Unpacking Depression: An Interview with Psychologist Dr. Margaret Wehrenberg

Today’s guest is Dr. Margaret Wehrenberg. Dr. Wehrenberg is a clinical psychologist in Naperville, Illinois. She is the author of six books on the treatment of anxiety and depression published by W.W. Norton, including, “The Ten Best-Ever Depression Management Techniques: Understanding How Your Brain Makes You Depressed and What You Can Do to Change It” and “Anxiety + Depression: Effective Treatment of the Big Two Co-Occurring Disorders.” An international trainer of mental health professionals, Dr. Wehrenberg coaches people with anxiety via the internet and phone. She’s a frequent contributor to the award-winning magazine, Psychotherapy Networker and she blogs on depression for the magazine Psychology Today.

Dan:

What is the difference between sadness and depression and why do people confuse the two so often?

Dr. Wehrenberg:

Because depression comprises sadness. Sadness is a response to a specific situation in which we usually have some kind of loss. The loss of a self-esteem, a loss of a loved one, the loss of a desired goal. Depression is really more about the energy – whether it’s mental energy or physical energy – to make an effective response. So, sadness is an appropriate and transient emotion, but depression sticks around and affects all of our daily behaviors and interactions.

The Depression Journey: Walking the Rocky Trail With a Therapist

 

Diagnosed with major depression by a psychiatrist when I was forty years old, I had to find a therapist who could help me. The physical side of the illness pounded me: sleeplessness, fatigue, and the inability to concentrate and be productive at my job as a lawyer. But also the psychological dimension: feelings of low self-worth, chronic sadness, and negative thoughts about my ability to recover and be happy again.

A friend recommended me to the man who would become my therapist for the next twenty years. Jerry was a psychology professor at a local university. From the Bronx, he has a wonderful, salty sense of humor. Not only was he brilliant, but he was also warm and engaging. I felt at home, and we quickly bonded.

During this dark time in my life, I felt isolated. More often than not, I felt lonely and didn’t know anyone with depression that could understand what I was going through. Jerry did. He became my closest ally, who was with me every step of the way as I dug my way out of the dark cellar of depression. It took time. And patience that was tough to come by as I slogged through depression for years. But his strong and kind presence saw me through. He gave me insight into what depression was and the ruminative, distorted thinking that the disease would churn out. Jerry called this “crooked thinking.” I learned to recognize such thoughts as not part of who I truly was but as part of the illness. It gave me a distance from them and made it easier not to identify with them. This opened up the possibility – and hope – that I could let go of these destructive thoughts and embrace more realistic, positive ones.

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.

You Can Recover From Depression

I am 57 years old. I am a lawyer. And I struggle with depression.

I was diagnosed when I turned forty.  I didn’t know what was happening to me. But I knew something was wrong. I was crying quite a bit.  My sleep became disrupted. It became difficult to concentrate.  I felt no joy in my life.

Ultimately, my family doctor diagnosed me with major depression and provided me with the help I needed. I started going to therapy and was put on anti-depressants. This saved my life.

Since being diagnosed all those years ago, I have learned to live with depression as have many of the 20 million people who are living with this illness right now in this country.

Your Brain on Depression: A Fascinating Interview with Neuroscientist, Dr. Alex Korb

Podcast: Play in new window | Download

 

The following is an edited transcript of the podcast recorded interview with Dr. Alex Korb.  

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 Frisbee 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 anxietymindfulness, physical fitness, and even standup comedy. Welcome to the show.

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

A Depression Drug That Researchers Have Called ‘The Most Important Discovery in Half a Century’ Just Got a Big Lift

Ketamine, which has been called “the most important discovery in half a century,” just got a step closer to becoming the first new depression drug in 35 years.  Johnson & Johnson, one of the pharmaceutical companies pursuing the drug’s fast-acting antidepressant qualities, presented some promising new research on Saturday that could raise the drug’s profile as a potential treatment for the condition.  Read more here.

Recovery from Depression: The Power of Expectation

Recovery from depression depends in part on what you believe is possible for the future. If you are to recover at all, you have to take action at some point. It could be a series of small steps about your daily routine – eating breakfast, walking out the door to get fresh air and natural light, making a point of talking to someone each day.

Or it could be much larger, like going to a psychiatrist and starting treatment, regularly meditating, exercising frequently, taking long walks. Whatever it is, you need to feel motivated to overcome the inertia, to stop the loss of warming energy to the cold stillness of depression.

To feel motivation, you need to believe, however tentatively, that you can change for the better, to expect recovery from the worst symptoms. You’re likely to hit a lot of barriers, though, that make it hard to keep up positive expectations.

When you expect to fail, it often happens that you stop taking action to help yourself recover. The deeply ingrained habits of depressive thinking and belief can quickly take over. You might start making rules and setting goals.

If recovery is not total and permanent, it’s not recovery. Treatments can’t fail, depression relapse can’t happen. You can’t be recovered if you’re still on medication. You have to get better in six months or a year, or some fixed period of time.

Of course, the rules and goals are entirely your invention, but they’re part of the expectations you feel in your gut. If you can’t meet them, the disappointment confirms your deepest conviction that you can never succeed.

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