Dr. Bob Murray

Major depressive disorder and other stress-related mental health issues affect about 30% of lawyers according to a number of recent studies. About the same percentage contemplate suicide at least once every year. It is arguably the world’s greatest killer. It is the dark shadow lurking behind much heart disease, cancers, suicides, dementia, accidents, blindness, isolation and a range of other potentially fatal ailments.

No firm anywhere in the world can fail to be affected by the disorder, yet few are prepared to take any effective action to reduce the stress that is at the root of so much of it.

The truth is that we don’t know very much about the etiology of depression. Most so-called cures—antidepressants, psychotherapy and the rest—have little, if any, lasting effect on it and even that little is confined to a very few of the cases of major depressive disorder (MDD) or generalized anxiety disorder (GAD).

There are some recent studies that show that some lifestyle changes can help. For example, the British Medical Council’s Journal and in the journal Health Promotion International both showed that the so-called Mediterranean diet—lots of fish, legumes, whole grains and olive oil and very little red meat, sugary things and processed foods—reduced depression by 45% in the majority of people suffering from MDD. A brief summary of these studies can be found in a recent Medscape.

One new study also suggested that one hour a week of any kind of exercise could go a long way to preventing depression. An earlier study came broadly to the same conclusion but added that if the exercise was done in the company of a friend it was much more effective.

But such studies, potentially useful as they are, are either irrelevant to many people who work in law. Either they can’t follow their recommendations or never get time to read them.

The painful truth is that for the last 30 years no major drug company has carried out any research into cures for depression. Instead they still peddle SSRIs (selective serotonin reuptake inhibitors) which virtually every bit of research says don’t work.

Since depression affects so many lawyers and thus reduces the income of so many so many law firms it seems worthwhile to have a look at some of the recent research into this most prevalent of mental afflictions.

What the recent science says

Let me start by saying that nearly all researchers see depression not as a single illness, but rather what is called a “syndrome,” a collection of rather similar symptoms that have no single common cause. For a start we know that about 30 – 40% of depression is genetic. We also know that there is no single neurochemical problem connected with it—certainly not the inability of certain specialized cell receptors to “uptake” serotonin effectively. Rather depression has been linked to the malfunctioning of a number of neurochemical systems—dopamine, oxytocin, cortisol and glutamate (low or high blood sugar reactions) are the prime culprits. Mood disorders—of which depression is one—can also be caused by the activity and the mix of the microbiota in our gut. And of course, there’s workplace stress, childhood abuse, neglect, criticism, overly high expectations etc.

Depression is also the most misdiagnosed of all psychiatric illnesses. Studies have shown that most physicians—even many psychiatrists—are unable to spot it accurately. It is most often confused with bipolar disorder (manic depression), panic disorder, hypoglycemia, ADHD, chronic fatigue syndrome, thyroid disorders and quite a few other mental and physical problems.

Over the last few years we’ve found that men and women have differing symptoms of depression. Depression was under-diagnosed in men because we used to assume that the symptoms that women displayed were universal. They’re not, men can display quite different ones.

The following studies have been published over the last few weeks. There have been many others, but these are perhaps the most significant.

Stress, depression and memory decline

Undoubtedly the most important study on depression for a very long time was published a month ago. For the first time the causal link was established between stress—in our time this is mainly work stress—and depression.

Depression is associated with impaired recollection. People who are depressed have poor memory for positive events, and enhanced memory for negative events, but the relevant neural mechanisms are poorly understood. This is the focus of a new study in the journal Trends in Neurosciences.

What the researchers found

Stress is a common trigger for nearly all initial depressive episodes, and chronic (ongoing) stress can prevent new cells being formed in the hippocampus—the brain’s memory center—to replace those that have died off. They found this stress can also inhibit mesolimbic dopamine neurons (thus prevent sufferers from feeling pleasure) and sensitize the amygdala’s response to negative information. The amygdala is the main fear center of the brain and this sensitization tends to make people feel anxious and fearful and more likely to look for what’s wrong rather than what’s right.

So, what?

As our society becomes increasingly stressful the rate of depression increases. Some recent studies have shown that up to 30% of US employees suffer from episodes of major depression. That is up from about 8% or so fifteen years ago. The stress produced by the way we are forced to work— including open plan offices and the like, the fear of job loss, the isolation of working from home, over work, being “on” via smartphone 24/7—is a major stressor. We are simply not designed to cope with it. Now we know for sure that this is, quite literally, killing us through the stress/depression nexus (often disguised as psychosomatic illness or very real heart disease).