It is a well-known fact that veterinarians have a higher rate of suicidal ideation than the general population (Canada and the U.S.A., the UK, Germany, and more...). When I was scrolling through my TikTok, another veterinarian was discussing how online complaints really contribute to compassion fatigue and mental health struggles in the veterinary community ---- and it needs to stop.
Pet parents rely on their veterinarians to help them with their pet's problems, but veterinary medicine is not publicly funded and only a handful of pet parents have enrolled their pets in pet insurance. Combine this expense with a highly emotional event and you get an irate person trolling the internet, posting rants on social media and leaving reviews online about how horrible veterinarians are. We rationalize this as the person is very upset and feels the need to put the blame on someone else other than themselves. In many cases, if we couldn't save them because they came in too late, or we had our hands tied because cost was a concern. We blame ourselves. We question our abilities and take that home with us.
Combine that information alongside the fact that veterinarians are in the top 5 percentile of their education prior to getting accepted into veterinary school. Veterinarians are predominantly perfectionist personality types (Holden 2020). Veterinarians are more likely to be Myers-Briggs ISTJ (introverted, sensing, thinking, judging) (Kubale et al 2022).
We pride ourselves on our integrity and when a member of the public questions this by saying we are only in it for the money, we take this very personally. Human interactions are exhausting for introverts, and we work in a field where the ability to communicate with pet parents drains us. Not to mention the 60 hour work weeks (on average) and taking our work home, not just in the literal sense of having to do our medical records at home, but the emotional trauma from our work day also comes home with us. Then when you get home you hear about an awful online review.
For every mean thing that someone posts online about us, we would need a minimum of 100 good reviews to counter that. Some veterinarians just never recover from the onslaught of hate. Dr. Shirley Koshi was one of them, when a crazy person decided to posted on Facebook ultimately leading to Dr. Koshi taking her own life.
Depression in perimenopausal/menopausal women
Having entered my 40's recently and finding out my AMH was lower than normal for my age. Having acute onset severe clinical depression and needing to start taking Zoloft made me start to question whether I was depressed because I have anxiety, was I depressed because of my career, or was something else contributing to my depression.
It turns out that when you hit your mid-30's you start to have a decline in your estrogen. My mother doesn't talk much about her personal experiences going through menopause. I just recall my step-dad getting frustrated with the mood swings. But if you know of a woman who is approaching age 45 put the bug in her ear --- If she starts to feel depressed, there is help for her (Shea et al 2020)!
There are two female veterinarians that stick in my mind who have committed suicide: Dr. Shirley Koshi and Dr. Sophia Yin. That was in 2014 and I graduated from veterinary school in 2016 so this is why these women stood out to me ---- these women unalived themselves while working in a profession that I was training to be.
I have this theory that due to their age (Dr. Koshi at 55 years and Dr. Yin at 48 years) depression snuck up on them with the wane of estrogen in their systems. Dr. Koshi was bullied with the use of social media, which can be the final nail in the coffin of a person who may already be suffering from a depressive episode. Dr. Yin's colleagues would have never predicted it with her "enthusiastic" demeanour. Again, just a theory, but if this is the case and my theory is correct, perhaps by drawing attention to this issue it will help women in a similar situation understand that they can ask for help. That help is called hormone replacement therapy.
Because I am still on this fertility journey, I cannot take hormone replacement therapy. But when I go through an endo-prep (estrogen supplementation to increase the endometrial lining) I feel really good! I feel energetic and I feel happy. Zoloft helped me regulate my irritability, but it never made me feel happy.
Estrogen helps the brain by increasing dopamine and serotonin binding. When we lack estrogen, we can feel like we have brain-fog. We cannot think straight. We end up with insomnia. The insomnia worsens the ability to think straight. We start feeling apathetic. We start having anhedonia.
We chalk it up to thinking it is compassion fatigue or burn out. We maybe just need a vacation away from work. We start blaming our work and the people around us. But our lack of estrogen is contributing to our lack of resiliency.
The difference between the drop in estrogen that you experience during premenstruation and menopause is that PMS is short lived. Lysis of the corpus luteum sends the feedback to your brain to start producing FSH and the follicles are stimulated to grow. Those follicles produce estrogen and you start to feel good again. During menopause, or leading up to menopause, that estrogen drop is prolonged and it is more substantial.
Did you know that I found out through a TikTok video that ADHD medication doesn't work as well in women during their luteal phase?? Now, I always like to get the primary literature on this information (Haimov-Kochman and Berger 2014). Thank God for women in medicine, otherwise this information would be null! I do not have ADHD, but one of my colleagues was recently diagnosed. She hasn't really talked about it much, but I start wondering if I should broach the subject. We're not yet that close, but if you're reading this, I'm always here to chat!
So I just want to circle back: if you are, or someone you know is, a woman approaching their mid-40's just have an open conversation about the effect of decreasing estrogen on mood and cognitive processes. You may be saving a life in the process.
References:
Haimov-Kochman, R., & Berger, I. (2014). Cognitive functions of regularly cycling women may differ throughout the month, depending on sex hormone status; a possible explanation to conflicting results of studies of ADHD in females. Frontiers in Human Neuroscience, 8, 191. Link
Holden, C. L. (2020). Characteristics of veterinary students: perfectionism, personality factors, and resilience. Journal of Veterinary Medical Education, 47(4), 488-496. Link
Kubale, V., Lobnikar, B., & Dvojmoč, M. (2022). The Myers–Briggs Personality Types of Veterinary Students and Their Animal Ethical Profiles in Comparison to Criminal Justice Students in Slovenia. Veterinary Sciences, 9(8), 441. Link
Nett, R. J., Witte, T. K., Holzbauer, S. M., Elchos, B. L., Campagnolo, E. R., Musgrave, K. J., ... & Funk, R. H. (2015). Risk factors for suicide, attitudes toward mental illness, and practice-related stressors among US veterinarians. Journal of the American Veterinary Medical Association, 247(8), 945-955. Link
Platt, B., Hawton, K., Simkin, S., Dean, R., & Mellanby, R. J. (2012). Suicidality in the veterinary profession. Crisis, 33(5), 280-289. Link
Schwerdtfeger, K. A., Bahramsoltani, M., Spangenberg, L., Hallensleben, N., & Glaesmer, H. (2020). Depression, suicidal ideation and suicide risk in German veterinarians compared with the general German population. Veterinary record, 186(15), e2-e2. Link
Shea, A. K., Sohel, N., Gilsing, A., Mayhew, A. J., Griffith, L. E., & Raina, P. (2020). Depression, hormone therapy, and the menopausal transition among women aged 45 to 64 years using Canadian Longitudinal Study on aging baseline data. Menopause, 27(7), 763-770. Link
Stoewen, D. L. (2015). Suicide in veterinary medicine: Let’s talk about it. The Canadian Veterinary Journal, 56(1), 89. Link
Walsh, M. J., Gibson, K., Hynd, M., Eisenlohr-Moul, T. A., Walsh, E. C., Schiff, L., ... & Schiller, C. E. (2023). Perimenopausal Effects of Estradiol on Anhedonia and Psychosis Study (PEEPs): study protocol for a neural and molecular mechanistic clinical trial. Trials, 24(1), 150. Link