A Lawyer’s Heart

I’ve felt plenty of anger over my twenty years as a litigator.  Sometimes, and thank God they were few and far between, I would blow up at opposing counsel or a client.  More often, my anger would sometimes simmer just below the surface.  This is an all too common reality for today’s lawyer.  “By definition, the adversarial system is conflict-ridden, and conflict creates certain types of emotions like anger, guilt and fear, which causes stress, says Amiram Elwork, Ph.D. author of the book, Stress Management for Lawyers

According to Chicago litigator, Shawn Wood, the “nature of civil litigation involves two lawyers (often Type A personalities) squaring off against one another under circumstances where there will be a winner and a loser, and part of each lawyers job will be to capitalize on any possible error in judgment that the other side makes.”  I really don’t buy into this completely.  Many lawyers that I know aren’t “Type A” personalities.  They are usually hard working and successful.  But, it can take a tremendous toll on their mental and physical health.  They struggle with the simmering variety of anger.

Anger turned outward is hostility.  Such hostility can express itself in a number of ways for lawyers.  Andy Benjamin, Ph.D., both a lawyer and psychologist who treats lawyers with stress, anxiety and depression, describes hostility as an “array” of the following thoughts and behaviors: 

  • Holding persistent negative, hostile, or cynical thoughts during relationship interactions;
  • Chronic impatience;
  • Frequent irritability
  • Disconnecting from others due to an empathetic deficit (for example, being rigid in relationship interactions);
  • Suffering continual fatigue.

You could say most people have these problems in our hectic, stressful world.  “But lawyers are particularly susceptible to stress-related illnesses because of the unique interplay of the legal profession and lawyer personality” says the ABA Journal.  A study that followed University of North Carolina law students as lawyers for 30 years suggested that those with significantly elevated levels of hostility were more likely to have died prematurely from cardiovascular disease.

According to Jesse Stewart, assistant professor of psychology at Purdue University, depression and hostility commonly occur together.  When a person is both depressed and hostile, the traits interact in a complex way to elevate inflammatory proteins in the body.  The combination of hostility plus depression appears to be as dangerous a risk factor for heart disease as high blood pressure or even smoking.

Edward C. Suarez, Ph.D., of Duke University, says a recent study, “. . . suggests the possibility that men who are . . . hostile and exhibit depressive symptoms, even in the mild to moderate range, are at heightened risk for cardiac events.”  This is so because of the release of adrenaline during times of stress.  According to Dr. Cleaves M. Bennet, clinical professor of medicine at UCLA Medical Center,  “Adrenaline is the growth hormone for the heart muscle.  On the one hand, its good to have a big, strong heart, but at the same time that the heart is getting bigger and stronger, the arteries are narrowing to protect the tissue.”

Given the clear connection between lawyer hostility, depression and the heightened risk for a cardiac event, what can lawyers do about it?

First and foremost, they need to educate themselves about the connection between depression, hostility and heart disease. Most people don’t see the correlation. But, there’s no denying the science which makes the links. 

Second, because hostility creates stress in the body (i.e. the release of adrenaline and cortisol when the body goes into the fight or flight mode), it’s critical to discharge the stress through some form of exercise.  When I go through a good workout after a confrontational day, it’s as if I am wiping the slate clean.  I am discharging the stress that is causing so much trouble in my body and bringing it back into some kind of balance.  Exercise is really just a formalized form of the flight response to stress.  Our bodies want to step on the gas.  Listen to your body and let it run.

Third, you need to find out where your hostility is coming from.  Is it from problems in your personal life that you bring into your daily life as a lawyer?  If so, these need to be met and addressed.  Or, is it the other way around?  Is it the daily grind and confrontation at the office that you bring home?  It’s important to figure this out.  If opposing counsel is a jerk and elicits a hostile reaction from you, it might be time to learn (and, yes, it is a skill you can learn) different ways of being assertive without harming your heart and increasing your risk for depression.  If it is problems at home, identify them and if need be, go for counseling.

Fourth, learn to tell the difference between being assertive and being aggressive. For further reading on this topic, check out this article “Are you Assertive – or Aggressive?” and the article “Assertive, Not Aggressive.”  To help evaluate your own levels of perceived stress and associated health risks, visit the University at Pittsburgh Center’s Healthy Lifestyle Program Web site.

The Weight of Advice

Each of us is a Dear Abby to the world. We dish out advice and opinions whether asked for or not; me included! Much of this is harmless; some necessary and kind. Then there’s the stuff we dole out without knowing what the hell we’re talking about. Where we should tread carefully, we plod along.

For better or for worse, there’s tremendous power in words. When we are vulnerable – as we are during a depression – the critical or misguided words of others take on the ring of gospel. Some may blame us for our depression in a ploy to get us to snap out of it. In one poll, 54% of Americans said that they thought of depression as a “moral weakness”.

Years ago, when I first told my four law partners that I was diagnosed with depression and would need to take time off, they sat there stunned. After a moment of awkward silence, one partner said, “What in the world do you have to be depressed about? You’ve got a great job, wife, family and friends. What do you need, a vacation?” This is an all too common response. His school of thought would argue that it was a lack of gratefulness that was at the root of my distress. Carried to its logical (or illogical) conclusion, we have control over our depressed state and if we only try harder by thinking positive thoughts, it will all go away.

In the book, Unholy Ghosts: Writers on Depression, author Susanna Kaysen says:

“The Failure of Will theory is popular with people who are not depressed. Get out and take your mind off yourself, they say. You’re too self-absorbed. This is just about the stupidest thing you can say to a depressed person, and it is said every day to depressed people all over this country. And if it isn’t that, it’s, Shut up and take your Prozac. These attitudes are contradictory. Conquer Your Depression and Everything Can Be Fixed by the Miracle of Science presuppose opposite explanations of the problem. One blames character, the other neurotransmitters. They are often thrown at the sufferer in sequence: Get out and do something, and if that doesn’t work, take pills. Sometimes they’re used simultaneously: You won’t take those pills because you don’t WANT to do anything about your depression, i.e. Failure of Will.”

These observations capture some of the angst – and yes, anger – of depressives. When I was struggling with other’s judgments about my depression, I thought, “What do I have to do to be worthy of their mercy?” In retrospect, it wasn’t a question of worthiness, but ignorance. Some people (friends, family and business associates) will never be able to overcome the inertia of their own ignorance. They’re not bad people. It’s just the way life is. And we have to learn to be okay with that. But then there are others. These precious souls – and there don’t have to be lots of them – who have our back. They truly want to understand and help. Mother Teresa was once asked by a hard-boiled reporter what God expects of humanity. I think the reporter expected some stock answer. Mother Teresa, in all her gracious dignity, said that all God really wants from us to be is a “loving presence” to one another. There are those in our lives who want to be that presence to us. Give them the chance to be that light.

.

Lying in the Hands of God

Growing up in a Polish-Catholic home, I was more of a cultural catholic than a church going sort. But, my alcoholic father would make us go with him sometimes. I think it gave him a sense of normalacy; a feeling that he could be with other people without throwing down shots of Jack Daniels at a local watering hole. Only later did I develop any real sense of  my own spiritual search. I’m still on that journey.

All religions have a lot to say on the topic of suffering, but not so much on the topic of depression. I guess you could say that depression is a “form” of suffering. Personally, I think that doesn’t cut it. When someone says to me, “Well, everyone suffers,” I walk away misunderstood and feeling the worse for the encounter. Maybe there’s not much dialogue about depression in our churches because of the raw fear that faith can’t fix everything.

When I first became sick, I didn’t know I had “depression”. I just thought I was having one of life’s many existential emergencies. I would kneel and pray that God would take away my pain. But, it simply didn’t happen that way. Sometimes, I would give God an ultimatum: “You either take away this damn pain, or I’m turning my back on you fella”. I demanded “a” solution, an answer. One wasn’t forthcoming.

As time went on, something happened. I stopped trying to dictate so many of the terms of my recovery from depression. Instead, I just  began to surrender myself. I began to see that God was bigger than my depression. It didn’t mean that I wouldn’t suffer now or in the future from it. But a light appeared through cracks in depression’s armor. There’s a sense of joyous relief that comes when we stop the war against depression. We lay down our burden.

In the new album by The Dave Matthews Band, Big Whiskey and the GrooGrux King, there’s a beautiful song (listen now), called Lying in the Hands of God. In one part, Dave sings:  “If you feel the angels in your head. Tears drop of Joy runs down your face. You will rise.”

At my best, when I feel “the angels in my head”, I weep with joy knowing that depression doesn’t have the final say in my life. Yes, there will be times when I suffer from it. But, it doesn’t last.

In her article written for my website, Sister Kathryn James Hermes (who suffers from depression), author of the book, A Contemplative Approach to Depression, wrote that prayer leads us to “. . . vulnerability – the learned powerlessness of the truly powerful who can simply be: simply wait, simply be present, simply wonder, simply trust that much larger hands are holding us and knows for whom we work in view of a much larger plan that we cannot as yet understand”.

Tune out the drumbeat of depression for a bit today. We don’t have to understand or control it all. Try lying in the hands of God awhile. And rise.

Creating a Self-Care Toolkit

I talked with a wonderful woman from halfway across the country this morning about her ongoing battle with depression.  At one point, she asked me so tenderly, “Am I ever going to get better?” My unwavering response was “Yes”. Maybe I had no right to say this. After all, I’m not an expert. But I have talked with hundreds of lawyers across the country who have shared their depression stories with me. Many of them have recovered or are on their way. The woman also shared with me that she was in therapy and taking antidepressants, but was still having a lot of problems with depression. I offered her a little hard won advice which I will share here.

When we think about recovery, we need to envision a Self-Care Toolkit. What’s that? It’s behaviors that you are going to do that are healthy and offer you relief and hope. Certainly, seeing a psychologist and a psychiatrist are self-caring acts. But, there is a lot more that we can do to help ourselves. I call them the pillars of recovery. Here are a few that I shared with my friend on the phone today:

1.    Join a support group for depressed people. Ask your psychologist or psychiatrist if they know of one. If not, maybe they will start one that you can participate in. Alternatively, contact the Depression & Bipolar Support Alliance. It’s a national organization dedicated to helping people just like you. Here is the link to finding a support group in your area. Another idea is to contact a Lawyers Assistance Program (LAP) in your State or community. These programs are confidential and are there to help lawyers with problems including depression. They may be able to help you find a lawyers support group in your community. Here is the link to find a LAP in your state. Please note that a support group is not the same thing as group therapy. Here is a great article from the Mayo Clinic about the difference between the two and the benefits of joining a group. One of the biggest problems is the loneliness that we as people with depression experience.  We often think to themselves, “No one understands my pain”. We compound this loneliness by isolating themselves from others. The act of joining a support group is a much healthier choice than walling ourselves off.

2.    Start a journal. Depression often causes us to bottle up our emotions or feel like we just can’t sort them out. In one study , conducted by The University of New England, police officers spent 15 minutes at the end of their shift writing in a journal about stressful events and feelings that had occurred during the shift. In just four days the officers experienced a 28% reduction in stress, anxiety and depression. “Keeping a journal is a good way to start coping with depression”, says Jessie Gruman, Ph.D., Executive Director of the Center for the Advancement of Health in Washington. “It’s not aggressive, it’s something you can do by yourself, and it gives you the chance to see your feelings in black and white and then make plans to do something about them.”

3.     Help your spouse/partner to help you.  Many spouses/partners who love people struggling with depression don’t know what to say or do. Sometimes, although well intentioned, they say something that only makes you feel worse and more alone. What a spouse/partner needs to do is get educated. I have recommend reading the book, When Someone You Love Is Depressed: How to Help Your Loved One Without Losing Yourself, by Laura Epstein Rosen, Ph.D. It’s important for your partner to be on the same page because depression affects the whole family.  I recommend that you buy the book for your spouse as a gift. It lets them know that you care and realize that they struggle with how to help.  Read this article from Psychology Today about how families often do better at recognizing depression than patients. Need online help? Wonderful resources can be found at the Families for Depression Awareness website at www.familyaware.org.

More later. For now, be well.

Managing Your Depressive Symptoms Is Not Enough

If you have been living with depression long enough, you will inevitably face the question of whether managing your depression is enough. Many lawyers dealing with depression (and there are 200,000 in America) are struggling to get rid of their symptoms of depression. I understand the value and necessity of this all too well. But once the symptoms seem manageable, what next?

In his book, What Happy People Know, psychologist, Dan Baker, offers his criticisms of much of modern day psychology: “Clinical psychology – the treatment in a clinical setting of people with mental disorders – was begun with great fanfare as an adjunct to modern medicine in the late 1800s. It was patterned after the conventional medical model of fighting pathology. Clinical psychology was based on the assumption that most people are mentally healthy – and happy- but some people contract mental pathologies that conform to neat diagnostic compartments, and require standardized treatments. The only problem is that it doesn’t work very well. It fails approximately two-thirds of the time.” As I write, let it be known that I attend therapy twice per month!

There is a great debate worldwide about the causes of depression. Most agree that it is a complex condition related to a combination of factors both genetic and environmental. While there is value in thinking about depression as a disease of sorts – say on par with diabetes or heart disease – there is a real danger to as well. That’s because it isn’t just a “disease;” it’s also a psychological and spiritual malady. If those aspects aren’t addressed, those who suffer from it may never taste the wonder and joy of life. They are left with the discontent of a life where they are only managing their depressive symptoms. Don’t we have the right to expect more?

Dr. Baker central point is that the approach of clinical psychology was not designed to help people find happiness. “It assumed that if mental illness were cured, happiness would naturally follow, as the normal human condition. But that doesn’t happen for the vast majority of people.” He continues, “I believe that even when people do not have diagnosable psychological illness, they still cannot be considered psychologically healthy unless they are happy. The absence of disease is not the same as health, just as the absence of poverty is not the same as wealth.” For a further exploration of the issue of happiness, see the interesting article in The Atlantic Magazine, “What Makes Us Happy” by Joshua Wolf Shenk. Interesting, Mr. Shenk is the author of Lincoln’s Melancholy: How Depression Challenged a President and Fueled His Greatness.

I believe Dr. Baker’s point is well taken. Yes, it is critically important to treat the symptoms of clinical depression. But we must stop and pause: is that enough? If it is, I can’t help but feel as though we have allowed ourselves to be victims on some level. Depression then has the danger of defining our identities as people. We are more than that. We must aspire to live a fuller life with times of joy, happiness and a sense of being alive. As Mark Twain once wrote, “Let us endeavor to live that when we come to die even the undertaker will be sorry.”

Warping Through Our Days

As a child, I would sit in the back seat of my parent’s old car with my dog, Sherman.  As the car wound through the countryside where we lived, Sherman and I would stick our heads out the window during the summer as the wind whipped through our hair.  There was such simple joy in this experience of speed, of motion.  Of being carried through carefree space.

When we think of the speed of our lives as lawyers we cringe, don’t we?  Our lives aren’t just lived in the fast lane, they’re lived at warp speed.  At the periphery of our vision, we see only problems and other stressors.  Any hope of joy gets sucked right out of our days like the grains of sand slipping through the narrow gap in a hour glass.

We hear so much talk of “time management”; of the next simple ten things we all need to get our lives together; to be a successful end product.  Such talk has its place, but it seems that we never catch up with ourselves.  We are warping onto the next thing on our “TO DO LIST”.

In his book, Crossing the Unknown Sea: Work as a Pilgrimage of Identity, poet and corporate trainer, David Whyte, uses the metaphor of a sea voyage to depict the journey through the world of work.  He views work not only as a means of support, but as a means for interacting with the world and developing self-expression and identity. This is not a self-help book of step-by-step pragmatism, but rather how to forge one’s relationship with time and daily ritual.  In one passage, he speaks about his friendship with Benedictine monk, Brother David Steindlrast.  David is speaking to him about his stressed out life.  Brother David tells him that the antidote to his exhaustion is not rest, but “wholeheartedness.” See this interesting clip on David giving a talk.

Put aside the appointment book for today. Turn off the ignition switch of your life for a bit.  In his book, David notes that the poet Keats believed that truly great people have the ability to accept that not everything can be resolved, that they can thrive on uncertainty.  As lawyers, it is so easy for us to emotionally shut down when faced with the grind of uncertainty.  Maybe we have lived lives like this for years; we have closed our hearts to our own hearts.  Yet, there may come a turning point in our lives when we are ready.  When we are ready to listen to what the poet Keats called “the holiness of the hearts affections.”  Part of David’s poem, The Opening of Eyes, reads:

“It is the opening of eyes long closed. It is the vision of far off things seen for the silence they hold. It is the heart after years of secret conversing speaking out loud in the clean air”.

 Listen to that heart within you today.  Let it speak out loud into the air of your day.

Atticus Finch

I grew up in a small town.  My four siblings and I lived with our folks in an old farmhouse atop a hill.  Summers were simply magical.  I would play in the woods by day and at night lay with my friends on our dead end road and gaze up at the stars.  The stored heat from the day radiated up from the road cradling my back. I didn’t know what I wanted to be when I grew up.  But, in some way, I wanted to be the beauty I saw in those skies years ago.

When I was in the seventh grade, my teacher gave me a copy of To Kill A Mockingbird by Harper Lee.  For those of you not familiar with the book, it’s a tale about a noble lawyer, Atticus Finch, who is asked by a judge to defend a wrongly accused black man in small southern town in 1936.

In the preface to the book, there’s a quote from the eighteenth century British author, Charles Lamb: “Lawyers, I suppose, were children once.”

Why would Harper Lee choose this quote to begin her novel?  Charles Lamb was never a lawyer, but his father was.  Interestingly, Charles also battled depression (then called melancholy) for much of his life and was institutionalized a few times.  We can only wonder what Charles thought when he saw his father come home after a long day at work.  Why, as an adult, would he write such a poignant lament?

Children are full of hope and innocence. Atticus’ two children, Jem and Scout, believe that justice and fairness will prevail and the accused, Tom Robinson, will be found innocent.  But Atticus knows better.  He sees only too well the racism, hatred, and the hardness of men’s hearts in his town.  Atticus could fall prey to cynicism, but he doesn’t.  He rises to the occasion not because he believes he can win, but because of who he is.  He is a person of integrity.  He isn’t one person at his law office and another person at home.  He defends Tom because it is the right thing to do.

In the movie, Atticus is seen sitting on his porch at night thinking.  He takes the time to reflect on his day.  He isn’t texting on his Blackberry or watching television to try to drown out this inner emptiness.  Many lawyers are driven perfectionists.  In her article, Your Legal Writes:  From Atticus Finch to Harry Potter, writer Kathryn E. Brown quotes legal consultant, Pat Sullivan: “I’ve been in firms where the drive for perfection turned into insanity.  Lawyers look for every possible facet, every possible angle, every possible document, etc. The result is they are overwhelmed with facts and tasks, so much so that there is no time for reflection or thought about a case.”

Watching Atticus, there is a sense of his simple humanity and harmony between his values and his actions as a lawyer.  As lawyers, it’s important not to just think about the pragmatic concerns involving our depression (e.g. whether we took our medication or exercised today); it’s just as important to think about the existential ones:  Who am I really?  Am I leading a life of integrity?  Are my actions as a lawyer in accord with my deeply held inner values?

I have talked to hundred of lawyers across the country and I can tell you this:  their depression is sometimes rooted in a sense of meaninglessness and not liking what they have become.  Of working for just a paycheck (sometimes very large ones) and not for an enriching life that is meaningful to them; of living a life not full of integrity. Lawyers need to take time to create a space of silence where they can reflect on their lives; where the content of their day isn’t measured by its pace, but by its meaning.

As the great writer Studs Terkel once wrote, “Work is about a daily search for meaning as well as daily bread, for recognition as well as cash, for astonishment rather than torpor, in short for a sort of life, rather than a Monday-to-Friday sort of dying.”

Coming Out of Our Caves: Male Depression

Guys have lots of trouble coming to terms with depression. All the more so if you’re a lawyer. Lawyers aren’t supposed to have problems; we’re supposed to fix them. Most male lawyers I know would rather drop dead than admit that they have problem with depression. I guess the exception to this observation is when the wheels have fallen off for them. Then – and only then – do they recognize (hopefully) that they are suffering from depression and the toll that it is taking on their lives. The consequences for failing to recognize this basic fact can be serious (loss of productivity at work, sleep problems, etc.) or fatal (middle aged lawyers commit suicide at twice the rate of the national average).

Psychologist, Terrance Real, the author of the book, I Don’t Want to Talk About It: Overcoming the Secret Legacy of Male Depression, makes the observation that we don’t think of men as depressed. This is so because what we are really thinking about is “overt” depression and more women show signs of that – weeping, a willingness to discuss painful feelings, etc. Men suffer from “covert” depression that expresses itself in addiction, isolation, workaholism, isolation and increased irritability.

“Men are just as feelingful, just as relational, just as connected, just as dependent, just as needy, as women are. Men have been coerced since childhood to forego these relational qualities and skills and squeeze their sense of membership and self-esteem through performance. Girls are taught to filter their sense of self-worth through connection to others, and boys are taught to filter their sense of self-worth through performance. That’s a vulnerable foundation for one’s self-worth” notes Real in an interview.

The excellent website, Men Get Depression, says there are three distinctive signs of male depression:

Pain
Depression may show up as physical signs like constant headaches, stomach problems, or pain that doesn’t seem to be from other causes or that doesn’t respond to normal treatments.

Risk Taking
Sometimes, depressed men will start taking risks like dangerous sports, compulsive gambling, reckless driving, and casual sex.

Anger
Anger can show itself in different ways like road rage, having a short temper, being easily upset by criticism, and even violence.

So often, the first symptom that male lawyers notice that they are slipping is in the performance department. One of the symptoms of clinical depression is difficulty concentrating. This leads to problems in getting work out the door. We may try to hide that our work is slipping – ask for extensions, take much longer to do tasks that were simple and routine in the past. If the problem doesn’t go away, some will seek out help – usually through their family doctor (who distribute 80% of the prescriptions in this country for antidepressant medications). Some will go the extra step of seeing a therapist that they can talk with about their problems.

My therapist used to liken my depression to a caveman camping out in his cave. It took a lot to coax me out of there. Men need to come out of their caves into the light of day where the colors are brighter, others live who can help us and where we can finally feel the sun of being worthy without having to perform twenty-four seven in our legal careers.

A Walk in the Park

During my depression, my world narrowed.  I just didn’t want to go anywhere.  My life was lived inside coffee shops, on the couch watching television, sitting in my office with the door closed.  There was something deadening about this.  In hindsight, I guess I felt that doing something else wouldn’t make a difference anyway.

I have learned over the years that nature is a powerful antidote to depression.  Being in nature does make a difference.  Maybe it’s because there is such power in nature.  It’s always in motion, isn’t it?  There isn’t any clinical depression in nature.  Humans evolved from the natural world, not from concrete and office towers.  One study found that a walk in a park or countryside reduced depression whereas walking in a shopping center or urban setting increased depression.  This summer, I am going to reconnect to nature by taking my daughter on nature walks.  During these times, I just want to let my incessant conversation with my depression go and let nature speak to me.

A favorite poem of mine, “Wild Geese”, by Mary Oliver, speaks to me of the beauty and healing power of the natural world:

You do not have to be good – You do not have to walk on your knees for a hundred miles through the desert, repenting.  You only have to let the soft animal of your body love what it loves.  Tell me about your despair, and I will tell you mine.  Meanwhile the world goes on.

Meanwhile the sun and the clear pebbles of the rain are moving across the landscapes, over the prairies and the deep trees, the mountains and the rivers.  Meanwhile the wild geese, high in the clean blue air, are heading home again.

Whoever you are, no matter how lonely, the world offers itself to your imagination, calls to you like the wild geese, harsh and exciting- over and over announcing your place in the family of things.

The Fog of Depression

In the early stages of dealing with depression, one of the more difficult aspects was trouble sleeping. At its worst, I would wake up at 3:30 every night and drive to an all-night coffee shop.  I would sit there like a block of cement and let the steam of the coffee wash over my face.  Looking out the large windows, the empty streets mirrored my own profound loneliness.  I didn’t know or understand why this had happened to me.  What had I done to deserve such misery?

Eventually, the sun came up. All I could think of was how I was going to do my job while feeling so bone weary and depressed.  Those days were tough.  They didn’t last forever, though.  What turned the tide was that I discovered that I had sleep apnea, a serious sleep disorder in which your brain wakes up during the night thus preventing a restorative night’s rest.  People with apnea are sometimes misdiagnosed with depression.  It’s important if you are having problems with fatigue and sleep to be evaluated by a sleep disorder specialist.   Watch this video of a man who suffered from sleep apnea and how he got help.

There are many people, like me, who have both sleep apnea and a sleep disorder caused by depression.  This is so because the causes of sleep apnea are not the same as the causes of a sleep problem associated with depression.  Thus, treatment and resolution of an apnea problem will not fix your sleep problems if you are also suffering from clinical depression.  Apnea is usually found in individuals with low muscle tone and soft tissue around the airway (e.g. due to obesity), and structural features that give rise to a narrowed airway. The cause of sleep disturbance because of depression is more complicated.

Our sleep patterns are dictated by the circadian rhythms in our bodies.  There is a body clock located in our hypothalamus of our brains which controls how we sleep and feel.  The center creates daily signals or rhythms that govern when our hormones and neurotransmitters are released – two critical elements in depression.  Antidepressants target neurotransmitters and hormones.

Due to problems with our circadian rhythms during depression, our sleep cycle does not function properly and we feel sleepiness in the daytime and will be awake at night.  My own experience is that the type of antidepressant you are on may be helping or hurting your ability to sleep.  You may need to change antidepressants (or the dosage). Alternatively, you may need to supplement your antidepressant with another medication that will help you to sleep.  I know many who are doing this and it helps them to sleep well.

Finally, there are a number of prompts or small behaviors that you can employ to let your body and mind know that it’s time to sleep.  This can be important because sleep disturbance is just not about biology, but also psychology.  Depressives ruminate and they do it at the worst of times:  when trying to fall asleep.  There are several things you can do to get ready for sleep.  Just don’t leave it to chance that you might sleep well.  Be pro-active and recognize the critical importance of a good night’s sleep in helping you to recover from depression.

Built by Staple Creative