New York Times Archives - Lawyers With Depression

“Plop, Plop, Fizz, Fizz” – Oh, What a Relief it is? Our Relationship with Antidepressants

Most folks with depression have a complicated relationship with their antidepressant medications.

I certainly do.

While these pills saved my life years ago when major depression struck, years later, I often wonder if I still need to take them, or, if they’re still effective.

If I feel tired and flat on a particular afternoon, is it depression, the side effects of my meds or a jumble of both? Or maybe, it’s just my persistently pensive nature?

I think about this a lot these days – and maybe you do as well.

While the one-two punch of Cymbalta and Lamictal have kept me out of the dungeon of major depression for years, its comes with a cost. I have interludes of passivity, numbness, and fatigue. Maybe a low-grade depression at times, as well. If I ditch the drugs, maybe I will feel more “alive,” I think. I fantasize that cutting my ties with meds could lessen the days lost to the deadening grayness of a medically induced sense of normalcy I sometimes go through.

But I also feel anxiety. If I went cold turkey and lived medication-free, would it end, well, in disaster? A return to the swampland of depression? A deadman’s land if ever there was one. Can I take that chance? Should I?

There’s scary research that suggests once you stop antidepressants that work (or sort-of-work) for you and try to go back on the same ones because being off of them caused your depression to return (or you just couldn’t tolerate the horrible side effects that can come with discontinuation), there’s a good chance they won’t be as effective.

So, what’s a depressed person supposed to do? What should I do?

There are two camps that offer some guidance on this issue. Both have persuasive arguments about why those afflicted should or shouldn’t stay on meds.

The Stay on the Meds Camp

If depression is an “illness,” like diabetes or heart disease, I need these meds to balance out my of whacky neurochemistry. Given my risk factors: a family history of depression (genetics), a crazy childhood with a nutty, abusive and alcoholic father, and a high-pressure job with too much stress, I should stay on the pills.

In his insightful essay in the New York Times, In Defense of Antidepressants, psychiatrist, Peter Kramer, author of the best-selling books, Listening to Prozac and Against Depression, suggest that studies show this: for mild or moderate depression, talk-therapy is as or more effective that medication. But for the Moby Dick sized sucker called Major Depression? Medications are warranted, and, indeed, lifesavers. They help many to function and live productive lives, albeit with a range of mild to more severe side effects.

The Get off the Meds Camp

Some people (including psychiatrists) see meds as the devil’s handiwork: supposed chemical solutions to emotional problems that flat-out don’t work. Many psychiatrists’ (and family doctors who write the overwhelming majority of scripts for these drugs in the U.S.), they maintain, are “pill pushers” who do the bidding of “BigPharma”, a multi-billion dollar industry in this country. Antidepressants aren’t so much a cure as a curse.

Irving Kirsh, Ph.D., author of The Emperor’s New Drugs: Exploding the Antidepressant Myth, writes:

“Putting all [the research] together leads to the conclusion that the relatively small difference between drugs and placebos might not be a real drug effect at all. Instead, it might be an enhanced placebo effect, produced by the fact that some patients have broken [the] blind and have come to realize whether they were given drug or placebo. If this is the case, then there is no real antidepressant drug effect at all. Rather than comparing placebo to drug, we have been comparing ‘regular’ placebos to ‘extra-strength’ placebos.”

The remedy from this group? Psychotherapy. They see depression as the result of off-kiltered, negative thinking patterns. The way out of these ruminative, pessimistic thoughts involves working with a therapist who uses, most often, Cognitive Behavioral Therapy, to challenge and encourage patients to replace such thoughts with more realistic and positive ones.

In his book Undoing Depression: What Therapy Doesn’t Teach You and Medication Can’t Give You, Richard O’Connor, Ph.D. argues that both therapy and medication are effective, but limited in certain respects. He advocates an additional factor often overlooked in depression recovery: our own habits. Unwittingly we get good at depression. We learn how to hide it, how to work around it. We may even achieve great things, but with constant struggle rather than satisfaction. Relying on these methods to make it through each day, we deprive ourselves of true recovery, of deep joy and healthy emotion.

The book teaches us how to replace depressive patterns with a new and more effective set of skills. We already know how to “do” depression-and we can learn how to undo it.

Some Recent News on the Meds and Therapy Conundum

The New York Times reports that a large, multicenter study by Dr. Charles Nemeroff, then a professor of psychiatry at Emory and now at the University of Miami, found that for depressed adults without a history of abuse, there was a clear ranking order of treatment efficacy: Combined psychotherapy (using a form of cognitive behavior therapy) and an antidepressant (in this case, Serzone) was superior to either treatment alone. But for those who had a history of childhood trauma, the results were strikingly different: 48 percent of these patients achieved remission with psychotherapy alone, but only 33 percent of these patients responded to an antidepressant alone. The combination of psychotherapy and a drug was not significantly better than psychotherapy alone.

So what’s a depressed person supposed to do?

I don’t know, really.

We’re in a pickle, aren’t we?

Maybe there’ll be a soon-to-be discovered test that can guide us on precisely what to do. But for now, many of us will stay-the-course and, for better or worse, stick to the “plop, plop, fizz, fix”.

I see myself somewhere in the middle of all this. I’ve never been hospitalized or tried to commit suicide. But I have known depression’s scorching winds, gales that have torn the flesh from my body. I will never forget this pain. It’s scarred me. And I never want to return to it.

If you’re thinking of discontinuing your meds, here’s a great article on how to do it safely.

I welcome your comments about your depression journey with or without medicaton.

Copyright, 2017

by Daniel T. Lukasik

Study: Poor Lawyers Less Miserable Than Rich Ones

A new study published in Georgetown Law Review finds that lawyers working in relatively low paying public-service fields, like public defense or Legal Aid, are more likely to report being happy (and drink less alcohol) than their partner-track counterparts at white shoe firms. Read the News

One-Man Show Casts ‘Brilliant’ Light on Realities of Suicide, Depression

From NPR, imagine going to a small, off-Broadway show that relies heavily on audience participation – and it’s all about suicide depression and suicide. Read the News

Summer On My Mind

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

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

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

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

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

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

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

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

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

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

Here’s to more wrinkles.

Newsweek Gets It Wrong: The Debate About Antidepressants

I yearned to get better; I told myself I was getting better. In fact, the depression was still there, like a powerful undertow. Sometimes it grabbed me, yanked me under; other times, I swam free. – Author, Tracy Thompson.

One study estimates that 19% – – or about 200,000 of this country’s 1 million lawyers – – suffer from depression. This isn’t just some statistic; this is about people – folks who happen to be lawyers for one reason or another.

Just what are these people supposed to do about their depression? Many if not most law students, lawyers and judges that I know have taken or are currently taking antidepressant medications. And they seem to be in the majority of people in this country who do so.

The ranks of the medicated are swelling. The number of Americans taking antidepressants doubled in a decade, from 13.3 million in 1996 to 27 million in 2005. One in ten Americans are prescribed these drugs making them the most prescribed medications in the country. By comparison, 18 million people take Lipitor for high cholesterol.

The biggest reason lawyers take these drugs? Like everyone else, they’re hoping want to feel better, but equally if not more importantly, attorneys want to return to their pre-depression levels of productivity at work. A profession that doesn’t suffer fools well and demands a lot out of mere mortals.

But is medication effective in treating depression and achieving this objective?

Late last week, I was walking down an icy sidewalk minding my own business. I could see the usual cast of characters in my peripheral field of vision; clusters of lawyers yucking it up on their way back from lunch, a judge lost in his own thoughts and a corporate lawyer I know (not particularly well) who once told me privately that he takes antidepressants, his lawyer wife did as well and five other lawyers in his firm did. I guess he felt comfortable telling me this because of my public disclosure about my own struggles. I often feel like a priest in a confessional; I hear about lawyers most private of struggles. Then, like such disclosures never happened, the curtain is opened and we each walk our own ways.

Walking by a newsstand late last week, I noticed the current cover story of Newsweek Magazine which read, “Antidepressants Don’t Work: The Debate Over the Nation’s Most Popular Pills”. The large print seemed to stick a proverbial finger in modern psychiatry’s eyeball and toss the question –along with people who suffer with depression- up in the air.

The article focused on a recent study which concluded antidepressants essentially worked no better than placebos (sugar pills). Oh, just great, I thought. What am I, who have taken medication for the past eight years, supposed to do now? Start popping M & M’s instead of Cymbalta?

The writer of the Newsweek piece concluded

“If placebos can make people feel better, then depression can be treated without drugs that come with serious side effects, not to mentions costs.”

This conclusion is the latest in a long line of recent books leading the charge against the use of medication to treat depression. Charles Barber, in his book Comfortably Numb: How Psychiatry is Medicating a Nation, argues that antidepressants are doled out like Halloween candy in this society. The motive: the big money made by the pharmaceutical industry. This is an appealing take because Big Pharma is commonly portrayed as the villains in the popular press; guys in black hats and white lab coats stuffing greenbacks into their pockets.

In an article written for Salon, Barber wrote:

“One has to wonder: Are we really that miserable? Manipulated might be a better word for the miserable. If we were to pick one factor that explains the dramatically increased number of antidepressants that now runs through our collective bloodstreams, it would be direct-to-consumer advertising, otherwise known as television commercials for drugs.” This point is well taken, but not surprising. Pharmaceutical companies are in the business of making money. Does such a motive make Lipitor any less effective? Should commercials about it deter us from taking this drug? I don’t so.

In fairness to Newsweek, they ran an accompanying piece which tried to give the other side of the coin. It was penned by psychiatrist, Robert Klitzman who framed the question about the study’s conclusions in this way:

“What should we make of the [study]? First, some facts: antidepressants have been shown to work for serious major depression. Most evidence shows they are effective for dysthymia: milder but chronic depression that continues for two years or longer. The question is whether they work for milder depression that may be shorter or less intense. That’s important, since major depression affects almost one out of five people [in this country] at some point in their lives. And most people with depression do not have severe forms of it.”

The response to Newsweek’s take on the study was sharp and quick. In an Op-Ed in the New York Times, Judith Warner wrote this biting retort:

“Happy pills don’t work, the story quickly became, even though, boiled down to that headline, it was neither startling nor particularly true. Yet in all the excitement about ‘startling’ news and ‘sugar pills,’ a more nuanced and truer story about mental health care in America was all but lost. The story begins to take shape when you consider what the new study actually said: Antidepressants do work for very severely depressed people, as well as for those whose mild depression is chronic (dsythymia). However, the researchers found, the pills don’t work for people who aren’t really depressed – people with short-term, minor depression whose problems tend to get better on their own. For many of them, it’s often been observed, merely participating in a drug trial (with its accompanying conversation, education, and emphasis on self-care) can be anti-depressant enough.”

As the article also points out, most people receiving antidepressants aren’t getting them from well-trained psychiatrists, but family doctors who don’t screen well for depression. One wonders how much training they get on how to probably diagnose depression and whether they can keep up on all the research on the topic. The result: we are, in some sense, an overmedicated nation; a country too quick to give sad or unhappy people pills that they shouldn’t be taking and don’t need.

That conclusion, however, does not mean that these medications don’t work for many (though not all) people suffering from true clinical depression. My take is that a family doctor who treats urinary tract infections and constipation shouldn’t be doling out Lexapro to a patient that he has spent 5 minutes with. Perhaps the problem isn’t just pharmaceutical companys bent on making a quick buck, but family doctors under managed care who don’t have any time to spend with patients and don’t know much about depression and the various medications used to treat it.

People feel ashamed and stigmatized by going to psychiatrists, but it could be a game-changer for many: either you don’t have depression and shouldn’t be on medication or you do and you could finally get relief from some of depression’s more devastating symptoms.

There is no doubt that exercise, psychotherapy and some form of community and support will help people whether they are suffering from some transitory upset/sadness in their life (by the way, this helps people with depression too). However, for many people afflicted with clinical depression, it’s unlikely that they will have a real shot at containing or overcoming their depression without short-term or long-term use of medication. They won’t be able to muster the energy, commitment and motivation to engage in the other healthy stuff; to go for a walk, to work out their distorted and negative self-beliefs about themselves with a good therapist or join a support group.

Depression has a terrible undertow; its riptides are often unforgiving. We need as many weapons in our arsenal to deal with it. People with transitory sadness or disappointments don’t need to become patients; they need to connect with other people or change their lives – maybe both. Therapy or just working it out by themselves with supportive friends and family may be all they need.

Walking in Bigger Shoes

Lawyers are an earnest, disciplined bunch. They love evidence – the “show me the money” approach to life. They’re hard-bitten pessimist, yet love the latest self-improvement projects pitched to them by the legal establishment. You know — graphs, charts and the Oprah-like cattle call to “Change Your Life in Five Easy Steps!” The goal of all these books and slogans is Happiness, as if it were a commodity for sale. There was a snappy piece yesterday in the New York Times Review of Books entitled, “The Rap on Happiness.” It’s a great take on this country’s obsession with finding the veritable Oz of bliss.

“The real problem with happiness is neither its pursuers nor their books; its happiness itself. Happiness is like beauty: part of its glory lies in transience. It is deep but often brief (as the poet Robert Frost would have it), and much great prose and poetry make note of this. Frank Kermode wrote, ‘It seems there is sort of a calamity built into the texture of life.’ To hold happiness is to hold understanding that the world passes away from us, that the petals fall and the beloved dies. No amount of mockery, no amount of fashionable scowling will keep any of us from knowing and savoring the pleasure of the sun on our faces or save us from the adult understanding that it cannot last forever.”

Lawyers walk in shoes that are too small for them, living lives that are too confining, unimaginative and which fail to challenge them to be their best. They need to switch from pinching wing-tips to cushy loafers. This switch gives a vital bounce to their steps rather than a lugubrious gait. The opposite of depression isn’t happiness; it’s vitality. It’s like a Swordfish bounding out of the ocean’s waves in defiance of gravity or B.B. King playing a blues riff on his guitar. They have a vibrancy that can’t be contained; they express themselves in a space where great stuff happens.

Part of the equation involves not so much pills or therapy, as the lifting up of our individual imaginations. Putting aside what’s possible in a concrete sense ( you know, the mortgage or student loans), have you ever looked out your office window and imagined the life you’d like to have? This is not the same as rumination; a constant churning of negative thoughts in our cranium which a depressive is prone to.

Rather, it’s an exercise in lively engagement with our Self. To engage in this effort, we have to pop our life’s stick shift out of “Neutral”, the frozen state that depression and/or anxiety can keep us stuck again. Locate the “Drive” on your shift and engage.

In this exercise, it might be helpful to think about the choices we make in a different way. Not in a self-recriminating way, but in a fashion that moves us in a constructive direction. We need to separate the wheat from the chaff in our lives; to decide what reduces or enlarges our spirits. Quality questions can help in regard. Not the common lament of depressives, “What the hell is wrong with me?” That’s a dreary question that goes nowhere because the answer we give ourselves is – – “Everything!” James Hollis, Ph.D., in his wonderful book, “What Matters Most: Living a More Considered Life” offers us a keen approach ourselves to view ourselves:

“Ask yourself of every dilemma, every choice, every relationship, every commitment, or every failure to commit, ‘Does this choice diminish me, or enlarge me?’ Do not ask this question if you are afraid of the answer. You might be afraid of what your soul will require of you, but at least you then know your marching orders.”

Incline your inner ear. Listen to your response to this challenging question. Enlargement of one’s self isn’t so much about happiness, as meaning. Deep down, we all want a life of purpose; where we feel our lives have a point, or many points of light for that matter. You don’t have to look far. It’s right beneath your bouncing feet.

Tag: New York Times