Moderate exercise may help people cope with anxiety and stress for an extended period of time post-workout. Read the Story
From Time Magazine, an article about a new study which shows the power of exercise to treat depression. Read the Story
A new study suggests that exercise is not as effective at reducing the symptoms of depression as previously thought. Read the Story
Each of these tactics has empirical support. So there’s a lot to recommend about them. But as I will discuss later, lots of people have a hard time embracing these approaches or sticking with them. First, let’s take a peek at what’s good and promising about these three treatment routes.
Why these approaches are Effective
Many studies show that ‘talk therapy” helps folks with depression. In particular, cognitive behavioral therapy; a form of counseling in which a psychologist compassionately confronts a depressive’s pessimistic thinking and tries to teach him or her more optimistic an productive ways of thinking about their. Research has shown that there’s a powerful connection between pessimism and depression: the more negative your thoughts, the more likely you are to get sucked down into the well of depression. Other studies show that lawyers are much more pessimistic than the general population. As such, CBT is a very good treatment option for many in the legal profession.
Antidepressant medications are often an effective way to treat depression for lots of people. It seems to alleviate the brutal physical symptoms – – loss of appetite, inability to sleep and chronic fatigue – – so that one can benefit from therapy. It’s tough to get much insight from therapy when you’re feeling so crappy.
However, recent research has discovered that it often takes two or three attempts before the right medication is found that will relieve a person’s particular depression.
Sweating it out has been proven to lift not only one’s general mood, but alleviate depression. Probably the best book I’ve read on the topic is Spark by Harvard physician, John Ratey, M.D. who writes:
“Antidepressants are curious because we think we’re changing brain chemistry when we take them. The science shows us that exercise does the same thing. By exercising, we’re improving the brain’s plasticity. And while it’s hard to get depressed people to get up and move because, well, they’re depressed, you have to sell them on the value of it. Once they get it, they go with it.”
Why People Don’t Do These Things, or Don’t Stick With Them
If these remedies are so effective for so many, why don’t more people who struggle with depression do them, do them more often or stick with them?
– I Don’t Want to Talk About It.
There are lots of reasons why educated and intelligent people don’t go to therapy. Here are a few of them:
People (lots of them men) don’t go because they just don’t want to talk about what ails them. Culturally, men are often not given permission to be vulnerable and emotive. There’s a limited range of feelings that the culture says are okay for men to vent: anger, irritability and humor. –
Sufferers sometimes can’t find the right therapist and give up.
Those around them do not believe in therapy. I know a lawyer with depression whose wife thinks therapy is a bunch of hand-holding baloney and a rip-off at $125 per hour (Buffalo rates, mind you). As such, he feels discouraged, doesn’t want to hear his wife complain about the cost and doesn’t go.
People are just too fearful of what the consequences would be if they admitted they had depression: “Will I lose my job?” As such, they often deny to themselves or others that something is wrong. – Procrastination: “Maybe it will go away”.
Shame: people feel they will be labeled “defective”, “weak” or “mentally ill.”
Or, for many, they just don’t know any better. The misery they endure is their “normal”. They can’t see how their maladaptive, pessimistic thoughts about life could be anything other than reality – – “That’s just the way life is.” They may even feel bitter when they see others having fun or being happy. They feel cheated. Why can’t I have more happiness in my life? They may feel that happiness is something doled out by the unseen hand of God or lady luck. However it is dished out, they’ve feel they’ve been given a pittance. Not surprisingly, they have no confidence that they have the capacity to create happiness within themselves. “No”, they think when they imagine to themselves that they have good things to look forward to, “That’s not how my life seems to turn out’. This disempowered state is a vicious circle that can only lead to more depression.
-Antidepressants: The Flip of the Coin?
There’s a billion dollar debate going on whether antidepressants work or not. On one side of the aisle are the folks in lab coats – the bespectacled researchers who look at brain tissue through microscopes; pharmaceutical executives in blue suits who smoke big-ass cigars; and the psychiatrists – the high priests of all that ails the depressed mind – – who advocate taking medication to treat clinical depression.
On the other side are patients who swear that the meds did nothing to help their depression and just screwed them up and made them feel like zombies. On the other are holistic practitioners who believe depression isn’t caused by a chemical imbalance in the brain, but by lack of proper nutrition, diet and balance (check out Dr. Andrew Weil) and my psychiatrists who believe that medications, while useful, are over-prescribed.
There currently are no tests, other than trial-and-error, to determine what type or types of medication will prove effective for a particular person. It’s really trial or error. Our family owns a big fat rodent. Did I say he was really fat? Anyway, he is black and white and lives in a large cage in a back room of our house. The colors make him look like a magician in a tuxedo. Hence, his majestic name – – Houdini. I felt like Houdini when my psychiatrist tried different medications on me in a quest to get the right one – a lab animal in which he tried this and then that. Some were real duds; some outright blunders. But I stuck with it. And I’m glad I did because the “right meds” were eventually found for me.
People won’t take medication because of the stigma attached to it. Or, they give up on it before the right medication, dosage or combination is found. Even when the right one is found, folks often stop talking it because of the side effects. I know depressed lawyers who would rather drink or drug rather than take antidepressants.
-Why We Won’t Get Moving
People find it hard to exercise because depression screws up their ability to sleep leaving them unmotivated and just too tired to get to the gym. Years ago, when I first was diagnosed with depression, I recall being bone-tired at the end of a work day and falling asleep a 9 p.m., sleeping on and off throughout the night, getting up at 3 or 4 a.m., shaving, getting dressed and driving to an all-night coffee shop to slurp coffee, get ready for work and wonder “Just what the hell is wrong with me?” But I didn’t have any answers back then. In retrospect, truthfully, the only thing that helped me survive it was to keep walking.
Three Quick Things to get you on the Right Track
1. If you’ve never been to a competent psychiatrist, remind yourself that you can just go for a consultation and hear what they have to say. Whatever their recommendation, you don’t have to agree with it or follow it. But why not get an opinion from someone who has treated hundreds of people with depression and could tell you whether or not you have it and what your options are? You can also get a second opinion. There are “Depression Centers” around the country where you can go for such a consultation and then return to your treating psychiatrist who can prescribe the recommended medication and monitor you. Bring a friend or family member to the appointment. Sometimes, when we’re depressed, we might not truly hear when the psychiatrist has to say. What does your loved one or friend think the doctor said?
2. If you don’t want to go to a therapist, you really have to ask yourself why not. I usually recommend that people call friends to ask for recommendations for a couple of therapists. Go visit a few for a 1 hour consultation to see if you click with that person. Remember, if you give into your depression, you will tend to isolate yourself and “suck it up.” What you really need to do is talk to a therapist who has treated hundreds of folks with depression who can give you some ideas about whether you can benefit from therapy. A good friend can listen and give you their love and compassion. But, they can’t do what a good therapist can do.
3. Make it easier to exercise. Here are three quick ideas. First, always keep your gym bag in your car – EVERY DAY. I’ve found that I’m much more likely to exercise at the gym, if only for 20 minutes, if it’s in the car. Second, don’t shave or shower when you get out of bed. Get dressed like you normally do for work and go get a coffee if you like. I find that I have to work out because I now HAVE TO GO to the gym if I want to get a shower and shave – it’s too late to go home now!
This piece reports that only one-half of all law students graduate with a full-time permanent job requiring passage of the bar exam. Tough news for young lawyers that are already prone to depression – about double the rate of the general population. Find out what to do about it. Read the Story.
Katie has been married to her law student husband for almost four years. She has grown into a more compassionate and well-rounded Certified Health Education Specialist and Mental Health First Aid provider from her experiences with her husband’s mental health issues, and enjoys sharing information with others about health and wellness. Her husband is currently searching for a job. As such, Katie has only given her first name.
Last year, my husband became a first-year law student at a state school with an excellent reputation. After several years of waffling between pursuing medicine, law, military, and scientific research careers, he opted for law and was admitted to a number of schools, accepting his best offer. We relocated so that he could attend, moving from the sunny Southwest to the frigid winters of the Mid-Atlantic. He was excited at first, eager to begin a new chapter of his life and enthusiastic to embark on a learning journey; he loves to read and study politics,
economics, business, and law, and felt that this endeavor would help him fulfill his potential both personally and professionally.
Shortly into the first year, I noticed my usually calm husband – laid-back almost to a fault – was frequently stressed. He worried constantly about understanding the material, completing his assignments, competing for grades, getting an internship, and even being able to get a job upon graduating. Although this may seem natural for law students (1L’s in particular), it was a marked change in his personality that lasted for weeks on end, almost to the point of keeping him from being able to study, write, or prepare for his classes.
His friendly nature struggled with the intense sense of competition among the other students, and he was unable to form many friendships, leaving him feeling isolated and lonely. Furthermore, the mounting pressure to perform dominated his thoughts, paralyzing him and making him reach a point of hopelessness; he felt that even his best wasn’t good enough, and that there was no
point in continuing if he couldn’t get a good job at the end of it all.
The Loving, but Ignorant, Spouse
I tried to play the supportive spouse. To me, it seemed likely that many other students felt the same way as him but managed to focus more on the task at hand, not tying every tiny detail to future results. It even angered me that despite all the sacrifices we had both made for him to be able to return to school, he was risking it all because he refused to focus on anything but his potential for failure. I told him time and again that I was absolutely positive he would do just fine, that I wasn’t worried about his ability to succeed and get an excellent job, that his understanding of the material would mean more for his career than a grade on his transcript, and that his best efforts would surely serve him well. But my encouragement didn’t help.
In the past, my husband was an avid athlete. He still holds a state record for his high school swimming times, he trained himself to run a half marathon every weekend, and he completed the entire P90-X workout course. This all stopped when we moved and he started school, principally due to his lack of time. He snuck in a few workouts at the beginning of his first semester, but quickly traded exercise for sleep whenever he had a spare minute. His ambitious early morning study sessions from the start of the semester had disappeared by fall break, andas the sun went down earlier every night, so did he. He began sleeping as much as he possibly could – at times even falling asleep while studying or sleeping and skipping studying altogether. My usually upbeat, happy husband started making off-the-cuff remarks about how worthless he was and how stupid he felt, even tossing out an occasional comment about shooting himself so I wouldn’t have to repay his school loans, followed by swift assurances that he was “just kidding.”
Getting Serious About Depression
Even though I am a trained public health professional and a Certified Health Education Specialists, the signs flew right by me. I just assumed he was having difficulty adjusting to life in a new state, unhappy about having to make new friends and commit considerable effort to his degree. I missed the signs of depression that were staring me in the face every single day. To make matters worse, three visits he made to the student health center for check-ups and care for his asthma found nothing of concern.
I am ashamed to admit that several months passed wherein I did absolutely nothing, I suppose in a state of self-denial. I couldn’t convince myself that he was not right, not healthy, that something was seriously wrong despite the symptoms I tried to tiptoe around on a regular basis. A kindly older neighbor was good enough to give me a kick in the pants to help my husband get the help he needed.
“What’s wrong with him?” she asked – no beating around the bush. “He’s changed – he used to be so bright and smiley, and now he just seems…unhealthy and sad. A sad, defeated man.”
I was dumbfounded, utterly shocked and hurt by what was the clear truth. My husband was suffering, he was miserable and I had neglected him. I tearfully squeezed her hand and marched straight home to make an appointment with a counselor for him. He went the following week and, after a series of visits, tests, and consultations, was diagnosed with major depression. I was heartbroken and embarrassed at my failure to notice his cries for help earlier in the year, but I was relieved that he would be getting the help he needed.
Living With – and Healing From – Depression
I am happy to report that with exercise therapy and regular talk therapy, he has been able to manage his depression without medication, although he still has some terribly painful bad days. We are starting to see what we hope is the light at the end of the tunnel for him. He is still pursuing his degree, and although he won’t be at the top of his class when he graduates, he has come to realize that a life-long career is built on more than where you fall on the grading curve. He has rediscovered his passion for running, and his sunny disposition is again bringing joy to both of our lives.
I wanted to share this story with any lawyers and law students potentially suffering from depressive symptoms to let you know that sometimes the people who most want to help you are not totally aware of what is going on in your head. Whether you think your behavior makes your pain obvious or you think you are hiding your emotions successfully, your loved ones are probably waiting for a wake-up call to push them into action. Be open with them about your pain, anxiety, and especially any suicidal thoughts. Sometimes a few words about how serious your troubles are may be the impetus for positive change – having a helpful friend to walk the long and difficult road with you can make it easier for you to get the help you need in a timely and effective manner.
For me, it took an old lady with a keen skill for observation to spur me into helping my husband get the treatment he needed; if you don’t think old Mrs. Wilson down the street will be doing the same for you, have a conversation with someone today about what you are experiencing, and let them know you don’t want to keep feeling that way. Help is available. You can get it, and a friend or family member will be happy to assist. Don’t wait – lawyers and law students are in unique positions to help others, and life is too short to spend time battling a mental disorder that steals your talents from you and the world. So go on, tell someone, and start feeling better soon.
Most folks describe depression as a weight they carry around: dumbbells lodged in their pockets that drag them down body, mind and soul into a stinking swamp.
There’s no humor in this bayou; no levity, no sense of the sweet exuberance life can bring. Instead, there’s a collapsing inward, an inertia in which we can’t imagine . . . well . . . anything good happening to us.
We have a yearning to be free of depression; a deep desire to cut our losses and spit in its eye. It has cost us enough heartache – no more, we think. We pine for a way out of it, but sometimes don’t know the way.
But if we are to recover, we need to think about a different kind of life for ourselves. One where we take the “UP” to happiness escalator instead of the “DOWN” one to depression.
Imagining a Life without Depression
Envisioning freedom is part of the journey out of the dark woods. So often, depressives imagine a future with uninterrupted bouts of depression. This sorrow is what leads so many to a state of hopelessness. We need, with the help of wise others, to begin to imagine what our life would look like without depression and walk, step by step, that way.
I used to say to my therapist when depressed, “Why am I being punished?” It was as if I had done something “bad” and was a “bad person” (though I didn’t know and couldn’t articulate whatever that was) and now the Karmic Universe was going to dish out the punishment I thought I surely deserved.
As depression author Dorothy Rowe writes,“Depression is a prison where you are both the suffering prisoner and the cruel jailer.” Start to see, just a little bit at a time, that depression is not just happening to you. It’s an inside job too. This took me years to learn. Our thoughts and style of thinking help create and sustain depression. When we feed it with negative ruminations, it grows larger – like an algae plume. Withhold this noxious nourishment — and it can, slowly, wither away or at least become more manageable.
Happiness Skills Can Help
Before even imagine the promised land of happiness, however, we may need medication to lift the more onerous physical symptoms of depression to give us enough focus and energy. No doubt, antidepressants aren’t the only way to do this. Many have accomplished the same results with exercise, nutrition and/or psychotherapy.
In her book, The How of Happiness, Sonja Lyubomirsky, Ph.D., writes:
“Even the most the most severely depressed individuals can improve by doing a simple daily happiness-increasing exercise such as taking time to recall three things that went well each day. Although the exercises are not designed to ‘cure’ depression, if you are depressed, trying one or more of these activities affords a strong chance of lightening the burden and darkness of depression and producing positive feelings.”
We can also look back further than just what went right on a particular day to increase our sense of happiness. There is a powerful connection between how we view our past and present day happiness says Rick Nubert, Ph.D. In a study of 750 people, he found that highly extraverted people are happier with their lives because they tend to hold a positive, nostalgic view of the past and are less likely to have negative thoughts and regrets than their neurotic counterparts. Howell says that while it may be difficult to change one’s personality to being an extrovert, he found that savoring happy memories or reframing past painful experiences in a positive light could be effective ways for people to increase their life satisfaction.
Other ideas offered up by Dr. Lyubomirsky include avoiding overthinking – a big problem for lawyers: “Very happy people have the capacity – even during trying times – to absorb themselves in an engaging activity, stay busy, and have fun. To practice this strategy, pick a distracting, attention-grabbing activity that has compelled you in the past and do it when you notice yourself dwelling [on the bad stuff and your problems]”. Check out her other ideas in her blog.
You deserve to be happy. You don’t have to keep riding the down escalator. While going up to the second floor, just wink and wave at your depression as it goes down into the bargain basement.
Spring has returned. The Earth is like a child that knows poems. – Rainer Maria Rilke.
Spring is a time of renewal. If we follow nature’s lead, it’s a time for rebirth. During the long nights of winter, depression can have a vise-like grip around our throats. The increasing sunlight and warmth seem to make this black dog recede back into the shadows.
Spring cleaning is a perennial happening in this country; people tossing out and cleaning up in every zip code imaginable. This feels good because it gets our bodies moving, we feel productive and somehow lighter. Depressives have a lot of dross in their drawers; layers of junk strewn haphazardly throughout the pockets of their days.
Today, I’m cleaning out that most sacrosanct of male domains – my garage. Laugh you may, but I really enjoy it. I love the productivity of it all, the manual labor that gets things done without relying on my ability to think and analyze problems. It seems to bring my life back into some sort of momentary harmony; a clarity where there used to be only the mildew of depression.
It puts me back in contact with nature, with the fresh air that blows and the ground where life is murmuring and waiting to come forth. Novelist Margaret Atwood writes, “In Spring, at the end of the day, you should smell like dirt.” I don’t know about you, but that’s my plan for the day.
Yes, Spring is a time of change; a transition from the hibernation of winter. It’s a good time to go back to the drawing boards of our lives and look at what is and isn’t working for us; what is and is not contributing to our depression. If something works, keep it; if not, chuck it.
Springtime is a great time not only to clean out garages, but also our minds that get gooey with too much depressive thinking. Too often, depressives are immobilized by . . . well, depression. Because they think that they can’t get anything done, they . . . get nothing done. That sort of thinking needs to be tossed to the curb along with the rest of the trash.
Depression seems to add 50 pounds of psychic weight to our bodies. We drag ourselves around the block like a broken wagon, never feeling that we have enough energy to do anything. Yet, it is profoundly true, that energy begets energy in this corner of the Universe; hence, my assault on the garage.
Depression is hard-headed and stupid. For some reason, this thought pops into my head as I watch my dog Sherman chewing on an old toy, slobber running down his brownish coat.
Depression can make you feel like that best thing for you to do is sit on the couch and watch Brady Bunch reruns while sucking down a Coke. But what’s really needed to make you feel better is movement.
That’s why I’ll be hanging out in my garage today. It’s such a simple thing to do. No game changer in the grand scheme of things. Just an ordinary thing, in an ordinary life, that makes me feel great.
I find writing about depression for lawyers a delicate balancing act. On one hand, I don’t want to pull any punches about just how awful depression is or how adversely it can affect your life and career. On the other hand, I want to offer hope and encouragement to those who are in the trenches and deal with it every day. I will try to do both today.
I have been encouraged by some to write only “positive” articles about dealing with depression. But I just can’t do that. To not deal with the more troubling aspects of depression seems to me a form of denial. The other day, I was at my local bookstore checking out the Self-Help section for any new titles on depression. Some of the titles seemed like they were being pitched by used car salesmen: “Overcome Your Depression in 30 Days!” This doesn’t help the conversation about depression because it sets up ludicrous expectations in the minds of those who suffer from it and their loved ones about the speed of recovery. For many with depression, they’re in it for the long haul.
One of the hardest parts about dealing with depression on a daily basis is its seemingly unpredictable nature: When is it going to start again and how long will it last?
Elizabeth Wurtzel, author of the best-selling book, Prozac Nation, gets it right when she wrote:
“That’s the thing about depression. A human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious, and it compounds daily, that it’s impossible to ever see the end. The fog is like a cage without a key”.
Many, many lawyers go into a mode of survival waiting for a depression to end. To me, the degree to which such a depression can create catastrophe in our lives as lawyers seems driven by the episode’s severity: is it a tropical depression or a full blown hurricane?
If it a low to medium grade depression, tools like Cognitive Behavioral Therapy (“CBT”) are very helpful. With CBT, we work in therapy to replace destructive, depressing, negative self-talk with positive, healthy and realistic self-talk. The efficacy of this approach has been studied and documented using PET scans of the human brain. Such scans show that an area in the frontal cortex (the thinking part of our brain) is hyperactive in depressives before CBT and then calmed down after successful CBT treatment. This same area of the brain is activated when people do self-referencing [relating external events, particularly negative ones, to the self] and depressives do too much of this. They spin around in a cycle of negative thoughts and try to use the cerebral cortex to snap out of their depression. With CBT, they learn to decrease their self-reference to the things that are negative. It’s a form of rehabilitation of the cortex where depressives learn to turn the volume down.
This is a critical skill for lawyers to develop. According to psychologist, Martin Seligman, author of the best-selling book, “Authentic Happiness,” lawyers are pessimists. They develop thinking habits which see problems as permanent and intractable. They also feel an overdeveloped sense of ownership or responsibility for such problems. Optimists, on the contrary, see problems as temporary, solveable and not necessarily their “fault”. The important point here is that optimism is a skill that can be developed and practiced. Read Seligman’s chapter, “Why Are Lawyers So Unhappy?”
If it is a deeper depressive episode, more like a trough of despair, CBT won’t work very well. During such an episode, there is the sense that it’s never going to end. Yet, this is the distorted voice of depression talking because for the majority of people with depression, IT DOES END. The trick is to learn how best to weather the storm.
I find that when I am in a deeper depression, I need to go outside my mind and get into my body. Consistently, the things that helped me the most were the following:
1. It’s virtually impossible to feel depressed while exercising and even for a good period of time thereafter. The problem, as most of us know, is getting to the gym or the park. Behavioral prompts can help. Always have your gym gear in your car. Also, be realistic. Remember that it takes at least 21 days to form a habit. So, those first 21 days won’t be the easiest ones. Tell your family and friends about the importance of exercise to you and have them support and remind you about this on a daily basis.
2. Cut off any unnecessary negative input in your life during these times. Don’t listen to any sad music, watch violent T.V. shows or read somber books. This isn’t a forever type of deal. Think of it more as a “timeout”. Some people stop reading the newspaper during an episode as well. Also, the time you’re not doing these activities gives you the time that you’ll need to exercise.
3. See a massage therapist. Touch has a powerful effect on the human body and is known to cause the release of endorphins (the feel-good chemicals). It doesn’t involve any thinking on your part. For busy lawyers, it’s a time to relax and receive something positive for the day.
Remember to be kind to yourself today.