Therapy Archives - Page 3 of 4 - Lawyers With Depression

One Trial Lawyer’s Journey From Severe Depression to Greater Fulfillment

I do not consider myself a lawyer. I am a human being who took on the role and career of a lawyer for 25 years. Unlike some people who entered law school with a burning passion to practice law, I ended up there because I was confused about my career direction and had no career counseling. Stop here. If you don’t feel excitement and joy when thinking about a career my hindsight advice is don’t enter it!

After a couple of years in NYC working for a small firm I quit because I hated following orders due to my anti-authoritarian streak dating back to early childhood. When I left for California I passed the CA bar exam, worked briefly for a solo practitioner, and then opened up my own solo practice. During my first few years I took whatever I could get including cases involving wrongful employment termination, wrongful eviction, workers compensation, and personal injury. I gradually steered my practice completely into plaintiff’s personal injury because I come from a family of physicians and I was truly fascinated by the medical aspects of these cases.

After I while I became rather successful as a lawyer, especially because I had a nose for what made a good case, I enjoyed investigating the facts, I cared about my clients (most of them anyway), and I frequently knew more about the medical/psychological aspects of the client’s injury than the defense. My Achilles heel was my biological tendency toward anxiety and depression which, to my mind, are two sides of the same coin.

Although I got excellent results in my cases I was plagued by fears of failure and so I worked myself to the bone when it came to preparing for depositions, hearings, and trials or opposing motions to compel discovery or obtain summary judgment. Although I was never sued by a client in 25 years I always worried that the innately disgruntled ones who complained about everything in their lives might sue me. So I worked extra hard to make sure their cases turned out well. To put in all these hours I gave up on exercise, sat more, and ate unhealthy, high salt, high sugar foods to give me some compensatory pleasure. Stop. If you are doing these things you will damage your physical and mental health. Our bodies crave outdoor exercise in the fresh air and they crave real food, not the processed crap made in factories.

At the beginning of the 1990s I took on some new challenges. I moved to a larger, more expensive office. I became a homeowner. And, my wife became pregnant with our first child. In the mid-1990s, I developed a bridge phobia, a phobia involving the fear I would fall out of the window of a tall office building, and panicky dread over crime in our neighborhood which seemed to be getting worse every day. To help myself through these irrational fears I became a good friend of Jack Daniels. This nearly led my wife to divorce me. The threat of divorce woke me up like a cold shower. I went to see a psychiatrist who put me on Zoloft and I stopped drinking. Things got better. We had a second child, a son. In the coming years I became a very good father. I adore my kids. They adore me. Both kids are flourishing. This is something I am very proud of.

In the decade between 1995-2005 I handled an increasing number of cases involving traumatic brain injury and made significant income. Initially these cases were very exciting. Over time they became a drag. Why? The defense, which had paid up relatively quickly in the early days, now used scorched earth tactics by hiring experts in human factors, biomechanics, neurology, psychiatry, neuropsychiatry, neuroradiology, etc. I had to hire counter experts in each field and I had to pay to depose every over-priced, hostile defense expert who gave me all their specious reasons why each client was a neurotic, a hysteric or a malingerer.

I felt like Sisyphus, the man condemned by the gods to roll a boulder up a steep hill every day. The litigation costs drained my coffers to the point where I was late on my rent, my copier machine rental, my records fees, and witness fees every month. In the midst of these depressing circumstances my mother suddenly died of a brain virus. And then, one day, my wife noticed we were completely out of money and our home equity lines were maxed out. I instantly plunged into what my psychiatrist called a psychotic depression in which I heard a voice from within me tell me to die over and over again, relentlessly 24/7 until after 4 days of it, I went to a hospital emergency room.

The psychiatrists who cared for me in the hospital told me I had snapped as a result of an inborn vulnerability to depression, years of stress from legal practice, and the trauma of my mother’s death and insolvency. They told me never to return to legal practice. My past 8 years have been a journey back from severe depression and into a new, more fulfilling life. Thanks to a private, own-occupation disability policy I was able to pay my family’s living expenses while recovering.

I researched and wrote my book for lawyers, The Upward Spiral: Getting Lawyers from Daily Misery to Lifetime Wellbeing, on stress and depression while studying and practicing Buddhist meditation. I became ordained as an interfaith chaplain and sat with dying patients at a local hospital. More recently I entered an MS program in mental health counseling at Capella University. I anticipate becoming a Licensed Professional Clinical Counselor at the beginning of 2017. I am finding my studies, practicums, and internships in mental health graduate school to be very meaningful and fulfilling.

Law is a very stressful profession which produces severe depression in one out of every five lawyers. What is my message to my colleagues in the law who suffer depression?

First, face the depression. Do not deny it and self-medicate it with unhealthy substance or behavioral addictions.

Second, try medication. For a depression with obsessive, suicidal rumination (like mine) it can be life-saving.

Third, see a therapist (a psychologist, MFT, counselor or social worker) so you can explore and understand the bio-psychosocial roots of your depression and choose the best form of therapy to resolve your depression.

Fourth, consider couples counseling or family therapy so your spouse and children can understand your depression and have an opportunity to educate you as to how it is affecting them. This can lead to improved understanding, communication, and cooperation at home within the family system.

Fifth, consult experts in nutrition, exercise, and sleep to develop ways for you to eat healthier, exercise more, and sleep better. A wonderful book on these topics is Go Wild by Dr. John Ratey.

Sixth, spend more time in nature because there is nothing better to quiet the mind, ease the sore psyche or restore the spirit.

Seventh, take time to actualize your potential as a unique self through whatever activity calls to you, be it photography, calligraphy, water color painting, baking, cooking, etc.

Good luck. I know you can beat depression and be happier.

Harvey Hyman, J.D. spent 25 successful yet stressful years practicing personal injury law in New York and California. Thanks to an episode of severe depression in 2007, he found happiness and joy that had always eluded him.

No Longer Wanting to Die

From The New York Times, a powerful piece by Will Lippincott who writes, “When depressed, the self-esteem I presented to the world belied just how out of control I felt inside.” Read the News

Previously Depressed People Can Help Us Fight Depression

A new study shows that peer support interventions by a previously depressed person to provide support and guidance to a currently depressed person really helps. Read the Blog

How to Ditch Depression and Get a Life: 8 Ways to Deal with the Black Dog

Here are 8 ways to combat depression in your daily life. Read the Blog

7 Thoughts From a Chronically Unhappy Person

From The New York Times, Diana Spechler writes, “My depression habits include avoiding pain and courting diversion. During every bout of depression, I grasp – at yoga, therapy, medication, romance – and hope that my tiny firefly of pleasure won’t wriggle from the cup of my palms.” Read the News

When Medication Isn’t Helping Your Depression

As many people know all too well, clinical depressions do not always improve after the first attempt at treatment. One in three people with depressions (I’ll explain the plural in a bit) find they have not gotten back to “normal” even after four different courses of standard treatment.

Depression is considered “treatment-resistant” if symptoms have not improved after two or more courses of well-established treatments of a sufficient dose and length of time, whether those treatments are evidence-based medications, psychotherapy, or other therapies that have been proven effective.

That “or more” can be problematic. The longer your depression persists, the greater the risk of financial costs, job loss, family stress, marital problems, and even possible brain changes. That’s why it’s a good idea to discuss a diagnosis of treatment-resistant depression with your practitioner after two failures of treatment. The earlier you address it, the better.

There are a number of reasons why your depression might not respond to a particular treatment. For one thing, there is no single type of depression; there are multiple causes. That is why it is actually most accurate to use the plural term (depressions), and why “one-size treatment” will never fit all.

For another, effective treatments that are not followed cannot work. If a person is not taking the doses of medication as prescribed or doesn’t stick with the recommended treatment, a depressive episode should not be considered “resistant.”

If my depression resists treatment, what are my options?

It’s easy to get discouraged when the treatments you’ve tried haven’t helped you reach recovery. (And remember: Better but not well is not good enough.) Above all, don’t give up hope. Here are some things to consider.

Simply switching from antidepressant to antidepressant may not be useful. As shown in the STAR*D study, the largest American study of treatment-resistant depression, more proactive steps appear to be needed once treatment resistance has developed.
Returning to a medication that worked in a previous depressive episode may be more effective than switching to a new one. If it doesn’t work as promptly as before, remember that it may do the job at a (safe) higher dosage taken for a longer time period.
Give treatments a chance to work. While the typical time frame for good response to a medication is stated as four to six weeks, for many people it can take 8 to 12 weeks to see improvement.
If medications or psychotherapy have been ineffective on their own, consider trying them in combination. Medications plus cognitive behavioral therapy, interpersonal therapy or dialectical behavior therapy traditionally outperform either treatment used alone.
Augmentation of your antidepressant with an adjunct or “add-on” medication, often an atypical antipsychotic, may be helpful if you’ve had partial response to a treatment.
Other “augmentation” agents that pro-vide benefits for some people include nutrition supplements such as Vitamin D, Omega 3, and folate.
Electroconvulsive therapy (ECT), commonly known as shock therapy, has long been stigmatized in popular culture. It is an extremely safe procedure, acts rapidly, can be life-saving, and is sometimes the only effective treatment. It does produce memory problems for some.
Other “neurostimulation” treatments, such as Transcranial Magnetic Stimulation (TMS), are coming into wider use. TMS is a non-invasive procedure that typically can be delivered in about an hour each day in an office setting.

Once you find something that works, don’t change a thing. Just as someone with diabetes requires ongoing treatment, most people who have developed chronic, recurring depression need to continue treatment indefinitely.

By John F. Greden, MD. Dr. Greden has been practicing psychiatry for 35 years. His clinical specialties include treatment-resistant depression and maintenance of wellness. The Rachel Upjohn Professor of Psychiatry and Clinical Neurosciences at the University of Michael Medical School, he is also the founder and executive director of the UM Comprehensive Depression Center (depressioncenter.org) and the founding chair of the National Network of Depression Centers.

Building Your Depression Toolkit

One study found that as many as eighty-percent of all people in this country that suffer from clinical 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 lifestyle, 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.

Regain Motivation With A Depression Action Plan

Everyone feels down at some point in their lives. But if you have major depression (also called major depressive disorder), you likely feel depressed every day for most of the day, especially in the morning. You might wake up and have no energy to get out of bed. And even when you do get up, deciding what to do first can feel like a mountainous task.

At those times of inertia, it’s easy to get discouraged. But giving up the idea of getting anything done can make you feel powerless and perpetuate feeling depressed. Instead, fight back with an action plan that propels you ahead, even when you’d rather lag behind.

Creating a Depression Action Plan

A depression action plan can help take the guesswork out of where to get started each morning. It can also empower you to see just how much you can do, which is important because people with depression tend to compare their current levels of activity to past ones.

“For an action plan to be effective, you first have to understand that major depression is an illness, not a weakness,” says Stephen J. Ferrando, MD, a professor of clinical psychiatry and clinical public health in the department of psychiatry at the New York-Presbyterian/Weill Cornell Medical Center in New York City. Stop comparing yourself to the past. “It’s not your fault you have depression,” he says.

To get started creating an action plan, it’s best to work with your doctor or therapist. “When you’re depressed, it can be difficult to determine where to begin,” says Randy Auerbach, PhD, ABPP, a researcher, an assistant professor in the department of psychiatry at Harvard School of Medicine, and the director of the Child and Adolescent Mood Disorders Laboratory at McLean Hospital in Belmont, Mass. Your doctor or therapist can help you identify both short-term and long-term goals to work toward.

Consider these steps you might want to include in your daily action plan:

Tasks you need to do

Make a list of four or five things you need to get done today, such as work and chores. To avoid getting overwhelmed, break down each goal into small parts. For example, instead of making cleaning the entire house your goal, decide to clean just one room today, says Brian Iacoviello, PhD, an assistant professor of psychiatry at the Icahn School of Medicine at Mount Sinai Hospital in New York City.

Activities you enjoy

If depression has taken the enjoyment out of all activities for you, write down what you once found pleasurable. Working toward doing the things you once enjoyed can help you slowly regain momentum. You can also try adding new activities, such as soothing stress-coping experiences (e.g., meditation, yoga, and tai chi).

Time with your support network

Research shows that a support network is critical for depression recovery. Make plans with friends and family and show up even when you don’t feel like it. It helps to have a friend who will hold you accountable. “Social support can be an enormous ally when you’re in dealing with depression,” Dr. Auerbach says. A local or online depression support group can also be a good resource.

Exercise

In a review published in in 2013 in the American Journal of Preventive Medicine, researchers reported that even low levels of physical activity, such as walking or gardening for 20 to 30 minutes a day, can help ward off depression. If you’ve stopped exercising, set reasonable goals to allow yourself to slowly get to the level of physical activity you want to reach. You might even combine exercise with socializing by picking a workout activity to do with a friend.

Healthy meals

Eating a balanced diet may help alleviate depression symptoms. Include steps in your depression action plan to create healthy meals each day. To maximize benefits, aim for three meals that include whole grains, fresh fruits and vegetables, beans, lentils, nuts, seeds, lean meat, fish, eggs, and low-fat or fat-free diary. Never skip breakfast. Be sure to drink plenty of water because even mild dehydration can affect mood. Limit your alcohol intake.

Medication

If you’re taking medication, include specific times to take it in your depression action plan. Sticking to your prescribed treatment plan is the best way to speed recovery.

Journaling

Your entries can provide insight for you and your doctor or therapist to review together to determine patterns of behavior that may be holding you back from doing everything you want to do. Record behaviors such as what you’re doing, how successful you’re being at doing those things, and what you think about when you’re doing them. Once you’ve identified any negative patterns, you can work with your doctor or therapist on how to let them go.

Rewards

Implement a system of rewards to give yourself when you’ve accomplished a goal in your depression action plan. Self-care activities — such as a massage, a new haircut, a movie, or any other activity that makes you feel good and follows your plan for recovery — make good rewards.

How to Stick to Your Depression Action Plan

When the temptation to do nothing crops up each morning, realize that you’ll have to push yourself to take the first step to get started. Once you do that, know that your level of motivation will likely increase. To stay on track, be sure to schedule activities at specific times so you don’t get overwhelmed about what to do next or how much you have to get done. Post your depression action plan in a visible place, and set up reminders by programming alerts on your phone.

Also, remember that your depression action plan may not follow a straight path. There may be setbacks, and that’s okay — just do your best to keep going. Then at your regular doctor appointments or therapy sessions, you can discuss your progress and work together with your doctor or therapist to identify what may still be getting in your way and figure out what to do to change it.

At the end of each day, focus on what you’ve accomplished instead of what you haven’t. “The greatest challenge for a person with depression is to overcome pessimistic thinking, helplessness, and hopelessness,” Auerbach says. “But with proper treatment and a good action plan, depression can be conquered.”

By Barbara Sadick

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