Guest Articles

Editor’s Note:  LWD creator Dan Lukasik recently sat down with New York City psychologist, LWD guest writer andLiving With Depression author Deborah Serani for a conversation about depression in the legal profession.

Dan Lukasik: Deb, let’s start out by telling us a little about yourself and your background.

Deborah Serani: I’m a psychologist and I practice in New York. I became a psychologist because I had a very bad experience as a young teenager with depression. Unaware of what depression was or how to detect it, I descended into a Major Depressive Episode when I was a 19 year old college student. Hopeless and suicidal, I nearly took my life with a handgun. Luckily, my attempt was interrupted, and swift medical help was sought. I found a psychologist who helped release me from the grip of my unshakable sadness and taught me about the mood disorder called unipolar depression. Not only did psychotherapy save my life, it inspired me to become a student of its practice. It was good that I studied many years as a psychologist and learned about mental illness in all its forms, because the second time I had a Major Depressive Episode in my 30’s, I was better prepared. Now in full remission, I use my personal experiences with depression to inform my clinical work. This dual approach gives me a unique perspective because not only do I know what it’s like to diagnose and treat depression…I know what it’s like to live with it too.

Lukasik: And you’ve recently written a new book?

Serani: Yes. I took my personal and professional experiences and wrote a book calledLiving with Depression and wanted to highlight how a person can successfully live with depression. It’s my hope that anyone who reads it will find it meaningful.

Lukasik: I think that’s interesting what you said about learning to live with depression because in my own experience as lawyer with depression, people would often ask me, five or ten years after I’d been diagnosed with major depression, ‘So you’re over it’ or ‘you’ve taken a pill and you should be over it?’ I think it’s interesting that you use the phrase ‘living with depression’. Can you tell us a little bit more about what you mean by that phrase?

Serani: Anyone who has a chronic illness needs to learn how to live well in spite of it. If you’re one of the 40% who’s had just one depressive episode and have never encountered or had to deal with symptoms, that’s a wonderful thing. But, most individuals who have a mood disorder, particularly depression, live with it on a chronic basis. I think it’s so important to learn to live with your illness, how to manage it and how to find and build a life that’s meaningful and not let the illness define you. So that’s essentially what I mean.

Lukasik: That is so encouraging and hopeful to all of us who live with depression that, it can, in fact, be managed both medically and psychologically. Is that your experience in your therapy practice?

Serani: Yes. In my professional experience I’ve worked with people who have done very, very well with talk therapy alone. I’ve had other individuals that chose not to work with me and just went with medication. And then I’ve also worked with a third group, those who’ve done medication and talk therapy. So there’s many, many ways that people can find management. Research says that the best approach is medication and talk therapy, but I always encourage people to find their own way… and listen to their own voices for what works best for them.

Lukasik: In my experience over the years working with lawyers with depression, some people are resistant to talk therapy and some people are resistant to taking medication.

Serani: True.

Lukasik: Why, in your experience, would someone who has depression be resistant to taking medication? What kind of things have they told you about why they feel that way?

Serani: There’s still this stigma that’s attached to mental illness. Despite the fact that research shows us that depression is a neurobiological illness, many people whodon’t want the social blemish that comes taking medication. There’s this feeling of embarrassment about needing to take medication. Or shame in having the illness. Or maybe they feel that they should be able to work this through on their own without the means of any type of medical support or even talk therapy. They should just kind of shake it off somehow. It’s always so troubling for me to hear things like that, but I know that, essentially, it’s part of their own acceptance of their illness. There are some people who remain in denial for a very long time. I always keep the door open and say, ‘I wish you well, but should you have difficulty coping, you know where I am.’ Some people do return. They come back saying, ‘You know, I kind of get it. I can’t be embarrassed. I realize now that I can’t do this on my own.’ It’s like me saying I want to change my brown eyes to blue eyes and I can just will it to happen. So, I think there’s a lot of social stigma and I think there’s a lot of personal shame. It’s so great that websites, like yours, self-help books, and grassroots movements are out there educating individuals to know what the real story is, what the struggles are and how to overcome them.

Lukasik: In your experience, say somebody does come to you for treatment for depression and maybe they’re a little bit over their own denial or maybe a little bit more accepting and they need help. Are there any problems with folks with their significant others, spouses, family, friends or co-workers?

Serani: Generally, I’d have to say that by the time somebody comes to my office, they’ve often been encouraged by someone else to make the appointment. I sometimes get phone calls from spouses who say ‘I want to bring my husband in’, ‘I want to bring my wife in’. Generally speaking, most people with depression have people who are very loving, worried and concerned about them.
What happens thereafter, as the person starts to improve and get better, is the worry of whether or not to disclose their current mental health situation. It almost sounds like I’m talking in a conflicting way from a moment ago. Society still hasn’t allowed individuals to fully come out and talk about their illness so it’s important to be wise and thoughtful about with whom you may and may not share your current situation with.

I’m my own boss. I have my own practice. I don’t have to worry about some social fallout of losing my job. Essentially, it’s easier for me to be outspoken about living with depression, because I don’t have too much to lose. But there are many individuals that may need to keep certain issues close-to-the-vest. Society still views a person with mental illness as impulsive, dangerous…even violent, unpredictable or unsafe. It’s almost as if we still have such a long way to go to help educate the general public. So, to answer your question, I think acceptance of chronic illness takes on a unique trajectory. Each person has to uniquely look at their situation and decide how to move forward be it with family, friends or co-workers.

Lukasik: That’s interesting. I have talked previously about the high rate of lawyer depression. The national statistic for the general population is about 10% and for lawyers the studies show about 20% . Why do you think that’s true?

Serani: I think that it’s so very clear to the way a lawyer’s minds work: it’s a very black and white way of thinking. Because the way the justice system is designed, either you’re a winner or a loser. It can make somebody who’s prone to thinking in black and white terms to measure only the failures and to not see the successes. I also think that lawyering is a very difficult, difficult career. You’re dealing with people whose problems they, themselves, don’t even want to have. As a result, clients often look to externalize blame on others, rarely assuming responsibility for their own behaviors, which can be a heavy burden to deal with as an attorney. There is a great deal of pessimism in the field of law too. And research shows that individuals in high pressure jobs who tend to hold pessimistic views are prone to depression. I’ve seen many, many lawyers who struggle just with balancing career, pressure and pessimism.

Lukasik: And with regard to both men and women who are in the legal profession, is there any differences that you can see to how a man versus a woman lawyer may manifest depression or treat depression?”

Serani: Well I do see a difference in men and women. Women tend to be far more expressive in the sadness and melancholy or the hopeless and helplessness they encounter in their career. Often times, men come in and they’re very agitated and irritable, even short tempered. Their depressive symptoms are different. It’s really helpful when I share with men that the kind of irritable depression they experience is the body and mind’s way of saying ‘you just don’t have any more room.’ Essentially, they don’t have any more room because they’re struggling with depression. What therapy does is help the depressed individual learn how to problem-solve so they can find their way back to a healthier life. But there’s a very clear difference, at least in my practice, when I ‘m working with men and women. Men tend to be less expressive, I guess because of gender roles. Boys are not quite the talkers that girls are, but by the time men are done working with me, they’re very good talkers!

Lukasik: During presentations that I’ve done with lawyers groups before, there’s often a question and answer session at the end and one question that I am frequently asked and I would like your thought about is: “Does being a lawyer cause depression?” What do you think?

Serani: Actually, research shows that the field of law can promote depression for individuals who are called “negative thinkers.” Those who are negative thinkers are actually very good lawyers because they use this kind of analytical thinking to help with their cases. The good news is that they are very prepared for what could go wrong, but the bad news is that they tend to hold pessimistic attitudes. And it’s that negative kind of thinking that worsens depression.

Lukasik: It sounds like what you’re saying is that it’s almost necessary, almost a prerequisite, or a skill that lawyers really need to have? So why would that be a factor that would be a risk factor for a lawyer to develop depression?

Serani: When depression hits, it interferes with the positive thinking, problem solving, hopefulness areas of brain functioning. If you don’t see the positive outcomes, you start to go down that slippery slope of depression. Being able to think in black and white terms may be a great prerequisite for becoming an attorney, but it also raises the risk of developing depression. Law schools may want to set up programs or curriculum that can address the mental health aspects of practicing law. Interestingly, there are many lawyers who don’t struggle with depression. Studies show that these individuals tend to be less invested in the personal aspects of their clients and more emotionally invested in their own self interests. These lawyers have a protective layer of narcissism. I’m sure you know some of them!

Lukasik: Oh yes.

Serani: I know some of them too and it makes sense because it’s almost as if they have a built in Teflon. That whatever it is that they’re doing or working on in the adversarial system just rolls off them. They don’t use the negative self-talk are struggle with pessimism.

Lukasik: I think that’s a great way of you characterizing it…the Teflon…the lawyer who is like that it just rolls off…At some of these meetings that I’ve spoken at there’s a lot of people who’ve said, “Well you know it’s a tough profession. All of us are unhappy. But unhappiness is different than depression.” Why is that the case?

Serani: I tell a lot of people who come in that we call it “work” because it’s not “play”. It’s work. Now, many people find work difficult and unsatisfying. And one of the very first things I do in a session is determine if the person is really in the profession that suits their personality, suits their skill-set, and try to understand exactly what’s going on. Depression is quite different than unhappiness. All of us are unhappy from time to time. We can feel joy from time to time. But, depression is something that is so pervasive it cuts across most aspects of your life. It’s not just when you’re sitting in front of Judge Smith and Judge Smith is giving you a hard time…or you’re writing a motion and you just can’t fathom the thought of putting your pen to paper because you hate writing. Depression casts a long a dark shadow across the board. So when we’re talking about dealing with depression versus unhappiness, you’re right, it’s essential to clearly define what’s going on.

Lukasik: Well let’s get back to your book, “Living with Depression.” I want everybody to read this wonderful book. I have and I think it’d be an excellent resource for anybody struggling with depression but, in particular, lawyers. Can you give usthree things that you think would help somebody in the legal profession that has depression? What are some things that they can do to help themselves?

Serani: One of the first things to do is to recognize that what you’re dealing with is a real medical illness. That’s so important. The second thing is to start looking at your physical experience; and when I talk about that, I mean if you’re really struggling with sleeplessness and fatigue, you’ll need to address those issues. Once you deal with your physical symptoms, and your energy returns, you’ll move to the third thing, which is to start problem solving to lessen your depression. So it goes like this: Acknowledge what you have is real, be mindful of the physical symptoms of this chronic illness and then start using newly learned skills to help you find your way back to health.

Lukasik: Well those are good really excellent suggestions and Deborah I want to thank you very much for talking with me and reaching out to those lawyers who have depression. Thank you!

Serani: Thank you, Dan!

Editor’s Note:  Richard O’Connor, Ph.D. is the author of two noteworthy books, Undoing Perpetual Stress: The Missing Connection Between Depression, Anxiety, and 21st Century Illness and Undoing Depression: What Therapy Doesn’t Teach you and Medication Can’t Give You.  He is practicing psychotherapist with offices in New York City and Canaan, Connecticut.  He has suffered from clinical depression and is a member of a depression support group.

A man and a woman both stumble over a table in a dark room. The woman says “Oh, how clumsy of me.” The man says “Who put that table there?” A little story to illustrate the generalization that women internalize and men externalize. While the sexual revolution isn’t over yet, at the end of the century the genders are still acculturated differently. Shown a picture of a crying baby and told that it’s a girl, people say “Awww, she’s so sad.” Told that it’s a boy, they say, “Oooh, he’s angry.”

So is it any wonder that men and women experience depression differently? Depression affects twenty percent of the population, but it’s much more commonly diagnosed in women. Women are taught to internalize; when something goes wrong, it’s their fault. Men externalize; it’s someone else’s fault.

Depression in men is much more likely to be expressed through action than feeling. In fact, a lot of male jerk-like behavior is a way of coping with the fears and insecurities that women experience as depression. Ghetto kids who are willing to throw their lives away if they feel disrespected aren’t that different from the arrogant driver in the Lexus who acts like he owns the road. Guys who get their macho swagger from alcohol or drugs who fall apart when they can’t get their substance-of-choice. Wife-beaters: what an expression of self-loathing, to beat up the one person in your life who’s committed to you. And of course, the boss who needs to exert power to make himself feel good. The rest of us would all be a lot better off if these guys would just feel their depression instead of making us feel it. So would they, because these life styles inevitably lead to loneliness, emptiness, and self-destruction.

So here’s my suggestion for all the men listening who have enough self-awareness to know that they’re making people they love miserable; who fear that their spouses or their employees see through the swagger and are laughing behind their backs. Go get some help. What you’re dealing with is as common as the common cold. Every macho guy has his share of insecurity and self-doubt; it’s the mature ones who face it directly.

Editor’s Note:  Lloyd Rosen was born in New York City. His family moved to Fair Lawn, New Jersey where he lived through high school. After high school, Rosen attended a local community college but stopped after one semester and enlisted in the Air Force. After being diagnosed as unfit for military duty, he was honorably discharged and returned to New Jersey where he found a job in the hospitality field. Rosen met his first wife in 1978 and relocated across the country to Seattle. They were married for 12 years and have two children from that marriage.

In 1998 Rosen met his second wife and together they set off to see the United States. They moved first to Nashville, Tennessee then to Jacksonville, Florida where in 2001 Rosen had his first real experience with major depression. It was there that Rosen first thought about and planned to commit suicide. Fortunately he did not fulfill his desire. He got help but did not get the real life changing help until 2006 when he and his wife moved to Texas. It was while seeing a therapist there that Rosen started writing. He published his first book Search for Happiness My Journey from Darkness into the Light which he hopes to use to help other people realize they are not alone in their fight with depression. Most recently Rosen was divorced from his second wife.

Rosen loves bowling competitively as well as continuing to write. He is currently finishing up his second book. He also enjoys traveling and sightseeing and has been to 46 of the 50 states. You can find out more about Rosen on his website.

The following is a story about having depression and life with a man who would not accept that I had an illness, my dad. I discuss in this story the life I had being my parent’s son, and not recognizing that I might have more of a problem than just the pains of growing up. In the following story I get into the more positive things that my dad and I did once we grew to understand each other and find that we had some things in common. Life with my dad, at times, was a very up and down emotional roller coaster. I look back on my life growing up as a life that experienced physical, mental and emotional abuse. Why? For one, my dad had what I would consider, from what I could surmise, a very troubled childhood due to the way his dad treated him. He, not knowing better, just treated me the same way thinking that he was doing right. My father very definitely was a man who used physical force on me. He would hit me with anything he could get his hands on from a strap, a metal stapler to a breadboard to a barbecue grill top. He also would use his knee and plant it in my stomach. This was after the first time I cursed at the dinner table in front of him. Having been mentally and emotionally abused, the physical abuse was not half as painful.

As far as being mentally abused, I remember those times as well, if not better. For more times than I can even remember, he would call me dumb, stupid or lazy. He even went so far as to call me a moron. He always finished the conversation by telling me he knew I wasn’t any of those things and that I should just use my brain. It still hurt me then and when I think about it still brings pain to me. I don’t know how a father can use such language to his child. Because of this I have never used those kinds of words with my children nor do I think anyone ever should. As far as emotional abuse, I can say that I do not remember my father telling me that he loved me in the 41 years that I had lived up to the time of his death in 1997. Did that hurt? Yes, but now I understand it was not him but his upbringing that caused him not to say it out loud. I actually never verbally told him I loved him either. It was not until Father’s Day of 1992, the year that I was divorced, that I wrote the words in a card. It also was the year that he was diagnosed with Alzheimer’s. At that time I realized that the clock had begun to tick on his life. I felt I needed to express my feeling even if he wasn’t going to.

My parents were the kind of people who would take their vacation without their children. Until we were old enough that we could behave ourselves or, at least,  that was their way of thinking and condoning their decision. Until then, my maternal grandparents would watch us. I wish they had taken us earlier because when we were allowed to go, I had a very good time. I learned on these trips with my dad that I had an interest in history similar to his. Our first vacations were to Pennsylvania in the Lancaster County area which was my first experience with the Amish. It was great. We took tours of the Amish farms and I got to see and learn how they lived. We also stayed not far from the Gettysburg battlefield and my father, having an interest in the Civil War, took us there to tour the National Park. Thinking back on it, this was my first exposure to American history and it was a very pleasant time to spend with my dad and come to the realization that we had more similarities with our interests. He took the time with me to read the notes on the displays and explain things to me, to teach me and give me the opportunity to learn. I am grateful to him and have him to thank for my interest in American history.

After a number of years going to Pennsylvania, my parents decided to try something different. They went to visit Cape Cod. Pennsylvania held many memories for me, especially since I had the fortune of meeting and marrying a Pennsylvania woman. As I grew older and went on vacations with the family, I found my dad to be more relaxed and share more happy times. Like the time a meteor shower was evident in the late night sky over The Cape. He did not just let us stay up, he actually was up with us outside the motel room, watching the show and pointing things out so we would enjoy it more and learn from the experience.

On vacations my mom, who is an avid shopper, would spend hours and I mean hours going to different stores or shops. That of course left those hours for my brother and me to spend with dad. Again, we got the chance to not just hang out, but to go places that my mom and sister would not want to go, such as historical cemeteries, or historical Provincetown, where the pilgrims first landed in America. Life got better as I grew older, my dad and I had similar interests that helped us to talk more. I don’t really think that my dad could relate to us when we were children and/or younger. This is a situation that I saw in myself when my two were younger.

I grew to be an avid sports fan, so we talked and watched baseball games. I had interests that ranged from sports to the news of the world as well as the weather, so that helped us to grow closer. It gave us topics to talk about after I moved away to Seattle in the summer of my 21st year. Believe it or not, my dad’s schedule never allowed him to go to any of my functions such as baseball games when I was playing or even attending a Major League game.

I moved away from him in 1978 to Seattle where I resided for 21 years. We would talk on the phone often about those things that interested both of us. I tried to get to see him at least once a year at family affairs, or just because I missed him. He came to Seattle on three different occasions. The first was for my wedding to my first wife, Chris, in 1979 and then again in 1990, right after the birth of my son. The last time was in 1995. He was diagnosed in 1992 with Alzheimer’s and was able to make his third visit to see me shortly before he started going downhill. After all the abusive years earlier in my life and then trying to forge a relationship after years of pain, I had to come to the realization that now it was time for me to take care of my dad.

On his visit to Seattle that summer I finally got my chance to attend that Major League baseball game I had never gotten to attend as a youngster. To this day, I still remember the Seattle Mariners’ game against the Baltimore Orioles. My father had started to go downhill and now it was my time to be the parent, taking him to dinner and making sure he got to the restroom and more importantly, did not get lost. Yes, I did have years of pain built up and yes, I was angry with him for things he had done, but it was now time to make amends. I had a daughter and a son and knew now what it was like to be that parent he so long ago tried to be. It was time to share. It was time to make sure those memories were there.

As it turned out it was the last time I would see my dad when he would have all his faculties. It was for me, at least, a very good memory. I did not see him again for 15 months. In December 1996; I had come home to attend a family function. By then, my father was a shell of his former self, living in a nursing home, and the worst thing of all is he did not even know who I was. That just crushed me. I was not prepared for it. It just took me by total surprise, especially when that moment came and she asked him if he knew who I was and he said no. I know it was the disease, but it still hurt all the same. I knew then that it was time to prepare for the end. The end did not take all that long to come considering how long some people suffer with the disease. He died in September of 1997.

Editor’s Note: Awarded the Mental Health America Ruth Altschuler Community Advocate Prism Award and selected as one of the 2010 Distinguished Women by Northwood University, Julie Hersh is an outspoken advocate for mental health. She speaks about the “Top Six” things she does to stay well, but encourages us all to develop our own wellness plan. Her Struck by Living blog is featured on the Psychology Today website.

In less than a year since release, Struck by Living went to second printing, touching the lives of thousands of people. Hersh’s informed yet approachable style allows her to reach audiences that range from high schoolers, parents, social groups, counselors to psychiatrists. Hersh has spoken to student groups and mental health professionals at a number of major universities (Stanford, University of Notre Dame, Utah Valley State and University of Pennsylvania). In addition to positive press on Fox and Friends, PBS and in the Dallas media, Hersh testified on behalf of electroconvulsive therapy (ECT) to the FDA. Profits earned through the sale of Struck by Living will be donated to programs and research to promote mental health.

After earning her BBA at the University of Notre Dame, Hersh worked in high-tech product development and marketing/sales in Silicon Valley. She “retired” from a lucrative sales management position after the birth of her first child. A long-time member of the Cooper Center, Hersh ran her second marathon at age 50. She is Chariman of the Board of the Dallas Children’s Theater, a board member of Southwestern Medical Foundation and active supporter of the Suicide and Crisis Center, CONTACT and other non-profit organizations. She lives with her husband and two children in Dallas, Texas.

Last spring, I shared my struggle with clinical depression to a group of Stanford graduate engineering students. I doubted that they’d relate to my story. After all, they’d made it. Stanford engineering, tops in the world, planted in Silicon Valley; how much more potential could a future hold?

I was wrong. Inherent in potential is the steep cliff of failure. These students had made it to the top so far, but still hadn’t secured jobs. Coming out of Stanford, a standard job wouldn’t do. They felt the pressure to go from one of the best schools in the world to one of the best jobs in the world. Anything less, would seem a failure. Like the crew of Apollo 13 (even though these kids only saw the movie), they knew: Failure is not an option.

One woman from Nigeria told me about a suicide that had occurred over the last few years within the graduate engineering program. This death came and went silently, without explanation. “In my country,” she said, “When people ask ‘how are you’ they wait for an answer.” She described how Nigerians stop in their daily tasks to listen to each other. She admitted that not a lot gets done, but people seem happier. In contrast, she described the engineering students, so deep into their work that they rarely make eye contact. The other students nodded.

The problem identified, one asked me the solution. The answer popped off my tongue. “Get some friends outside of engineering.” They all laughed. I backpedalled for a more tactful response, but I’ve seen this problem more than once. Similar people congregate, often skewing the importance of an issue for that group. Business people, doctors, soccer moms or lawyers in a cluster often build brittle, lopsided solutions. Small items become life or death. A homecoming mum becomes critical for social existence. Being named a Partner becomes synonymous with life success. Being right outstrips the best outcome.

Over time, the hysteria of group myopia chips away at one’s psyche. For people like me, those thousand cuts lead to a mass hemorrhage of depression. My tourniquet for wellness requires me to step outside my social comfort zone. I purposely seek out people who think differently than me. Their different perspective allows me to gain clarity on my own life.

When I give audiences my top six means for keeping my depression at bay, my sixth and perhaps most important tactic is to have friends who are fun and who have a sense of perspective. I mingle with people who are older, younger, of different faiths, gender or interests. With variety, myopia becomes difficult to sustain. I learn that there is often more than one answer to the same question. I learn to laugh at my own stubbornness.

What the Stanford students have yet to realize is that although it’s wonderful to work hard toward a goal, the weight of looming potential will not lift with that first job. With one goal met, the next sprouts legs and sprints ahead. As my husband says, “There is no there, there.” For me, the best balance lies in enjoying the race at a pace that’s mine. Sometimes fast, other times not, I’ve learned (and continue to relearn) to listen to others, but also hear myself.
For more information about Julie K. Hersh visit her Struck by Living website.

Editor’s Note: Cincinnati, Ohio attorney Tabitha M. Hochscheid, Esq., a partner at the law firm of Cohen, Todd, Kite & Stanford, LLC. In this moving tribute, she writes about her law partner and dear friend Ken Jameson who committed suicide in May of 2011 after a battle with depression.

How well do we know those with whom we spend our work days with? Is it possible to practice with someone and be there friend for years yet, not truly know that they are suffering from the depths of depression? Being around other attorneys can give us the camaraderie and support we need to grow and build our practice. But, often times, people keep their emotional health a secret and suffer from depression in silence. By the time their colleagues realize what is going on, it can be too late to do anything about it. My partner and friend Ken Jameson was one of the people. This is his story.

Ken Jameson was, by outward appearances, successful, well liked, a loving husband and father, a friend to everyone and a dependable partner. In fact, Ken was perhaps the epitome of the well liked, client centered and dedicated lawyer many of us envision when we think of how lawyers should behave. On the inside, however, Ken was struggling with the depression which eventually took his life.

I first met Ken in the summer of 2007 for breakfast to discuss my interest in joining Cohen, Todd, Kite and Stanford, LLC. Ken was so easy to talk to and we instantly bonded because he too had left a small firm to find a place to grow and build his practice at Cohen, Todd, Kite & Stanford, LLC. After I joined the firm in January 2008, Ken was always available to help and support me and we grew into friends, as well as, colleagues.

Like so many attorneys, Ken built a practice by creating a network of referrals, by giving his clients personal service and building long term relationships. He was an attorney who facilitated resolutions and provided estate plans for people of all income levels. Ken enjoyed his work. After joining the firm himself in 2006, his practice thrived. He became a trusted member of the firm and was on the management committee. Ken shared is life outside of the office with his wife and best friend of 35 years, Betsy, and three adult children of whom he was most proud.

Ken was a universally well liked person. He conducted himself professionally in such a way that he never seemed to have conflicts with others. Ken cared about his firm family, he always checked in on people if they were sick or if he knew you were under stress. He was active member in his Church. Ken took care of his physical health by walking 5 miles a day, attending Pilates classes twice a week and maintaining a healthy diet. By all outward appearances, Ken had success in his work, a happy home life and seemed content.

However, Ken had underlying mental health issues. Like many attorneys he had trouble sleeping well. Sleep is something that eludes most attorneys from time to time, but his type of sleep loss was chronic. He would fall asleep and wake up in just a few hours and not be able to go back to sleep. As long as I knew Ken, he had this issue. He tried relaxation techniques to help him sleep better, he read books about stress management and attempted to delegate work to others. Ultimately, Ken was a self confessed perfectionist and as such, had an inner critic who told him he had to be at work all the time.

Most lawyers struggle with the challenges of building a law practice, client demands and finding out how to have precious downtime. Ken was doing all the right things, but he still wasn’t able to sleep. In March of this year, he took time out of the office due to exhaustion. He went to see his family doctor and was prescribed something for sleep. He tried to come back to the office part time within a few weeks but was unable to sustain a schedule. Ken represented to those of us at work that he was exhausted and initially did not tell others what was really going on.

In late April, he left the office again. This time it was lack of sleep and a pinched a nerve in his back. With this new medical issue, his depression worsened. He spent sometime in the hospital to adjust to new medications and was scheduled for back surgery. At this point, Ken began expressing worry about the office and felt as if he was letting the firm down. Finally, Ken had back surgery for the pinched nerve in the middle of May. After the surgery, Ken seemed to be doing better; everyone thought his return to the office was imminent.

Ken never returned to the office. On Sunday, May 22, 2011, I received a call from our office manager. She informed me that Ken’s depression had worsened and that he had taken his own life that morning. As the next few days unfolded, details began to surface. Ken underwent surgery on his back and in the days following the procedure, had checked in with people at the office and had seemed like his old self. Ken also visited his mother and called his best friend. All the while, Ken meticulously planned how to take his own life.

No one can answer the question of what was going through his head or why he was in such despair that he took his life. The next five days were difficult at the office. People were in a state of shock and disbelief. His office door has remained open since Monday, May 23, 2011. A memorial was held the Saturday following his death and it was standing room only. Ken clearly touched the lives of thousands and his life was remembered in eulogies by his friends, his sister and his wife. It was touching to see so many people who loved him, but the confusion as to what occurred actually increased for many.

Do you ever really know the people we practice law with? Everyone at the office felt they had a personal relationship with Ken. But, did anyone of us really know what was happening. It is easy now to look back and see the signs of Ken’s illness (sleep deprivation, self criticism, feeling of letting others down, a search for answers and inability to allow others to help) and to wonder what if anything could have changed the outcome. Time, however, does not give us this luxury and these questions will never be answered. The best that can be done is to acknowledge that Ken’s illness, depression, can be deadly.

It seems that our profession gives little in return for years of hard labor. Learning a way to balance the demands of the business of being a lawyer with the need for downtime is essential to one’s mental and physical health. Ken’s depression is an all too real downside of the practice of law. His suicide is a tragedy to his family, our law firm and to the legal community. He was one of the “good” guys and the profession needs more people like him.

For those of us left behind we struggle for understanding and to carry on in spite of the sadness we each feel. Inevitably when speaking with others we are confronted with the questions of why? Most people will ask the normal questions – were there money problems, did he have marital problems or health issues. The answer to these questions is no and then people just cannot fathom why Ken chose to end his life. I know in my heart that, as the minister said during his memorial, that Ken felt he was “fixing” the situation. Ken was a fixer and this was his only choice left.

I’ll always miss Ken Jameson. The courage and commitment he showed to his clients, his family and those of us in business with him is something I admire. However, his suffering in silence has left me and his other colleagues with regrets as to what we could have done to help. In the end, however, Ken could not give himself permission to be less than perfect and eventually, felt those in his life were better off without him. It is truly a sad ending to a beautiful life that could have been prevented. My hope in sharing Ken’s story is that there will be greater recognition of depression and the despair that can accompany and that it will help someone struggling with these issues. As for Ken, I hope he has found the peace that life did not provide.

Editors note — If you or someone you know suffers from depression and may have thought about suicide, visit the national organization The American Association of Suicidology which contains great information, resources and how to get help. Lawyers can also contact Lawyer Assistance Programs in their legal community. To locate a program near you, visit the ABA’s Commission on Lawyer Assistance Programs.

Editor’s Note: Margaret Wehrenberg, Psy.D., is a Licensed Clinical Psychologist and is the author of The 10 Best-Ever Depression Management Techniques. An expert on the treatment of anxiety and depression, she also has extensive training and expertise in the neurobiology of psychological disorders. She is co-founder of the Reflex Delay Syndrome (RDS) Research and Training Institutes, founded to promote research and treatment for this disorder affecting academic, social and emotional functioning in children. She earned her M.A. specializing in psychodrama and play therapy with children. She was trained in addictions counseling and has years of experience in that field, working with the U.S. Army in Germany and Lutheran Social Services in Illinois before beginning a private psychotherapy practice.

Since obtaining her doctorate from the Illinois School of Professional Psychology, she has specialized in treating clients with trauma and anxiety disorders. As a consultant, she is a sought-after speaker for continuing education seminars, consistently getting the highest ratings from participants for her dynamic style and high quality content.
I will admit it. I am a crabby traveler. And I am writing this as I sit for an indefinite delay on my departure to my next location.

I believe my travel irritability is understandable. Planes are more likely to be late than on-time. Flights are ever more crowded and there are fewer non-stop options. Don’t get me started on the TSA procedures! I just do not like that lack of control coupled with the unpredictability of air travel.

I am not proud of being crabby on the road, and worse, I have discovered that being in a bad mood does not help me. Actually it causes me more stress than if I were cheerful in the same situation. Others are not pleased about it: Not one single person has ever been nicer to me because I was grouchy. And acting on the outside the way I feel on the inside, makes me feel even worse because I don’t like myself that way and situations are not improved. Talk about lose-lose!

I have only one reasonable option: If I am feeling bad, I have to act as if I am in a good mood. I have discovered that if I can just contain my perfectly well-deserved, reasonable, crummy mood, I am better off. Why? Neuroscience can explain. There are two important brain-based principles at work when you act pleasant even though you do not feel it. One is interactive and one is intra-active.

Our brains are set up to respond to others with complementary, contingent and congruent faces, which means our facial expressions return to others the face they give us or a face that is in response to their face.

• If I smile, you will smile back.
• If I frown you will not offer a pleasant facial expression in return.
• If I am crying with sadness you might not feel sad, but might (congruently) look sad and comfort me.
• If I look scared you might (contingently) look calm and help to soothe me.

The impact of neural networking contributes to the other brain-based principle. Memory is efficiently stored for easy retrieval by emotion. Whatever my emotion, my memory scans for other times I have had a similar feeling and finds the situations that triggered it. In other words, if I get annoyed at the current trip, I am more annoyed remembering every other time security procedures, crowded or late flights or lousy service on a plane interfered with my plans. This principle makes it necessary to deliberately haul my memory out of the negative emotion network if I don’t want to dwell there.

In these principles lie the hope to change a bad mood into a better mood, and here is the hope for depression. Depression irritability functions exactly as my travel crabbiness does. When you are depressed, you probably show your bad mood to others who are more likely to leave you alone than try to cheer you up. And, thanks to efficient neural networking that has wired together your similar rotten moments, depression gets worse as one bad mood brings back other bad moods.

There is a brain-based benefit to acting as if you are feeling okay. For example, just this week, I qualified for “re-screening” when something in my briefcase needed a closer look. I asked the TSA agent how I could pack differently to prevent the screening on my next trip and he joked, “Well, if you did it right then you would miss out on waiting around here, and you would not hear all of our friendly conversation and jokes.” I replied with a smile and a laugh and perfect honesty, “Sure, but it is hard for me to generate friendly conversation with steam coming out of my ears.” He laughed very hard at that. He thought I was kidding!

But that little exchange lightened my mood. I smiled and laughed and I did not take myself so seriously. I was pleased with myself for the restraint to make a joke instead of showing irritability. So, I stayed out of the neural network and boosted my self-esteem a tiny notch. Plus, I switched into a neural network of times I have felt pleased with myself. Both the TSA agent and I were better off because I contained my inner irritability and smiled.

You can help your brain to exit networks of unpleasant memory by deliberately switching up what you say and think when you are feeling irritable. Plan to look and speak kindly or pleasantly, even if you cannot muster a happy mood. Smile at others. Thich Nhat Hanh in his precious book The Miracle of Mindfulness, talks about the benefits to you of cultivating a half smile: your inner self feels more pleasant as a result of the smile, and others respond more pleasantly to you when you have a pleasant expression on your face.

Despite your depression, it is not fake or phony to smile and be pleasant to others when you feel crummy inside. It is kind and wise. Kindness is an admirable value and you will feel better about yourself for rising above a bad mood. And you will immediately change your brain to a better place, which is very wise. That is a win-win.

This article first appeared in Psychology Today who owns all copyrights to this piece.

Editor’s Note: Jonathan Rottenberg Ph.D. is a leading researcher in the area of emotion and psychopathology, where he has focused on major depression. He recently edited Emotion and Psychopathology: Bridging Affective and Clinical Science,published by the American Psychological Association.

Since receiving his PhD degree from Stanford University, he has been at the University of South Florida, where he is an Associate Professor of Psychology and Director of the Mood and Emotion Laboratory. His work has been generously funded by the National Institutes of Mental Health and he has authored over 35 scientific publications, including many in the top journals in psychology and psychiatry. His work has received national and international media coverage, reported in outlets such as Science News, Scientific American, The New York Times, abcnews.com and BBC radio.

If you’ve personally suffered from depression or known someone who has, you know that when people are really depressed, they have a strong urge to stay in bed.

Why do depressed people lie in bed? It isn’t because of great snuggle time under the blankets. It’s because depressed people can’t bring themselves to get out of bed. Almost any activity or task becomes a painful ordeal, even things as simple as taking a shower or getting dressed.

A perfectly able-bodied person can’t bring him or herself to rise out of bed. How does this happen?

The intuitive answer is that a lack of motivation is to blame. Depressed people are directionless because they are under-committed to goals. Without goals to drive future behavior, current behavior becomes frozen for long periods. Beds are the most natural location for a behavioral pause, as the place in the house most associated with inactivity.

The intuitive answer is okay as far as it goes. The problem is that it just doesn’t go very far. It begs the question of how a person loses the desire to pursue goals in the first place. The answer involves a surprising theory that takes us closer to understanding how it is that low moods intensify into more serious episodes of depression.

First, we have to detour to contemporary evolutionary psychology, which tells us that moods have a function: Moods help us pursue goals efficiently. High moods help us to more vigorously pursue rewards. Low moods tell us when our progress towards goals is poor. Often, low moods first arise when we’ve hit an obstacle, or when an important goal is threatened. Our usual first reaction to a low mood is to redouble effort towards the blocked goal. If the goal still proves to be unreachable, the low mood will escalate. At some point, something has to give: Usually the person will give up, or scale back on the goal and/or move on to another activity that has a better pay off. Authors such as Randoph Nesse and Eric Klinger have made a powerful case for the utility of low mood. In a world where time, resources, and effort itself are all precious and finite, having an evolved mechanism to hasten disengagement from a failing goal is very important to survival.

These relationships between moods, goal and effort hold for a variety of species. A bear fishing for salmon without luck in a favorite river bend uses low mood to help it move on to another spot. For better or worse, human self-regulation is more complicated because we can choose either to act or not to act on our mood. I believe that humans are the only species that can decide to ignore low mood and to continue pursuit of an unreachable goal. In a sense, this creates the potential for a stand-off between the person and their ancient mood system. To resolve the standoff, the mood system must do something more drastic: It turns down the volume on goal pursuit, not only on the one goal, but on goal pursuit across the board.  Eventually, when the mood system wins the result is flat-on-your-back depression, with fatigue, torpor, a lack of motivation, the whole nine yards.

So this alternative theory turns the standard explanation on its head. Depressed people don’t end up lying in bed because they are under-committed to goals. They end up lying in bed because they are overcommitted to goals that are failing badly. The idea that depressed people cannot disengage efforts from failure is a relatively new theory. It has not been much tested in research studies. However, the idea is well worth exploring. It fits well clinically with the kinds of situations that often precipitate serious depression — the battered wife who cannot bring herself to leave her troubled marriage, the seriously injured athlete who cannot bring himself to retire, the laid off employee who cannot bring herself to abandon her chosen career despite a lack of positions in her line of work. Seeing these depressions in terms of unreachable goals may be useful clinically, and may help us better understand how ordinary low moods can escalate into incapacitating bouts of depression.

This article first appeared in Psychology Today who owns all copyrights to this piece.

Editor’s Note: Noel McDermott is a psychotherapist based in the United Kingdom. He has more than fifteen years of experience helping people overcome anxiety, depression, trauma, recovery in addiction and mental illness, loss, loneliness, childhood trauma and abuse. He offers talking oriented methods of psychotherapy and counselling and also non-verbal and creative arts approaches. You can learn more about McDermott on his website.

Depression can be very devastating but can respond very positively to appropriate help.

Depression has a number of sources and indeed many levels of severity. It is probably best thought of as being a spectrum or constellation of experiences. It can have many causes and triggers and this may indicate one method of help over another.

But it can creep up slowly or have been around for so long we don’t notice it. The first step in dealing with depression is spotting it in our selves or in others.

Spotting The Problem

Here is a quick guide given to me by a General Practitioner but it should not be used as an alternative to visiting your doctor! Always seek professional help for a diagnosis.

Ask yourself if you have experienced any of the symptoms from the list below in the last two weeks. Rank each answer on a scale of 0, 1, 2, 3, (0=not at all, 1=several days, 2=more than half the days, 3=nearly every day).

A. Little interest or pleasure in doing things.
B. Feeling down, depressed, or hopeless.
C. Trouble falling or staying asleep, or sleeping too much.
D. Feeling tired or having little energy.
D. Poor appetite or overeating.
D. Feeling bad about yourself – or that you are a failure or have let yourself or your family down.
E. Trouble concentrating on things, such as reading the newspaper or watching television.
F. Moving or speaking so slowly that other people could have noticed? Or the opposite –being so fidgety or restless that you have been moving around a lot more than usual.
G. Thoughts that you were better off dead or of hurting yourself in some way.

So the scores for your depression would rank something like this
1-4 Minimal Depression
5-9 Mild Depression
10-14 Moderate Depression
15-19 Moderately Severe Depression
20-27 Severe Depression

Then decide if the problems you have identified have made it difficult for you to work, take care of things at home or get on with people; i) not at all ii) fairly difficult iii) very difficult iv) extremely difficult

This is a rough guide and in no way should replace a proper consultation! But if you are bothered by these symptoms, do not ignore them. Depression, if caught quickly and if it is not complicated by other factors such as childhood trauma, has a high likelihood of responding to modern pharmaceuticals and talking therapy.

Talking Therapies

CBT (Cognitive Behavioral Therapy) or solution Focussed Therapy (SFT) are forms of talking therapy that utilize key concepts of reframing thoughts and setting goals, changing  behavior. They differ from in depth psychology approaches in that the focus is on the presenting issue and develop responses to that without linking to any underlying cause, which is why CBT/SFT work well when there is no underlying cause for depression such as childhood trauma. Talking therapy, in combination with medication such as anti-depressants, can help you to successfully manage your symptoms.

Typically sessions will happen once or twice a week and will look at thought patterns linked to depression such as negative thoughts about self, about the world, or about the future. The negative thoughts will be identified. For example: I’m no good (negative to self) others are better than I am (negative to world) no one can help me (negative to future/world).

These thoughts will be logged on a worksheet and looked at for patterns such as times of day and linked activity to see if the negativity is linked to actual times and events in the world.

The therapist will work with you to reframe the thoughts where possible. The thought, “no one can help me” might be reframed as “there are plenty of techniques and treatments for feeling low, I have to work at finding the ones that work for me”.

Activity monitoring may help you to realize how adding pleasurable activities might lift your mood. Additionally it can help to reframe negative thinking about current activities that though once meaningful and pleasurable might be currently experienced as not pleasurable because of the depression.

For example if prior to the depression you found cycling fun but now find it not so pleasurable, you might say to the therapist, “I don’t enjoy cycling anymore”.

That way of thinking contributes to your low mood and discourages you from engaging in physical exercise which is known to be a mood enhancer.

The reframe with the therapist might be to compare the low feeling of cycling to the low feeling of being at home alone and bringing us to an understanding that in comparison cycling is more pleasurable than isolating at home and therefore worth doing.

The cycling example includes the behavior bit of cognitive  behavioral therapy.  behavior itself can change our depressive symptoms if we are persistent. A common experience in depression is to lose motivation and to isolate; this in turn makes us more depressed as we suffer from lack of activity and social contact.

By continuing to engage in our normal routines while suffering from depression it will help us come out of the illness. Going through the motions can help bring us out of our depressive shell.

Get planned, organized and engaged in your healing.

It is worth having this type of action plan ready in case you become ill, like planning for the unlikely event of a fire in your home. Knowing your fire drill in a fire can save your life. Knowing your action plan in the event of mental illness can help get you better quicker.

Action Plan:

• Be aware of the symptoms of depression in oneself and also in others.
• Seek help.
• Use medication if advised by your doctor.
• Give your symptoms the double whammy of a dose of talking therapy.
• Stay engaged in activities and life as much as you can bear (and then a little bit more).

Going Deeper Than An Action Plan For The Emergency

This action plan may not always be enough if there are revealed underlying issues during the depressive episode.

But don’t get anxious.

The techniques you have learned above will keep you on an even keel. You may need to extend the period you use medication for and you may need to continue the self-help exercises learned from your CBT or other related therapies. But you may also need to go deeper and resolve some of the conflicts that have opened up for you internally.

This is where depth approaches such as psychodynamic psychotherapy may be beneficial. Psychodynamic psychotherapy has evolved from psychoanalytic traditions in that the primary focus is to reveal issues we may be unaware of and which the depressive or anxious feelings are used as a defense against our becoming aware of.

It relies on the interpersonal relationship between client and therapist more than other forms of depth psychology. It tends to be more eclectic than others, taking techniques from a variety of sources, rather than relying on a single system of intervention.

Typically one would see a psychotherapist once a week for a period of two or three years to be able to work through the internal conflicts, face fears hidden in the depressive symptoms and engage in ones emotional and interpersonal life in a more complex, whole and complete manner.

Psychodynamic therapists will be integrative/eclectic and may well be cognitive behavioral practitioners as well. The difference is the opening up of the past and linking it to current behavior and symptoms. But this does not create conflict with cognitive techniques if the practitioner is skilled at identifying those thoughts and feelings that need management via CBT/SFT and those that need to be opened up and integrated via more dynamic and depth work.

Typically the psychodynamic therapist will understand that we have become maladaptive to our current life’s circumstances because of hidden fears, shames, events and traumas. By bringing these to light and sharing them with a compassionate, kind and skilled person we can integrate the emotional experience of these events and thereby overcome them.

There should be no reason why this work would stop one from continuing to engage in life, work and family etc. In fact if one becomes unable to cope emotionally then it is probable that the work is progressing at too swift a pace and needs to slow down.

Moving Beyond Illness

This leads to the arts therapies, which can be considered as depth approaches. Arts therapists practice in all the arts modalities: Art Therapy, Music Therapy, Dramatherapy and Dance-Movement Therapy.

They draw from their creative artistic roots and also from psychological theory and blend the two. Becoming creative is understood as healing in its own right and this would be encouraged in clients.

In Dramatherapy (my modality) the therapist draws upon play, theater, role-play, script, narrative and story to work with a client to understand and develop a different (creative) relationship to their problems. Also it enables a client to learn new practical skills via rehearsal in the drama, developing a fuller role repertoire in their lives and so on.

In Dramatherapy we draw upon common human themes from myth and story across cultures and times enabling a client to link in to a sense that they are connected with human experience. This is particularly powerful in depression where the sense of becoming an ‘island’ unto oneself can be devastating.

With depression that may have been used as a defense against acknowledging childhood trauma and abuse, drama therapy can be useful in containing the trauma within a myth, enabling the client to maintain a connection with human experience while acknowledging the depth of the pain they feel. This containment can make it a uniquely safe way of exploring difficult life experiences.

Editor’s Note: Judith J. Wurtman, Ph.D, received her PhD from George Washington University. She is the founder of a Harvard University hospital weight-loss facility and counsels private weight management clients. She has written five books, includingThe Serotonin Power Diet, Eat Carbs, Nature’s Own Appetite Suppressant, to Stop Emotional Overeating and Halt Antidepressant-Associated Weight Gain and more than 40 peer-reviewed articles for professional publications. She lives in Miami Beach, Florida.

Recently I saw a television advertisement for a weight loss program that showed a woman changing her shape from obese to skinny while taking the advertised weight loss product. As she stepped on the scale over a period of time, her expression changed from desperate to joyous as the scale registered her amazing weight loss. Perhaps television advertisements for antidepressants should use the same pictures except run them in the opposite direction. The first picture would have a skinny woman stepping on the scale looking happy and the last picture, the same woman, now obese, looking horrified at the numbers on the scale.

Like the weight loss shown in the advertisement, weight gain associated with the use of antidepressant, mood stabilizers and other drugs prescribed for mood disorders does not occur overnight. The process may be gradual and perceived initially as an unwelcome change in appetite. Often people who do gain weight on these drugs never had a problem with overeating, food cravings, portion control and unhealthy food choices until they started on their medication. But after several weeks, they notice that they are no longer feeling satisfied after a meal that would have contented them pre-medication. Snack foods that had no appeal before treatment are now irresistible. Late nights become a battleground between will power and cravings and will power usually loses. Adding to this unhappy mix of factors causing an inevitable weight is gain is the inability to exercise at pre-treatment levels. An email I received recently from someone who gained more than 60 pounds on his medication attributed some of the weight gain to his inability to exercise. “I stopped going to the gym,” he said, “I just feel too lethargic and tired to exercise.”

Weight gain as a side effect of antidepressants has been known since the l960’s and despite the proliferation of new drugs over the past twenty years; this side effect will not go away. Not everyone experiences it but for those who do, the weight gain can range from trivial to heartbreaking.

No one has yet identified how these medications change the appetite and perhaps even levels of physical activity and the metabolism to cause weight gain. It has been suggested that some of the antidepressants may act on other chemicals, neurotransmitters, in the brain that are known to increase hunger. Animal studies have also found that one drug, used for severe mood disorders, might possibly block the ability of serotonin to shut off eating. But of course, even if and when we understand how these drugs cause overeating, the problem of what to do about it still remains.

Fortunately, the type of overeating caused by the medications gives us a hint of what might be taking place in the brain. Most people complain of a need to eat more carbohydrates and of an inability to feel satiated or satisfied after eating a meal. This combination of symptoms; i.e. carbohydrate craving and absence of satiety point to a problem with serotonin. In addition to regulating mood, serotonin, acting on other cells in the brain, monitors our eating. Serotonin doesn’t make us start to eat but rather turns off our eating by making us feel that we have eaten enough. The feeling of satiety or satisfaction is similar to what we feel when we have had enough liquid to drink. No matter how thirsty we may have been when we started to drink, once the body receives enough water, it is very hard to continue drinking. Serotonin makes us disinterested in eating even if the food is tempting.

Antidepressants, mood stabilizers and related medications seem to interfere with this effect. Instead of feeling content and disinterested in further eating, an individual thinks, “I feel full but I still want to eat something “or “Those leftovers aren’t going to be leftover very long because I have an urge to snack.” In worst case situations, some medications leave an individual so unsatisfied, another dinner may be eaten an hour or so after the first or the person will wake up in the middle of the night feeling ravenous.

It is easy to see how adding on calories from larger portions, frequent snacks or indeed two rather than one supper each night causes weight gain. It won’t happen overnight but like the advertisement for weight loss run backward, over weeks or a few months, the body can be transformed into an unrecognizable overweight shape.

Typical weight loss methods are irrelevant for this type of weight gain. Obesity experts promote nutritional education, calorie labeling for fast foods, increasing consumption of fruits and vegetables and strategies to prevent stress related overeating. These wise and workable methods are fine for someone who gains weight the traditional way. But people gaining weight because they are on Zoloft or Depakote or any other medication for mood disorders know how to eat healthily and would be doing so now if they were not on their meds. Their brains’ control over eating has been damaged and an admonition to eat more greens is not going to change that.

Restoring the ability of the brain to control appetite is the only strategy that will work and this means restoring serotonin’s appetite controlling function.

We discovered somewhat by accident that increasing serotonin in the brain brought about this effect. The pesky sometimes almost frightening need to eat and eat brought about by antidepressant use goes away when serotonin is made. Dieters whose weight gain was caused often by a mixture of medications (antidepressants, mood stabilizers, anti anxiety drugs) were able to stop gaining and start losing weight when they increased serotonin levels prior to meals. Patients who came to TRIAD, the weight management center I ran at a Harvard hospital, were told to eat a specific amount of carbohydrate an hour or so prior to meals and also as a snack. The carbohydrate, eaten on an empty stomach and with little or no protein or fat, stimulated the production of serotonin. In less than an hour after eating the carbohydrate, new serotonin was made and it decreased the nagging need to eat. Our patients reported feeling content and, often for the first time in weeks, the constant need to put food in their mouth was gone. They lost weight because they gained control over their eating.

Eating carbohydrates to make serotonin may seem like too simple a solution to antidepressant weight gain and given the belief that carbohydrates are a ‘fattening’ food, perhaps a hard one to accept. But healthy, fat free or very low fat carbohydrates are a potent tool to fight against the weight gaining potential of antidepressants, and you and your scale will benefit.