diagnosed with major depression. I go regularly to a psychiatrist and I am currently taking Wellbutrin SR. What is the potential for recurrence of depressive symptoms while taking a prescribed medication that has worked well for over three years? Can you give me some information about the number of mental health professionals who have major depression? I still worry about the stigma even though I work daily in the field.

Answer. I can understand how the stigma of your depression might be a source of distress to you, even though we now have a number of excellent role models of successful mental health professionals who suffer from mood disorders. An excellent example is Dr. Kay Redfield Jamison, author of An Unquiet Mind; Jamison herself suffers from bipolar disorder, and has confronted this publicly and in her writing.

Regarding rates of relapse or recurrence of major depression: the bad news is, major depression tends to be a recurrent illness. As a group, about 55% of individuals with a single episode of major depression will go on to have a second episode. Individuals who have had two episodes have a 70% chance of having a third. The good news is that with appropriate medication and psychotherapy, the outlook is quite favorable. Frank et al (Arch Gen Psychiatry, Dec. 1990) found that when patients with recurrent depression were treated with imipramine 200 mg per day in combination with interpersonal therapy, nearly 80% went for three years without a recurrence of major depression. This has generally been my clinical experience with patients who initially do well on various antidepressants (including Wellbutrin) and are maintained in appropriate psychotherapy.

I am not aware of any studies that have actually determined rates of major depression among mental health professionals. However, there are several studies of professional “burnout” that you may be interested in. Clark et al (Hospital & Community Psychiatry, August 1987) looked at burnout among psychiatrists in community mental health centers and found that 46 of 96 expressed dissatisfaction with their work. Another study of burnout found that among the psychiatric staff of a large HMO, “high emotional exhaustion and depersonalization” were found, based on the Maslach Burnout Inventory (Snibbe et al, Psychol Rep, 1989; 65:775-80). You may also be interested in the article by Cushway & Tyler on “stress in clinical psychologists” (Int J Soc Psychiatry, Summer 1996).

Regarding signs to watch for, this could become a problem if it begins to preoccupy you. Hypervigilance usually creates its own problems, in my experience. Symptoms I am sure you are familiar with-sleep disturbance, loss of appetite, reduced energy, etc. – would be of concern, of course. If it is of any consolation, I have personally known or treated a number of mental health professionals with major depression, and you are far from alone in this respect. Your professional practice organization might have more information and/or referrals for support. Good luck!