How Stress and Anxiety Become Depression

Lawyers suffer from depression at an alarming rate.  I am one of them.

I have been a litigator for more than 22 years, and I didn’t suffer depression in the beginning of my career. 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 the problems and disasters to confront me the next morning.  After years of this, the pendulum swung from states of anxiety to states of depression.  Why did this happen?  It took me a long time to understand.

Recently, scientists have been focusing on the connection between stress and anxiety and the role they play in triggering and maintaining depression.  This is something that should be of concern to all lawyers, who carry high stress loads in their law practices.

Too Much Stress Can Lead to Anxiety

“Stress” is anything in our environment that knocks our bodies out of their homeostatic balance.  Stress responses are the physiological adaptations that ultimately reestablish balance.  Most of the time, our bodies do adapt, and a state of balance is restored.  However, “if stress is chronic, repeated challenges may demand repeated bursts of vigilance,” warns Dr. Robert Sapolsky, an expert on stress-related illnesses and author of the best-selling book, Why Zebras Don’t Get Ulcers: An Updated Guide to Stress, Stress Related Diseases and Coping. “At some point, vigilance becomes over-generalized, 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,” writes Sapolsky.

About 20% of the population will experience some form of anxiety disorder at least once in their lifetime.  Studies show that law students and lawyers struggle with anxiety at twice that rate.

Anxiety and Depression

Stress went on too long in my life as a litigator.  I had, indeed, entered the realm of anxiety.  I felt like I had a coffee pot brewing 24/7 in my stomach.  I became hypervigilant; each file on my desk was like a ticking time bomb about to go off.  At some point, the anxiety made me dysfunctional, and I was unable to do as much as I had before.  I felt ashamed of this.  I denied it to myself and hid it from others, but the litigation mountain became harder and harder to climb as the anxiety persisted over a period of years.

Sapolsky writes, “If the chronic stress is insurmountable, it gives rise to helplessness. This response, like anxiety, can become generalized: A person can feel . . . at a loss, even in circumstances that [he or] she can actually master.”  Helplessness is one pillar of a depressive disorder that becomes a major issue for lawyers because we think of ourselves as invulnerable superheroes who are the helpers, not the ones in need of help.  Lawyers often don’t get help for their depression and feel ashamed if they do.     

Many lawyers do not appreciate the connection between their stress and anxiety and their risk for developing clinical depression.  But the occurrence of anxiety disorder with major depression is frequent; in fact, 60 percent of people with depression are also suffering from an anxiety disorder.

Maybe this connection helps explain studies that find such high rates of both anxiety and depression in the legal profession.

Depression “is stress that has gone on too long,” according to Dr. Richard O’Connor author of the book Undoing Perpetual Stress: The Missing Connection between Depression, Anxiety, and 21st Century Illness.  Many people with depression have problems dealing with stress because they aren’t “stress resilient,” writes O’Connor.  It’s not some central character flaw or weakness, but a complex interplay bewteen genetics and one’s experiences over a lifetime.

How our bodies and brains deal with stress and anxiety hasn’t changed much in the last 10,000 years.  This wonderful defense mechanism, which is wired into our nervous system, is called the fight-or-flight response.  When confronted with a threat – – whether real or perceived – – this response kicks in and initiates a sequence of nerve cell firing and chemicals like adrenaline, noradrenaline and cortisol that flood into our bloodstream and propel us into action to meet a threat.  This was an essential survival device for our ancestors who lived in the jungle and would have to flee beasts or fight foes trying to kill them.

Lawyers don’t fact these types of real life-or-death threats.  But they 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 we were being chased by a hungry lion.  Accordingly, the stress response can be set in motion by mere anticipation, and when humans chronically believe that a homeostatic challenge is imminent, they develop anxiety.

Over time, this chronic anxiety causes the release of too much fight-or-flight hormones.  Research has shown that prolonged release of too much cortisol damages areas of the brain that have been implicated in depression: the hippocampus (involved in learning and memory) and the amygdala (a fear processing hub deep in the brain).  Another area of the brain, the cingulate (an emotion-dampening center located near the front of the brain), in tandem with the amygdala, helps set the stage for depression.

Lawyers need to learn better ways to deal with stress and anxiety to avoid the multiple triggers that can cause or exacerbate clinical depression.  Turning and facing those things that make us stressed and anxious, and doing something about it, gives us the best protection against depression.

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27 thoughts on “How Stress and Anxiety Become Depression

  1. Great entry, but it raises a couple of questions. Here’s what comes to mind:

    1. Given as human beings have a natural reaction to stress, as you note, and given that litigation is essentially a substitution (unique the English Common Law system we’ve inherited) for private warfare, is there anything we can really do about the damaging stress, or does this say that the system itself inevitably destroys part of the litigator. In other words, our genes have prepared us for spikes in stress, but not decades of continual stress; and

    2. “Lawyers need to learn better ways to deal with stress and anxiety to avoid the multiple triggers that can cause or exacerbate clinical depression. Turning and facing those things that make us stressed and anxious, and doing something about it, gives us the best protection against depression.”

    What can we do about it?

  2. By way of an additional question, if this process actually results in damage to the brain, can the brain recover?

    I’ve seen that noted more than once, but what I wonder is this. Once a person has been undergoing this process for a decade or more, and sustained the damage, can that damage be reversed?

    1. Yeoman, that is a great question. Once a person has lived (or not “lived”) with severe anxiety and stress for years, can the damage to the brain areas be reversed? Dan–Maybe some of your medical collegues would know the answers?

  3. You know, I’m really in the pressure cooker right now, due to an upcoming trial, so I’m experiencing the stress aspect of this, and the blues, to the max.

    How does a person address this? I just can’t quite shake it.

  4. Asking questions are in fact fastidious thing if you aare not understanding anything totally,
    but this piece of writing presents pleasant understanding even.

  5. I have practiced law 34 years, with 95% being civil litigation. I graduated Order of the Coif, and was hired by a big city firm in my state. Because of my abilities, almost immediately senior partners started fighting for my help on serious civil litigation, both plaintiffs and defense. Instead of “assisting and learning”, I was being the defacto lead counsel, trying a federal district court products liability defense case, involving a paraplegic plaintiff, after less than 3 years of practice.!i was given more and more responsibitly in big lawsuits, for some of the firm’s biggest client’s. I became the “go to” lawyer for every important lawsuit for our 20 person firm, and was, basically, the “designated hitter” for serious litigation. Once, I won a 5 day federal jury trial for over $500,000, only to come to work the following Monday and have our eldest, managing partner to call me to his office so he could ask me to take over a serious price discrimination lawsuit that his son, who had over 10 years seniority on me, had been working for two years. The trial was ONE WEEK later! I took it and won it, which only added to the demand for my help and firm respomsibity .
    As a ster high school athlete, I was used to carrying a lot of weight, I.e. stress , on my shoulders, and everyone always said I was mature for my age. I had the normal pre-game ” butterflies” before games, but it never affected my game performance. I was kinda shy and didn’t like to speak in public, but again, nothing abnormal. When I got to aw school, I sat on the back row so as not to be ç called on, because I was afraid I would make a foo of twelfth in front of my peers/classmates . I had developed a hypersensitivity to embarrassing myself as an adolescent, as a result of my father making fun of me, in front of his friends at our house, for messing up or not knowing how to do something. Ever since, I have to cover my eyes , or change the TV channel, when I see somebody is about to make a fool/embarrass themselves.
    I made it thru law school, with the sometimes severe, but normal, one test a quarter “test jitters”, graduating 8th in my class. But I was not prepared for the level of “nerves”, “butterflies” and stress I encountered upon entering my litigation practice. It started as the normal jitters and apprehension for my first few little trials and depositions the first could of years. But as my abilities came thru and my success grew, so did the stress and butterflies. I attributed it to my lack of experience and hoped it would get better, over time, but the opposite occurred . I started dreading my job- at first just depositions and court appearances, where I had to perform in front of others( my fear of embarrassing myself), but it grew to outright fear. I didn’t”t know what “anxiety” was. I became afraid to open my mail , thinking “bad news” was inevitable. I started missing work to avoid having to face things at work. I developed major depression. Ii would stay home from work, more and more, and lay in bed and sleep most of the day, feeling guilty and not wanting to do fun things. I would go out and buy things, and spend money compulsively, unknowingly at the time I was Subconsciously trying to make myself feel better. I developed severe “buyer’remorse”, but I couldn’t help myself or stop.
    My absences at work were noticed and grew worse. Even though I was our firrm’s highest income producer for years, and often it’s highest paid lawyer, I was fighting my stress, but I was losing. I sought professional help from a psychiatrist and psychologists, who tried both meds and therapy, witty little or no improvement. Finally,in June, 2004, after 25 years with my firm and as head of its litigation department, I was terminated. The month before that, my wife had to drive me, on four seperate occasions, to a local hospital emergency room for treatment of full-blown migraine headaches. I am 58 now, but at 40 I was diagnosed with Type II diabetes and high blood pressure. Since then, I have been treated for heart disease and Barrett’s Syndrome
    When I left the firm in 2004, I returned to my rural, small hometown and opened my own solo practice. I thought going to a smaller town, with smaller cases and no “firm partners” to deal with, would lessen my stress and anxiety to the point I could function. I was wrong. Even with smaller cases and much less competent adversaries, my “Pavlovian” daily responses to anxiety have only continued to grow. The result – missed work, continuances, client complaints and severe financial hardship. Rumors abound that I am “drinking” or “on drugs””. Fortunately, even with my OCD, I never turned to drugs or alcohol. I have not told any of my judges or fellow lawyers about my mental issues.. The last two years I have only averaged working a couple of hours one or two days a week. I have trouble leaving the house. I cringe every time the phone rings or someone is at the door. My wife has to open the mail.
    In November, 2013 I took an overdose of Ambien and spent two days in intensive care and a few days in-patient at a mental hospital. I still have suicidal thoughts. I have been married to 34 years, and my wife and four daughters are my support/strength. I am on 5-6 meds for my anxiety amnd depression . I have been diagnosed with General Anxiety Disorder, PTSD due to secondary stressors, Major Depression, Bi-polar and OCD.
    I don’t know what else to do. I’ve lost everything financially, I’m about to lose my law license probably, and I have NO safety nets. If you have any suggestions that could help, I’d appreciate it.

    Thanks,

    Barry

    1. Mr. Maxwell,

      I read through your comment and I am sorry to hear about your situation. I am at the infancy of my career but I too suffer from much of what you describe in your comment. Stress leads to anxiety, anxiety leads to depression, and everything spirals out of control. No matter what, suicide is not the answer. You have a career to be proud of and YOU ARE NOT ALONE. I don’t have any answers, but please know that I, along with the rest of the community on this website, are here for you.

      Mr. Lukasik, I came across your website after searching the web for help with anxiety and depression issues. I have to admit that I felt somewhat relieved that I was not alone. I am very grateful for your website and your insight in your well thought out articles. In one of your articles, you mentioned the importance of support groups. I agree that a support group can be very beneficial. It helps to be able to share your thoughts and feelings with someone who is going through a similar situation. I know I often feel I need someone to talk to but don’t have anyone to turn to. Its hard to communicate what you are going through with someone who does not understand. I think it would be a good idea to create some sort of online support group. Perhaps a chat group, a forum, or some other way that members of this website can communicate with one another in an anonymous fashion. Inevitably, anonymity is important given the careers we hold. I am sure many of the individuals that regularly visit your website don’t openly talk about their issues. An online support group could allow for open communication and provide an outlet for us suffering with these issues to express ourselves. I would like to be able to communicate with Mr. Maxwell and offer whatever support I can. Even though I know I do not have the answers, sometimes its nice just to talk to someone who is going through the same issues. Let me know your thoughts.

      Mr. Maxwell, please hang in there for the sake of your family. I assure you that you are not alone and that everything will be fine. Thanks,

  6. To: Barry Maxwell-
    As I read your post, I was struck by a sense of deja vu. I built a thriving law practice and lost it all during a major depressive episode. i drew a three year suspension of my license and am in the process of attempting to reinstate this fall. Please be aware that under the ABA guidelines, metal health can be a significant mitigating factor. I successfully argued this and was able to reduce the sanction in my case from presumptive disbarment to a three year suspension. With the help of some gifted therapists and time, I was able to recover from a laundry lost of mental heath issues much like yours. It has been a long three plus years, I lost everything including a twenty year marriage, my house, my practice and my dog died, but I lived through it, in spite of two rather serious suicide attempts. You can survive this! Life on the other will be different, but perhaps better. I know it is hard to beleive, but life can get better. Your current mess is the result of medical and mental health problems, it is not your fault. Hang in there!

    Best wishes!!!!!

  7. To overcome stress and anxiety lawyers will benefit from learning how to meditate. If meditation does not come easy, the key is to make the meditation practice more fun- with the help of inspirational wall art, such as Tibetan thangkas and Feng Shui paintings. For details please read:

    How Feng Shui Art Can Help Lawyers Achieve Health, Prosperity, Work-Life Balance
    http://www.explosionluck.com/blogs/feng-shui-sand-pictures-wall-art-paintings-photos-explosion-luck-blog/78033030-how-feng-shui-art-can-help-lawyers-achieve-health-prosperity-work-life-balance

  8. Thanks for the supporting comments. I have continued to battle my anxiety and depression, with little or no improvement. But I am still here! Barry

    1. I would be willing to bet that there are a large number of people wanting to get out of the law but cannot do so because of the weight of their student loans. I haven’t heard much about the effect that these loans are having on lawyers and depression, but at least for me it’s a pretty big part of the picture. I don’t think I could find another job that pays enough to even dent them, and the way the interest capitalizes on them, my loan balance has grown almost 30% since I graduated 7 years ago. I pay all I can afford to every month, but I will never be able to pay these off. I have to take care of my family and pay the loans with nothing left over for retirement. If this in and of itself isn’t stressful, the practice itself is going to do me in soon. I can’t find any decent staff in my area and I am constantly getting sick from the stress. I don’t know what the solution is other than to just keep going. I don’t see how medication would help any with all the financial issues from these loans. And the response to this is always “You borrowed it, pay it back,” well if course I am! I graduated in 2011, at the lowest hiring point- when I started law school I had no idea the job market would be so awful or I would never have even gone to law school. But here we are.

  9. Hi all. Barry, im so sorry to hear your story. Im sure many lawyers can relate. I certainly can in many respects. Here is one answer: get out of law. I know many lawyers feel their job defines them. Choose to not let it define you. You are young (yes u are) with so many skills & knowledge that can be applied to other jobs and professions. Just look, try, see what u can find. I myself dont even know how a person like me came to be a lawyer- im a family lawyer so conflict is high and its very litigious. Over time, despite ostensibly having success, i too feel that my ability to cope with ever increasing anxiety is harder. It has been worse since i had my first child (i now have 3 daughters). I feel a constant dread, i feel almost as if im in my clients shoes. Sometimes its painful. Colleagues have praised me for my composure in difficult situations- if only they saw the fireworks going off in my head. I feel like a fake & imposter most of the time, like finally someone will call me out- that they will see im not smart or capable. How childish am i- im fricken 38 years old, i have a law degree and over 15 years experience in my field, im financially well off & have no obvious “issues” in my practise. What i do have is that big, black ball that fills my stomach and makes it impossible for me to take a deep breathe. Anyway, anyone who is reading this will probably know what im talking about. After a big drama last week (mostly in my head) i decided to look at other job options. My husband has encouraged me. I think its time to open my eyes & wake up to other possibilities in life. I just have to figure out what exactly it is that i want. Barry, you are rich beyond measure. Look at your children. They need u to stay. Just keep going! I wish you the best.

  10. I can also relate having gone through a similar, in some instances almost identical, journey. It’s a daily struggle that sucks from your being the little energy you may have left. Dreading opening an envelope certain that it brings bad news: been there. After, 20 years as a litigator, I’ve slowly transitioned my practice to more transactional matters, just to avoid the stress-anxiety-severe depression I experienced during my time as a litigator. Let’s face it, it doesn’t get any better. If anything, I get even more stressed and more anxious in the simplest cases. The mere anticipation of going to court or to a deposition triggers an onslaught of negative thoughts and feelings. I call it “Litigation PTSD”.

    I’ve dramatically limited my practice to a point where I barely make enough money to cover the essentials causing stress in family and personal relationships. I’ve been able to keep a very small number of clients who think I’m a great lawyer, but not even that is enough to convince myself of the same. I know my weaknesses and limitations, and that is enough to keep me away from the spotlight, another sign of a severely diminished self-esteem.

    Having said all that, something did work. Therapy worked. Symptoms do not disappear, depression still looms every day, negative thoughts still attack without mercy, self-esteem still at an unacceptable low level, but it makes a difference when you start learning how to recognize what’s going on in your head. How those thoughts come out of nowhere, but if you can label them, then you can at least try to discard them. Finding the right doctors is not easy, especially considering the stigma on mental illness, but once you do, it makes a big difference on your journey towards recovery. I can now say it’s been at least 3 years without medications (not recommended if you’re still on early stages of recovery or if suffering from more serious conditions) thanks to effective therapy. But right now, I feel like I will never leave therapy. I’m too afraid of another episode of severe depression. So the journey continues.

    I wish the best to everyone going through this imposition of nature. Please don’t give up. Keep looking for answers and for ways to feel better about yourselves, even if it seems impossible at the moment. It’s time consuming but it’s worth it. I will keep looking for my own answers and remedies, they must be out there. Just as there’s people who love you, even some who don’t even know you, strange but true.

    Finally, thank you for this website. It has secretly kept me going for some years now. Every time I feel down, I look for it, I look for the latest entry or article. It has made a difference in my life to hear about “my people” talking about what I feel and experience. Thank you and love you all.

    1. Thanks so much for sharing JD! I know that I, and many readers of this website, connect with you everything you’ve written. Thanks again. Dan

  11. This is all both comforting and scary….I see I’m not alone but it sounds like this horrid inner turmoil doesn’t just go away even though I’m in with a good counselor. It was bad for awhile but exploded about 3 months ago and feels out of control. Plus even though I’m 57, I have to keep going due to disability of children. I am so weary

    1. Hang on. Sometimes a good counselor is not enough. A Psychiatrist may be necessary to treat more serious symptoms. Fight back!

  12. I do have one…prescribes an anti-depressant and Clonazepam. Having severely autistic son and other problems at home that are “just life” problems certainly doesn’t help.
    Feels like the old song…”I fought the law, and the law won…..” most of the time.

  13. I too, suffered debilitating anxiety and depression from litigation, compounded by a sleep disorder and living “in the closet.” I’ve been blessed to find competent medical help, a practice that is “writing only,” and supportive friend’s and family.

    Now my writing job is ending and I face the prospect of having to go back into court. I’m in dread of it. I tremble like a leaf sometimes when anxious and I’m not sure I can do litigation again, even on meds. Ugh.

    D

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