New Light on Depression: Help, Hope, and Answers for the Depressed and Those Who Love Them

Chapter One

Some people see depression as the designer disorder of our age, implying that this disorder somehow became more prevalent with the introduction of effective medications to treat it. Prozac, an antidepressant that helped vault depression into prominence a few years ago, is so well-known there are jokes about it. Yet behind the laughter, for many, the biblical proverb is true: "Even in laughter the heart may be in pain" (Prov. 14:13 NASB).

The truth is that depression is as old as humanity, at least since Adam and Eve were driven from their place of perfect peace. In what may be the Bible's oldest portion, Job, the paragon of patience, says, "Sighing comes to me instead of food; my groans pour out like water. What I feared has come upon me; what I dreaded has happened to me. I have no peace, no quietness; I have no rest, but only turmoil" (Job 3:24-26). Obviously, depression is no respecter of faith-affecting believers and unbelievers alike.

Depression is also no respecter of persons, as it afflicts politicians and world leaders, recipients of various prestigious awards, athletes, authors, actors, musicians . and garden-variety folk like you and us. It affected Sarah, as follows in her own words:

"By my late thirties," she writes, "I had suffered a series of losses over a period of a few years, and though I had grieved, I believed I had weathered the losses well. After years of struggling with infertility, I had conceived, only to loose my unborn child through miscarriage in the fourth month. The grief was deep and painful, but I was not debilitated by it. In fact, I experienced newfound strength in the wake of it as my faith sustained me. Then a near-adoption of two adorable little preschool sisters ended abruptly when the birthmother changed her mind.

"A few years later, to our delight, my husband and I adopted a nine-year-old boy who had known great loss and trauma in his own short life. A few months later I conceived again, this time ending in a ruptured tubal pregnancy that almost took my life. There were new waves of grief, but once again I also felt inner strength and resolve. I felt God's power in very tangible ways and knew that God would weave the grief into my life in healing ways.

"Within a short time, we began to experience major upheaval as we tried to help our son forge a new life for himself. We had expected this, given his prior life events, but it still stretched us in every way. I loved being a mom, though I also experienced the drain and discouragement of realizing that all the love in the world for our son could not meet his deepest needs. In his young adolescent years we watched in pain and the worst kind of helplessness as our son descended into a life of drug abuse. As we struggled to anchor him through this time, one of his birthparents swept back into our lives, which sent our son into a tailspin. At the tender age of fifteen he left us to live with this birthparent, dropped out of high school, and adopted the chaotic lifestyle of drugs and poverty. This was a new kind of grief and loss that lacked the resolution of my earlier losses, leaving me feeling empty and hollow, dejected and demoralized. I was grieving deeply, but my faith was secure.

"A year later I was still filled with intense sadness and having some difficulties managing anxiety, but I did not consider myself depressed. I was grieving, and grieving hurts. I was also worrying for my husband, whose grief was deep but beyond my reach to help. I did realize, however, that I had lost a sense of knowing what 'normal' was. I felt I was emotionally limping.

"Then we sold the business we had nurtured together for nearly two decades and took positions at a company in another state, leaving behind our home church, close extended family, and lifelong friends. The new job did not turn out to be what I had expected. I found myself in a company embroiled in internal struggle and the upheaval of major changes in philosophy and mission-coming apart at the seams.

"My anxiety level became toxic. I became unable to eat or sleep, fearful of getting out of bed and facing the day. I felt guilty for being so weak and ashamed that I felt like I was falling apart. At work, others perceived me as all together because I hid my fears, but at times I was unable to stop trembling, my heart pounded, and my breathing was labored. By the time I got home from work, I just wanted to curl up on the sofa with a pillow and blanket and watch television, hoping for sleep to come. I couldn't rest or relax-all I felt was turmoil and stress, anxiety and darkness.

"In retrospect I can see the depression clearly, but at the time I was blind to it. All I saw was that I was weak and filled with worry-and I felt guilty about both. It did not occur to me to see a medical doctor. I was sure my coping problem was due to my emotional weakness and was actually failure. So I kept trying to talk myself into being stronger and getting myself through this, while berating myself for not being able to pull out of it.

"All the previous losses in my life resurfaced, and I grieved them again. All my former support systems-long-term friends, home church, extended family-were many miles away. Eventually, I concluded that I needed help with the anxiety, while at the same time feeling too overwhelmed to try to find a counselor. I was certain the problem was all in my head, and I felt ashamed of that. I simply could not muster the strength and energy to search for a counselor, and I felt guilty about that as well. I was caught in a negative cycle that I couldn't seem to break.

"Then I learned I needed surgery, which turned out to be a blessing in disguise. My wise surgeon recognized my depression and anxiety and sent me to a new primary care physician. I'll never forget that first visit as 'the light went on' when the doctor asked a series of questions: How was I sleeping? How was my appetite? How was work going? What was I doing that I enjoyed? I recognized these as classic questions about depression. How had I missed this in myself? By the time she finished asking her questions, I already knew the answer. I was clinically depressed.

"Then she explained that, no matter what had brought on this depression, it had become a biological problem that needed biological treatment. She recommended medication immediately.

"I had mixed reactions to taking an antidepressant, though. I did not want to turn to pills just because I couldn't handle life's problems, and I was afraid of developing a dependency on them. I had always sought to understand myself and to rise to every challenge with God as my strength. Would this be a cop-out? Would it be escape instead of healing? Would I only be masking deeper problems? Shouldn't my faith be enough to sustain me?

"Yet I was desperate and I knew it. Though fearful of the medication and its implications, I was more fearful of the darkness inside that was smothering my ability to function. And I did hear the voice of God in the calm voice of reason from my doctor. Her words, reinforced by a few wise friends and family, helped ease my concerns. I agreed to treat my medically depressed condition just as I was treating my body with its need for surgery. Something was in need of repair, and it only made sense to treat it. I began the medication the same week I had my surgery."

There's Nothing Easy about Depression

Have you personally struggled with depression or tried to help someone mired in what John Bunyan, author of Pilgrim's Progress, called the "slough of despond" (the muck of despair)? If so, you can surely identify with some of the feelings Sarah expresses: pain mixed with faith, drained and discouraged, helpless, empty, dejected, anxious, fearful, guilty, ashamed, needing to hide, exhausted, immersed in and smothered by darkness, weak, feeling like a failure, isolated and lonely, overwhelmed, stuck, confused, torn, desperate, immobilized, having lost a sense of normalcy. You also already know that there is nothing easy about this disorder. Regardless of what some experts may claim, it's not easy to understand depression's causes and cures or to comprehend the myriad masks it wears. Only those who have experienced depression personally can imagine its ability to thoroughly permeate a person's life, stealing whatever joy existed and replacing it with murkiness and pain.

In addition to these challenges, a most daunting task is to define what we mean when we use the term depression. Were you to ask people on the street to define it, you might hear words like "sad," "the blues," or "down in the dumps." Nearly everyone you might ask would offer some description, though, because depression happens to most everyone at some time in their life.

The word depression is used in navigation to mean the angular distance of a celestial object below the horizon. In geology, a depression is a low point or hollow. The Stock Market crash of 1929 led to what in the United States became known as the Great Depression and contributed to a general worldwide economic depression. Surely during this dark period in history, many individuals suffered deeply with the disorder called depression. Yet to say that during the Great Depression many people were depressed is to sound like President Calvin Coolidge, who once said, "When large numbers of men are unable to find work, unemployment results."

Were you to ask a group of counselors to define depression, you might hear words like "mood disorder" or "psychiatric condition," but many of the terms you'd hear would classify or describe depression rather than define it. You might also hear questions, depending on their points of view, such as, "Are we talking about 'situational depression,' 'biological depression,' 'developmental depression,' or 'spiritual depression'?" and "Is it serious enough to be labeled a 'clinical' or 'major' depression?" From some you might hear terms connected with their theories of depression's causes, stating that depression is, for example, "a natural reaction to stress," "frozen rage," "repressed grudges," or even "unresolved guilt." Isn't it interesting how one word can have so many nuances of meanings? Speaking metaphorically, nailing down a definition of depression is like trying to nail psychological Jell-O to a wall.

Our preference is to keep it simple: Depression is a state of existence marked by a sense of being pressed down, weighed down, or burdened, which affects a person physically, mentally, spiritually, and relationally.

In other words, depression is not a state of mind but a state of being.

A Complex Yet Common Disorder

Depression is a common disorder and a major cause of disability worldwide. According to the two largest and best-designed studies performed in the United States in recent years, the prevalence of depression serious enough to warrant treatment ("major" or "clinical" depression) is between 5 and 10 percent, although only 1 to 3 percent of Americans receive treatment for depression in any given year. This means that between 14 million and 28 million Americans are suffering from depression as you read this. Women are more likely than men to experience depression by a ratio of about three to one. According to the American Psychiatric Association, 5 to 12 percent of women and 2 to 3 percent of men meet the criteria for major depression.

It is possible that this discrepancy is related to the fact that, while women often talk about their problems and verbalize their feelings, men typically suffer in silence, immerse themselves in their work as a distraction from their pain, and dull that pain with drugs or drown it in alcohol (men have at least twice the rate of alcoholism as women). Some men would prefer to develop more socially acceptable stress-related illnesses, such as heart disease or ulcers, than to have it known that they are consulting a professional for depression. Other masks of masculine melancholy include difficulty forming intimate relationships, abusive behavior, and rage.

In the year 2000, according to the World Health Organization's project The Global Burden of Disease, major depression was the fourth-leading cause of disability in the world overall and the second-leading cause of disability for persons aged fifteen to forty-four. The same study predicted that by 2020 depression would be the second-leading cause of disability in the world, second only to heart disease. Disability, as used here, means impairment of normal human abilities in such arenas as maintaining relationships with family or friends, fulfilling one's job responsibilities, or being able to relax and enjoy such things as recreation or vacations. Lifetime occurrence of depression is estimated at between 10 and 25 percent for women and between 5 and 12 percent for men.

Major depression is marked by the presence, intensity, and longevity of a significant number of symptoms known to be associated with this disorder, including (but not limited to) depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration. It is a complex disorder that affects the whole person, regardless of its causes, which is why the most effective treatment usually involves some form of counseling as well as medical intervention, pursued as early as possible after a diagnosis has been made.

The longer depression goes untreated, the harder it will be to treat effectively. Thankfully, we live in an era in which the downward spiral of depression can often be reversed through the cooperative effort of well-informed experts willing to confront what author Andrew Solomon called "the noonday demon" with an arsenal of medical, psychological, sociological, and spiritual treatments. Such a multifaceted process can facilitate the release of a depressed person from what has seemed like an inescapable dank, dark dungeon-one that depressed people only a generation ago often endured in agonized silence.

As persons who have benefited ourselves from some of these treatments, we see them as gifts from God that cannot in good conscience be withheld from those who need them on any basis-theological, philosophical, theoretical, or otherwise. We'll have a lot more to say about this in chapter 9 on treating depression with antidepressant medication.

Classifying depression according to its causes (the fancy word is etiology) is not as helpful as was once thought because depression comes with many faces, all of them sad and streaked with tears. However, classifying a patient's depression by its apparent primary cause can aid those who are trying to formulate and implement an effective treatment plan.

Continues.