With Persistence, Recovering from Depression

Posted: October 22, 2013
With Persistence, Recovering from Depression

Staying the course to get the right treatments, and having lots of support, lets this man enjoy his family again

From The Quarterly, Fall 2013

Twenty years ago, Steven Addlestone, then a recent graduate of Vanderbilt University Law School, had just begun his practice with a major Atlanta law firm and was newly engaged to his law school sweetheart. It was a time that should have been one of the happiest of his life. But seemingly out of the blue, he spiraled into a major depression that lasted four months. As his moods yo-yoed beyond his control, Steven went from one treatment to another without much success. It would be 12 years before his doctor was able to stabilize his symptoms.

What sustained him during those years and made it possible for him to function, if with difficulty, was the support he received from his family and colleagues who, he says, “understood what was going on and were willing to work with me.” Now, at 44, having had no major relapses for the past seven years and feeling “really well,” Steven holds a post as senior counsel at a Fortune 500 company in Tennessee, where he lives with his wife, Claire, and their teenage son and daughter. “Most importantly,” he says, “I’m able to enjoy being with the family who supported me so much during the hard times.”

Recently, hoping to help others who may not have adequate support, Steven signed on as a peer counselor in a program for members of his profession who are experiencing mental or emotional distress. “There’s still a lot of stigma attached to mental illness,” he says, “and often people don’t seek treatment because they’re embarrassed at having a ‘weakness’ they don’t want to admit.”
Steven was particularly fortunate that while still in Atlanta, when his worst crisis hit and his thoughts turned suicidal, he was treated at Emory University Hospital. There his journey to recovery finally began, jump-started by electroconvulsive therapy (ECT). “I responded well, and I have no doubt it saved my life,” he says.

In ECT, electrical currents are passed through the brain to trigger a brief seizure, which often works to ease the symptoms of depression when antidepressant medications fail. Unlike the “shock treatments” of years ago, today’s ECT is painless and relatively free of side effects, but there can be some memory loss. In Steven’s case, the treatment was effective, if short-lived. He had to return for additional ECT every couple of weeks. By the time he reached 100 sessions, his doctors became a bit concerned. “Every time we tried to stretch out the time between treatments,” he says, “my depression recurred.”

The doctor who finally came up with a mix of medications that allowed him to stop ECT was a young psychiatrist named Paul Holtzheimer, M.D., M.S., Associate Professor of Psychiatry at the Geisel School of Medicine at Dartmouth. Dr. Holtzheimer is a former trainee of Helen S. Mayberg, M.D., Professor of Psychiatry, Neurology and Radiology at Emory University School of Medicine, three-time NARSAD Grantee and Foundation Scientific Council member. Dr. Mayberg is widely regarded for her innovative work with brain imaging to identify depression pathology in the brain and develop new treatments to more effectively treat resistant depression. Dr. Holtzheimer received a NARSAD Young Investigator Grant in 2007 while working with Dr. Mayberg at Emory to further studies on an area of the brain called the subcallosal cingulate (or “Brodmann Area 25”) that she identified as being involved in depression.

In addition to a combination of medications––the antidepressants fluoxetine (Prozac®) and buproprion (Wellbutrin®), the antipsychotic medication risperidone (Risperdal®), the anti-anxiety medication buspirone (BuSpar®) and the mood stabilizer valproic acid (Depacote®)―used to treat his depression, fluoxetine helps control Steven’s symptoms of obsessive-compulsive disorder (OCD), which he is also addressing through cognitive behavioral therapy, conducted via Skype with a therapist in Knoxville. The co-occurrence of more than one mental illness is not uncommon.

Steven now recognizes that he has had OCD symptoms since childhood, but, as he recounts with wry amusement, “I didn’t know then that setting my alarm clock 100 times before I went to bed was anything unusual.”

No one who has had experience with mental illness needs to be told that it’s a family affair. Claire Addlestone was an up-and-coming corporate attorney when she put her career on hold to take care of her husband during his darkest days and to shoulder the lion’s share of their children’s early rearing. Today, she practices a very different kind of law, as a guardian ad litem, a court-appointed legal representative for neglected and abused children. In that role, she sees daily the ravages that parental stress and mental illness can inflict on families who lack the knowledge or resources to obtain appropriate diagnoses and help.

The Addlestones’ support of the Brain & Behavior Research Foundation began for them with a very personal appreciation of the work of the NARSAD Grant-supported scientists at Emory.

“We think it [the research] is all so promising,” Steven says. “We marvel how far research and treatment have come just since I started having my problems. It’s really uplifting.”