“I Don’t Want To Talk About It”: Guys With Depression

Years ago, 1997 to be exact, I was thinking about writing an article for a lawyer’s magazine about my experiences with depression while practicing law.  I had lunch with a good friend of mine, Bob, who at that time worked in a large litigation firm in New York City.  Since then, Bob has become a federal judge and remains a dear friend.

After we had ordered, I told Bob about my idea to write the article. He sat quietly and listened, looking down at his salad as I spoke.  Finally, he said, “Dan, this is an awful idea.  While noble, why would you expose yourself to the insults some people are going to hurl your way.”  We spoke at length and I finally told my dear friend that I was going to write the article anyway.

male depression

For the first few years after that initial talk, Bob would call me regularly and check in, “How’s it going, Dan? Is everything all right?”  I so appreciated Bob’s loving concern.  More importantly, however, something began to change in our relationship.  Bob eventually disclosed to me that he had had a episode of major depression some years ago and had tried to commit suicide.

It seems to me that my willingness to speak frankly about my depression gave Bob permission to speak about his.

Unfortunately, talking about depression is not easy for most men. They have lots of trouble coming to terms with depression, even when they get treatment. All the more so if they’re a lawyer.

Lawyers aren’t supposed to have problems; we’re supposed to fix them. Most male lawyers I know would rather drop dead than admit that they have problem with depression. I guess the exception to this observation is when the wheels have fallen off for them. Then, and only then, do they recognize (hopefully) that they are suffering from depression and the toll that it is taking on their lives. The consequences for failing to recognize this basic fact can be serious (loss of productivity at work, sleep problems, etc.) or fatal (middle aged lawyers commit suicide at twice the rate of the national average).

Psychologist, Terrance Real, the author of the book, I Don’t Want to Talk About It: Overcoming the Secret Legacy of Male Depression, makes the observation that we don’t think of men as depressed. This is so because what we are really thinking about is “overt” depression and more women show signs of that – weeping, a willingness to discuss painful feelings, etc. Men suffer from “covert” depression that expresses itself in addiction, isolation, workaholism, isolation and increased irritability.

“Men are just as feelingful, just as relational, just as connected, just as dependent, just as needy, as women are. Men have been coerced since childhood to forego these relational qualities and skills and squeeze their sense of membership and self-esteem through performance. Girls are taught to filter their sense of self-worth through connection to others, and boys are taught to filter their sense of self-worth through performance. That’s a vulnerable foundation for one’s self-worth,” notes Real.

The excellent website, Men Get Depression, says there are three distinctive signs of male depression:

Pain. 
Depression may show up as physical signs like constant headaches, stomach problems, or pain that doesn’t seem to be from other causes or that doesn’t respond to normal treatments.

Risk Taking. 
Sometimes, depressed men will start taking risks like dangerous sports, compulsive gambling, reckless driving, and casual sex.

Anger. 
Anger can show itself in different ways like road rage, having a short temper, being easily upset by criticism, and even violence.

So often, the first symptom that male lawyers notice that they are slipping is in the performance department. One of the symptoms of clinical depression is difficulty concentrating. This leads to problems in getting work out the door. They may try to hide that their work is slipping – ask for extensions, take much longer to do tasks that were simple and routine in the past. If the problem doesn’t go away, some will seek out help – usually through their family doctor (who distribute 80% of the prescriptions in this country for antidepressant medications). Some will go the extra step of seeing a therapist that they can talk with about their problems.

My therapist used to liken my depression to a caveman camping out of his cave. It took a lot to coax me out of there. Men need to come out of their caves into the light of day where the colors are brighter, others can help them and they can get better.

 

 

“I’m Already Getting Help For My Depression: Now What?”

One study found that as many as eighty-percent of all people in this country that suffer from depression don’t get any treatment.

Given that depression is the leading cause of disability in the U.S. and that over 20 million people are afflicted with it, that’s a lot of people – about 16 million.

However, many of the law students, lawyers and judges with depression that I’ve met tell me that they don’t need to be told to get help because there are already getting it. They’re already in therapy, taking medication or both.  They get it.  They know that depression is an illness and they have to deal with it.

Some of them have been coping with it for a very long time.  I call these people “depression veterans”.  I have met many such veterans and their courage and determination to recover and stay well inspires me. As I wrote in a prior blog, these people are really my “heroes”.

I also have met many in the legal biz who say they’re at the end of their rope.  They’ve been in and out of therapy over the years with little or negligible improvement in their depression.   Others have started and stopped a number of antidepressant and/or other mood stabilizing medications tired of to little impact on the mood and too many side effects. But the depression always returns for them.

For most of them, it’s not a relapse into major depression.  Rather, a mild or moderate depression interspersed with fatigue, a lack of pleasure and a glum outlook on life. What they are experiencing is a fact about depression and its course.  That it often a chronic and life-long illness for those so afflicted.

Then there are many who go through long stretches of feeling pretty well most of the time, but still have pockets of depression.

I put myself in this camp.

Most days, my depression, on a scale of “1” through “10” is a 1 or 2, if it’s present at all.  If it gets worse, it’s less often, not as strong and has a much shorter duration is much shorter – maybe a 3 or 4.  This seems to be especially so during the dark days of winter.

What worked for me to reign in the beast of depression was a change in life style, which included regular therapy, medication, a support group, prayer and exercise.  While there is no one thing that is a panacea for depression sufferers, I am convinced that such the positive changes have a direct, lasting an significant alleviation of depression’s worst symptoms.

To make a lifestyle change, I develop a depression “toolkit”.  A game plan that I’ve pretty much stuck to for a number of years. The value of such a toolkit is that it provides a map for us to stay on course.  It gives us a sense of structure and a sense of hope.

If you thinking about how to really recover from depression stay healthy, it’s important to come up with your own depression toolkit.  There are lots of ways to go about it.  The two best examples of depression toolkits I’ve found come from the University at Michigan’s Depression Center and the Depression and Bipolar Support Alliance.

So pick up your pen and start building  your own toolbox today.

Copyright 2014 by Daniel T. Lukasik

 

 

Hope Has The Final Say: A Lawyer Shares His Pain

I made a new friend this week.

A lawyer from down south emailed me.  He had found me through my website. He told me about some terrible and unexpected turns his life had taken recently which had plummeted him into a major depression.

I e-mailed him back and said that I would like to speak with him by phone.

I learned that his drop into the well of depression wasn’t his first experience with this terrible illness. He had gone through a bad episode twenty-five years ago, but since then nothing until his most recent crash.

During our thirty-minute talk, I felt the rawness of his pain in his voice.  I recognized this sound all too well.  It was the pain of depression.

He told me that the only respite he felt was when he fell asleep because it was only in this state of unconscious that he had some relief from the grinding wheels of depression.

I also learned that he was married, a father of four and had worked very hard for over twenty-five years as a lawyer.  He was a Catholic who prayed often. He felt horrible about the pain and anxiety his depression had caused his wife and children.  He told me that he felt comfortable talking with me because I was a lawyer and someone who had been through depression.  As we talked, his voice became a little lighter and his tone a bit more optimistic.

I don’t attribute to anything I did.

Instead, I see it more as a testament to this central truth about life on earth: It is in sharing with one another our stories that we heal.

And I believe that we’re all called to be healers of one another.

And in listening to one another’s stories, we learn that suffering doesn’t have the final say.

And in this truth, we find hope.

Dan’s Latest Top 10 Book Recommendations on Stress, Stress-Management and Anxiety

 

full-catastrophe-living

Over the years, I’ve read too many books to count about stress, anxiety, and depression.  Like most people, I’m always looking for tips and clues about how to handle things better.

Some of these books have turned out to be real stinkers.  Others, retreads of books and articles that have said the same things over and over again.

I have found some gems, though.  Books that have something original to say, or are well-written.

I’ve found that the most useful ones make me want to read them further after the first 25-pages, or so.  Good rule of thumb.

I hope you find help, hope, and insight between their pages.

Manage Your Time to Reduce Your Stress: A Handbook for the Overworked, Overscheduled, and Overwhelmed  — Rita Emmett

The title of this book grabbed my attention because it seemed to capture so much more than just stress management.  Stress management is truly about managing being overworked, overscheduled, and overwhelmed.

According to the author, the key is not time management but “stuff management — taking control of all those tasks to do, people to see, commitments and obligations to fulfill.  Mismanagement of all that “to-do” stuff is what leads to stress.  Emmett combines quick, easy-to-digest tips and infectious good humor to give readers positive ways to handle stress and their overly busy lives.

You can also check out her website for other helpful tips and ideas.

Monkey Mind: A Memoir on Anxiety — Daniel Smith

I first read about Smith’s book in a New York Times article called “Panic Buttons“.  This memoir on stress and anxiety is not only informative and insightful, it’s well-written and funny.

The long list of things that, over the years, have made Daniel Smith nervous includes sex, death, work, water, food, air travel, disease, amateur theater, people he’s related to and people he’s not related to, so the prospect of a book review probably wouldn’t seem like a very big deal to him. Or would it?

This fleet, exhausting memoir, is an attempt to grapple with a lifetime of anxiety: to locate its causes, describe its effects and possibly identify a cure. Or, if not a cure, at least a temporary cessation of the worry that’s been plaguing him since his youth.

Check out his website, The Monkey Mind Chronicles, for more interesting stuff.

Hardwiring Happiness: The New Brain Science of Contentment, Calm, and Confidence — Rick Hanson

Rick Hanson, Ph.D. is a neuropsychologist and best-selling New York Times author.

Hardwiring Happiness lays out a simple method that uses the hidden power of everyday experiences to build new neural structures full of happiness, love, confidence, and peace.

In an interview discussing the book, he states:

“So, how do you get good things—such as resilience, self-worth, or love—into your brain? These inner strengths are grown mainly from positive experiences. Unfortunately, to help our ancestors survive, the brain evolved a negativity bias that makes it less adept at learning from positive experiences but efficient at learning from negative ones. In effect, it’s like Velcro for the bad but Teflon for the good.

This built-in negativity bias makes us extra stressed, worried, irritated, and blue. Plus it creates a kind of bottleneck in the brain that makes it hard to gain any lasting value from our experiences, which is disheartening and the central weakness in personal development, mindfulness training, and psychotherapy”.

Check out his website for more information about the book and his suggestions.

Why Zebras Don’t Get Ulcers: An Updated Guide to Stress, Stress-Related Diseases and Coping – Robert Sapolsky, Ph.D.

Why don’t zebras get ulcers–or heart disease, clinical anxiety, diabetes and other chronic diseases–when people do?

In a fascinating that looks at the science of stress, Stanford biologist Robert Sapolsky presents an intriguing case, that people develop such diseases partly because our bodies aren’t designed for the constant stresses of a modern-day life – – like sitting in daily traffic jams or racing through e-mails, texting and running to pick up our kids after a tough day at work. Rather, humans seem more built for the kind of short-term stress faced by a zebra–like outrunning a lion.

This book is a primer about stress, stress-related disease, and the mechanisms of coping with stress. How is it that our bodies can adapt to some stressful emergencies, while other ones make us sick? Why are some of us especially vulnerable to stress-related diseases and what does that have to do with our personalities?”

Sapolsky, a neuroscientist, concludes with a hopeful chapter, titled “Managing Stress.” Although he doesn’t subscribe to the school of thought that hope cures all disease, Sapolsky highlights the studies that suggest we do have some control over stress-related ailments, based on how we perceive the stress and the kinds of social support we have.

Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness – John Kabat-Zinn, M.D.

As a busy lawyer, I was immediately attracted to the title Full Catastrophe Living. It literally leapt of the bookshelf and cracked me on the head.  Who doesn’t live a life so jammed with stuff to do that it feels like a catastrophe?

Chronic stress saps our energy, undermining our health, and making us more vulnerable to anxiety, depression, and disease.  The heart of the book is based on Kabat-Zinn’s renowned mindfulness-based stress reduction program at the University at Massachusetts Medical Center.

The author takes the phrase “full catastrophe living” from book and movie “Zorba the Greek”.  If you’ve never seen it, an Englishman Basil – – who is half-Greek – – inherits a run down mine in a small Greek town.  To help him restore it, he hires  a local character named Zorba to be the foreman of the local laborers. Zorba, full of the zest of a life truly lived, is asked by Basil, “Do you have a family?” Zorba responds “Wife, children, house – – the full catastrophe!!!”

Undoing Perpetual Stress: The Missing Connection Between Depression, Anxiety and 21st Century Illness – Richard O’Connor, Ph.D.

Author of my favorite book on depression, “Undoing Depression”, Richard O’Connor, Ph.D., has written another simply brilliant book on the consequences of “perpetual” stress in our lives – the alarming and escalating rates of clinical anxiety and depression.   This was the first book I read that made clear to me the connection between stress, anxiety, and depression. It formed the basis for my blog on the topic How Stress and Anxiety Become Depression. The human nervous system was never meant to handle this many stressors. It’s as if the circuit breakers in our brains are blown by too much stress running through our brain’s circuitry.  This book is a perfect fit if you want to learn a lot about the brain and physiology of stress – I found it fascinating.  If you’re looking for a quick read and pick-me-up, this isn’t it.  Check out his website.

A Mindfulness-Based Stress Reduction Workbook — Bob Stahl

The author writes that the key to maintaining balance is responding to stress not with frustration and self-criticism, but with mindful, nonjudgemental awareness of our bodies and minds.

This book employs some of the same mindfulness strategies discussed in Full Catastrophe Living but does it in the format of a workbook.  I find this format very helpful because it’s practical and gives me exercises to do to put into practice mindfulness to reduce my daily stress load.

The 10 Best-Ever Anxiety Management Techniques – Margaret Wehrenberg, Ph.D.

Medication, once considered the treatment of choice, is losing favor as more and more sufferers complain of unpleasant side effects and its temporary, quick-fix nature. Now, thanks to a flood of fresh neurobiology research and insights into the anatomy of the anxious brain, effective, practical strategies have emerged allowing us to manage day-to-day anxiety on our own without medication. Addressing physical, emotional, and behavioral symptoms, Margaret Wehrenberg, Ph.D., a leading mental health clinician, draws on basic brain science to highlight the top ten anxiety-defeating tips. Everything from breathing techniques to cognitive control and self-talk are included.   I really like that the 10 chapters are highly readable and short. Dr. Wehrenberg is also a frequent blogger at the Psychology Today website.  Here’s one of her blogs, The One-Two Punch of Negativity and Fear.

Things Might Go Terribly, Horribly Wrong: A Guide to Life Liberated from Anxiety – Troy DuFrene

This book approaches the problem of anxiety a little differently than most. Instead of trying to help you overcome or reduce feelings of anxiety, it will help you climb inside these feelings, sit in that place, and see what it would be like to have anxiety and still make room in your life to breathe and rest and live, really and truly live, in a way that matters to you.  This approach is based upon a research-supported form of psychotherapy called Acceptance and Commitment Therapy, also known as ACT which starts with the assumption that the normal condition of human existence is suffering and struggle, ACT works by first encouraging individuals to accept their lives as they are in the here and now. This acceptance is an antidote to the problem of avoidance, which ACT views as among the greatest risk factors for unnecessary suffering and poor mental health

The Worry Cure – Robert L. Leahy

For “highly worried people,” or those who suffer from the “what-if disease,” this book presents a systematic, accessible self-help guide to gaining control over debilitating anxiety. Leahy is an expert in changing thought processes, and he walks worriers step-by-step through problems in the way they think, with pointers on how to change these biases. The author then outlines a seven-step worry-reduction plan (remember, I love plans!) beginning with identifying productive and unproductive worry, progressing to improving skills for accepting reality, challenging worried thinking and learning to harness unpleasant emotions such as fear or anger.

Self-Coaching: The Powerful Guide to Beat Anxiety – Joseph J. Luciani, Ph.D.

This is a good book for those who don’t want to see a therapist or, if they do, need extra doses of encouragement and practice to overcome their stress and anxiety. The author advises readers to identify themselves as specific personality types (e.g., “Worrywarts,” “Hedgehogs,” “Perfectionists”) and then gives specific instructions on how to change the particular thought patterns associated with this type of personality.  So many people who struggle with anxiety never got what they needed while growing up – – enough love, encouragement, and affirmation.  Lacking these core experiences, we develop can develop particular maladaptive strategies to cope with people and situations that push our buttons.  This is the only book that I’ve read that pairs specific coping recommendations with particular personality types.

What books would you recommend?  Hit the comment button and submit your favorites.

Next Steps:

If you are interested in talking to Dan about CLE eligible trainings he offers law firms, call him at (716) 913-6309 or via our contact form. One-on-one coaching is also available for lawyers who need individualized attention. Go to Dan’s website Yourdepressioncoach.com to download his free book and schedule a consultation.

 

Why We Can’t Think Our Way Out of Depression

In the book, The Mindful Way through Depression:  Freeing Yourself From Chronic Unhappiness, four experts explain why our usual attempts to “think” our way out of depression or “just snap out of it” lead us deeper into a downward spiral where depression only worsens.  Through insightful lessons (and an included CD with guided meditations) drawn from both Eastern meditative traditions and cognitive therapy, they demonstrate how to sidestep the mental habits that lead to depression, including rumination and self-blame, so that one can face life’s challenges with greater resilience.

spiral

The authors explain how our trying to outthink depression is problematic:

“When depression starts to pull us down, we often react, for very understandable reasons, by trying to get rid of our feelings by suppressing them or by trying to think our way out of them.  In the process we dredge up past regrets and conjure up future worries.  In our heads, we try this solution and that solution, and it doesn’t take long for us to start feeling bad for failing to come up with a way to alleviate the painful emotions we’re feeling.  We get lost in comparisons of where we are versus where we want to be, soon living almost entirely in our heads”

Lawyers, by the nature of our work, are required to live in their heads a lot.  Not only that, our thinking habits are prone to pessimism –we look for problems everywhere and try to fix them.   We are the ultimate “fixers”.  This can get us into trouble, however, if we are prone to or suffer from depression.   The authors point this out:

“Once negative memories, thoughts, and feelings, reactivated by unhappy moods, have forced their way into our consciousness, they produce two major effects. First, naturally enough, they increase our unhappiness, depressing mood even further.  Second, they will bring with them a set of seemingly urgent priorities for what the mind has absolutely got to focus on – our deficiencies and what we can do about them.  It is these priorities that dominate the mind and make it difficult to switch attention to anything else.  Thus we find ourselves compulsively trying over and over to get to the bottom of what is wrong with us as people, or with the way we live our lives, and fix it.”

mindful guy

The author’s solution to this virtual swampland of depression:  mindfulness.  The practice of mindfulness is actually quite simply to do and involves sitting in silence and watching our feelings and thoughts float by the stream of our consciousness.  But instead of taking them literally – that such depressing thoughts and feelings are REALITY – we just detach from them and let them continue to float down the river.  We stop trying to react to these states by stopping our attempts to try to fix them.  We move from a “doing mode” to a “being mode.”  We pay attention to a neutral experience – the in and out sensation of our breath.  When we notice a thought or feeling flowing by and see that we are getting embroiled with it, we let it go and return to our breath.  Check out this great video, “Mindfulness with Jon Kabit-Zinn.”

In “The Zen Path through Depression”, Philip Martin advises us to stop running away from our depression and face it.  It can even provide us with a unique type of experience:

“In depression our back is often against the wall.  Indeed, nothing describes depression so well as that feeling of having nowhere to turn, nothing left to do.  Yet such a place is incredibly ripe, filled with possibility.  It gives us the opportunity to really pay attention and just see what happens.  When we’ve done everything, when nothing we know and believe seems to fit, there is finally the opportunity to see things anew, to look differently at what has become stale and familiar to us.  Sometimes when our back is against the wall, the best thing to do is to sit down and be quiet.”

Part of the quality of our lives, of maintaining ourselves, is learning and growth.  The ongoing pain of our depression is a wakeup call that we need to think about how we typically respond to our depression and how we might respond differently – by moving from a doing to a being mode. This can be achieved with mindfulness meditation.

Copyright, 2013 – Daniel T. Lukasik

 

68 Facts About Clinical Depression

1. To be diagnosed with major depression, you need the following: a depressed mood or a loss of interest or pleasure in daily activities for more than two weeks; mood represents a change from the person’s borderline mood; impaired function: social, occupational and educational.  Then it make a laundry list of specific symptoms. You needed to have five of these nine, present nearly every day: depressed mood nearly every day, decreased interest or pleasure in most activities, significant weight change or change in appetite, change in sleep, change in activity, fatigue, feelings of guilt or worthlessness, difficulty concentrating and thoughts of death or suicide, or has a suicide plan.

battling the blues

2. Roughly 19 million people in the United States suffer from depression every year.

3. At some point in their lives, about one in four Americans will experience depression.

4. Women are twice as likely to suffer from depression than men.

5. People who are depressed are more prone to illnesses like colds than non-depressed people.

6. The main risk factors of depression include past abuse (physical, emotional, sexual), certain medications (drugs that treat high blood pressure), conflict with family members or friends, death or loss, chronic or major illness, and a family history of depression

7. Globally, more than 350 million people of all ages suffer from depression.

8. There are interrelationships between depression and physical health. For example, cardiovascular disease can lead to depression and vice-versa.

9. Depression affects all people regardless of age, geographic location, demographic, or social position.

10. The World Health Organization estimates that depression will be the second highest medical cause of disability by the year 2030, second only to heart disease and it is predicted that depression will soon outstrip heart disease as the leading cause of disability worldwide.

11. Many creative individuals experienced depression, including Ludwig van Beethoven, John Lennon, Edgar Allan Poe, Mark Twain, Abraham Lincoln, Winston Churchill, Georgia O’Keefe, Vincent van Gogh, Ernest Hemmingway, F. Scott Fitzgerald, and Sylvia Plath.

12. Major Depressive Disorder is the leading cause of disability in the U.S. for ages 15-44.

13. While major depressive disorder can develop at any age, the median age at onset is 32.

14. Symptoms of dysthymic disorder (chronic, mild depression) must persist for at least two years in adults (one year in children) to meet criteria for the diagnosis.

15. Dysthymic disorder affects approximately 1.5 percent of the U.S. population age 18 and older in a given year. This figure translates to about 3.3 million American adults.

sad

16. The median age of onset of dysthymic disorder is thirty one.

17. Symptoms of bipolar disorder include wide swings between mania and depression.

18. Bipolar disorder affects approximately 5.7 million American adults, or about 2.6% of the U.S. population age 18 and older in a given year.

19. The median age of onset for bipolar disorders is 25 years.

20. In 2006, 33,300 (approximately 11 per 100,000) people died by suicide in the U.S.

21. Nearly 400,000 people attempt suicide every year in the U.S.

22. Suicide is the sixth leading cause of death in America and more deaths are attributable to suicide than death by handguns.

23. More than 90% of people who kill themselves have a diagnosable mental disorder, most commonly a depressive disorder or a substance abuse disorder.

24. 15% of those who suffer from some form of depression take their lives each year.

25. Four times as many men as women die by suicide; however, women attempt suicide two to three times as often as men.

26. Depression causes people to lose pleasure from daily life, can complicate other medical conditions.

27. Depression can occur to anyone, at any age, and to people of any race or ethnic group.  Depression is never a “normal” part of life, no matter what your age, gender or health situation.

28. Unfortunately, although about 70% of individuals with depression have a full remission of the disorder with effective treatment, fewer than half of those suffering from this illness seek treatment. Too many people resist treatment because they believe depression isn’t serious, that they can treat it themselves or that it is a personal weakness rather than a serious medical illness.

29. “In the last 5 years, American employers have lost over $150 billion of productivity to depression alone. That is more than the GDP of 28 different States during the same period.” – Former Congressman, Patrick Kennedy.

dep face

30. Nearly 30% of people with substance abuse problems also suffer from depression

31. Men typically experience depression differently than women and use different means to cope. For example, while women may feel hopeless, men may feel irritable.  Women may wish to share their suffering, while men may become socially withdrawn or become violent or abusive.

32. Depressed people get colds more than non-depressed people.

33. Freud, who revolutionized the practice of psychiatry with his theories of the unconscious, postulated that depression comes from anger turned inward

34. Researchers have found a direct relationship between depression and the thickening of the lining of the carotid artery in women, a major risk factor for stroke.

35. Sufferers of depression may experience more cognitive impairment on less sunny days than on sunny days.

36. Post-partum depression, or depression after the birth of a child, affects about 10% of new mothers.

37. People with depression are five times more likely to have a breathing-related disorder than non-depressed people.

38. The lifetime risk of developing depression in those born in the decades after WWII is increasing.  The age of onset is becoming increasing younger.  Today the average age for the onset of depression varies between 24-35 years of age, with a mean age of 27.

39. Depressed individuals have a two times great overall mortality risk than the general population due to direct (e.g. suicide) and indirect (medial illness) causes.

40. Seasonal affective disorder (SAD) is the term for depressive periods that are related to a change of season.  SAD is four times more common in women than in men.

41. People with depressive illnesses do not all experience the same symptoms.  The severity, frequency and duration of the symptoms will vary depending on the individual and his or her particular illness.

42. Anxiety disorders often accompany depression.  The anxiety disorder may precede the depression, cause it, and/or be a consequence of it.

43. “Health economists consider depression just as disabling as blindness or paraplegia”. Richard O’Connor, Ph.D.

44. “The cost, in terms of direct treatment, unnecessary medical care, lost productivity, and shortened life span, was estimated at $83 billion dollars a year in the United States alone for the year 2000”.  Richard O’Connor, Ph.D.

45. Only a third of people with long-term depression have even been tried on antidepressants, and only a small number of them have ever had adequate treatment.

black

46. 189 million prescriptions were written for antidepressants alone in 2005.

47. The percentage of adults on antidepressants between 1994 and 2002 tripled.

48. Living in overpopulated areas and taking in too much information (which could, for instance, include being on the inter net too much) are common causes of depression

50. Researchers at New York University established that depression destroys nerve cells in the front part of the cerebral cortex, which is responsible for optimism.

51. 34% of people living with depression reported that first experienced symptoms of depression before age 18. Across the life span, the difference in discernment was a mean of 12 years.

52. 20% of people living with depression reported being diagnosed before age 18. Almost 30% were diagnosed between the ages of 18-29 and 30% between the ages of 40-49.

53. 20% percent of people living with depression reported that they first received psychotherapy or counseling before age 18; 21 percent between ages 19-29; and 18 percent between the ages of 30-39.

54. 14% reported first taking psychiatric medication before age 18; 24% between ages 18-29; and 23% between ages 30 – 39.

55. 60% of people living with depression rely on their primary care physicians for treatment rather than mental health professionals. This has implications for professional education, particularly in prescription and monitoring of medications.

56. 67 % of people living with depression currently use psychiatric medication as their primary treatment compared to 16% who use psychotherapy or counseling as their primary treatment. However, two-thirds use psychotherapy and counseling overall.

57. 35% report being extremely or very satisfied with current treatment; however, a similar amount 33% report dissatisfaction.

58. Alternative strategies are reported to be very helpful. These include prayer, physical exercise, animal therapy, art therapy and yoga.

59. Although only about 20% of people living with depression have used animal therapy, 54% found it “extremely” or “quite a bit” helpful.

60. 5% of people living with depression currently use nutritional or herbal remedies, but of the 27% who have tried them, only 8% have found them very helpful. However, this contrasts with 23% of the caregivers who believed they were helpful for the person in their care.

61. Major depression is 1.5 to 3.0 times more common among first-degree biological relatives of those with the disorder than among the general population.

62. Addictive drugs affect the same areas of the brain involved with depression.

63. Antidepressant medications currently account for $11 billion in drug sales in the US and are the third most commonly prescribed medication.

64. One in ten Americans are on an antidepressant, and this rises to one in five women between 40 and 59.  60% take them for two years or more.

65. 71% of Americans say that they do not know much about depression.

66. 20% of Americans surveyed feel that depression is a personal weakness.

67. 23% of Americans said they would not tell others if a family member were diagnosed with depression.

68. “The term clinical depression finds its way into too many conversations these days.  One has the sense that a catastrophe has occurred in the psychic landscape.”  – Leonard Cohen, songwriter

Leaving Behind Depression

People with depression tend to hide.  They hide their pain.  They hide the truth about their suffering because they fear no one will understand.  So, they hunker down.  They suck it up.  They deal with it.  Millions of Americans do this every day, seven days a week.

What is the alternative?  The polar opposite of hiding seems to be a coming out into the open, a revelation of one’s true self.  This involves vulnerability and trust and not a small measure of courage. But it can be done.  Millions of Americans do this every day, seven days a week.

I know that in my own life, my hiding began in childhood.  Seeking to avoid physical and emotional abuse at the hands of my father, I hid.  I did so to be safe.  Where would I hide?  In the closet behind the hung clothes, the rafters of our garage or the cool and musty basement with the spiders. Sometimes, I would run as fast as I could on summer afternoons into the deep, verdant woods that surrounded my childhood home.  I would lay down in the middle of a pine forest with my dog, surrounded by the trees that were my friends, that were my protectors as they hid me from my raging alcoholic father.

Drifting into adulthood, I didn’t let go of my habit of hiding.  I had learned that others were not safe or just didn’t care.  Like many other depressives, I became a pleaser, an overachiever and a success in my career – all the while hiding a sense of dread that I couldn’t figure out, let alone name.

I now know that I don’t need to hide anymore.  I know that it is okay to be my true self with others I care about: my wonderful wife, my precious daughter, friends who are like brothers and sisters to me.  Not hiding doesn’t always eliminate depression, but I have come to believe that there is a deep healing that takes place in intimacy that no antidepressant on its best day could match.  I have come to believe in the strength and resilience of the human spirit, both mine and others.  We won’t always find love and acceptance when we reach out to others.  But then again, no one does in this imperfect, fragile and beautiful world.  But I do know if we take the risk, if we leave the voices of our childhood that we’re not safe behind, we open ourselves to healing and an end to depression.

 

Don’t Let the Sun Go Down on Me: Seasonal Affective Disorder and Depression During the Winter

There is a distinctive pallor that comes over our world at this time of the year; grey parking lots seem a lot harsher, people wandering into Starbucks this morning a tad glummer. But nothing seems tougher to deal with than a dearth of sunshine.  It feels as though Mother Nature has pulled down the shades and they ain’t coming back up anytime soon.

As I scrape the shellacking of quarter-inch ice off my windshield at 6 a.m. that had built up overnight before I drive into work, I find myself pining for spring, for the sweet smell of the soil bursting back to life.  But most of all, I yearn for the return of more sunny days, to the end of the great ball of light’s hibernation.

“One must maintain a little bit of summer, even in the middle of winter” wrote Henry David Thoreau.  Well, that’s not always easy for those of us stuck in office buildings behind desks.

For some, the lack of sunshine actually causes a type of depression called Seasonal Affective Disorder (SAD); a syndrome of god-awful crummy symptoms that affects about 14 million Americans during the winter. Symptoms of SAD include decreased concentration, increased appetite, weight gain (whereas some other forms of depression can lead to weight loss), social withdrawal, moodiness, and fatigue.

Some people chalk these nagging symptoms up to just being down in the dumps when in reality, SAD is really a form of clinical depression.  SAD is highly dependent on a person’s hormonal state, seasonal characteristics like ambient temperature, and exposure to natural light (which can influence the body’s production of melatonin).  Research has linked the prevalence of SAD to higher latitudes, regions that tend to have more intense and longer winters.   Just great, I thought. I live in Buffalo, New York.

But the lack of sun just doesn’t cause depression in those who might not ordinarily have it.  One study found that a lack of sunshine actually may cloud memory and other thinking functions in some people who already have depression to begin with.   Depressed adults from the least sunny areas were more than twice as likely to have impairments in memory and cognitive functions as those with the greatest sun exposure.  The sunshine-cognition link was not seen in adults without depression, however.

Here are some ideas to start feeling better:

Shake it in the morning.  For those afflicted with SAD, the time of day you work out matters.  Studies show that morning exercisers report better sleep, burn up more calories throughout the day, and have lower blood pressure.  Even if you don’t make it to the gym, just walking outside in the morning can really help.

Avoid the Pit Stop at The Olive Garden.  When I read that white pastas, bagels and bread could lower my mood, I just switched off my computer in protest – I love pasta as much as my mom and there’s no way I can possibly give it up. But I started watching as my mood did dip after consuming a leviathan portion of rigatoni. That’s so because simple carbohydrates – think white flour stuff – give us short-lived every boost, so it’s only a matter of time before we reach for that second helping of cake spackled with butter-cream frosting.  Instead, choose foods rich in protein and complex carbohydrates which release sugar into the body slowly and have a low glycemic index.  Check out foods that will actually help lift your mood.

Fill Up Your Calendar.  I know, I know.  It’s six o’clock and you just pulled in the darkened driveway on a freeze-your-ass-off day and you just want to eat dinner and park yourself in front of the old T.V. Even on weekends.  Yet research shows that people who suffer from depression report higher levels of well-being and satisfaction after positive social interactions.  Feeling a sense of belonging makes us all feel better, but all the more so when you’re feeling down.

Sleepless in Seattle.  Getting less slumber during these darkened days sounds like a crazy prescription for lifting one’s mood.  When we feel down and the world is dark, it seems like more sleep is what’s called for to make us feel better.  Not so say scientists. Instead, it’s very important to maintain a steady rhythm of sleep per night by waking up and going to bed at the same times every day – including weekends.

Light the (Artificial) Light Shine In.  A light therapy regimen can significantly reduce SAD symptoms, regardless of the condition’s severity.  Light therapy boxes range in brightness and type of light, so consult a physician before buying one.

Read Up.  Pick up a copy of Winter Blues by Dr. Norman Rosenthal, the psychiatrist who came up with the SAD term and has studied it extensively.  Check out his very informative website.

They say time heals all things.  If we can hang on just long enough, the days start getting longer and the sunshine becomes more plentiful.  In meanwhile, try these tips to make things more bearable and remember what the French philosopher Albert Camus once wrote,

“In the depth of winter, I finally learned that within me there lay an invincible summer.”

 

The Tunnel of Depression

Depression makes a person’s world very small and narrow.  During a depressive episode, he enters a long tunnel of despair; a dark passageway encasing him in its concrete walls.  If he can see an exit, it is in the far distance, a sliver signifying a long and arduous journey ahead.

The tunnel constricts his vitality, his link to the world which isn’t all doom and gloom; where miracles and beauty and goodness are happen, But he cannot see it, cannot perceive the actuality of such events.  His reactions to these events is often sadness; a despair borne of his inability to feel the happiness of such things.  There is also a sense of hopelessness because the failure to enjoy such things isn’t just temporary.  He feels it’s permanent.  He will never feel the joy of a great vacation, a heart-felt complement or the glow of a child’s sweet face.

As he travels the tunnel, it can close in on him.  He can feel suffocated; that he will die of asphyxiation before he blows out the other side of the tunnel.  His breath feels like it is being sucked out of his lungs.  He just doesn’t have the stamina to continue.  But continue he must, if only on bloodied knees.

As long as you’re on your knees, it might help to pray.  Abraham Lincoln, who suffered from depression his entire life, once wrote:

“I have been driven many times to my knees by the overwhelming conviction that I had nowhere to go.  My own wisdom, and that of all about me, seemed insufficient for the day.”

Lincoln knew all too well the tunnels of depression.  But he kept going, kept persevering.  And you will too.

Flashlights can help us in the tunnel as can wise guides or trusted friends; flashlights of skills about how to deal with depression before we go into the tunnel.  One of the most important skills is the hard-won knowledge that there is a beginning, a middle and end to our depression — even if we don’t feel this is so at the time. A wise guide can be a therapist who can tell us what to expect and not to listen to the howling winds of depression that blow through the tunnel, to ignore the bats of doubt that live in the recesses of the walls.  A trusted friend, can be someone who experiences depression him or herself, but is well enough at the time to walk through the tunnel with you, step by step.

While flashlights don’t light up the whole tunnel, don’t make the depression magically go away, they do provide a beam of concentrated light that burns through that darkness and provides a path, a walkway to an opening that is the end of the experience of a depressive episode.

Often, folks with depression can see the entrance to the tunnel and are heart-struck with a sense of real dread.  Having experienced depression before, they know just how bad the journey will be once they’re through the portal.  But they are pulled, as if from a rope emanating from the dark reaches of the tunnel, into depression.  Attempts to turn around work sometimes.

Sometimes we are strong enough.  Sometimes, we have the strength to override the gravitational pull of the tunnel.

But sometimes we don’t.  And in this sense, it’s confounding.  Because if we can do it sometimes, why can’t we do it all the time?  Maybe that’s part of the mystery of depression.  Because sometimes, even when armed with the best of skills, we still must enter the tunnel of depression.

But we must always remember the bright light that awaits us on the other side.

 

 

Dan’s Top 10 Stress Books

Full Catastrophe Living

Based on Dr. Jon Kabat-Zinn’s renowned mindfulness-based stress reduction program, this book shows you how to use natural, medically proven methods to soothe and heal your body, mind, and spirit. The title?  Oh, that’s from the classic book Zorba the Greek.  Zorba is a Greek full of a salty zest for life.  At one point, his intellectual benefactor asked him, “Zorba, are you married?”  Zorba snorts, “Married? Wife, kids, house . . . the full catastrophe!”  When all of our lives are pulled about by the catastrophe of daily living, we need mindfulness to ground us, we need the deep breathing and quiet to enrich the quiets place in all of us. 

Why Zebras Don’t Get Ulcers

Dr. Robert M. Sapolsky has chapters on how stress affects sleep and addiction, as well as new insights into anxiety and personality disorder and the impact of spirituality on managing stress.
As Sapolsky explains, most of us do not lie awake at night worrying about whether we have leprosy or malaria. Instead, the diseases we fear-and the ones that plague us now-are illnesses brought on by the slow accumulation of damage, such as heart disease and cancer. When we worry or experience stress, our body turns on the same physiological responses that an animal’s does, but we do not resolve conflict in the same way-through fighting or fleeing. Over time, this activation of a stress response makes us literally sick.

Buddha Brain

Jesus, Moses, the Buddha, and other great teachers were born with brains built essentially like anyone else’s, but used their minds to change their brains in ways that changed history. With the new breakthroughs in neuroscience, combined with the insights from thousands of years of contemplative practice, this book shows readers how to have greater emotional balance in turbulent times, as well as healthier relationships, more effective actions, and a deeper religious or spiritual practice. It’s full of practical tools and skills readers can use in daily life to tap the unused potential of the brain and rewire it over time for greater peace and well-being.

Spark

This book offers a fascinating investigation into the transformative effects of exercise on the brain, from the bestselling author and renowned psychiatrist John J. Ratey, MD. Did you know you can beat stress, lift your mood, fight memory loss, sharpen your intellect, and function better than ever simply by elevating your heart rate and breaking a sweat? The evidence is incontrovertible: Aerobic exercise physically remodels our brains for peak performance. This is one of the few books that got me off my ass and into the gym.

How to Train a Wild Elephant

This is a short book and easy to read.  Jan Chozen Bays, M.D., a physician and Zen teacher, has developed a series of simple practices to help us cultivate mindfulness as we go about our ordinary, daily lives. Exercises include: taking three deep breaths before answering the phone, noticing and adjusting your posture throughout the day, eating mindfully, and leaving no trace of yourself after using the kitchen or bathroom. Each exercise is presented with tips on how to remind yourself and a short life lesson connected with it.

The Relaxation and Stress Reduction Workbook

This book details easy, step-by-step techniques for calming the body and mind in an increasingly overstimulated world. It’s based on the latest research, and draws from a variety of proven treatment methods, including progressive relaxation, autogenics, self-hypnosis, visualization, and mindfulness and acceptance therapy. In the first chapter, you’ll explore your own stress triggers and symptoms, and learn how to create a personal plan for stress reduction. Each chapter features a different method for relaxation and stress reduction, explains why the method works, and provides on-the-spot exercises you can do to apply that method when you feel stressed.

Stress-Proof Your Brain

Our brains have evolved powerful tools for coping with threats and danger-but in the face of modern stresses like information overload, money worries, and interpersonal conflicts, our survival reflexes can do more harm than good. To help you adapt your nervous system to the challenges of today’s world, neuropsychologist Dr. Rick Hanson presents Stress-Proof Your Brain. Join him to learn research-based techniques and meditations that will literally re-shape your brain to make you more resilient, confident, and peaceful, including: – How to replace your brain’s unhealthy reactions to stress with protective and self-nurturing responses- Techniques for using memory to soothe and release painful feelings of sadness, guilt, anxiety, inadequacy, or anger – Guided meditations for calming chronic worries, developing gratitude, building inner strength, and more.

Stress Proof Your Life

Stress proof your life is for people who struggle to find time for a shower, much less a bath. The ones who worry that stress is affecting their health and relationships. Or they would worry if they weren’t so knackered. Some people are really good at avoiding some stresses without realizing that they are slaves to another kind. Elisabeth Wilson looks at the sources – occupational, genetic and environmental – and reveals 52 brilliant techniques for creating a stress-free zone. When your batteries are blown and burnout is imminent these top tips can help you regain control.

Getting Things Done

If you’re like me, my biggest source of stress comes from the pressure to get lots of things done everyday.

In Getting Things Done, veteran coach and management consultant David Allen shares the methods for getting things done. Allen’s premise is simple: our productivity is directly proportional to our ability to relax. Only when our minds are clear and our thoughts are organized can we achieve effective productivity and unleash our creative potential* Apply the “do it, delegate it, defer it, drop it” rule to get your in-box to empty.

Upward Spiral

Lawyers help others but take very poor care of themselves. In their quest to max out their earning potential and afford the best material goods our economy has to offer, lawyers lead a narrow, grimly serious existence without emotional rewards. They work inhuman hours yet always feel pressured for time. Since they never stop, breathe, and relax, they are frequently tense, irritable and ready to bark. Author Harvey Hyman, himself a former trial lawyer, gives us the latest science, wit and wisdom in a book I highly recommend.

Stress Management for Lawyers

When you practice law, stress comes with the territory. Such stressors as time pressures, work overload, conflict, and difficult people can rob you of a satisfying career and personal life. It doesn’t have to be that way, however. You can take effective action and this book, written specifically for lawyers, shows you how.

 

Built by Staple Creative