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Tish Vincent, JD, LMSW, ACSW, CAADC, at the Michigan Bar Journal, wrote a wonderful article this past July about the impact of suicide on those involved, the gravity of the issue, and its presence in the field of law. In her article, she was also kind enough to highlight the Dave Nee Foundation's work to educate legal professionals on the signs and symptoms of depression and when and how to get help.  Please take a moment to read her article here.

By Robin Frazer Clark, President of the State Bar of Georgia

Where did I go wrong, I lost a friend Somewhere along in the bitterness
And I would have stayed up with you all night Had I known how to save a life

– “How to Save a Life” The Fray

Suicide is a subject that most of us would consider unthinkable. Therefore, we don’t think about it—until we are forced to do so when the unthinkable occurs and someone we are close to takes their own life.

Then, it’s difficult to think of anything else except persistent questions: Why? What did I miss the last time I saw or talked to my friend? What could I have done to have kept this from happening? The answers don’t come easy.

Suicide has touched me personally, many years ago and, unfortunately, this year. I am certain it has touched most of you. When I first brought up this subject during the last Board of Governors meeting on Jekyll Island, it was clear it had touched many in the room. It, unfortunately, touched the families and friends of an Emory Law School student this year. My fellow bar presidents in our sister states are dealing with this very issue right now, too. In Kentucky, for example, five Kentucky Bar members committed suicide in the last several months.

It might surprise you to know that suicide is the third-leading cause of death among lawyers. Then again, it might not surprise you. The nature of our work presents a unique level of stress. Many of us handle life-and-death issues for our clients. Putting food on our families’ tables, meeting payroll and other law practice expenses, repaying law school debt and business loans and generally keeping our heads above water financially is dependent on success in the courtroom and/or long days and nights compiling a required number of billable hours. As Judge Anne Workman put it in her address to the DeKalb Bar Association in 2008, “Our clients do not routinely believe we serve their interest. We are not admired by the public in general. Management of our workload overwhelms us. We are beset by ever-increasing overhead, by an overload of technological devices that tether us to the office around the clock, by unhappy and at times unmanageable clients, by a surfeit of mind-numbing work just to keep afloat and by a general malaise brought about by the combination of all these factors.”

Failure is not an option in a high-stakes profession such as ours. As a result, lawyers are three times as likely to suffer from depression as any other profession, and the rate of death by suicide is two to six times that of the general population. These statistics come from the website of the State Bar of Texas, which has taken a leading role toward suicide prevention awareness in the legal profession. Soon, the State Bar of Georgia will follow suit.

If the State Bar of Georgia, with its resources, can save a life, then I think we should do it.

Next month, our Lawyers Assistance Program (LAP) Committee Chairman Charles B. “Chuck” Pekor Jr. will appoint a Suicide Prevention Subcommittee, whose primary goal will be to raise awareness among Bar members about addressing the dangerous situation within the legal profession, how to recognize the risk factors and warning signs of suicide, and the fact that help is available to Georgia lawyers through the LAP.

Pekor says, “Anxiety and depression can go hand in hand, and anxiety, if not depression, is almost impossible to avoid in this profession. Obviously, when depression gets severe enough, it can lead to the tragic results we have unfortunately seen lately more than once. I think it is important that as many members of the Georgia Bar as possible are aware that the State Bar has a very good set of resources in place for any lawyer dealing with these issues (including, obviously, substance abuse and other mental health problems), which is accessible with one totally confidential phone call to our LAP hotline which is on the Bar website.”

He adds, “As a recovering alcoholic with 27 years in recovery, and in my work with the LAP Committee and program over the years, I have learned that it is amazing how much help you can get just by talking with someone who is sympathetic and willing to listen. We can’t force lawyers who are in major/clinical depression to call us (or the other resources that are available), but we can certainly do all we can to at least make as many lawyers as possible know that help is one phone call away. We take calls 24-hours a day, and have very qualified counselors available all over the state. Our people will talk with any lawyer who calls 24-hours a day, and then get them to the help they need. If it will help, we also have attorney volunteers who will help any way they can. I suspect that many suicides could be prevented if the person had just been able to make a call to someone sympathetic and trained.”

Pekor especially emphasizes the strict confidentiality of the LAP hotline, which he says is “almost stronger” than the attorney/client privilege. “I think that is sometimes a deterring factor even for lawyers who have heard about us, so the absolute confidentiality in the Bar rules is very important.”

Our suicide prevention awareness initiative, which will be named “How to Save a Life,” borrowing the title of the song by the rock band The Fray, will have a dual purpose, directed toward those who are suffering from anxiety and depression and may be at risk for suicide, as well as all Bar members, who need to recognize the severity of the problem and be able to identify warning signs among our colleagues.

The Dave Nee Foundation, based in New York and created in the wake of the 2005 suicide of Fordham University law student Dave Nee, lists these 12 signs you might notice in yourself or a friend that may give cause for concern and at least point to a need to talk with someone:

  • Feelings of hopelessness or worthlessness, depressed mood, poor self-esteem or guilt Withdrawal from friends, family and activities that used to be fun
  • Changes in eating or sleeping patterns
  • Are you sleeping all the time? Or having trouble falling asleep? Are you gaining weight or never hungry?
  • Anger, rage or craving for revenge
  • Sometimes people notice they are overreacting to criticism
  • Feeling tired or exhausted all of the time
  • Trouble concentrating, thinking, remembering or making decisions
  • Are you suddenly struggling in school or at work?
  • Sometimes academic or professional performance suffers and grades drop or work product worsens
  • Restless, irritable, agitated or anxious movements or behaviors
  • Regular crying
  • Neglect of personal care
  • Have you stopped caring about your appearance or stopped keeping up with your personal hygiene? Reckless or impulsive behaviors
  • Are you drinking or using drugs excessively?
  • Are you behaving unsafely in other ways?
  • Persistent physical symptoms such as headaches, digestive problems or chronic pain that do not respond to routine treatment Thoughts about death or suicide

If you are dealing with one or more of these issues or know someone who is, please take advantage of the State Bar’s confidential LAP hotline at 1-800-327-9631. Staffed by trained counselors 24-hours a day, seven days a week, the hotline is for anyone associated with the legal profession—whether a lawyer, law student, support staff or family member—who has a personal problem that is causing you significant concern. LAP also offers up to three prepaid in-person counseling sessions with a licensed counselor per year. To help meet the needs of its members and ensure confidentiality, the Bar contracts the services of CorpCare Associates Inc. Employee Assistance Program, a Georgia-headquartered national counseling agency.

I have also asked Executive Committee member Elizabeth L. Fite to take a leading role in the “How to Save a Life” awareness campaign. Elizabeth recently attended “Uncommon Counsel,” a panel discussion (including Chuck Pekor as a presenter) at Emory Law School. While the event was directed toward law students, she described it as an informative session that featured discussion of many symptoms of stress that, when combined, could mean the sufferer is on a dangerous path to substance abuse, malpractice or suicide.

“The best takeaway (from the panel discussion) . . . was that it really is OK to talk to other people about the stress you are feeling,” Fite said. “People in law school, as well as members of the Bar, probably feel like there will be some negative repercussions for sharing about the stress they are feeling. I think that is an important aspect for us to emphasize, which is that talking about it won’t land you in trouble, but not talking about it may.” As the president of the Kentucky Bar Association, Doug Myers, wrote this month in his President’s Page titled “You Are Your Brother’s—and Sister’s—Keeper,” “Depression is a health problem, not a character flaw. We should neither be ashamed nor afraid to seek treatment.”

You will hear much more about the “How to Save a Life” initiative in the months ahead. We will be brainstorming for awareness—raising ideas such as panel discussions and CLE sessions on suicide prevention for professionalism credit, promoting the program on the Bar’s website and others. Feel free to send me an email with any suggestions you have.

In the meantime, if you are worried a friend may be thinking about suicide, immediate action is critical. Call the LAP hotline, 1-800-327-9631, or the National Suicide Prevention Hotline, 1-800-273-TALK (8255), for a referral.

No one wants to be in the position of having to ask themselves, when it’s too late, “Why didn’t I do something?” Do something now.

Robin Frazer Clark is the president of the State Bar of Georgia and can be reached at





Helping law students break through the silence of depression

By Hollee Schwartz Temple

While vacationing with his family in the summer of 2005, Bill Treanor got the call every law school dean dreads. One of his most promising recent students, Fordham University School of Law grad Dave Nee, had taken his own life.

“People were just devastated by his death,” says Treanor, now dean at Georgetown Law Center. “Depression is a real blight on so many law students, and part of the reason why it’s so painful and can lead to such terrible consequences is that people who are depressed think they’re alone.”

After Nee’s death, a group of his friends devel- oped a program to fight depression and prevent suicide among law students. This school year, the Dave Nee Foundation has brought its Uncommon Counsel program to more than 1,000 students across the country, educating the newest members of the profession about depression, its prevalence in the law and the effectiveness of treatment.

“We realized that law school is a hotbed of untreated depression,” says Wynne Kelly, a friend of Nee’s and an Uncommon Counsel volunteer. “We want law students to know that they are at higher risk for depression than the general population, and that there are treatments and resources that can really help them to be better and happier law students.”

The statistics on law student depression merit concern. Law professor Larry Krieger of Florida

State University studies how the law school experience affects students’ mental health. He has reported that between 20 and 40 percent of law students suffer from clinical depression by the time they graduate; that the incidence of clinical- ly elevated anxiety, hostility and depression among students is eight to 15 times that of the general population; and that, out of 104 occupational groups, lawyers rank the highest in depression and fifth in incidence of suicide.

The reasons for law student depression are well-documented. Marjorie Silver, a professor at Touro Law Center in Central Islip, N.Y., who speaks to students about her own struggle with depression, notes several contributing factors. First, law students come into the profession expecting success—and then 90 percent are disappointed when they don’t rank in the top 10 percent. Further, Silver says, students are thrust into an unfamiliar learning environment in which the predominant Socratic teaching method undermines self-esteem.

“We’re dealing with students who all expect to do well, who have never gotten lower than a B before,” says Silver, who has been active in expanding mental health programming offered through the New York Lawyer Assistance Trust. “Depending upon how much the law school is doing to help students put that in perspective, it can really undermine them.”

The economic downturn has complicated life for law students, who feel tremendous pressure to succeed and worry that they will never see a return on their hefty investment, Treanor adds.

But law schools are stepping up. Ten years ago professors wouldn’t hound students who stopped showing up for class on the theory that adults could make that choice, Treanor says. Today’s professors are taking a different tack.

“Now what we’re realizing is that often when students aren’t coming, it’s not necessarily a choice but because they are in pain in some way, suffering from depression,” says Treanor, who has expanded the counseling services available to Georgetown law students.

Uncommon Counsel is bringing that message to law students through on-campus programs and literature left in popular gathering spots. The Dave Nee Foundation recently aired a public service announcement about untreated depression on the CBS Super Screen on 42nd Street in New York City.

“Since we lost a friend, our message is not only to be vigilant about yourself but to look out for your friends,” says Kelly, an assistant U.S. attorney in Washington, D.C. “We need to look out for each other because of the idiosyncrasies of this profession. We’re at a higher risk than the general population; but with treatment, lawyers can get back on the right track.”

Michael Lane, a shareholder with New York City-based Anderson Kill & Olick and an adjunct professor at Fordham, received the foundation’s 2011 Uncommon Counselor Award for his commitment to the betterment of the profession and concern for fellow attorneys and law students. Lane was one of Nee’s professors and has witnessed firsthand how the foundation’s programs have helped young lawyers.

“When these young attorneys come in and talk about it so earnestly,” Lane says, “it really breaks down the walls. There’s no need to suffer.” 

Hollee Schwartz Temple, co-author of Good Enough Is the New Perfect, directs the legal writing program at West Virginia University College of Law.

Reprinted with permission from the February 2012 issue of ABA Journal,
© 2012 ABA Journal. All rights reserved. Foster Printing Service: 866-879-9144,



Dave Nee Foundation

* Here is Bess Levin’s take on the Groomzilla lawsuit brought by Todd J. Remis, son of a Goodwin Procter partner. [Dealbreaker]

* What advice would crisis management guru Lanny Davis give to Herman Cain about Cain’s sexual harassment scandal? Here’s an imagined conversation. [The Hill]

* And here is a real conversation — between Herman Cain and Ginni Thomas, also about the sexual harassment allegations. [Daily Caller]

* Current law students, at Brooklyn Law and Cardozo, call upon the ABA to get its act together. [BLS Advocate; Cardozo Jurist]

* The legal career of NBA star Ben Wallace is off to a great start. [Yahoo! Sports]

* Antonin Pribetic asks: “Are GCs Shifting The Balance of BigLaw Power?” [The Trial Warrior]

* Congratulations to Judge Paul Oetken on joining the distinguished S.D.N.Y. bench! (I was lucky enough to attend his ceremonial induction last week, which was fabulous.) [Poliglot / Metro Weekly]

* And congratulations to the Dave Nee Foundation, a non-profit committed to fighting depression and preventing suicide, on its record number of law firm supporters for this year’s masquerade ball (taking place tomorrow night). [Dave Nee Foundation (press release)]


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The stigma around seeking help for depression is not limited to those outside of the mental health profession. As the New York Times recently reported, Dr. Marsha M. Linehan, the creator of a treatment used worldwide for severely suicidal people, struggled with facing her demons for years.

You can read about her fight to come forward here.

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“What drives people to harm themselves, and how best to dissuade them from doing so, remains a mystery, says professor of psychology Matthew Nock. ‘More people die by their own hand than by someone else’s’—suicide is more common than homicide. ‘It’s a huge societal problem, a huge clinical problem, a huge research problem, and we know so little about it.’”

Read more in the Jan-Feb 2011 issue of the Harvard Magazine.


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Our friend Dan Lukasik, who runs Lawyers With Depression, recently featured a blog concerning law school students and depression.  You can find his article here.

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Read this incredible review for “The Kids Grow Up”, a gripping film made by friends of the Foundation.

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A study of 3,265 college students who have utilized campus counseling services has shed light on the increase of mental illness, as well as the use of psychiatric medications within this demographic. This analysis investigated the prevalence of “mental disorders, suicidal thoughts and self-injurious behaviors” through the years 1997-2009.  Though the percentage of students who admit to suicidal thoughts within two weeks of counseling decreased over time (from 26% in 1998 to 11% in 2009), the rate of students suffering from depression increased (from 34% to 41%), as well as the use of psychiatric medications (from 11% to 24%).  Recently, many organizations have been founded with the mission of supporting college students affected by mental illness.  Active Minds, a past Dave Nee Foundation grant recipient, which now has 271 chapters, is one of the organizations credited with making efforts to help students. Active Minds’ founder, Alison Malmon, received a Leadership Award at the Erasing the Stigma Leadership Awards banquet.

More information about this study can be found here.

To learn more about Active Minds, click here.

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Lawyer and distinguished psychology expert Dan Bowling is conducting a research study designed to examine the impact of a law school student’s personality on academic success, as well as their well-being. Bowling plans to use his findings to assist students as they begin to make life changing career decisions. By working with both incoming law students and law graduates, Bowling will also examine whether character traits influence the specific career choices they have made, hypothesizing that “unhappy lawyers are mismatched with their careers.” Bowling offers a piece of advice for all law school students, which is to learn the ability to momentarily disengage from the “thinking like a lawyer” mentality.

To read more about Dan Bowling’s upcoming study, click here.

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In 2008 Jordan Burnham, who suffered from severe depression, jumped from his family’s 9th floor balcony.  Though his intentions were to end his life, Burnham survived the 90 foot fall. As a suicide survivor, Burnham has reevaluated his life and now hopes to prevent other teens who are suffering from depression from making the nearly fatal mistake that he made.  Working with the advocacy group Active Minds, the Foundation’s 2007 inaugural grant recipient, Burnham helps teens understand efficient coping strategies and available treatment options for depression.

More information on Burnham’s work can be found here.

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The South Washington County School District is currently petitioning to increase funding for student mental health programs after two high school students committed suicide.  The proposed plan suggests increasing care by an additional $50 per student (approximately $800,000).  Addressing these health issues in a school setting is believed to help students whose emotional health is interfering with their schoolwork. Supporters believe this funding is necessary to ensure  that all students’ needs are met.

The complete article can be found here.

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In a recent article, several people who have attempted suicide share their advice about how to help a friend who is contemplating suicide.  Alexis Moore, a second year law student, courageously describes her own suicide attempt and passes along valuable words of wisdom regarding how someone who is having suicidal thoughts may respond to a friend taking action on their behalf.

The full article can be found by clicking here.

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The Wall Street Journal Law Blog directs its attention to the link between the isolation many attorneys face in their own legal practices and how that isolation may lead to depression and suicide.  The article points out that “[o]ver the years, attorneys have become more isolated from their peers. If you are a solo or small firm practitioner, practicing law can be a very lonely existence.”  Several explanations are presented as to why this may be and a lengthy discussion has formed in the comments to the blog entry.

For a direct link to the blog click here.

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In a review of ABC’s new series, “The Deep End,” Alex Williams goes beyond a simple analysis of the show and addresses the reality facing many attorneys at large law firms, including the risk of depression inherent in big firm practice that has been exacerbated by the recession. Dan Lukasik of, a friend of the Foundation, is quoted in the article.

The whole article is available here.

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According to a recent study funded by the National Institute of Mental Health, approximately half of Americans with major depression do not receive treatment for the condition, and in many cases, the therapies people do receive are not consistent with the appropriate standard of care.

The results were published in the January issue of the Archives of General Psychiatry, a journal of the American Medical Association. The work was also funded by the National Institutes of Health and the National Institute on Aging.

More details on the study can be found on or by clicking here.


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A new federal law, the Mental Health Parity Act, will take effect for most insurance plans on Jan. 1, 2010, that is targeting increased coverage for mental health.  As the economic crisis continues mental health issues are becoming a bigger concern in two major ways.  First, stresses over one’s financial situation have exacerbated preexisting mental health problems.  And second, due to decreased earnings, more people are foregoing treatment in order to save money.  In a recent article for MSNBC, health writer JoNel Aleccia discusses how the recession has taken its toll on the nation’s mental health. Ms. Aleccia’s article, “Suicides in the downturn raise worries about recession’s real cost”, can be found by clicking here.

For a brief review of the Mental Health Parity Act please visit the New York Times article by Leslie Alderman entitled, “In Anxious Times, Medical Help for the Mind as Well as the Body“.

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ABC News reports that the government will provide a cash infusion to dozens of crisis call centers that operate as part of the National Suicide Prevention Lifeline.  In the past several months these call centers have reported record increases in distress calls. “In July alone, the nationwide Lifeline network of 140 local call centers answered 57,000 calls — more than it’s ever received in one single month.” For more details and to read the full article please click here.

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The American Bar Association is currently offering an MP3 download of a program entitled “What Lawyers Need to Know About Suicide During a Recession: Prevention, Identity and Law Firm Responsibility.”  The program is offered FREE of charge and can be downloaded here.

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Leigh Jones, associate editor for The National Law Journal, provides an anecdotal account of how job losses have been affecting young lawyers.  Ms. Jones reports that “[l]ast month alone, an estimated 1,100 attorneys lost their jobs at major law firms, which means that the market is choked with highly educated former associates whose severance is running out and whose bills are piling up…

For the first time in their lives, many of these lawyers are struggling with a profound feeling of failure. And while they acknowledge that their troubles are just a part of the jobless scene nationwide, such perspective provides little comfort for these high achievers who are grappling with a loss of purpose and direction.”

The rest Ms. Jones’ article, entitled “Laid-off lawyers find themselves adrift”, as published March 9, 2009, in The National Law Journal, can be found here.

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Karen Sloan, staff reporter for The National Law Journal, reports on an increase in demand for lawyers assistance program as the economy worsens.  For instance, “[t]he Illinois Lawyers’ Assistance Program had its busiest month on record in April. The organization, which helps attorneys deal with problems like depression and substance abuse, had 42 new referrals — nearly twice the monthly average in 2008.

The phenomenon isn’t limited to Illinois. Across the country, lawyer assistance programs are seeing demand for their services grow as the economy struggles.”

The rest of Ms. Sloan’s article, entitled “Depression stalks the legal profession”, as published May 4, 2009, in The National Law Journal, can be found here.

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As reported by the blog, Life at the Bar, Michael Cohen, the Executive Director of Florida Lawyers’ Assistance, cites several startling statistics in his presentation on substance abuse and mental health issues facing members of the Bar.  Mr. Cohen (whom Nee Foundation Board Member Wynne Kelly has had the pleasure of hearing speak), is a dynamic individual who fearlessly and honestly shares his personal story of substance abuse to young lawyers.  Mr. Cohen, in a speech heard by Life at the Bar a few years back, shared these statistics:

15-18% of attorneys will have substance abuse problem vs. 10% of general population.

Over 1/3 of attorneys say they are dissatisfied and would choose another profession if they could.

Attorneys have the highest rates of depression and suicide of any profession.

The entire post from Life at the Bar is available here.

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Below is a recent article written exclusively for our website by Dr. Regan Stanger.  Dr. Stanger is a member of the Board of Advisors for the David Dawes Nee II Foundation.  She is also a Clinical Psychiatrist specializing in child and adolescent psychiatry and is currently training at the New York Psychoanalytic Institute.  Dr. Stanger is in private practice in New York City.

“Really?” is a common surprised response when I inform an adolescent or young adult that he/she is suffering a clinical depression.  As a child, adolescent, and adult psychiatrist in private practice, I have the unique perspective of observing how depression presents itself across the decades of life.  Not only can the symptoms of depression present somewhat differently at various ages, but a person’s awareness of their illness can also be quite variable.  Children almost never self-diagnose depression, whereas older adults often present with a chief complaint of “I’m depressed”.  But the young adult hovers somewhere in the middle.  The young adults often greet me with complaints of “I’m anxious”, “I’m having a hard time”, or “I don’t feel like myself”.  They frequently do not recognize that they are suffering from the medical illness of depression.

Mood disorders often present for the first time in late teen years and early twenties.  The reasons for this are plentiful.  Not only is there a likely biological component to the emergence of symptoms at this age, but it is an time of tremendous upheaval and transition.  There is potential social isolation as the young adult leaves family, friends, and a familiar community.  Managing newly found independence can be overwhelming.  For the first time, a young adult may be living with a roommate, buying their own food, or planning a daily schedule.  Without parental oversight, young adults may begin to experiment with drugs or alcohol. If a young adult enters college or graduate school, they may be faced with profound academic stressors.

Clearly, it is a time in life when people may be more vulnerable to developing a mood disorder.  However, the young adult may never have experienced a depression before, and can find the symptoms unfamiliar and bewildering. Most people understand that sadness and suicidal thinking are hallmarks of depression.  However, there is a myriad of other symptoms that can indicate depression, many of which people may not be aware of.  The societal stigma associated with depression can influence someone to view themselves as anxious, or “just having a hard time”.  For these reasons, I wanted to describe in detail the symptoms of depression that are included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).  My hope is that this description will further clarify the symptoms of depression, so that people suffering from depression (or their family and friends) can have a better understanding of this illness.

Someone suffering from depression suffers from a low mood most of the day, nearly every day.  This is a painful state of mind, often characterized by hopelessness.  People may experience frequent tearfulness and feel overwhelmed by their emotions. One patient told me, “I feel so much pain and disappointment that it seems like too much to deal with”.  A depressed person will observe happy people around him and feel as though it is impossible for him to ever feel that way.  A depressed person may feel like they are a burden to others, especially family members or friends.  For this reason, they may be reluctant to share their emotional experiences, further isolating themselves.  There may be cyclical shifts in mood throughout the day;  this can lead people to believe that they are not truly depressed because they feel a bit better at certain times of the day.  One young woman complained of feeling very sensitive, that she would burst into tears at the slightest frustration or disappointment.

With depression, there is a diminished interest in activities. I find that this often occurs because people feel that any task is a monumental effort.  The daily routine feels overwhelming.  People become socially isolated because all socializing feels like too much of an effort.  This is one sign that friends may notice.  People become more withdrawn, may spend much of the day in bed, watching TV, or sitting in front of the computer.  People complain of feeling stuck, and contemplate fleeing their current situation with hopes that their emotional state will improve.  I often hear people with fantasies of quitting their jobs or quitting school. Weekends are difficult;  time passes too slowly and people find that they begin to dread the weekends. I often hear the complaint that people are “going through the motions”, without deriving any noticeable pleasure or satisfaction from their lives.  Often, people with depression are able to function at a fairly normal level, although they feel miserable.  This may lead them to believe that they are not be depressed.

I often hear about changes in appetite and weight.  Depressed people often lose weight because they lose their appetite or feel that food no longer tastes good.  I also see people gain weight because they are unable to make the effort to purchase or prepare healthy foods.  They also use unhealthy foods as a reward for getting through the day.

People with depression may have either insomnia or increased sleep. Insomnia can present with difficulty falling asleep, difficulty staying asleep, or early morning awakening.  Insomnia can cause people to feel exhausted during the day.  It can also create anxiety, as people worry about how the lack of sleep will affect them the following day.  Patients also tell me that sleep feels like their only escape;  this can lead to increased sleep throughout the day.  People with depression often have trouble getting out of bed because they wake up and immediately feel dread about facing the day. Fatigue is an obvious result of sleep disturbance.  Poor sleep  (either insomnia or increased sleep) can cause someone to feel incredibly lethargic.  This is another symptom that family and friends may notice in someone who is depressed.

Depression can also affect a person’s energy level.  Some people develop agitated behaviors:  pacing, restlessness, fidgeting.  On the other hand, some people seem more slowed and lethargic.  Their movements may seem as though they require more effort.  One woman told me that it felt like an effort to even raise her arms above her head to get dressed in the morning.  Again, these are symptoms that can be observed by others.

Patients may complain that they feel worthless.  They expect that the rest of their lives will be pointless.  They despair they will ever have academic, romantic, or professional success. I also hear people complaining of feeling guilty. The guilt may be related to experiences in the past or may occur for no tangible reason.

Depression can also impact one’s concentration and ability to make decisions.  People complain that their memory seems poor, that they have trouble reading. This can be a significant problem for a young adult in school or starting at a job.

One of the most troubling symptoms of depression is the recurrent thought of death or suicide.  People sometimes have thoughts of hoping to go to sleep and not wake up.  They may have fantasies of being hit by a car or developing a life threatening illness. The most serious type of suicidal thinking is formulating a plan to harm oneself.  If someone expresses this type of wish, they must seek immediate medical attention and should be taken to an emergency room.  However, all types of suicidal thinking should be taken very seriously and indicate that someone must seek treatment as soon as possible.

There are other symptoms of depression that are not listed in the DSM-IV but are frequently seen in practice.  For example, I often find that anxiety accompanies depression.  People find that they are worried and nervous.  They often ruminate, which means that they think about worries or negative experiences over and over again.  I frequently see people who go over events from their past repeatedly, wondering if they should have done something differently.

I also see people increase their use of alcohol and drugs in an attempt to alleviate the pain of depression.  People often use alcohol in particular to alleviate anxiety.  This is obviously problematic for many reasons, but one significant issue is that alcohol and drugs can worsen depression and anxiety.  This is another symptom that family and friends may notice.

It is imperative that young adults be educated about this illness so that they can recognize the symptoms in themselves or friends.  It is also tremendously important to know that depression can be successfully treated with psychotherapy, medication, or both. If you or someone you care about is suffering from the symptoms described above, I strongly encourage that you seek treatment for yourself or for your loved one. I have seen countless patients suffering tremendously from depression who, with treatment, have overcome this terrible illness.

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Recent Suicide Screening Study shows that a proactive approach to screening for suicidal tendencies identifies issues that may otherwise be missed.  The Foundation is proud to be involved in these screening endeavors through its relationship and sponsorship of TeenScreen.

NEW YORK (Reuters) – School-based suicide screening can identify students at risk for suicide and other mental health problems not recognized by school professionals, new research suggests…. (The remainder of the article can be found here.)