Depression

This section is taken from a three part article written by Cliff Graves, D.Min., M.Div., M.A.

Mr. Graves is a pastoral counselor with the Fair Oaks Presbyterian Counseling Center in Fair Oaks, California.

Part I: When to Suspect Depression

Most people will wrestle with some degree of depression during their lifetime. One recent study revealed that one in ten Americans suffers from a serious bout of depression each year. During any 6-month period, 9 million American adults will suffer from a depressive illness. It is as frequent as the common cold.

As a passing phenomenon, we endure our dark periods and know that brighter days will come. Depression typically accompanies times of grief and loss. In those instances, grief, in the form of depression, is the normal way that we process loss. But when the passing phase becomes a chronic condition, we need to assess ourselves.

The National Institute for Mental Health describes a “depressive disorder as whole-body illness, involving your body, mood, and thoughts. It affects the way you eat and sleep, the way you feel about yourself and the way you think about life. It is not just a passing blue mood. Neither is it a sign of personal weakness or a condition that can be willed or wished away. When depression is fully underway, people cannot just “pull themselves together”. If untreated, symptoms can last for weeks, months, or years. However if properly addressed, it is very treatable.

The causes of depression are varied. A serious loss perceived or real, chronic illness, difficult relationships, financial problems or any unwelcome change in life patterns can trigger a depressive episode. Like so many other maladies, there can be a genetic predisposition. It is not uncommon for depression to run in families from one generation to the next. Psychological makeup also plays a role in vulnerability to depression. People who have low self-esteem, who consistently view themselves and the world with pessimism, or who are readily overwhelmed by stress are prone to depression.

But it needs to be noted: depression is not a respecter of persons, or our relative states of mental health. Anyone can suffer depression. The Bible is replete with towering figures who underwent various bouts with depression: Job— crushed by adversity—cursed the day he was born; Elijah, exhausted and hunted by Jezebel sat under a broom tree and told God “I’ve had enough. Take my life.”; David who went on a year-long decent into depression following his moral collapse.

The common thread in depression biochemical. Medical research has established a link between biochemical imbalances in the brain and depression. Studies show that people who suffer from depression have imbalances in neurotransmitters, the chemical substances through which brain cells communicate with each other.

The array of depressive symptoms is varied. It includes persistent sad, anxious, or empty moods—feelings of hopelessness, pessimism—feelings of guilt worthlessness, helplessness—loss of interest or pleasure in hobbies and activities that you once enjoyed, including sex— insomnia, early-morning awakening, or oversleeping -appetite and / or weight loss or overeating and weight gain—decreased energy and drive, fatigue—morbid or suicidal thoughts or attempts—restlessness, irritability—unaccountable tearfulness or crying—difficulty concentrating, remembering, making decisions, persistent physical symptoms that do not respond to treatment.

Not everyone who is depressed experiences every symptom listed and the severity of the symptoms varies widely. But if you or someone you know experiences at least three of these symptoms for more than two weeks, you have reason to suspect depression.

There is reason to hope, however. Depression is not only common, but treatable. In the next article, we’ll explore helpful responses in the treatment of depression.

Part II: Recovering From Depression

In the last article I pointed out that some of the most towering figures in Scripture suffered bouts with depression. God’s response was not one of anger or disappointment. Rather, in each instance, God was patient and encouraging.

Neither were most Biblical cases of depression indicative of moral failure. Job’s depression was founded on horrific personal loses quite out of his control. Elijah succumbed to mental and spiritual exhaustion after a remarkable season of prophetic ministry. Paul and his companions in Asia Minor came to “despair of life” right in the midst of a bold missionary venture. Typically, if it is not biologically triggered, depression follows some experience of lose or perception of loss profound enough to foster feelings of hopelessness, helplessness and worthlessness. In the cases of Job, Elijah and Paul, none were judged deficient or faithless for becoming depressed. Instead, they received comfort from God.

During the process of recovery it will be helpful to keep the following in mind:

• God views depression as a problem you have, not a problem you are. He discerns between you and it, and stands with you against it.
• Set goals and take on responsibilities that are in proportion to your physical and emotional energy level. This mean guarding against unrealistic expectations which will only increase feeling of failure if you fall short.
• Do not make major life decisions at this point in time.
• Do what you can as you can. The choice is not between inertia and activity. It is a question of progressively and proportionally re-engaging life.
• As much as is possible attempt some form of mild exercise or recreation. Get outdoors, especially when the sun is out. Don’t hole up.
• Do not criticize yourself if you don’t simply snap out of it. All things being equal, slow, steady improvement is the most common and reliable route of recovery.
• Don’t withdraw from the company of caring Christian friends and fellowship. The community of faith is a “hospital” you go to while you are “bleeding”, not after you’ve stopped bleeding. Avoid complete isolation.

Depression is no respecter of persons. Anyone can suffer from depression. So while you will feel bad, spare yourself feeling bad because you feel bad. One pass over this rugged emotional terrain is enough.

Depression is a heart shrouded in dread and darkness, but as St. John reminds us, “. . . God is greater than our hearts, and knows all things.”

A word about antidepressant medication is in order also. Medical research has established a clear link between biochemical imbalances in the brain and depression. While depression may begin as a reaction to loss, over time, it can take on a biochemical life of its own. Studies indicate that many people suffering from depression have developed imbalances in neurotransmitters: the chemical substance through which brain cells communicate with one another. Therefore, both faulty thinking and altered brain chemistry must be addressed if depression is to be dealt with in a comprehensive way. The modern approach to depression often includes treatment from two angles: therapy and medication.

A whole host of medications are available which restore the original balance. With the elevation in one’s energy, mood and outlook, the stage is set for tackling the psychological causes of the depression. They simply provide an emotional platform upon which to better reach out for and receive spiritual and psychological guidance.

God has created us as a unity of body, soul and spirit. The gift of modern medicine used in conjunction with counseling is in keeping with how He has constructed us. We are working with, not against God’s design.

Part III: Reaching Out to the Depressed

People who are depressed don’t always look or act depressed. Often there are no telltale ‘bandages’ to suggest injury. If they are not suffering a disabling depression, they will be moving along beside you at work and at home looking much like they always do. But inwardly, they will be struggling.

When the depression is disabling, family members may feel that they are living with a shadow of the former person. Where is the old person they knew so well?

Against these sad and frustrating conditions, those who care often wonder what to do. If you are a spouse, parent, child, employer, or friend of someone suffering from depression you have a valuable role to play in their recovery. Do not underestimate the importance of providing informed compassion. Keep the following in mind:

• Depressive illness can interfere with a person’s ability or desire to get help. Depression makes a person feel tired, worthless, helpless, and hopeless. People with depression often need encouragement to get an accurate diagnosis and to seek treatment.
• Morbid or suicidal comments should be taken seriously and reported to their therapist.
• If a diagnosis of depression is made, accept it and begin familiarizing yourself with the symptoms and implications of depression. There is a wealth of information available.
• The attitudes and expectations you display can help or hinder recovery.
• Do not discount or disparage the negative feelings and apathy you encounter, but listen intently, gently, point out reality, and offer reassurance. Nothing is more counterproductive than trying to nag, badger, or cajole a depressed person into recovery. Both you and the depressed person will become frustrated by these approaches. Instead, use patience, understanding, affection, and encouragement. Like gardening, you don’t grab plants and tug on them to make them grow. You water and cultivate the soil around them and growth happens quite naturally.
• St. Paul said we should “bear one another’s burdens,” and balanced this against allowing each person to “bear his own load.” A ‘burden’ borne alone can injure an individual and thus requires help. A ‘load’ can be managed individually. For the depressed, former ‘loads’ have become ‘burdens’. It is not that a depressed person should be exempt from life: a depressed person needs to maintain contact and involvement with the world around them and the demands of that world. Rather, it is a matter of encouraging them to progressively re-engage life as they are able, until ‘burdens’ once again feel like ‘loads’.
• Maintain your vision for their recovery, but be realistic about the rate of recovery. Speed of recovery varies. It is easy to become discouraged if the illness lingers. Learn to identify, encourage and value incremental progress. Rapid recovery does occur. But slow, steady improvement is the most common and reliable route to recovery. Remember that the vast majority of people with depression do recover and return to normal living.
• Caretakers need to take care of themselves as well. To be a resource for others you must have resources yourself. If your loved one’s depression persists over weeks or months, you need to find support and refreshment apart from the situation. Even Jesus pulled away from the demands of ministry for times of renewal. The caretaking that follows these strategic retreats will be better for it.
• Do not take the indifference you sometimes encounter personally. Maintain contact. A thoughtful card or note expressing concern and support is a minimum. A invitation for a walk, a cup of coffee, some conversation, or special activity provide diversion and company. Be gently persistent but not intrusive or demanding. Let this person know you care and are available.
• Guard your heart. Supporters must personally resist the negativity that engulfs a depressed person. Remember that in the middle of this perplexing fog there is a unique and precious person with a special history: someone God loves very much. Honoring the image of God in that person means affirming their human dignity in the face of their inability to affirm it themselves.
• Commit yourself to pray for the duration of the illness. The Psalmist who knew the darkness of depression wrote, “I waited patiently for the Lord; and he inclined unto me, and heard my cry. He brought me up out of a horrible pit—and set my feet upon a rock.” Depression is a deep pit into which many fall. Within all the forms that your compassion takes, you are asking God to reach down into that pit. Those who would be God’s hands reaching out to the depressed must first extend those hands heavenward in pray

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