Lawyers often get depressed

Self-employment and depression

For the self-employed, depression is problematic in several ways. On the one hand from a financial point of view: While an employee does not get into existential difficulties at least financially by paying wage replacement benefits while on sick leave, the professional future of the depressed self-employed can be at stake. Although the self-employed have usually covered sick leave with daily sickness allowance insurance, what do the little master craftsman, business owner, doctor or lawyer do when the continuation of their business is tied to their personal capabilities? If customers stay away because the boss or the owner is suffering from depression, the company or business will quickly run out. In short: the self-employed, for whom everything depends on personal commitment, simply cannot afford the long periods of illness that depression usually entails.

On the other hand, there is a threat of therapeutic hardship: "Small" self-employed, who by definition work independently and constantly, often have weekly working hours of 60 hours, sometimes more. That means stress - for sure. Whereby the psychology distinguishes "Eu-Stress" from "Dys-Stress".

Eu-stress is stress that is well tolerated because it is associated with a constant sense of achievement, while dys-stress is detrimental to the psyche because it brings with it a feeling of being overwhelmed. Eu stress is typical for the self-employed, because it would be up to them to reduce the workload if they wanted to.

Unfortunately, the psychotherapeutic side often assumes dys-stress with regard to the workload of self-employed depressives, without questioning this assumption in more detail. "Have you felt overwhelmed with your work lately?" Answer: "Yes." Conclusion: dys-stress, the patient has a burn-out syndrome and has completely overworked himself over the years. Therapy goal: Reduction of working hours, possibly even complete job termination.

However, there is definitely an alternative approach: Depression often has no concrete or any tangible trigger. The brain is an organ like any other and can also suffer from metabolic disorders. The most common metabolic disorder of the brain is called "depression". Of course, depression can occur on an occasional basis, for example triggered by a stroke of fate.

However, many types of depression occur just as unexpectedly and for no reason as, for example, appendicitis. It can happen to anyone. A typical symptom of depression is lack of drive. Even everyday trivial tasks such as getting dressed can become a strain. Who is surprised that the business owner is suddenly overwhelmed with the daily routines in his business?

There is no excessive demand due to "burn out", but simply a massive inhibition of drive in the context of a depressive syndrome. The therapy goal is therefore not “healing the depression by reducing work”, but “healing the depression and thus reducing drive”. Only when the patient still feels overwhelmed by the workload after the depressive syndrome has subsided, is it time to initiate appropriate measures with changes in the workplace. The following principle must be heeded:

DURING A DEPRESSION, THE PATIENT SHOULD NOT MAKE LIFE CHANGING DECISIONS! 

Imagine that the master sells his workshop because the psychotherapist has shown him that the depression is a consequence of the burnout caused by overwork. Ms. Meier files for divorce, because she feels that Mr. Meier is only annoying. After the depressive syndrome has subsided, the self-employed person misses the company in which he worked successfully and Ms. Meier would get along well with Mr. Meier because she no longer reacts extremely sensitively to every word.

What to do if a self-employed person gets depressed Time is of the essence than with other patients. The fastest and most reliable way out of severe depression is ECT, as the current guidelines make clear:

Theelectroconvulsive therapy (ECT)is recognized as an effective treatment for resistant and severe depressive disorders. The onset of action usually takes place quickly. Although mainly patients with unfavorable disease courses are treated with ECT, remissions can be achieved in 60 to 80 percent of cases with a maximum response after two to four weeks. In patients with psychotic symptoms, the remission rate under ECT is around 90 percent with an expected relief of the patient after ten to 14 days. There is some evidence that ECT reduces the risk of suicide rapidly. TheScope of the ECT includes about 80 percent that therapy-resistant depression. If two lege artis treatments with antidepressants from different drug classes have not led to any improvement, treatment with ECT is indicated and the patient should be informed about this treatment option. In addition, the EKT comes atmajor depressive episodes primarily used in one of the following situations:  

  • other treatments are contraindicated, have a higher risk, or have greater side effects;
  • the condition is particularly urgent (e.g. vitally threatening or severely suicidal);·the patient expressly wishes the treatment;
  • A good response to ECT is expected (experience from previous ECT treatments or prognostic evidence such as psychotic symptoms or psychomotor slowing down.

(Source:http://www.leitlinien.de/nvl/html/depression/kapitel-3) 

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You can find detailed information on EKT at http://www.zakt.org/.