Depression

Depression is the most common and often most misunderstood of all the painful emotions. Despite the fact that Scripture presents some very clear examples of depression in its heroes (Elijah, Saul, David and Paul) and in the history of great preachers, many of whom suffered from severe bouts of melancholy (Luther, Wesley and Spurgeon), Christians have tended to hold to the belief that to be depressed is a sign of failure or spiritual weakness. Some conservative preachers and Christian writers have even gone so far as to suggest that depression is a sign of God’s punishment or rejection, leaving many feeling more confused and guilty.

We have failed to grasp the naturalness of depression and the fact that often it has biological origins. Even the severest of depressions can have healing benefits if we strive to understand its purpose and cooperate with it. Because so many do not understand the depressive process, they feel like spiritual failures. The time is long overdue for Christians to set the record straight on this common cold of the emotions!

How common is depression? One out of every eighteen adults—about ten million of us—suffers from a clinical depression at any one time. In a church of 250 members this means that at least fourteen parishioners could be suffering from an incapacitating depression. One in five adults will experience a severe depression at least once in their lifetime. This reality about the commonness of depression cannot be avoided. What people need is clear guidance on when it is a normal process that should be left to take its course, and when it is necessary to seek treatment.

Current Progress in Understanding Depression

We live in an era when fantastic progress has been made in providing relief for this debilitating condition. Even in my own professional lifetime we have gone from virtually no effective treatment for the biological depressions (electroconvulsive shock treatment was the only help available at the time I began treating depressions) to a rich armament of effective medications that are not addicting and have minimal side effects. Yet many Christians turn their backs on this help, fearing that they will be stigmatized by others, become drug addicts or, worse still, find that their problem is spiritual and not psychological or biological. The result is unnecessary suffering by untold millions of Christians, as well as by family members who must stand by and try to cope with a dysfunctional loved one.

Why is Depression so Common?

While the more serious depressions are essentially biochemical in origin with a strong genetic tendency, modern-day stress seems to be a major aggravating cause. The frantic pace of modern life combined with a breakdown of traditional values is causing many to feel hopeless, uncertain and disappointed. This stress aggravates the genetic factors that predispose to biological depressions. It also sets the stage for an appalling sense of loss, which is the primary cause of psychological depressions. Demoralization is rampant in our modern culture and can turn an even minor setback into a major depression in a body overextended by stress.

Many losses in our modern world are tangible and material. More significant, however, in causing psychological depression are such losses as insecurity, uncertainty, rejection, lack of fulfillment in one’s vocation, and a general sense of the meaninglessness of life. These are losses that were not as prevalent in earlier times. As a culture, we may well have entered our own emotional “Great Depression.”

The Cost of Depression

The economic cost of being depressed in the United States is estimated to exceed $16 billion a year. Estimating the emotional and human costs of serious depression, in the lives of both those who are depressed and the family members and friends who must suffer alongside, is almost impossible, but we know it is considerable. Major depression always disrupts, and sometimes disintegrates, otherwise healthy families, families whose lives are turned topsy-turvy by the emotional devastation of one member who is not able to function normally. Should the depressed person commit suicide, the consequences can continue for the rest of a family’s lifetime.

In times past, depression was always associated with a major mental breakdown and seemed to be restricted to a few poorly adjusted, usually anonymous persons. It was a concealed problem. Now it has assumed a common, real, familiar and very personal identity for all of us. It is found with frightening regularity in ourselves, our relatives and our friends. There is hardly a family today that is not touched by depression’s tentacles.

Who Is at Risk?

Depression is no respecter of age, sex, socioeconomic status or occupation. We are seeing an alarming increase in childhood depressions. In fact, the dramatic increase in depression in both the very young and the elderly is among the most frightening features of modern-day depression.

Women, however, are significantly at greater risk for depression than men (a two to one ratio). The reasons for this are twofold. First, the reproductive biochemistry of the female body implicates depression more often. At various times during the menstrual cycle, as well as in the life cycle of reproduction, depression results from hormonal changes. Problems with depression just before menstruation (premenstrual syndrome) as well as later in life (menopausal depression; see Menopause) are extremely common.

Second, it is very clear that women today are under greater stress than men. Mothers often have to work a full-time job in addition to taking care of family needs. Their resources for coping are therefore pushed to the limits. The result is a greater propensity toward fatigue and depressions caused by adrenaline exhaustion.

Dealing with Depression

Nothing is as tough to fight as depression. The depression itself robs you of the energy and motivation to do anything about it. Untreated biological depressions are often debilitating and can last up to three years during each attack.

For some the depression hits with an unannounced suddenness that is quite alarming. For others it stalks up insidiously and may go unrecognized for months or even years. When sufferers finally realize that they are in its grasp, it has already sapped their strength and fogged up their mind so that they don’t believe anything can be done to help.

Alarmingly, only about one-third of those seriously depressed will actually seek treatment. Some don’t know they can be helped. Some are afraid to admit they need help because it might stigmatize them. Some are callously told by their pastor or Christian friends that they should just pray harder or try to find the sin that is causing the depression. Most don’t seek treatment because they’re too depressed and feel too hopeless to believe they can get better; they try to “tough it out.” Unfortunately, this can have serious consequences not only for the sufferer but for all those connected to him or her.

Among these untreated depressed persons are many Christians. They don’t realize that with the right sort of treatment they could probably bounce back in a matter of weeks and, more important, prevent any recurring episodes of their depression later in life.

How Can You Tell If You Are Depressed?

One of the most unfortunate secondary effects of depression is that it often causes the sufferer to be oblivious to the depression. Depression eludes recognition, especially in the less severe types. Some people can be depressed for a long time, therefore, and not realize it. Depression can also mask itself in irritability, fatigue and workaholism. Many who overeat do so as a form of “self-medication” to ease their dejected state. Even when someone vaguely knows he or she is depressed, there is a tendency to deny the depression. Depression is often mistakenly viewed as a weakness, and people fear that even acknowledging their emotional pain to themselves is an admission of defeat.

So a large percentage of people with depression don’t get appropriate treatment because they don’t recognize their depressive symptoms. Religious sufferers tend to spiritualize their condition and want to blame God, Satan or some spiritual failure for their malady. The first step, then, in getting help is to recognize the symptoms and acknowledge that one is depressed.

What Are the Symptoms?

The following are among the most common symptoms of depression: persistent sadness, anxiety or an “empty” mood; a sense of hopelessness and pessimism; feelings of guilt, worthlessness, helplessness; crying at the slightest provocation; loss of interest or pleasure in ordinary and pleasurable activities, including sex; sleep disturbances such as insomnia, early-morning waking or oversleeping; eating disturbances (either loss or gain in weight); decreased energy, fatigue, feeling slowed down; thoughts of death or suicide; restlessness and irritability; difficulty in concentrating, in remembering and in making decisions; and physical symptoms (headaches, digestive disorders and chronic pain).

In all depressions fatigue is a prominent symptom. This is particularly true for the biologically based depressions that tend to drain energy. There is also a general lack of interest in normal activities. Sadness or crying may or may not be present. In some, sadness is the least important sign of depression.

Getting Help

How one copes with depression depends on its cause. Since all depressions fall basically into two categories, endogenous (or biological) and exogenous (or psychological), this discussion will focus on each in turn and provide some treatment guidelines.

Endogenous depressions. Endogenous literally means “from within.” Since there are many biological causes for depression, treatment must be directed primarily at the underlying disease or biochemical disorder. Besides obvious serious illnesses such as cancer or heart disease, disruption of the endocrine system is a particularly common cause of many depressions. So whenever a biological depression is suspected, a thorough evaluation of the endocrine system, particularly the thyroid gland, is warranted.

When endocrine dysfunction is ruled out, attention turns to the nervous system and the brain’s chemistry. The cause of two of the most common forms of endogenous depressions—major depression and bipolar disorder (the sufferer alternates between mania and depression)—lies clearly in a deficiency of a neurotransmitter within the brain’s nervous system. Fortunately, there are now very effective antidepressant medications available that can correct these deficiencies.

While a complete discussion of these medications is not possible here, the following important points need to be stressed:

• Not everyone benefits from the same antidepressant. Individualized treatment is therefore essential.

• Antidepressant medications do not act immediately; they take between two and four weeks, or even longer, after the appropriate level of treatment has been reached before relief is experienced. Persistence in treatment is therefore essential.

• Modern antidepressant medications have far fewer side effects than earlier ones and are perfectly safe when taken under supervision for long periods of time. Don’t be in a hurry to stop them.

• Antidepressant medications are not addicting. They may be taken without fear of becoming dependent on them.

Exogenous or reactive depression. While these depressions are not usually as serious as the biological ones, they can be much more difficult to cope with. There is no medication to speak of that treats them. Besides, since they are a reaction to loss, medication is most times inappropriate. What is needed is the more painful work of grieving.

Reactive depression is essentially a call to let go of whatever it is we have lost. God has designed us for grief, so that whether the loss is the death of a loved one, the departure of our first child to college, getting fired from a job or a business venture that has gone bad, we have to face this loss with courage and allow ourselves to grieve. Ecclesiastes tells us that “to every thing there is a season” (Eccles. 3:1 KJV) and that there is “a time to weep” (Eccles. 3:4). This is what reactive depression is all about. It is a healing time to help us cope with loss.

The grief work needed for a major loss can seldom be accomplished without talking it through with someone else. Consulting a professional counselor, preferably a Christian, is almost essential in more severe depressive reactions. However, an understanding pastor, lay counselor or friend can also be tremendously helpful.

Whatever resource is used, the following important points must be kept in mind:

• Grief work takes time, so don’t be hurried. The more significant the loss, the longer it will take to get over it and the deeper will be the depression.

• Don’t try to “short-circuit” your depression by rushing to replace your loss. Sooner or later your mind will bring you back to complete your grieving for past losses.

• Invite God to be a part of your grieving. Don’t blame him for your loss, and there is certainly nothing to be gained by getting angry at him. He knows your pain and longs to be your comforter, so don’t turn your back on him.

• As the title of one of my books suggests, every cloud has a silver lining. This means that within every grief experience there is great potential for spiritual and personal growth. Embrace your experience with the full confidence that when you come out of the fire you will be a little better for it (Job 23:10).

» See also: Anxiety

» See also: Grieving

» See also: Health

» See also: Illness

» See also: Stress, Workplace

References and Resources

Dean Foundation for Health, Research and Education, Depression and Antidepressants (Madison, Wis.: Dean Foundation, 1995); A. D. Hart, Counseling the Depressed (Waco, Tex.: Word Books, 1987); A. D. Hart, Dark Clouds, Silver Linings (Colorado Springs: Focus on the Family, 1993); U.S. Department of Health and Human Services, Depression in Primary Care: Detection, Diagnosis and Treatment (Washington, D.C.: U.S. Government Printing Office, 1993).

—Archibald D. Hart