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Coping with Depression

One of the great difficulties these days with contracting a serious illness is that the disease makes us tired, emotional, vulnerable, and uncertain at a time when we most need to be mentally sharp, resourceful and diligent in order to reach out and determine the most effective treatment.

This is especially true with diseases like cancer where it is almost impossible for your doctor to know about which experimental trial might be the best for the patient to try to participate in.  But, it may also be true with a common condition among lawyers, like depression.

In this article, I will try to suggest a few guidelines for treatment for a lawyer suffering from depression, to help a lawyer who is feeling overwhelmed by depression, unable to return phone calls, perhaps may be unable to get out of bed in the morning, but needs to take action to address this debilitating, emotional condition.

First, what is depression?  Depression is a disabling disorder that is clearly much more than the blues or appropriately feeling sad when something sad has occurred.  A diagnosis of depression (which can range from mild to severe) requires a depressed mood or lack of interest in everyday activities for at least two weeks, plus at least four of the following symptoms:  a change in appetite or weight, an inability to sleep or oversleeping, slowed or restless movement, reduced energy, difficulty concentrating or making decisions, feelings of guilt or worthlessness or thoughts of death or suicide.  These symptoms must be severe enough to interfere in the ordinary functioning of life.

Depression can be worsened by other conditions and depression can be simply a symptom of an underlying condition.  Diseases like heart disease, diabetics, cognitive impairments, and thyroid problems can be accompanied by or heighten exciting depression.  Depression is also a primary symptom of alcoholism and other addictive disorders.

What the interplay of addiction with other disorders means is that the starting point for a good treatment is good evaluation of the problem.  Many lawyers are put on anti-depressants by their family doctor or their gynecologist because they appear to have symptoms of depression.  Most lawyers who show up needing help for chemical addiction are also taking anti-depressant medications.  The piecemeal attempt to address symptoms without getting a comprehensive evaluation of the problem is almost always going to result in treatment that is ineffective or not as effective as it could be.

Depression is also like most diseases – the sooner it receives proper medical treatment, the greater the chance of remission and the better the long-term prognosis.  So, if the symptoms mentioned above ring true, start with a good evaluation.  With medicine specialized like it is, this is going to usually require at least two parts.  First, get a good comprehensive physical.  Ascertain if there are any separate conditions, like thyroid or diabetes, that might be causing or contributing to the problem.  Second, see a psychiatrist who is certified by the American Society of Addiction Medicine.  Many psychiatrists who are not trained in addiction medicine are simply unable to pick up this problem and because of the self-deceptive nature of addiction, the patient is usually of little help.  Similarly, many physicians who prescribe anti-depressants, but are not trained as psychiatrists, are simply not experienced in the trial and error sodalities of being able to prescribe appropriately for a patient with depression who needs neuropharmacological treatment.

The next step for a patient with depression is do not simply address your problem with medication. Medication can be a real godsend for some patients, but for many depressed patients, only taking medication may be a way to believe one is addressing the condition; while in reality, you are addressing it only partly or in the most inadequate way.

Most lawyers and nearly 60% of the population generally that use anti-depressants, say that they haven’t had counseling along with medication.  Dr. David Burns, a psychiatrist on the faculty at Stanford, started his career as a neuropharmacologist, trying to figure out how to address mental disorders with medications.  Eventually he came to believe that medications for depression were not nearly as effective as new therapeutic techniques.  He switched the focus of his work to clinical practice and has been a leader in the field of cognitive behavioral therapy.  The underlying premise of cognitive behavioral therapy is that if you change the way you think; you can change the way you feel.  What Dr. Burns and others like him have discovered is that underlying most depressive states are negative thoughts and beliefs that are not true, but are the reason one feels bad.  For lawyers this is particularly difficult because we disassociate our beliefs from our feeling states and rationalize that one does not affect the other.  Dr. Burns says that today most of his patients who show up with depression and are treated by him with cognitive behavioral therapy are symptom free after eight to twelve sessions.  Cognitive behavioral therapy is about the most difficult therapy for a therapist to do well.  The key for lawyers is finding a therapist who is expert at this modality that is a good match for you.

Medication and therapy are not the only parts of a comprehensive treatment of depression.

Exercise is extremely important.  A study done at Duke showed that regular exercise was just as effective as taking anti-depressant medication at easing the symptom of depression.  Exercise appears to help alleviate depression by increasing levels of seratonin and it is also one of the most effective ways to dissipate the buildup in the body of negative chemical agents created by stress.

Diet is another important part of any treatment program.  Alcohol, caffeine, and sugar may all give temporary highs, but they all can worsen depression.  Avoid food and beverages that contain them.  Avoid just eating cereal for breakfast.  Be sure you get adequate protein in the morning so you don’t have a decrease in blood sugar mid-morning.

Social support is a simple but powerful weapon against depression.  Participate on a weekly basis with others to whom you can talk openly and frankly about who you are and the issues that depression is causing in your life.  Twelve-step groups such as Emotions Anonymous or Depression Anonymous may be particularly helpful.  In certain areas of the state, the Lawyer Assistance Program facilitates support groups to lawyers with depression because this aspect of addressing the disorder can be so life changing.

In summary, if you believe you might be dealing with depression, here are guidelines for an integrative approach:

1)      Address the issue sooner rather than later.

2)      Get a good physical exam by your physician and a good emotional exam by an ASAM certified psychiatrist.

3)      If medication is indicated, don’t use it as the sole response to this disorder.

4)      Get good counseling, particularly utilize cognitive behavioral therapy.

5)      Exercise on a regular basis

6)      Utilize good nutrition

7)      Participate in a self-help program of social support.

These things are not hard to do; in fact, most are a part of any program of good health, but most often they have been neglected and their neglect is part of what has led to the depression.

– by Don Carroll

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