Posts Tagged ‘anti-depressant medication’

So many cases like this appear at my office that I’ll construct him/her as a composite. That way perhaps I can spare myself the chore of receiving those “how dare you write about one of your clients” comments that I receive every week when I get specific in detailing my fictions and some of you decide I simply must be writing about your roommate.

So here goes.

He/she is very young – 22 or 23 or 24 or 25.

He/she moved across the country to go to a law school that I’ve heard of vaguely. It turns out to be number 79 or 83 or 66 out of the top 100, according to some hack newspaper that profits from disseminating this sort of nonsense.

He/she is the son/daughter of immigrants from Bangladesh, Peru, Kenya, Romania or Ireland.

His/her immigrant parents operate a doughnut bakery, dry cleaner, small hobbyist shop, motel or air-conditioner repair service.

His/her parents are adamant that he/she marry someone from Bangladesh, Peru, Kenya, Romania or Ireland in a traditional ceremony – soon – and produce male children.

Before then – quickly – he/she has to become a doctor.

He/she is no good at math or science or dating, so that’s not going to happen to him/her any time soon. Being a lawyer is the official second choice – not as good as a doctor, but acceptable.

He/she has just started law school at number 79 or 83 or 66 out of 100 and is presenting with anxiety around test-taking and deep feelings of insecurity about his/her abilities compared to those of his/her classmates.

We talk about CBT – cognitive behavioral therapy – to identify the thoughts that are triggering the anxiety – fears of being unable to live up to dad/mom’s demanding agenda, especially when, despite getting accepted into number 79 or 83 or 66 out of 100, he/she suspects he/she has never been all that great at school. College was a struggle, too. It is possible that he/she is simply doing his/her best, but isn’t cut out for academics and would be happier doing something else, such as operating a doughnut bakery, dry cleaner, small hobbyist shop, motel or air-conditioner repair service. But he/she runs from that idea – it doesn’t compute with the dreams and expectations of his/her immigrant parents from Bangladesh, Peru, Kenya, Romania or Ireland.

We learn his/her parents remind him/her that they sacrificed everything for their son/daughter, so he/she could have a future. His/her parents gave up their own happiness so he/she could succeed. This notion is recited to him/her in some form or other about five times each week, most recently in the form of phone calls from home.

We learn he/she has an older brother/sister, who is a doctor, is married to someone from Bangladesh, Peru, Kenya, Romania or Ireland, and has two male children.

We also talk about the ever-widening pharmacopeia available to him/her, should he/she decide to go that route. There are the anti-depressants, which take two weeks or so to work, and have side-effects he/she might not like. There are the anti-anxietals, the benzos, like Xanax and Klonopin, which might be habit-forming. There are the stimulants, like Adderall or Concerta or Ritalin, which will help you focus on studying, at least unless you abuse them, like many law students, and stay up night after night without sleep and start hearing voices – which happened to a client of mine (no – for you helpful comment-writers out there – not while under my care, and no, I’m not a medical doctor, so I didn’t prescribe the stuff.)

But there is another issue that I can’t help discussing with him/her: magical thinking.

Because even as he/she talks to me about his/her anxiety around being back in school, a few more facts are glossed over.

First, he/she is in the process of borrowing $170,000 which he/she cannot discharge through bankruptcy.

He/she has never seen that much money in his/her life and has no concept of how much money it is. Remember, he/she is only 22 or 23 or 24 or 25.

He/she has never worked in law. He/she only graduated from college 1 or 2 or 3 or 4 years ago, and spent most of that time working in his/her parents’ doughnut bakery, dry cleaner, small hobbyist shop, motel or air-conditioner repair service.

When I ask him/her why he/she is pursuing law, I get a canned speech of the law school essay variety.

He/she wants to become an environmental lawyer/ international human rights attorney/ entertainment lawyer/ executive director of a group to help the oppressed/ federal judge.

Pressed on the details, he/she admits that he/she might have to spend a few years at a top law firm first, earning $160,000 per year, minimum. But he/she isn’t doing this for the money.

Pressed to describe what precisely an environmental lawyer/ international human rights attorney/ entertainment lawyer/ executive director of a group to help the oppressed/ federal judge actually does, or how one attains these titles, things grow vague.

Pressed as to how he/she will pay back the $170,000 in loans that he/she will have accumulated at graduation, he/she looks at me like it’s obvious. If you make $160,000 per year, then you need one year to pay off $160,000 and maybe another month or two for another $10,000 and it’s paid off. Duh.

Oh yeah, and maybe taxes or interest or whatever – say a year and a half.

I stare at him/her. He/she stares back at me. There is a steely determination in his/her eyes. He/she isn’t going to back down. This has all been arranged. It is decided.

We are at a stand-off.


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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?


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