Recurrent Depression

There was a powerful article about one woman’s battle with life-long depression in last Sunday’s edition of The New York Times Magazine.

A Journey through Darkness

Depression, which she describes as a “thick black paste” and “the muck of bleakness”, can be a chronic and reoccurring condition for many sufferers (as it was for this woman).  The research bears this out.  Sixty percent of people who have had one episode of major depression will have a recurrence.  With each episode, the risk of recurrence increases from 60% to 70% after two episodes, to about 90% after three. Further, studies show that when symptoms continue, recurrent episodes can be longer and more severe, with less time between episodes.  Scientists have recently found that long-term treatment with antidepressants can be beneficial.

New Approach for Recurrent Depression

My view is that it is critical to cut depression off at the pass before it gets a foothold in our lives.  That is why I encourage lawyers who are in the midst of their first depressive episode to hit it with everything they’ve got:  medication, talk therapy, exercise, a spiritual practice and support groups.  If we do not, we run a significant risk of the depression returning.

As the old Japanese proverb goes, “Falls seven times, stand up eight.”  Winston Churchill, who suffered from depression his whole life, had a modern take on this ancient wisdom: “If you are going through hell, keep going.”  Take action, be determined and trust that you will get better.

Stress Depression Connection

At the beginning of my law career, I didn’t suffer from depression. But I did have trouble managing the stress of my practice. Over time, this constant stress developed into anxiety. I started feeling like I couldn’t control everything. I would go to bed fearing what problems and disasters were to confront me the next morning. After years of this, the pendulum swung. I went, more and more, from states of anxiety to states of depression. Why did this happen? It took me a long time to understand.

Depression develops because of a complex interplay of genes, neurochemistry, emotional history and personality. Recently, scientists have been focusing in on the connection between stress and anxiety and the role they play in producing and maintaining depression. This subject should be of great concern to lawyers who frequently report feeling stressed or burned out in their practices.

“Stress” is anything in our environment that knocks our bodies out of their homeostatic balance. The stress response is the physiological adaptations that ultimately reestablish balance. Most of the time, our bodies do adapt and a state of balance is restored. However, Dr. Robert Sapolsky, an expert on stress-related illnesses, warns: “If stress is chronic, repeated challenges may demand repeated bursts of vigilance. At some point, this vigilance becomes overgeneralized leading us to conclude that we must always be on guard – even in the absence of stress. And thus the realm of anxiety is entered.” For an excellent article which nicely summarizes his theories, see:

Robert Sapolsky Discusses Physiological Effects of Stress.

Stress went on too long in my own life as a litigator. I had, indeed, entered the realm of anxiety. For me, this anxiety felt like I had a coffee pot brewing twenty four-seven in my stomach. I became hypervigilant; each of the files on my desk felt like ticking time bombs about to go off. Over time, the litigation mountain became harder to climb as the anxiety persisted over a period of years.

Dr. Sapolsky states: “If the chronic stress is insurmountable, it gives rise to helplessness. This response, like anxiety, can become generalized: a person can feel they are at a loss, even in circumstances that she can actually master.” Helplessness is a pillar of a depressive disorder. It becomes a major issue for lawyers because we aren’t supposed to experience periods of helplessness. We often think of ourselves as invulnerable super hero’s who are the helpers and not the ones in need of help. Accordingly, lawyers often don’t get help for their depression and feel ashamed if they do.

Many lawyers do not appreciate this connection between their stress and anxiety and the risks they pose for the development of clinical depression. Indeed, the presence of co-morbid anxiety disorders and major depression is frequent and, according to some studies, as high as 60 percent. Maybe this connection helps explain the studies which find such high rates of depression for lawyers. In many ways, we are too stressed and anxious too much of the time.

The human body was not designed for such punishment. Dr. Richard O’Connor, author of the best-selling book, Undoing Perpetual Stress: The Missing Connection Between Depression, Anxiety and 21st Century Illness states that depression “is stress that has gone on too long” and that many people with depression have problems dealing with stress because they are not “stress resilient”. Not because of some central character flaw or weakness. But because of a complex interplay between genetics and one’s experience over a lifetime. This interplay is played out daily for lawyers in how their bodies and brains deal with stress and anxiety.

Our bodies haven’t changed much in the last ten thousand years. We have a wonderful defense mechanism wired into our nervous system called the fight-or-flight response. Dr. Sapolsky, in his acclaimed book, Why Zebra’s Don’t Get Ulcers, walks us through the connection between this ancient defense mechanism and depression. When confronted with a threat – whether real or perceived – this response kicks in and floods our bodies with powerful hormones that propel us into action. This was an essential survival device for our ancestors who lived in the jungle and would have to flee beasts that were trying to eat them or fight foes that were trying to kill them.

Lawyers don’t face these types of real life-or-death threats. Instead, lawyers perceive life-or-death threats in their battles with opposing counsel while sitting in a deposition or sparring in the courtroom. Our bodies respond as if they were being chased by that hungry lion. Accordingly, the stress response can be set in motion not only by a concrete event but by mere anticipation. When humans chronically and erroneously believe that a homeostatic challenge is about to come, they develop anxiety.

Over time, this type of chronic anxiety causes the release of too much of the powerful fight-or-flight hormones, cortisol and adrenaline. Research has shown that prolonged release of cortisol damages areas of the brain that have been implicated in depression, the hippocampus (involved in learning and memory) and the amydala (involved in how we perceive fear).

If we don’t as litigators learn better ways to deal with stress and anxiety, we expose ourselves to multiple triggers that can cause and/or exacerbate clinical depression. It is in turning and facing those things which make us stressful and anxious that we provide ourselves with the best protection against depression.

 

Suicide

This is my first blog entry. I am the creator of the website Lawyers with Depression. I created it two years ago. I have been a lawyer for over twenty years and have suffered from depression for the past seven. I created the site to create a virtual home for lawyers all across America who struggle with depression. I went looking for such a home on my computer two years ago and couldn’t find one – – so I built one.

Since it was launched, I have heard from thousands of lawyers, judges and law students about their battles with depression. It is my hope that this blog will be a good supplement to the website. It will offer frequent commentary, thoughts, observations and insights about working as a lawyer and dealing with depression.

The launch of this blog starts on a very sad note indeed.I was interviewed for a piece in The National Law Journal which appeared today.

Reports of Suicides Point to Job Stress – The National Law Journal

The interview concerned the rash of lawyer suicides. I have known or spoken to many lawyers who have either thought about suicide or attempted it. Unfortunately, there are attorneys in my own community who took their lives when the pain got too deep.

One of them was a dashing man who taught me trial technique years ago. He was a pillar of our legal community and a person of integrity. After a string of stressful events, he slit his wrists in a bathtub. Why people commit suicide is a complicated question.

For an excellent discussion of the issue, the best book I have ever read is Night Falls Fast: Understanding Suicide by psychiatrist, Kay Redfield Jamison. What makes the book so compelling is Dr. Jamison’s own bipolar illness and past suicidal ideation.

As I said in the interview with The Journal, stress due to layoffs may explain a few of the recent deaths. But such stress is, most likely, only the most recent incident in a long line of stressful incidents for these poor people.

Stress, as I will discuss in future blogs, plays a major role in the creation of depression.

Built by Staple Creative