u/DryHoliday5928

I used to be an incredibly driven and high-functioning person academically. I was valedictorian of my high school class, earned a scholarship to a top-20 university, graduated summa cum laude, and continued performing near the top of my class through the first two years of medical school.

At the end of second year, my girlfriend broke up with me, and I fell into a severe depression during third year that eventually culminated in a psychotic break. I was being treated for depression at the time, but I was in deep denial about the psychosis itself. I eventually came out of it without antipsychotic treatment, but ever since then I’ve felt like I’ve never cognitively recovered.

Since the psychotic episode, I’ve struggled with poor working memory, slowed processing speed, mental fatigue, difficulty learning new material, and just an overall feeling that my brain does not function the way it used to. Before all of this, academics came naturally to me. Now even routine cognitive tasks can feel exhausting and overwhelming.

I managed to get through my clinical years, partly because I was heavily invested in pursuing a specialty generally considered less cognitively demanding. But fourth year ended with me not matching. I SOAPed into a TY year, and honestly, I struggled throughout the year despite finally opening up fully to my psychiatrist about the psychosis history. I am by far the worst intern in my class and my evaluations have showed it. I’m very fortunate that they’re letting me complete the program.

Since then, I’ve cycled through multiple antidepressants, antipsychotics, and ADHD medications (Adderall and Strattera), but nothing has brought me anywhere close to my old baseline cognitively. My psychiatrist has even told me that the cognitive dysfunction may be irreversible, which has honestly devastated me.

I reapplied this cycle to my original specialty plus another related specialty that is much more rigorous and cognitively demanding in day-to-day practice. I matched into the latter, and now I’m about to finish my TY year and start residency. The problem is that I’m terrified.

I still remember what it felt like to be quick, sharp, intellectually confident, and capable of handling huge volumes of information effortlessly. Now I constantly feel slower and mentally overwhelmed. My family still sees me as the person I used to be and has very high expectations for me based on my past academic success, but they don’t understand how profoundly this experience changed me. They think I’m lazy or not trying hard enough.

I don’t even fully know what I’m asking for here. Maybe I just want to know if anyone else has experienced severe cognitive changes after psychosis, depression, or burnout and whether things improved over time. Did anything help? Medication changes? Cognitive rehab? Lifestyle changes? Therapy? Time?

And for anyone in medicine specifically: how do you cope with grieving the loss of the person you used to be while still trying to function in a demanding career?

I’m scared that I’m about to enter a residency that I’m no longer cognitively capable of handling, and I genuinely don’t know what to do.

I used to be an incredibly driven and high-functioning person academically. I was valedictorian of my high school class, earned a scholarship to a top-20 university, graduated summa cum laude, and continued performing near the top of my class through the first two years of medical school.

At the end of second year, my girlfriend broke up with me, and I fell into a severe depression during third year that eventually culminated in a psychotic break. I was being treated for depression at the time, but I was in deep denial about the psychosis itself. I eventually came out of it without antipsychotic treatment, but ever since then I’ve felt like I’ve never cognitively recovered.

Since the psychotic episode, I’ve struggled with poor working memory, slowed processing speed, mental fatigue, difficulty learning new material, and just an overall feeling that my brain does not function the way it used to. Before all of this, academics came naturally to me. Now even routine cognitive tasks can feel exhausting and overwhelming.

I managed to get through my clinical years, partly because I was heavily invested in pursuing a specialty generally considered less cognitively demanding. But fourth year ended with me not matching. I SOAPed into a TY year, and honestly, I struggled throughout the year despite finally opening up fully to my psychiatrist about the psychosis history. I am by far the worst intern in my class and my evaluations have showed it. I’m very fortunate that they’re letting me complete the program.

Since then, I’ve cycled through multiple antidepressants, antipsychotics, and ADHD medications (Adderall and Strattera), but nothing has brought me anywhere close to my old baseline cognitively. My psychiatrist has even told me that the cognitive dysfunction may be irreversible, which has honestly devastated me.

I reapplied this cycle to my original specialty plus another related specialty that is much more rigorous and cognitively demanding in day-to-day practice. I matched into the latter, and now I’m about to finish my TY year and start residency. The problem is that I’m terrified.

I still remember what it felt like to be quick, sharp, intellectually confident, and capable of handling huge volumes of information effortlessly. Now I constantly feel slower and mentally overwhelmed. My family still sees me as the person I used to be and has very high expectations for me based on my past academic success, but they don’t understand how profoundly this experience changed me. They think I’m lazy or not trying hard enough.

I don’t even fully know what I’m asking for here. Maybe I just want to know if anyone else has experienced severe cognitive changes after psychosis, depression, or burnout and whether things improved over time. Did anything help? Medication changes? Cognitive rehab? Lifestyle changes? Therapy? Time?

And for anyone in medicine specifically: how do you cope with grieving the loss of the person you used to be while still trying to function in a demanding career?

I’m scared that I’m about to enter a residency that I’m no longer cognitively capable of handling, and I genuinely don’t know what to do.