By Dr. Alexis Artwohl, Police Psychologist
PoliceOne guest columnist
Let's say you have been feeling really lousy for a couple of months. You feel tired all the time, no matter how much sleep you get and you can barely drag yourself out of bed in the morning.
Sometimes you can't sleep at all, while other times you find yourself napping your day away but not feeling refreshed when you get up. Life seems to have lost its zest. You feel blah and aren't motivated to do much of anything.
You drag yourself to work but you're just going through the motions. You've been drinking more and more coffee just to keep going. When you're off duty you just sit around the house staring at the TV and don't really care about doing the hobbies you used to enjoy.
You've stopped working out. You find other people increasingly irritating and you are isolating yourself more. Maybe you're drinking a little more alcohol than usual. You're falling further and further behind on projects.
Your significant others have been complaining that you are grouchy all the time and coworkers are commenting that you don't look so good and ask you if you've been sick.
You've been suffering more from illness and physical problems and you're starting to burn that sick time.
You have been skipping meals and lost ten pounds over the past two months or you've gained a bunch or weight from emotional overeating and lack of exercise.
Your concentration seems shot and you're having trouble making even minor decisions.
Maybe you've never had a sustained IA complaint, but lately you've had a few encounters with citizens that were less than ideal and you hope your supervisor never finds out about them. Your supervisor, whom you have liked up until now, seems to be riding you more closely than usual and you're starting to resent it. In fact, you're starting to resent life in general and all the jerks who are making your life miserable.
At the same time, you feel even worse about yourself and you dwell on all your failings and mistakes. You start thinking thoughts like "Why bother?" or even "Sometimes I wish I'd just drop dead and get all this garbage over with."
At first you didn't realize how sick you had been getting. It seemed to start gradually and insidiously. There were any number of reasons for feeling so lousy: not enough sleep, working too many hours, not eating right, not enough time or energy to work out, not to mention all those jerks who were making your life miserable.
Finally something happens to make you face how lousy you've been feeling. Maybe a family member got into your face and demanded that you to see the doctor.
The doctor takes your history, maybe does some lab work, and then sits you down to give you the news:
"I've got bad news and good news. The bad news is you have a serious illness. Left untreated, it could be fatal. Even if it doesn't kill you, you will feel so much pain at times that you wish you were dead. It will greatly reduce the quality of your life because you won't be able to function very well at work or in your personal life. Unlike appendicitis, you can't be cured from this illness.
"The good news is that it's highly treatable. There are effective treatments that make the symptoms go into remission and restore you to full health. The treatments are very low risk, readily available, and covered by your health insurance. What do you want to do?"
So what would you do? Personally, I'd not only accept the treatment I'd demand it!
What I've described is depression, an illness that usually goes undiagnosed and untreated in most people who have it. It not only causes personal suffering, studies show it costs employers billions of dollars and is one the leading causes of absenteeism and poor work performance.
There are two basic causes of depression: psychological and physical. They are not mutually exclusive; you can have one or the other, or both.
The psychological cause is related to issues like unresolved loss and trauma and is treatable with psychotherapy. A recent article in Consumer Reports concluded that psychotherapy is an effective and recommended treatment for psychological depression.
The other cause of depression is physical. There are any number of illnesses that can cause the symptoms mentioned above so a physical exam is a good starting point. Sometimes your doctor will discover an illness such as thyroid hormone deficiency that is causing your symptoms.
If routine tests don't find anything obviously wrong, then the problem may lie in your central nervous system, i.e., your brain. The brain is composed of nerve cells called neurons. They don't physically touch each other but they have to communicate with each other or we'd be the functional equivalent of a carrot. Since they don't touch, the nerve cells communicate by sending chemicals back and forth, called neurotransmitters.
Your brain has many different neurotransmitters and you can't function normally if any of them get out of whack. For instance, the illness that Janet Reno has, Parkinson's Disease, is caused by a deficiency of the neurotransmitter dopamine. Without adequate supplies of dopamine your brain can no longer properly control your muscles.
There is another neurotransmitter called serotonin. If your brain develops a serotonin deficiency you lose your biological capacity to maintain a normal mood state and you develop the symptoms of depression mentioned in the beginning of this article.
Most people have some of these symptoms every now and then but not all suffer from depression. However, if you have five or more of these symptoms persisting for two weeks or longer, you should be concerned.
If you are suffering from a biologically based depression, the treatment is antidepressant medication. These medications (such as Prozac, Paxil, and many others) are not stimulants, not tranquilizers, and not crutches for wimps or whiners. If you are just a whiner they won't fix that. If you are not biologically depressed, they won't do much for you, which is why you never hear of your local dope dealer selling Prozac on the street corner.
If you are biologically depressed however, they will restore your brain to its normal serotonin levels and you will again have the biological ability to feel normal. Fortunately, for most people these medications are safe, not addictive, and don't usually cause serious side effects. (As with all medications, some individuals may have adverse reactions that would preclude them from safely or comfortably taking antidepressants).
Should cops take these medications?
Yes, if they have been diagnosed as biologically depressed and there is no medical reason not to. The medications usually don't cause side effects that would be a safety hazard. In fact, depression itself is a much greater safety hazard. Think about a cop who is sluggish, tired all the time, has difficulty concentrating, is chronically sleep deprived, has trouble making decisions, is irritable, pessimistic, negative, apathetic and unmotivated, and sometimes feels like he or she has nothing to lose or to live for. How safe is that?
About 12-24% of all people experience serious depression at least once in their life, so it is not a rare disease. Unfortunately, there is still a stigma attached to having a psychological illness or injury (being a "mental") and an even bigger stigma attached to taking medication for it. As a result, too many cops never get the treatment they need: They suffer, sometimes to the point where they don't want to live any more; Their agency and the community suffer because of their increased absenteeism and impaired work performance; Their families suffer because depressed people are a drag to live with and are at risk for suicide, which is devastating to the surviving family members.
Depression is one of the major causes of suicide. Suicide is the 9th leading cause of death in the USA, killing about 30,000 people a year. Although depression is diagnosed more often than women, men are more likely to commit suicide.
The average cop, like the average citizen, is significantly more likely to commit suicide than to die from a homicide. Depression is not to be taken lightly.
Once when I was teaching in-service training, several of us were chatting during break about antidepressant medications. One person said, "A cop on meds? Now there's a scary thought!" That is a common belief that needs to change through education. What's really scary is a depressed cop who isn't getting the help he or she needs.
Nobody knows why some people develop a serotonin deficiency in the brain. Sometimes it is related to trauma or stress, but not always. Genetic predisposition can certainly be a contributing factor. For people who develop a serotonin deficiency, it's not their "fault" any more than a kid coming down with diabetes, someone's thyroid gland not working any more, or Janet Reno's brain running out of dopamine. It just happens. Our bodies aren't perfect.
There is absolutely no reason for a cop to be ashamed that he or she is on antidepressant meds. It's no different from a diabetic taking insulin or someone who's low on thyroid hormones taking a thryroid pill every day. Let's just be glad there is a good treatment for it.
If you think you may suffer from depression, go see a doctor and/or a mental health professional. There's excellent chance you could be feeling much better in a few months. As for all those people who are already on antidepressant meds? They deserve respect for taking care of their bodies and for making the effort to be the best they can be.
Editor's note: Watch for an upcoming PoliceOne column from the Force Science Research Center titled, "Should troubled officers take antidepressant medication?" [The answer: Yes. The article will explain.]
About the author:
Dr. Alexis Artwohl is a prominent police psychologist, trainer, consultant, researcher and author of, Deadly Force Encounters: What Cops Need to Know to Mentally Prepare for and Survive a Gunfight. She is a member of the National Advisory Board for the Force Science Research Center, the Force Science News and other law enforcement organizations. Her areas of training include peak performance in high stress situations, preparing to survive deadly force encounters, investigating officer involved shootings and managing the psychological damage caused by trauma and organizational stress. Full details are available on her Web site.
Related tip: Police officer suicide prevention