The Dark Side of Success: A Psychiatrist’s Exploration of Depression in the Legal Profession

By Joann Mundin, M.D.

There are significant effects of depression in the legal profession that are pervasive. Lawyer depression can have terrible personal and professional ripple effects for attorneys but also impacts clients, business partners, employees, and staff.

The general population is significantly affected by depression, with 17.3 million persons, or 7.1% of all adults in the US, reporting having experienced a major depressive episode in 2017. But, the proportion of depression among attorneys is considerably higher: according to ALM’s Mental Health and Substance Abuse Survey from 2020, 31.2% of the more than 3,800 respondents report having a depressive disorder. This indicates that compared to the ordinary US adult, lawyers have an approximately three-fold higher risk of developing depression.

Nevertheless, the stigma associated with mental illness keeps lawyers from getting help immediately. This can cause excessive and prolonged distress, making the problem worse over time.

The Neuroscience of Depression: Creating an Upward Spiral with Dr. Alex Korb

The following is an edited transcript of the podcast recorded interview with Dr. Alex Korb.  This transcript has not been reviewed and is not a word-by-word rendering of the entire interview.

Hi, I’m Dan Lukasik from lawyerswithdepression.com. Today’s guest is Dr. Alex Korb.  Dr. Korb is a neuroscientist, writer, and coach.  He’s studied the brain for over fifteen years, attending Brown University as an undergraduate and earning his Ph.D. in neuroscience from UCLA. He has over a dozen peer-reviewed journal articles on depression and is also the author of the book, The Upward Spiral: Using Neuroscience to Reverse the Course of Depression One Small Change at a Time. Interesting, he’s also coached the UCLA Women’s Ultimate Freesbie team for twelve seasons and is a three-time winner for Ultimate Coach of the Year.  His expertise extends into leadership and motivation, stress and anxiety, mindfulness, physical fitness, and even standup comedy. Welcome to the show.

The Blues Is Depression. Should You Treat It With Pills?

What people refer to as the blues is usually depression.  Depression, or the blues, is an unpleasant emotional state characterized by what therapists refer to as “the negative cognitive triad.”  That’s 1) negative thoughts about oneself, which are the voices of your inner critic harping on you for what you supposedly have done wrong, should have done differently, and on and on 2) negative thoughts about others that lead you to see what you don’t like in them instead of heeding their virtues and enjoying them, creating relationship problems and 3) negative thoughts about the future.

Some people describe the blues, and also depression, as feeling like there’s a dark cloud over you.  Others refer to depression as seeing the world through dark glasses.  Feelings of hopelessness and helplessness are another indicator.

How can you get rid of your blues and your inner critic by treating the underlying depression?

There are four main strategies:

  1. Change your feelings.Take pills or use one of the newer treatment methods that change your bluesy mood by changing your inner body chemistry and brain functioning.
  2. Change your thoughts.  Eliminating the inner critic may get rid of the depressed, bluesy feelings.
  3. Change your actions. Get exercise.  Go out and be with people.  Express more gratitude.  Do acts of kindness.
  4. Identify and address the problem that initially triggered your depressed feelings and thoughts.  Find a new solution and both the negative feelings and the negative thoughts will evaporate.

Why do people take antidepressant medications?

There are four main reasons why people who may be distressed by something in their lives end up defining their depression as an illness and taking medication.

First and foremost, depression is a terrible feeling that sufferers sorely want to get rid of.

Second, most folks have not been fully informed of the medications’ downsides. I’ll elaborate on drug dependency below.  In addition, these medications can cause serious weight gain, a significant drop in libido (ability to enjoy sex), hazy thinking, and a general emotional numbness that blocks feelings of joy in addition to feelings of depression.

Third, people who take the medications may not have been informed of their relatively low rate of effectiveness.  They can be effective if they work, but they only work for something like about 60% of people who use them.

Fourth, most people who take anti-depressant medications have not been informed by their doctor about alternative treatment options.  To a man with a hammer, the world is a nail.  Physicians know about illness and prescribe medications.  As psychologist Martin Seligman has explained, depression is a relatively normal, if quite unpleasant and often self-defeating, response of giving up in response to a challenging life circumstance.

What are the downsides of assuming that depression is an illness and therefore needs pills? 

As mentioned above, two particularly negative side effects of medication that doctors do not sufficiently explain include potential weight gain and decreases inability to experience sexual arousal. Doctors may mention them but often do not clarify that both extra pounds and decreased interest in sex can have strongly negative impacts on personal self-esteem, on attracting a mate and on sustaining a marriage.

The other significant risk that doctors may or not fully explain is that users may have a hard time getting off these medications.  When a drug company says that their anti-depressant medication is not addictive, strictly speaking, they are telling the truth.  A strict clinical definition of an addictive substance or activity is one that induces both dependency and craving.  Antidepressants do not induce craving.  Over time they do, however, make users drug dependent.

Craving is a familiar feeling to anyone who has fallen in love.  The intense sexual desire that drives someone in love to find every way possible to be near the object of their desire is a craving.  Someone who craves alcohol similarly may wake up in the morning already urgently wanting a drink.

What does “drug dependent” mean?   Drug dependency is the state a body goes into when it has adapted to the presence of a chemical to the point that the body requires steady doses of the substance to maintain normal functioning. We are all, for instance, chemically dependent on water.

Our society is highway-dependent.  Many of us have become accustomed to having highways that enable us to drive to work from the suburbs.  Having bought a house in the suburbs on the assumption that we can take the highway to work, we have become highway dependent.  It’s unlikely that anyone has a craving for highways.  Many of us though have become highway dependent.

If you for some time have been taking an antidepressant medication, the odds are that your body has become drug dependent.  That means that if you should decide today that as of tomorrow you will no longer take the medication, starting tomorrow, you are likely to discover that without the pills that you normally take your body will plunge into a serious depressive state.

Does this depression mean that you need after all to stay on your meds because the pills are all that have stood between you and the depths of despair?   Not at all.  To the contrary, this depression means that your body has become dependent on the antidepressant pills.  Is this addiction?  No, but it is drug dependency.

I am not saying that no one should ever take antidepressant medication.  They do help some people.  Some people experience relatively few to zero negative side effects.  My point is just that if you are considering taking these medications, or have for some time been using them, you deserve accurate information about the factors to take into account in your decision, including information about other treatment options.

Here are six vital points to consider.

1) There now are multiple excellent alternatives to medication for working your way out of depression, including various kinds of talk therapies such as CBT, energy therapies such as Bradley Nelson’s Emotion Code and Body Code, acupuncture, exercise, electrical stimulation of the brain, the visualization you can download for free from my website, or read about how to do on one of my other blogposts, couples therapy, and more.

2) Depression is induced by a situation in which you have experienced insufficient power. If you close your eyes and picture whom or what you may feel angry at, you will see an image of the trigger person or situation. Fix that situation, and your depression will be likely to go away.

3) If your doctor is recommending medication as a short-term fix, use the pills until you feel better. Use your renewed energy to address the power-loss situation. Then begin the medication-weaning process asap.

4) Wean slowly. Consult your prescribing doctor for an appropriate weaning schedule for the particular medication that you are taking.

5) Be aware that research has shown that the most powerful way to overcome depression and keep it far from you, in the long run, is the combination of therapy and medication. Medication alone and psychotherapy alone have very similar effectiveness rates, but medication has an impact more quickly, and psychotherapy tends to have more longer-lasting impacts.

6) There is a visualization exercise that you can do with a therapist, a friend, or on your own that may help you conquer the depression in just a few minutes.  See my posting on A New Treatment for Depression.

6) In my clinical experience, I find that most depression is a response to relationship problems. Look into marriage educationcouples counseling, or a combination of both to upgrade your relationship. These treatment routes can make you a double winner.  You can both end the depression and simultaneously gain a vastly more gratifying marriage or romantic partnership.

Susan Heitler, Ph.D., a Denver Clinical psychologist, is an author of multiple publications including From Conflict to Resolution for therapists, The Power of Two and poweroftwomarriage.com for couples who want to strengthen their relationship. Dr. Heitler’s most recent book is Prescriptions Without Pills, with a free companion website at prescriptionswithoutpills.com.

 

Out of the Blue of Depression

blue-sky-cloud-summer-summerday-sun-Favim.com-400890

August.

It seems like the sweet sun’s been high in a blue sky for months.

It’s steamy outside. But that’s just fine with me.  My feet aren’t cold, dark clouds don’t threaten snow, and everyone’s outside watering yards and going for walks at night.

Author Natalie Babbitt captures some of  summer’s magic when she writes:

“The first week of August hangs at the very top of summer, the top of the live-long year, like the highest seat of a Ferris wheel when it pauses in its turning. The weeks that come before are only a climb from balmy spring, and those that follow a drop to the chill of autumn, but the first week of August is motionless, and hot. It is curiously silent, too, with blank white dawns and glaring noon’s, and sunsets smeared with too much color.”

I’ve been upbeat and productive these past few months.  I wake with the light thrown through cracks in my bedroom curtains. I charge up on coffee, create a killer to-do-list, and fly out the door with a sort of crazy, off-kilter optimism.  Looking out at the sun-baked, south of France Monet-like landscape, all is good.

I am out of the blue of depression. And haven’t been in that god forsaken place since a murky week-long stretch last spring.  I am sure the stinky weather had something to do with it.  Months of accumulated winter darkness had tipped me into a dark well. Happily, it didn’t last too long.

And for this, I am grateful.

One of the things I do to stay healthy is to take time to reaffirm the goodness in my life when things are on-kilter and going well. It’s like building up a reservoir of fresh water that I can tap into when my streams run dry. I do this by taking the time to be grateful for the good people and things in my life. It warms my soul. And may even put a smile on my face.

Yes, it can be very hard to feel grateful when depressed. When in a bog of waist deep misery, it’s not only unlikely that we’ll give thanks, it might be impossible. We just can’t conjure up the goodness at such times. Everything feels like a mess.  We’re fragmented, lonely, and depressed.  There isn’t much to hope for. We sort of trudge through our days existing, but not really living.

The devil of depression seems to squeeze out all the goodness out of life. We’re left high and dry. When this happens, we need loved ones and a therapist to help us reap the goodness both past and present.  We can’t do it alone.  But when we’re feeling well, man is it a great practice.

campfire-burkina-faso-richardson_63200_600x450

Here’s a neat and timely tome on this theme from humorist and NPR’s Prairie Home Companion creator Garrison Keillor:

“To know and to serve God, of course, is why we’re here, a clear truth, that, like the nose on your face, is near at hand and easily discernible but can make you dizzy if you try to focus on it hard. But a little faith will see you through. What else will do except faith in such a cynical, corrupt time? When the country goes temporarily to the dogs, cats must learn to be circumspect, walk on fences, sleep in trees, and have faith that all this woofing is not the last word. What is the last word, then? Gentleness is everywhere in daily life, a sign that faith rules through ordinary things: through cooking and small talk, through storytelling, making love, fishing, tending animals and sweet corn and flowers, through sports, music and books, raising kids — all the places where the gravy soaks in and grace shines through. Even in a time of elephantine vanity and greed, one never has to look far to see the campfires of gentle people.”

The goodness of others is grace. It’s the universe’s way of reminding us not to fret too much, that things will work out, that our important jobs are, well, just a part of life, and that uplifting fortune cookie messages sometimes do come true.  If I could, I would stick this quote by author Anne Lamott on one of those skinny wrappers:

“I do not at all understand the mystery of grace – only that it greets us where we are but does not leave us where it found us.”

Think of the kind people you’ve had in your life from your past and today; the everyday saints who were dropped into your life for no other reason than to remind you that life can be good, that you are special and that life is worth living.

These people always leave us feeling better than when they found us.

Take the time today to reflect and take in the goodness in your life.  Depression may be part of your life.  But it isn’t the whole enchilada.

There is always the other side of the coin.

And it’s sweet when we think about it.

By Daniel T. Lukasik

Further Reading:

The Neuroscience of Why Gratitude Make us Healthier by Ocean Robbins in the Huffington Post.

How Gratitude Combats Depression by Dr. Deb Serani in Psychology Today.

9 Ways to Promote Gratitude in Your Life by Therese Borchard at Everyday Health.

 

What’s Up? Gratitude and Depression

hamas_tunnel_idf-768x432-300x169

When first squashed by clinical depression years ago, some told me to think of all the things I had to be thankful for – as if this would cure my “blues.”

But I didn’t have the blues. I didn’t just feel “sad.”  I had an illness.  I had entered a long, dark tunnel.  I didn’t see a glimmer of light at the end of it.  I wandered in it for years before things got better.  At some point, I saw an end, of sorts, in sight.  I exited that tunnel and felt the warming sun of life reinvigorating my body. I knew I was going to be okay.

It was only after having exiting the tunnel that I was capable of even thinking about gratitude.  But now it’s an important part of my “Depression Toolkit”: things I do to keep what sufferer Winston Churchill called “the black dog” at bay.

Listen to the podcast of my interview with Rabbi Mark Gellman

The Deadzone of Depression

There is a zone in a depressed person’s life where nothing seems to happen — except the pain of the absence of everything. 

Kay Redfield Jamison, M.D., in her book, Night Falls Fast, writes:

I wish I could explain it so someone could understand it. I’m afraid it’s something I can’t put into words. There’s just this heavy, overwhelming despair – dreading everything. Dreading life. Empty inside, to the point of numbness. It’s like there’s something already dead inside.

Such anguish is so overwhelming that every other concern is squashed in its wake.  Our capacity for willful actions seems to be gone; we can’t “figure it out.”  We are stuck.

I have learned a lot about the zone over the years and how to handle it.  It’s really like surfing a giant wave.  To handle these waves, you study them and prepare yourself for when the next big one rolls in.

When I feel I’m entering a Dead Zone, I start a deliberate and kind conversation with myself that is practiced and rehearsed.  I don’t let the toxic voice of depression drown me out.  It’s important to empower ourselves in whatever ways we can during these times because depression will lead you to falsely conclude that you’re helpless to lift your dark mood.  This conclusion is one of the central tenets of depression; one of its main “themes”.  We need to create – and we can – different and healthier themes for our lives.

Start with a three-by-five index card.  Use it to create your own deliberate and kind script of themes for yourself that day.  Here’s is an example of what I had written on one of my cards:

— This depression isn’t forever. It will pass.

— I have handled it in the past. I will handle it now.

— Get out of my head – don’t sit around and ruminate.

I usually write a new card out every morning.  When depression is absent (and there are long periods of time when it is), the theme of the card might be more celebratory or grateful:

— I appreciate all of the goodness in my life.

— Thank you God for all of the wonderful people you’ve put in my life.

— I am happy that I am not experiencing depression today.

According to psychologist, Deb Serani, Psy.D, there are both emotional and psychological reasons why this is so:

So, why do these gratitude experiences boost happiness and alleviate depression? Scientists say that these techniques shift our thinking from negative outcomes to positive ones, elicit a surge of feel good hormones like dopamine, serotonin and oxytocin, and build enduring personal connections.

The insight and reflection of counting these moments is what makes the practice of gratitude so powerful. But the key to combating depression is making these positive experiences part of the fabric of your life.

Try this for a while and see if it helps you. Don’t wait until you are in the zone of depression to construct the cards because your thinking during such times will be distorted.

Doing this is a healthy and self-empowering step that you can take today.

By Daniel T. Lukasik, Esq.

 

Summer On My Mind

I’m in Ottawa, Canada now. I’m on vacation with my family in this capital of Canada. It’s about a 5-hour drive from Buffalo, my hometown, and I’ve never been here before. It has a European sensibility with historical buildings everywhere. ottawa 2

And it’s been hot; steamy, lava-like hot. But having endured yet another merciless Buffalo winter where the bitter cold felt epoxied to my hands and feet, I can’t complain.

I’m an early riser, and I’m no different on vacation. Whatever town I’m in, the first place I look for is a Starbucks. Many Ottawans, however, seems to pooh-pooh that dark brew from Seattle. “Go organic and go local, man,” says my hotel concierge; a pasty, redheaded young man of maybe twenty-two who looked fifteen named, “Brad.”

So here I am at Bridgehead, a chain that you can only find in Ottawa, that serves “organic, fair-traded and freshly roasted” coffee. The interior of the place is decorated with IKEA furniture with giant windows letting in morning light muted by today’s grey, watercolored clouds.

I’ve been feeling pretty grateful, lately. Maybe it’s the summer sun or the cyclical nature of my moods, but I feel happy. Waking up this morning, my wife and daughter were still asleep. I just celebrated my 18th year anniversary and my daughter is entering her sophomore year in high school. wedding A few weeks ago, I received my 25-year pin from my bar association to commemorate my silver anniversary in the profession. My mom’s been gone four years and I’m 35-five years removed from my high school graduation. Check out the blog I wrote for my 30th high school reunion.

I have a lot less hair, but I think a bit more wisdom. A piece in the New York Times took a stab at what wisdom is:

“They learn from previous negative experiences. They are able to step outside themselves and assess a troubling situation with calm reflection. They recast a crisis as a problem to be addressed, a puzzle to be solved. They take action in situations they can control and accept the inability to do so when matters are outside their control.”

Maybe. But the few people I’ve met in my life that I think wise, are more than that. They have warmth of heart; an appreciation of life despite its troubles and the occasional tragedies that everyone is sure to be struck with if one lives long enough.

Sitting here sipping my coffee in my middle-aged self, I don’t really know how wise I am. But I do know that I’ve had more than my share of blessings and good fortune to be wise enough to smile in appreciation on this summer’s day.

As Mark Twain wrote, “Wrinkles should merely indicate where the smiles have been.”

Here’s to more wrinkles.

Built by Staple Creative