A New York Times article from a few weeks ago holds enormous potential ramifications for lawyers bent over their desks at big law firms. The tentative conclusion of the piece was simple: if you are dealing with minor depression, or in fact, with anything other than massive, serious depression, popping anti-depressant pills is probably a waste of time. In fact, a placebo might do you more good.
How many lawyers are currently taking anti-depressants? According to the admittedly anecdotal evidence from the lawyers I’ve seen over the years in my private practice, quite a few.
It’s such a lawyerly thing to do. You figure out you’re depressed, so you do something about it – march over to your doctor, or maybe a high-powered shrink with a top reputation, get diagnosed, and get your pills. The whole thing takes a few minutes, and you’re back on the job. No wasting billable hours, no whining and complaining on a therapist’s couch – you take care of the problem and move on. Take a pill and knock it off with the martyr routine.
However, there are a few problems with anti-depressants…
First, like I said, they might not work. Don’t believe me? Here’s an excerpt from the article:
Some widely prescribed drugs for depression provide relief in extreme cases but are no more effective than placebo pills for most patients, according to a new analysis released Tuesday.
The findings could help settle a longstanding debate about antidepressants. While the study does not imply that the drugs are worthless for anyone with moderate to serious depression — many such people do seem to benefit — it does provide one likely explanation for the sharp disagreement among experts about the drugs’ overall effectiveness.
Second, the side-effects. This includes the “sexual side-effects” – which might mean, if you’re a guy, erectile dysfunction, and whichever gender you are, inability to reach orgasm. And there are “regular” side effects, too – like weight gain.
Third, anti-depressants only work while you’re on them. I’ve heard of people staying on anti-depressants for decades, but I have no idea what the long-term effects are because no one knows. If you’d like to experiment on yourself, I’m sure the pharmaceutical industry would be fascinated to find out.
Fourth, to the extent they do work, it’s by erasing feelings. Anti-depressants tend to narrow the bandwidth of what you feel, chopping off the top and the bottom – no more highs, no more lows. That can bring relief, but at a cost.
Fifth, other than the vague explanation that they “affect neurotransmitter levels,” no one really understands how they work. Anti-depressant medications, especially the new generation of drugs, are a relatively recent development, and the exact mechanism that produces the results isn’t fully understood.
Is there another option?
Some lawyers are skeptics when it comes to psychotherapy.
I’ll quote from a comment on AboveTheLaw.com from one of my earlier posts:
This guy [The People’s Therapist] gives me even more reason to think that therapists are disgusting creepy slimeballs. They think that they somehow have this unbelievable god-like ability to get inside your mind and make everything all better. They have all the answers, if you’ll just let them in. Gross. These people are god-complex freaks. Would never go to a therapist, ever.
Well…okay. A good therapist welcomes authentic feeling.
And maybe this writer’s got a point. Even if pills aren’t the answer – why would anyone want to visit a slimeball like me?
The short answer is that, while no psychotherapist has a god-like ability to get inside your mind, if he’s properly trained, he will know what he’s doing, and he can help. Psychotherapy is an effective treatment, especially for depression.
Depression is caused by bottled anger. If you are a depressed patient, a psychotherapist will use interventions with you designed to encourage you to talk, and keep talking, in a way that expresses that bottled anger. Before long – I guarantee it – you’ll see affect restored, and a more authentic, happier self emerge.
Just feeling the right to express emotions you didn’t realize you were holding inside can have a strong healing effect.
It’s not a pill, like in Alice in Wonderland or The Matrix. But psychotherapy doesn’t have to take forever, and you’ll probably feel better after the first session.
So ask yourself why you’re so distrustful of someone whose job is to listen to you and actually hear what you’re saying. Would that really be so bad?
Maybe no one’s ever done it before – so you don’t trust anyone ever could.
That’s understandable. It’s something you could work on in therapy.
[Editor’s note: this piece is part of a series of columns created by The People’s Therapist in cooperation with AboveTheLaw.com. My thanks to ATL for their help with the creation of this series.]
If you enjoy these columns, please check out The People’s Therapist’s new book.
The People's Therapist 
Medication is a choice that is personal, made between doctor and patient on an individual basis; blanket statements about who should or shouldn’t take them are generally dangerous.
I think of my therapist as a kind of metaphorical tour guide; I pick the destination, his experience guides me to where I need to go, and because my experiences are unique to me, he goes on the trip too or else he’s just charge me and give me a map. For my therapy to work Will I have to be a good patient, I have to do the work, not expect that because I have a willing and competent therapist to heel me that all will be OK. I think you will agree, all the pills and therapy in the world will not resolve anything if I don’t participate fully in the process.
I’m concerned about the degree of harm this position might cause individuals. There are certainly people on medication who don’t need to be (or at least I’m willing to indulge the assumption). But suggesting that medication is unnecessary and ineffective for some people is dangerous. I’ll acknowledge that I’m biased. But I will be the first – and probably not only – person to admit that a good anti-depressant has saved my life. I’ve worked in conjunction with a therapist. And the fact that my brother, uncle, mother, and grandmother have similarly been on anti-depressants for a period of time suggests to me that there might be something biological going on. Of course, there’s family structure and an assortment of other issues. But are you really disputing the biological component to the illness?
I’m not denying the benefits of therapy in the slightest. But depression is an illness–presumably you’ll acknowledge that reality? And like many illnesses, there are a variety of effective treatments. For some people (I can’t quantify that), medication is necessary. I don’t like it. I’d rather be medication free. But my brain doesn’t work properly when I am.
Certainly, some people need to be on medication for mental illness – I do not dispute that. For example, I work with several patients suffering from bipolar disorder for whom mood-stabilizing medication is an absolute necessity, and it has been a godsend for them. But for most of us, with minor depression, my concern is that the drug companies are pushing these drugs – and discouraging psychotherapy – and that isn’t helping anyone.
I’m all for the healthy diet, plenty of exercise, socializing and some sort of spiritual practice approach. Sounds good to me! But for most of us, psychotherapy will be an important part of any effective regime to control depression.
As to whether depression is an illness, or genetic or “chemical” – it may be all of those things. Depression is a harmful condition, we all exist as the result of DNA, and our brains are a mass of chemical reactions. But whatever the case, depression manifests itself as bottled anger – and taking that anger to an appropriate place, and putting it into words instead of acting out on it, is essential to recovery.
As for the “I’m not a doctor” charge – I’m not a doctor. I wrote an entire post about that, titled “Doctor? Fortune teller? Svengali voodoo Taoist shaman priest?” Please give it a read. I do work closely with colleagues who are psychiatrists, and I do recommend a psychopharm consultation when I think it is advisable.
Just found your site and I love it. I agree with you about minor depression, but I think it’s wise to consider adding a caveat (in addition to bipoloar disorder, etc.), that people with chronic and severe depression, who are suicidal, probably need to see a therapist AND take anti-depressants, at least in the short-term. Therapy is important, but it’s hard to devote yourself to it when you’re consumed with thoughts about flying off the Golden Gate Bridge. Trust me.
After my screwing by the university I went through 6 years of various levels of depression. Sometimes it was not too bad and I felt relatively hopeful. Other times I wanted to die and yet avoided walking over high bridges (ambivalence–I didn’t REALLY want to die, I wanted the misery to die). I tried various therapists, some more helpful than others, and various Rxs. I also had a great friend who was studying (and became) a psychiatric nurse practitioner and provided me with lots of other options he found through his schooling and research. The other approaches have always been more successful than meds.
His Tx plan:
Exercise every day
Socialize
Fruits, vegetables, water
Spiritual practice
So I joined a gym (cheaper than meds or a therapist for the self-insured), joined meet-up groups (and even went to a 12 step meeting or two when I felt particularly shitty), got up every day and showered and dressed, talked to people, ate healthier, and re-started meditation.
One problem I found with meds is the way you can get accustomed to feeling nothing. Whether it’s self-medication with alcohol or illegal drugs or prescribed meds–feeling fuzzy and foggy becomes the norm.
I totally see both sides of the coin here. I had a BIG problem with sleep deprivation, which my doctor diagnosed as depression and gave me meds in college. No talk of therapy – just take the pill and get out. Once I got out of hyper over-achiever mode and started to sleep for more than three hours a night, I suddenly got dramatically better and stopped taking the meds.
I did try a therapist – two, actually, after a cruel breakup by a long term boufriend. One was convinced I had to be suicidial based on what he did (I wasn’t) and wanted me on LOTS of meds. The other spent more time trying to talk about aberrant sexual behavior (completely out of the blue). Needless to say, I found trouble opening up to either and gave up trying to find someone – especially since my insurance majorly limits my options.
One thing I have found is that being on Paxil/Xanax for a few years seems to have permanently messed up parts of my mind. I no longer feel completely numb like I did while on the meds, but I don’t really feel highs or lows before. Part of that probably is that my life is brief writing – and how many highs or lows can you feel doing that?
Compared to the other attorneys I work with, I’m remarkably “normal.” I don’t drink. I don’t do drugs. I don’t have odd tics or obsessive behaviors (like the girl next door who touches every corner of her screen when she saves her work).
Maybe people who want to become attorneys are slightly nutty. And maybe we become nutty from our soul-sucking jobs.
If you acknowledge that you’re not a doctor — and there’s nothing wrong with practicing psychotherapy with an MSW — why title your bio (above right) “the doctor is in”? It’s misleading at best.
It was meant to be a joke – a reference to Lucy’s psychiatric booth in the Peanuts cartoons. My sister-in-law loves Peanuts. It should be pretty clear from my degrees and everything else, that I’m not a doctor – I’m a licensed, registered NYS LMSW psychotherapist. I would change the site…but it’s a little hard to believe anyone could be misled by a jokey sidebar. My credentials are very clearly stated.
On the other hand, I could be a medical doctor and have no idea how to do psychotherapy (like most medical doctors.) Try doing a therapy session with your allergist and see how that works out for you.
Thanks, I’ll stick to my own psychotherapist. I thought that it might be a Peanuts reference, but you should probably still change it. Are the bio bromides (“This is your space, too, and psychotherapy is experiential. Let’s relate and explore together. Tell me about your feelings.”) also meant to be jokes?
They’re meant to balance the light-hearted with the serious – just as I do in my office. In my work, I can deal with some pretty heavy stuff – but there’s also room for a smile, occasionally.
Will,
As a lawyer with a dilettante’s interest in psychoanalysis, I really like your thoughts on lawyers and psychotherapy. Would you consider making this a regular feature of your site, or perhaps starting a parallel blog devoted to that?
And by the way, judging by the experiences of some of my law school classmates, the real issue with lawyers and pill-popping isn’t anti-depressants: it’s prescription amphetamines, like Adderrall, Ritalin, etc. Do you have any insight in that situation?
Yes! The abuse of these “performance-enhancing” drugs is huge issue. Maybe I’ll talk about it in an up-coming column. You’re absolutely right. This is a big problem right now – I see it all the time, especially with young students.
I love this Will. You’re so right on!
To clarify, I don’t think I’m responsible for the “not a doctor” line of reasoning. I have family members who have seen social workers for therapy (and a family member who is a social worker), so I definitely don’t discredit your line of work. I’m simply concerne by a suggestion that medication doesn’t work for many cases of depression. As I suggested, though, I’m likely biased. At least according to a few individuals (of the therapist and/or psychiatrist variety), mine is not the “mild” or “minor” form of depression treatable without medication. Believe me, I wish it were. I’ve learned that lesson the hard way twice.
(apologies if this doesn’t end up in the right location–my computer cuts off part of the screen for your website for some reason)
I have been on an SSRI for a number of years and am in the slow process of weaning myself off. Whether it works or not (I read about that study when it came out), getting rid of it changes brain chemistry, and it takes some time. But the issue of whether it works reminds me of why my doctor always says about the placebo effect: “Helllooo? Effect!”
Meds are great for the right people but too often they are given in a shotgun approach. The do good but also much harm. I have worked with dogs in recue organizations and it is all the rage to give them meds.The managers feel that if they were helped by the the dogs will be also.
That is not the case with trained fighting dogs in that they give no warning before lashing out in a very deadly manner. I have never found a dog wild or not too not show some sign before striking like a snake. Remember that chimp in Stamford was on some form of SSUI.
What do you mean “depression is caused by bottled anger”?
I’ll try to sum it up quickly. A child cannot express anger at a parent – instead he blames himself, because it is his evolutionary task to please the parent and so obtain care. Under stress, you regress into that child’s way of relating. Instead of expressing your anger and standing up for yourself like an adult (mind you, not going into action on the anger, but expressing it in words) – you bottle it up, and locate the fault within. So…your self-esteem plummets, and you walk around with flattened affect, saying you’re not angry, you have no right to be angry – or you’re only angry at yourself.
Voila! You’re depressed.