Depression in Law Enforcement
Cops aren’t exempt from becoming depressed. What you do and see over a career puts you at higher risk. iStock
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Does depression strike cops? That would be a resounding yes! In fact, The Archives of General Psychiatry states that major depression affects 14.8 million American adults. Now, you may think cops would or could escape such a debilitating disease, but let's take a look at what depression actually is.
One of the questions we ask when screening someone for a mood disorder is family history. Often there’s a genetic link to someone in the immediate family who's been identified as having depression, anxiety, bipolar disorder or an addiction. There’s still much debate among all the different theorists as to why mood disorders are passed among families, but we can agree genetics plays a big part in whether or not someone can become a candidate for a mood disorder.
Another cause commonly believed to play a role in the development of mood disorders are events in a person’s life that change how the neurotransmitters function in their brain. It could be one event or a chain of events over time that decreases the amount of serotonin and/or dopamine that is released. For officers this could be a critical incident, a death of a co-worker, a change in physical health, job-related injury, retirement or perhaps most commonly, a separation from immediate family.
A cause that’s distinctive to first responders is the repetitive adrenaline dumps in the body where the fight-or-flight response is triggered. LEOs need adrenaline. It enables you to be faster, physically stronger and hyper-vigilant, and you experience a dopamine rush that elevates your mood.
Adrenaline is a mixed blessing. It’s needed when you’re running lights and siren, in a foot pursuit or pushing against the urge to relax or sleep while making a big break in a case.
However, too much and too often, it’s poison to your body that has negative effects on a person’s physical and emotional well-being. As they say, what goes up must come down. Too much adrenaline in the system can add to, as Kevin Gilmartin calls it, magic chair syndrome. Instead of being productive and feeling good after a shift, sitting in the chair with your favorite beverage, isolating yourself, channel surfing or getting lost online becomes too familiar. The officer finds it hard to move, which can lead to depression.
Mood disorders are simpleto diagnose for experienced mental health professionals. It's a basic question-and-answer interview that identifies symptoms, as set by the DSM-IV. The most common forms are major depression, dysthymic disorder and adjustment disorder with depressed mood. Bipolar is a more complex and often-misunderstood disorder, so it will be saved for a later article.
Instead of listing the symptoms of the mood disorders, links will be provided at the end of the article to the DSM-IV diagnostic criteria for your review.
I thought it would be better to present the interview format I use during the first session to diagnose my patients and to see what level of intervention is warranted. I ask:
- What brings you here today?
- With everything that is going on, how are you sleeping? Do you find it hard to fall asleep or stay asleep. Do you wake up too early?
- Do you generally feel tired most of the day or do you have enough energy?
- Any changes in how you are eating or has there been any weight loss or weight gain?
- Do you ever feel hopeless, like you are living in a black hole and the darkness is heavy or never-ending?
- How do you feel about yourself and how you fit into this world? Do you feel like you have value and worth, or do you feel like you have little worth?
- Do you ever have thoughts of not wanting to live or escaping? If yes, how often do you think about it? What would you do to hurt yourself? Have you ever tried to hurt yourself in the past? Have you ever been hospitalized for psychiatric?
- Do you ever think about wanting to hurt other people? If so, how and who?
- Any changes in how you focus or concentrate? Are you able to finish tasks?
- Are you more irritable? Do little things get under your skin? How often do you yell at other people?
- At work and in the home, have there been in changes in productivity?
- What do you do for fun? When was the last time you did that?
- When making decisions, are you able to make them, do you question yourself, or do you waiver between choices?
- What do you worry about?
- Do you pay bills on time, and are you having any financial difficulties?
- Any changes in your life in the past five years, such as job changes, moves, deaths or changes in relationships?
- Who are the people you feel close to emotionally? Do you spend time with them or do you prefer to be alone?
- When was the last time you felt happy and life just felt good? Do you generally feel happy, frustrated, angry, stressed, worried or sad?
Based on the interview, I form an initial diagnosis and treatment plan. If the depression is life threatening to them or someone else, quick and intense intervention is needed and may require hospitalization to quickly stabilize a patient on their medications. Otherwise, most forms of depression are treated in some form of outpatient care, such as office visits.
Many LEO’s will not seek treatment for depression, especially if they’re having thoughts of death, because they fear hospitalization. However, they must go and get treatment, and work with a mental health professional to decide together the appropriate level of care. Thoughts of death aren’t necessarily an indicator for inpatient care, unless you are in imminent risk of hurting yourself or someone else. Depression is 90% curable and, with the proper treatment interventions, those thoughts can go away. Eating your gun is not an option; treatment is.
From the above interview, I can decide whether or not someone will benefit or is a candidate for medication. The benefit of psychotropics is that it treats the neurotransmitters in the brain. How I explain this to my patients is that when the brain is not releasing enough serotonin into the blood stream, people become depressed. We all have mood swings during the day and speed bumps. When a depressed person hits a speed bump, their mood goes low and stays there. When a non-depressed person hits a speed bump during their day, they go low, problem-solve the solution and then the mood comes back up. What medication does is helps the lows to not stay low. It’s not the complete answer to the depression. It will treat 60–80% of the mood and then the other 40–60% comes from what we will do in therapy together. If medication is warranted and the patient is agreeable, I then make a referral to a psychiatrist who is a medical doctor that specializes in the treatment of mental disorders.
Talk therapy is the key component to the treatment of depression. The approach most widely used is cognitive behavioral therapy (CBT). In a nutshell, CBT combines both cognitive and behavioral therapies to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic approach. Depending on the intensity of the depression and the motivation of the patient, talk therapy can last from three sessions to six months to several years. It depends on what each person needs.
Cops are not beyond depression. The events you encounter during a career make you at risk. If you’ve been feeling unlike yourself for awhile and it’s affecting how you feel about yourself, your relationships or your performance on the job, plus you no longer enjoy your off-time, make an appointment to talk to a licensed, mental-health professional. It’s an easy response to a very treatable condition.
To learn more about depression, visit the following websites:
The Mayo Clinic: Major Depression
Kevin Gilmartin’s Emotional Survival for Law Enforcement & Their Families