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.

 

 

 

 

 

Finding Meaning in the Legal Profession:An Interview with Dr James Hollis

This is my interview with psychoanalyst, James Hollis, Ph.D., author of the best-selling books, “What Matters Most: Living a More Considered Life,” and “Finding Meaning in the Second Half of Life: How to Finally, Really Grow Up

Dan:  What is depression?

Jim:   I think first of all we have to differentiate between depressions because it‘s a blanket term which is used to describe many different experiences, different contexts and different internalized experiences of people.  First of all, there is the kind of depression that is driven by biological sources and it is still a mystery as to how that works.  We know it affects a certain number of people in profound ways.   Second, there is reactive depression which is the experience of a person who has suffered loss and as we invest energy in a relationship or a situation and for whatever reason, that other is taken away from us, that energy that was attached to him will invert as depression.  Reactive depression is actually normal.

We would have to figure out where that fine line is and where it might cross over into something that was more than normal.  When we say that a person is grieving too long or it is affecting their lives so profoundly, that’s a judgment call, of course, but we do know people that have been sort of destroyed by reactive depression because they had attached so much of their identity to the other, whatever it might be: a position in life that they lost or a relationship that was important.

But I think none of us can avoid occasional reactive depressions because life is a series of attachments and losses.  Most commonly, when we think about depression, however,

Dealing With Negative Emotions at Work

We seem to really get a kick out of complaining about work. We hover around the water cooler, confide in our friends, and even share our workplace horror stories with our spouses.

But recounting all the things that made us miserable one day doesn’t help us enjoy our workday more tomorrow. A better strategy is to actually address the negative feelings we have.

When annoyance, self-doubt, or the blues surface at work, we can learn to work through these feelings. Here are three emotion regulation strategies you can use—and how to put them into practice for a happier work life.

  1. Mindful acceptance: Let the things you cannot change be.

Negative emotions exist. Pushing them away or ignoring them does more harm than good, even if we might be tempted to do so.

Instead, try acknowledging your emotions and giving them a seat at the table. Maybe you feel bad because your boss plays favorites—and you’re not the favorite. Or maybe you’re frustrated because your teammates are always running late. It’s okay to feel these negative emotions. You don’t need to judge yourself.

To learn how to practice acceptance at work, start at home by writing out a list of the things you can and cannot control. First, focus on the things you cannot control. Let any emotions you have rise to the surface. Work on accepting these emotions, and yourself, just as you are—saying things like, “I am angry that I didn’t get a promotion, but that’s okay. I am allowed to feel angry.” Experience these emotions, but don’t hold on to them or ruminate on the causes. Just let them fade in their own time.

A word of caution: You might be better served by actually changing your situation if you have the ability to do so, rather than accepting an abusive boss or unhealthy work environment. Use that list of things you can control to take action.

  1. Self-distancing: Observe your situation like a fly on the wall.

We all experience unpleasant situations, especially at work. You may ruminate about a meeting that went poorly, a coworker who slighted you, or a lack of acknowledgment for a project you poured your heart into. But the longer you feel bad, the more that bad feeling compounds.

To calm these negative emotions, mentally removing yourself from the situation is a helpful trick. Research suggests that a more distanced, third-party perspective can reduce the intensity of the negative emotions you feel. To try it, imagine that you’re a fly on the wall, observing your situation. How do you see the situation? How do both people look—you and the other person? By cultivating a broader perspective, you’ll often discover that the situation is not as bad as you thought it was.

A word of caution: Be careful not to mentally remove yourself from the situation permanently. There are many benefits to staying mindfully present for your work life.

  1. Reappraisal: Find the positives in negative situations.

Finding the positive in negative situations is an especially useful regulation strategy when something happens at work that you judge to be undesirable.

To begin to change your perspective, learn to pause in the face of something negative and think of or write down at least one positive. For example, did you get critical feedback on a recent presentation you gave or a report you wrote? Might you reappraise this as helpful information for your career growth—an opportunity to learn how to do better next time? The more frequently you challenge yourself to find the positives, the easier it will be for your brain to start noticing them on its own.

By Tchiki Davis, Ph.D.

Tchiki is a consultant, writer, and expert on well-being technology. Over more than a decade, she has helped build happiness products, programs, and services for non-profit and for-profit businesses, for children and adults, and for online as well as in-person audiences. Tchiki is currently working with Silicon Valley tech companies and UC Berkeley’s Greater Good Science Center to build more effective well-being technologies.

 

 

The Link Between Disorganization, Depression and Anxiety

Although it appears to be a mundane sort of thing, I find disorganization and chaos to be one of the biggest problems reported by depressed and anxious individuals. Emotional baggage has a way of building up and then expressing itself in an outward display of turmoil — as if a tornado had let loose in your brain and your surroundings.

The symptoms of feeling overwhelmed and not wanting to face the day often stem from not knowing where to start or not wanting to face the mountain of tasks that lay ahead.  I have found folks to be so bogged down with even the everyday task of leaving the house on time that their entire day is a mess before they ever get started. By 8 am they are frazzled.

There are screaming children, pets that need walking, work begins at a certain time, the laundry isn’t done, and available clothing is something picked out of the bin from the week before that didn’t make it to the dry cleaner.  Stress chemicals are running rampant, and irritability and panic set in as well as resentment of the household, job, family and everything else.

What is worse is that typically if disorganization is a problem at home it is a problem at work as well. A cluttered desk, half-finished tasks, and unmet deadlines are the career version of the problem and are also with you all day.

Does your automobile look like a homeless person’s shopping cart?  If so, none of your major environments is peaceful. There is nothing pleasant about your surroundings, and this is a major stressor.

The problem is not that you have too much to do or work full time, it is that you have not found a routine and effective organizational plan, or you found one but are not consistent in following the plan.

Running around willy-nilly, being chronically late, never being able to find things, and having a dirty or sloppy house are stressful conditions and contribute to the anxiety depression cycle. Things scattered about affect your ability to concentrate, and irritability sets in if not outright anger.

Simply put, the stress chemicals from disorganization eat up the good chemicals needed for mood stabilization. With that process in effect, you feel depressed and overwhelmed.

Look around your house. It should be your sanctuary, not a hell-hole screaming your name to come clean it.  The house and time management issues are all about the planning and execution of a schedule and routine. If something is not getting done or is causing you distress in the household it is because you have not found the right system for you.

Very simply, a place for everything and everything in its place is a good saying to live by. Think of the simplicity of that statement. Yet this is the biggest bug-a-boo I see, not knowing where you left your car keys, clothing, sports equipment, checkbook, you name it.

We often allow our emotional state to dictate these sorts of practical matters. “I am so depressed I don’t care what the house looks like.” “I am so nervous I can’t concentrate.” “I am so ADD (Attention Deficit Disorder), I will never be able to organize myself.” It does not matter if you are depressed or anxious, your house and time need streamlining, and with that will come an improvement in your symptoms. You will feel an immediate shift just from the empowerment and taking control of your life. If you really are ADD then organization and time management are the very set of skills that you need.

Getting Started

To get started take an inventory of the areas where you need organizing. Maybe there is just one area out of control or maybe the entire place needs an overhaul. Either way, it can get done and not be overwhelming by breaking it down into sections and tasks. The major areas that cause disruption are your house, car, purse or wallet, finances, and paperwork.

I am now going to take you through a general plan that you can begin to institute immediately.

  1. Get out a pad of paper and look around. Jot down room by room what the major problems are such as laundry everywhere, kid’s toys, and paper clutter. Where are the major stressors?
  2. Now go to where these items would ideally reside. Is there enough room for them all to be put away at once? Do you need to get rid of some of it or do you need more space or better organization of it? If you have enough space, then it is probably more a problem of time management and routine. If there isn’t enough space, you may be keeping too much stuff or just not have the proper storage solutions.
  3. List all chores that require travel such as groceries and dry-cleaning. Can you do those on your way home from work? Can you do them all at once in order to be more efficient rather than make multiple trips?
  4. Think through your morning routine, this is usually where the day starts to go downhill. How much time do you need to get yourself ready? Pets? Kids? Breakfast? Pick up your house before you leave so as not to come home to a depressing mess. If you have a family, I suggest getting up 2 hours prior to when you need to leave or when they need to be out the door. This gives you time to get ready, get them up and ready, prepare and have breakfast as a family, and squeeze in a 30-minute walk or exercise of some sort. In order to do this, you will need to have already planned the night before for things such as:
  • Lunches
  • Clothing
  • Homework
  • Projects of your own
  • List of priorities for the day, knowing exactly where to focus your energies on any given day
  • Gas in the car

Now think through your evening routine. How do you get the above things done? Is there too much stuff in your evenings? Maybe the kids are in too many activities or you need help getting them around. Are you eating healthy food at night? Are you eating too late and not cleaning up because you are exhausted? Then you have to get up to a mess and again it’s all downhill from there. Remember you are in control of your schedule and your life, and sometimes too much is just too much. Even though you are trying to provide a quality of life by having many activities available for your family, it is not a quality of life if you are depressed and agitated and the house is a mess and you are eating takeout every night. Think about the memories you are creating.

Now you should have an idea of where the problem areas are and where your time is being utilized. Here are some general guidelines that will make a world of difference immediately if you put them to work for you.

House

  1. Keep dishes and plates put away all the time, fill dishwasher after every meal.
  2. Do a good cleaning once a week. Enlist the family, including children, to help especially in their own rooms. Many people feel guilty making their children learn chores but there is nothing to feel guilty about. They are simply participating in the household and will have to run their own households someday. If they learn now they will not have to struggle with these issues later.
  3. Keep money matters in one place as well as files for all your important papers and issues such as credit card information, taxes, medical, legal, travel, etc.… It is very nice to be able to put your hands right on something the minute you want it.
  4. A place for everything and everything in its place. It’s really that simple.
  5. Go with a schedule for cleaning, weekly daily, monthly and seasonally. Then stick to it.

Car

Does your car look like you live in it? This too is very stressful and carries chaos from your home into your driving. You will be more distracted and harried while driving if your car is a mess.

  1. Clean it out daily from anything you may have eaten, wrappers, coffee cups and work-related papers.
  2. Wipe console free of dust and grime with a wipe made for this to free your view of dirt.
  3. Take it to the car wash once a week if finances permit or at least every other week. Allow them to vacuum it and wipe it down.
  4. Each child riding in the car is responsible for his or her own seat area if old enough.
  5. Dog nose prints on window wiped off daily.

Purse/Wallet

Another war zone, filled with extra papers, bunched up money, cough drops, candy with dirt embedded in a wrapper, year-old receipts, hair items and cosmetics. This is a virtual dumping ground of things we collect daily. None of them should be here.

Go through all purses and wallets, and take out all junk. If you use multiple purses clean out one per day until they are all done.

Vacuum or wipe out purses as you go.

I know these things sound very simplistic and not the topic you might think to bring to a psychologist. But I really can’t tell you the number of times that I have seen clients experience great relief from their symptoms of depression, anxiety, and anger just from taking control of their life routines and belongings. It frees up your time for more constructive thinking, planning and daydreaming!

There are many books, as well as internet resources, pertaining to organization and time management. If this is an issue for you, begin reading one today! It’s never too soon to start, and you won’t believe how just 15 minutes a day dedicated to organizing your home can make you feel better fast!

About Audrey Sherman, Ph.D.

Sherman is a psychologist, speaker and author of the book Dysfunction Interrupted-How to Quickly Overcome Depression, Anxiety and Anger Starting Now. She has been working with individuals and families for over 20 years and her expertise is in helping others to overcome the emotional baggage that keeps them stuck in unhappy and unproductive relationships, jobs and more. She currently works with clients in person or via Skype or telephone. To learn more about Dr. Sherman, her book, and workshops you can visit her website, PsychSkills.com.

 

 

Emotion Rules When There is Depression

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

Pexels

“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.

 

Some Law Schools Take The Lead in Students’ Well-Being, Report Finds

The National Task Force on Lawyer Well-Being said in a report released earlier this week that law schools must change their cultures so that everyone—professors, administrators, and students—takes responsibility for student well-being. The report, issued by a coalition of groups including the American Bar Association and the Association of Professional Responsibility Lawyers, stems from a groundbreaking study published last year showing that more than 40 percent of students felt they needed mental-health help and a quarter were at risk for problem drinking. Read the rest of the story here.

‘Better Call Saul’ Highlights Stress and Mental Illness in the Legal Profession

The ABA Journal reports: “Chuck McGill’s suicide in Better Call Saul reflects what is happening within the legal profession throughout the United States. But anxiety and depression are not confined to practicing lawyers. A study of law school students at Yale University found that 70 percent admitted to suffering from some form of mental health issues. Eighty percent of those respondents considered help, but only half of them actually sought it out. Read the article.

 

The Strategies That Science Actually Shows Are Effective for Depression

From Forbes, Alice C. Walton writes, “And as most people who have dealt with depression know, good treatments are hard to come by—but they do exist. Part of the issue is that a given treatment may work for one person and not the other, and it may take several tries before the right therapy, or a combination of therapies, is arrived upon. Here are some of the methods that have been shown to work, and are worth considering. As always, finding a therapist you trust and connect with is often the first step to figuring out which route to take.” Read the rest of her article here.

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