medication Archives - Lawyers With Depression

Do You Need To Take Medication For Your Depression?

Today’s guest post is by Dr. Eve Wood, a psychiatrist who treats patients struggling with depression, anxiety, burnout or extreme stress.

Do you find yourself wondering if you need to be on medications for depression, or hoping you can stop them? If so, you are not alone!

In 1980, Americans filled 30 million prescriptions for antidepressants, and in 2010, 30 years later, the number of prescriptions for antidepressants filled had risen to 264 million in a year!

What are we to make of this? Twenty eight percent of attorneys nationwide are struggling with depression! Why? And, what is to be done about it? In this short blog, I intend to highlight the relationship between stress, burnout, and “depression”, and the role of diagnosis, medical treatments, and other strategies. I encourage you to think broadly about what you can do to make your life better.

What is Depression?

To be totally clear: We do not really know what depression is! We have a lot of theories, and can identify biological correlates, with some depressive symptoms. And, we do know that a small percentage of people suffer with an incapacitating illness that won’t quit. However, much of what is being called Depression today, is probably Burnout, or a normal response to abnormal stress!

While I am simplifying the diagnostic process a bit, I think you will appreciate the point. We diagnose Depression by establishing that you have a requisite number and type of symptoms, to meet the diagnostic criteria, as laid out in the DSM (Diagnostic and Statistical Manual). Over the course of the last 35 years, there have been 6 iterations of the DSM. As the book has gotten longer, and the number of diagnoses has progressively increased, the “illness” criteria has gotten too loose to be useful.

Before the printing of DSM III, the incidence of depression was quite low, prevalence rate of 1.2% in 1996. After the DSM III was released in 1980, a NIMH study found the prevalence of Depression had risen to 5%. After DSM III-R the prevalence rate had risen to 10 % of the adult population in the United States. And, the rate continues to rise.

In my 35 years in medicine, I have not seen the numbers of people with serious depression, true debilitating symptoms that no one could deny were life-threatening, change much. I have, however, seen a significant escalation in the numbers of people told they “have depression” and consequently get treated with medications.

Today, when you might be dealing burnout, exhaustion, disillusionment, or extreme worry, you are given a clinical diagnosis or two, and prescriptions. This strategy stops you from looking at the precipitants to your distress, and proactively identifying solutions. It also exposes you to “side-effects” or unnecessary risks.

But, Isn’t my Depression due to a Chemical Imbalance in my Brain?

Chances are pretty good you’ve been told that your depression is due to a chemical imbalance in your brain, and medications correct that abnormality. The problem is, all attempts to prove that theory have totally failed.

The fallacy is reinforced by the names given to psychiatric medications. For instance, the term SSRI (selective serotonin reuptake inhibitor) was chosen to imply that the medication inhibits the uptake of a neurotransmitter and thus creates benefit. It originated when the pharmaceutical company SmithKline Beecham, was trying to distinguish its medication Paxil, from its competitor Prozac.

“SSRI” came out of their marketing department and was used to market a new “class” of drug, even though all antidepressants (new and old) have some impact on serotonin. And, we have no idea how significant that impact is! The term SSRI gives rise to cool pictures of neurons and chemicals which can be used to sell drugs.

Do Antidepressants Work?

Clinical trials of antidepressants show that only 1/3 of patients get better in 8 weeks. The other 2/3 respond in part or not at all! And, within 3 years, 75% of the responders have quit treatment, likely due to side effects, cost or diminishing efficacy.

In many studies of antidepressant effectiveness, drugs perform no better than placebo. And, several studies have found that the biggest predictor of response is you believe meds will help, and vice versa!

So, do pills work? At times, yes, and they even save lives. But, they don’t help most people consistently. And, other interventions might be just as good, or better tolerated. Examples with clear anti-depressant efficacy include improved work-life balance, therapy, specific breathing practices, yoga, mindfulness, light exposure, meditation, nutritional interventions, cognitive restructuring techniques, spiritual practice, time in nature and exercise.

What Should You About Medication?

You are probably wondering whether you should be on medicine. The answer is unique to you and your history. That said, here is what I have seen in 35 years of work with attorneys. Many of you are experiencing normal responses to extreme stress. While you have tremendous power to self-heal, rebound, and thrive when episodically stressed, you become depleted, and burned out when the pressures on you are continuous.

The symptoms of burnout; emotional exhaustion, interpersonal disengagement, and a low sense of meaningfulness and accomplishment are very similar to those of depression. And, interventions for burnout, often transform depression symptoms. Most of my clients stop, or massively reduce their medication need, as they tackle burnout, build resilience, decrease stress, and improve their lives.

In choosing your next steps, consider when you last felt well, and your attendant life circumstances. What was working, or gave you joy? Have medicines saved your life, or are you taking pills because you can’t seem to make your life work? Do you need training on techniques and tools to promote well-being, and minimize your need for medications?

If your life is not as you wish, you can change it! You are a gifted, capable person, as evidenced by how far you have come. You can learn evidence-based solutions, to transform what doesn’t work!

Dr. Eve A. Wood helps lawyers and judges dealing with depression, anxiety, burnout and extreme stress learn to transform their lives for well-being, joy and professional fulfillment. She offers practical, science-based programs and coaching that promote whole person healing, decrease stress and depletion, transform anxiety/depression and reduce reliance on medication.

5 Good Ways to Boost Your Mood

Depression makes everything harder: motivation is low, we get little pleasure from things we normally enjoy, we have no energy, and relationships tend to be strained. Small wonder it’s the leading cause of disability in the world, according to the World Health Organization.

Several treatment options are effective in reducing depression. The majority of psychological treatments with strong research support are cognitive-behavioral (CBT) and focus on changing thoughts and behaviors to improve mood. Some forms of medication, such as the selective serotonin reuptake inhibitors (SSRIs), can be as effective as CBT, at least for as long as a person takes them.

So, which treatment option should a person choose? Obviously, it’s an individual choice and one that should be made in consultation with one’s doctor. For those who prefer to start with a psychological treatment—either because they’ve not found medications to be helpful and/or the side effects weren’t tolerable—CBT is a good candidate given the strong research support.

A recent study, the largest of its kind—showed that a simple treatment requiring less

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DNA Tests Can Take Some of the Guesswork Out of Treating Depression

Today, most psychiatrists rely on their education and experience to choose which of the dozens of FDA-approved antidepressants is likely to work best for a particular patient. But human biology (and especially the brain) is complex. So often, it’s not until a doctor’s second (or third or fourth…) “guess” that they land on a medication that’s effective. Now, psychiatrists can use something far more concrete to guide their antidepressant decisions: a patient’s DNA. Read more here.

20 Shades of Sadness: Why Do We Get Depressed?

In answer to the question, ‘can we improve the success rates of treatment for depression?’ Dr. Azab answers with a ‘definite yes.’ She believes correctly and thoroughly diagnosing the interrelated yet distinct causes of depression is the key first step in doing so. Read more here.

Top 5 Traps That People With Depression Fall Into

A trap for those suffering from depression and anxiety is that many of people’s natural coping reactions make the problem worse rather than better. Here are a few examples of that, and some practical solutions.

Note: Please be compassionate with yourself if you can relate to any of these patterns. They’re common pitfalls, not an indictment on you as a person.

Number 1: You don’t fix problems that frustrate you.

Feeling irritable is one of the main symptoms of depression for many people. Some problems that trigger repeated irritation and frustration are easily fixable. However, people with depression often go into a passive “survival” mode and don’t address these issues, even though they could.

For example, you don’t have enough power outlets in the spot where everyone in your household likes to charge their devices. You’re constantly annoyed about people unplugging your device in favor of their own. This is the type of tension that can be solved by getting a multi-plug or another similar practical solution.

People with depression often just put up with this type of issue (and complain about it), rather than deploying a solution. It’s understandable to do this, but not very helpful.

Number 2: You’re waiting for your sleep to improve before you take other actions.

Difficulty sleeping is one of the most horrible symptoms of depression. Unfortunately, it’s often the last symptom to resolve when people’s mood starts to improve. Therefore, even though it’s hard, it is important that you start other strategies even though you’re feeling tired and grumpy. For example, exercise. If you over-focus on getting your sleep right before you start other strategies, you’re setting yourself up to fail.

Number 3: Wanting a pill as a cure-all.

Medication is helpful for many people with depression but it certainly doesn’t address all of the thinking and behavioral patterns that are associated with depression. For example, you’ll likely still need psychological strategies to deal with tendencies towards rumination (overthinking) and avoidance/procrastination.

Solution: Try drawing a pie chart and estimating what role you think medication has in your depression recovery. Include whatever is relevant to you in your pie chart, such as thinking changes, exercise, meditation, laughter, problem-solving etc. Your personal pie chart won’t be the same as someone else’s since everyone’s preferred mix of strategies for depression recovery is a little bit different. When you start adding all these other components to your pie chart, you’ll see that medication is only a part of the picture.

Number 4: Asking for help too often.

People with depression frequently struggle along on their own for far too long before seeking effective help, and may not realize they’re depressed. However, sometimes people can become over-reliant on others when their mood is low. Examples include too frequently asking for help with: making decisions, using technology, or reaching out socially (such as making phone calls).

The same person can be too resistant to seeking help in some respects and too reliant on others in other respects!

When someone who is depressed constantly leans on others it can create anger, resentment, and other problems in relationships. This is especially the case when the depressed person repeatedly asks the same people for help or asks for help with the same task that they could learn to do themselves.

This point relates to the next one, so keep reading to learn more.

Number 5: Putting life, learning, and projects completely on hold.

People often feel like their brain is foggy and their concentration is impaired when they’re depressed. Therefore, it’s natural that people withdraw and think they’ll put off working on projects or learning anything new until they’re feeling better.

When you’re depressed, it’s a great idea to go easy on yourself and resist taking on too much. This does not mean putting off anything and everything challenging or unfamiliar. If you do this, you’ll, unfortunately, dig yourself into a very big hole, where you withdraw from life and avoid, and your confidence and energy erode further.

Don’t push yourself too hard, but understand that experiences of both pleasure and mastery are incredibly important for mood hygiene and depression recovery.

Solution: For this tip, I like to think of each day in three chunks – morning, afternoon, and evening. Aim to have one experience of pleasure and one experience of mastery in each of these chunks. These can be tiny, like canceling a subscription you’ve been paying for but not using.

You can actually fold other advice for alleviating depression into this strategy. For example, exercise could be either a pleasure or mastery experience for you or both. Something like taking the stairs rather than the elevator could be counted.

If you include mastery experiences in your day, you’re not likely to fall into the traps of asking for help too much or failing to solve easily fixable problems that trigger your irritability.

Wrapping Up

Which of these problems seems most relevant to you or your loved one? Which of the solutions presented seems most important for you to try? How can you implement that in the easiest way possible? How can you bypass the most likely obstacle to your succeeding with your strategy?

By Alice Boyes, Ph.D. Alice has had her research about couples published in leading international journals, including Journal of Personality and Social Psychology.Her work focuses on how people can use tips from social, clinical and positive psychology research in their everyday lives and romantic relationships. She is regularly interviewed for magazines and radio about a wide range of social, clinical, positive, and relationships psychology topics. She can be contacted for media interviews by emailing admin@aliceboyes.com

Side Effects Can Develop Even if You’ve Been Taking a Pill for a Long Time

This Washington Post article details how the side effects of medication may not become apparent immediately and as a result patients should continue to consult with medical professionals over the duration of the time they are taking medication. Read the article here.

Your Health: Her Depression is Treated with a Combination of Two Common Drugs

Doctors across the country are now testing a drug combination for patients with drug-resistant depression. The hope is that the new combination will inhibit the breakdown of a common anti-depressant. Read about it here.

Biotech Sage Therapeutics Skyrockets More Than 70 Percent After Depression Drug Breakthrough

Sage Therapeutics said in a release that 64 percent of patients achieved Major Depression Disorder remission using the SAGE-217 drug in the 15th day of treatment. Read the article here.

Emotion Rules When There is Depression

Stuck in a negative network, changing thoughts or actions is just plain hard.

“I cannot do what you suggest – I know it won’t work.”

That was Jon’s mantra as he sat in my office and said that he can never be happy. The one thing he wants – a wife and family – will never happen because fate has determined he is not going to achieve that goal. Yet most opportunities he gets to meet someone new, he believes will not work.

Why is he resisting meeting new people when someday one might be interested in him? His inability to move from one idea to another to create a change in thinking or in attitude is typical for depression. And, as in Jon’s case, it seems like it’s intentional. Or at least that’s what family and friends see when they tell their depressed loved ones to “Just do it!” It is easy to judge from the outside, but it is hard to see on the inside of a person with depression.

That stuckness is a feature of underlying neurobiology. All of us think in networks: when we start to think about a topic, we enter a network of related concepts that allows thinking to be efficient and helpful. Ideas are linked and things we need to know are easier to access when we enter a network of similar ideas, experiences, or emotions. That is why when people are trying to develop a creative solution to a problem, they brainstorm. That is, they utter or write every idea that pops into their minds about solving a problem – no matter how ridiculous it sounds on the surface – and do not assess the idea until they have a long list of options. Brainstorming is valuable because it helps us remove ourselves from the already framed network and helps create a new one.

That same efficient brain that networks and categorizes also causes a problem when depression hits. Entering a negative network that connects similar thoughts, experiences and emotions result in a depressed person linking negative networks. It promotes the discouraged outlook that is typical of depression. And, unfortunately, in depression, the ability to move to another more positive network is impaired. The weakened activity of the neurotransmitters causes “stuckness” in the pathway in the brain that allows shifting of thought and emotion.

That pathway includes a part of the brain called the anterior cingulate cortex (ACC) that should allow for rapid shifting between emotion and thinking and should aid in developing creative problem-solving. But when people suffer depression, this pathway of the brain is impaired. It may be overactive – spinning in place without creating movement. Or it may be sluggish and unable pass along cognitive decisions like, “I will try something new,” to the emotional part of the brain that generates the discouraged, “I never have good results.”

Emotion rules when there is depression. The negative “It won’t work for me,” style of thinking seems to have more power than the optimistic, “Just give it a try,” method of thinking.

Sitting with Jon, I want to say, “Just do what I am suggesting!” I want him to borrow my ability to generate a new idea, but some things have to change before he can try something new. He cannot respond to “just do it” while his negative networking is making him believe that his case is different. His notions about how to act are the ones in the network of what he has typically done, which is a very negative network.

How can he get out of this?

He needs a MAP.

When you use a map – even your navigator – you have to know where you are starting and where you are going. Jon needs to know he is currently stuck and that another way just might be possible. But where is he going? He needs to believe in a reasonable solution. In our conversations, Jon is beginning to believe that his depressed thinking is a problem.

Medication might help him be less negative – it can correct the neurotransmitter problems that cause the sluggish or overactive pathway to prevent new ideas. (Supplements and nutrition and sunlight can also help!) Next, he needs to redefine his goal. If marriage to exactly the right person is the only thing that will make him happy, then I cannot help him. He needs a matchmaker and a lot of money for that. If he wants to redefine what a happy life looks like to him, therapy can guide him. But once he can see the need for help to navigate his goal of a happy life, he needs to find a map. This map will need to take him toward feeling better and developing a more flexible, creative way of thinking. If he can get out of the negative network he will be more able to generate new actions and take charge of his discouraged mood.

MAP – Move, Ask, Play

M – (You may want to consider medication as the first M and then go to this one)

Jon needs to move. Literally, move his body. The stuck brain finds it easier to shift gears when the physical body is moving. Walking, swimming, bike riding can all be good. Try movement without earbuds pumping music. The creative brain will take over and just might jump the tracks of negativity while you move. And vigorous exercise has a way of pumping up energy that lightens depression.

A – Ask for input. When we brainstorm it works better if we have more than one person adding ideas. We spur each other into different networks. Jon might benefit if he shares his challenge of being stuck with a friend or three. And it will be good for him to ask people what gives them happiness or satisfaction. He might hear that there are many ways to be content.

P – Play around with different options. Jon does not have to commit to an idea of what is fun or pleasurable or satisfying. He would benefit from playing with the children in his life whose joy is infectious. Play sports or games. Playing stimulates different networks and may result in some changes in his mood or thoughts that may help him be less depressed.

There is a saying that life is a journey, not a destination. I do not know Jon’s ultimate destination, nor does he. The outcome of this MAP will help him find a better, more creative, and less depressed way of living his life.

By Margaret Wehrenberg, Psy.D. Margaret is the author of 5 books published by W.W. Norton, includingThe 10 Best Ever Anxiety ManagementTechniques, The 10 Best Ever Depression Management Techniques and her most recent 10 Best Anxiety Busters, an ideal book for the general public. She earned her M.A. studying psychodrama and bioenergetics, and had years of experience as a certified drug and alcoholism counselor, before earning her Psy.D. She now specializes in treating anxiety and depression and has a private practice in Naperville, IL. She is a frequent contributor of articles to The Psychotherapy Networker magazine, has contributed a chapter to Clinical Pearls of Wisdom (Ed. M. Kerman), and has produced CD for breathing, muscle relaxation and imagery for anxiety management.

This article originally appeared in Psychology Today magazine.

How to Handle a Depression Relapse

Depression blogger Therese Borchard writes, “For anyone who has ever been debilitated by severe depression, there is nothing more frightening than the feeling that you’re relapsing into another episode. We chalk up the first few days of angst to a bad stretch and hope it gets better from there. But by the time we’ve hit six weeks of crying spells and the kind of anxiety that steals our appetite, there’s usually some panic that we are headed into the Black Hole of Depression yet again.” Read the Blog