What Is Depression?

Depression is a complex problem that is not easily defined. It is a term used rather loosely in our culture but that does not negate the seriousness of depression.

Depression is not just occasional sadness, or even persistent grief. These can be normal experiences of living in a fallen world. When sadness, grief, hopelessness, or despair takes control of one’s life and impairs daily functioning, then a clinical depression or mood disorder may be present. These types of depression can last as little as a few weeks, to months, to sometimes years at a time. Each occurrence of a major depressive episode increases the likelihood that another will follow.

Depression has signs and symptoms, but each person’s experience varies some. It occurs on a continuum from mild to severe. Charles Spurgeon likened it to "the horror of a soul forsaken by God." It can be a hellish experience when people give up on life or believe that life has given up on them. Hope is all but lost.

The consequences of untreated depression can be devastating. They range from neglected household duties to loss of employment, from conflicts in relationships to divorce- even homicide, from physical health problems to early physical death, from self-injurious behavior to suicide. It is a serious problem that requires understanding, diagnosis, and treatment.

How is depression overcome? What treatments and helps are effective?

Overcoming depression is hard work. We need to rely on God’s grace and power, to obey Him, and to seek the help of others such as friends, doctors, and/or counselors. Humility, honesty, and perseverance are also key elements of overcoming.

Depression is often a signal from the soul that some change and/or action are needed. If dealt with well, it can lead to improved health.

Grief counseling, grief work and mourning help if the depression results from a loss. Grief must be worked through.

Depression stemming from loneliness, isolation or separation from loved ones is aided by getting involved with others, reaching out for support, and being a help to others in need. If past trauma and hurt are at the root of the problem, counseling, talking, and/or writing about the events and feelings are healing.

If guilt from some sin is the source of the depression, repentance and confession are needed.

Depression resulting from misplaced hopes needs to be admitted. Our idolatries must be put aside in favor of placing our hope in God.

Depression resulting from unhealthy thinking patterns and faulty belief systems needs treatment. Depression can also affect thinking and be impossible to change without help and medication. What we think has profound effects on our moods. Healthy, wholesome and realistic thinking and beliefs can help dramatically in reducing depression caused by an unhealthy mental life. Likewise, healthy faith, proper relationship with God, spiritual growth, and living by spiritual principles can help depressions caused by a spiritual void.

If addictions are a factor (and they often are), overcoming these bondages will lead to a surfacing of suppressed emotions. Allowing these feelings to surface and sharing them honestly with God and others can do much to resolve depressions.

Clinical Depression & the Importance of Medication

Depression resulting primarily from a biochemical problem needs competent medical and/or psychiatric evaluations and treatment. Medications can be a great help. Brain chemistry was just as affected by the fall as everything else, yet we still want to think that medication is not an option when it comes to depression. The opposite is true. Depression kills. Remission saves lives. Complete elimination of symptoms means a return to family, friends and productivity. Medication can help a person maximize functioning – therefore enabling them to more fully serve God and others. The personal, social and economic benefits of effective treatment are enormous.

Use of medication can break the person out of the depression cycle so that counseling and other helps can have their therapeutic affects. For some, medication will be temporary until brain chemistry can be restored to normal functioning. For others, medication will need to be taken longer term, maybe for a lifetime if brain chemistry is not functioning properly. Even depressions that start with a loss, abuse, or some other nonphysical problem, may need medical intervention if it has developed into a biochemical problem.

In the real world, one size of treatment does not fit all. Managed care plans and state Medicaid formularies must not restrict choices made by physicians. The physician-patient relationship is critical in setting expectations and emphasizing the importance of finding the right plan, the right mix of medications and taking/staying on medication. Patient input is critical in the helping the physician achieve this. Don’t be afraid to speak up!

Electro convulsive Therapy (ECT) – more commonly called shock therapy, is sometimes used with patients with severe depression who do not respond to medications or other treatments. Much controversy continues over its efficacy and long term effects. The treatment has been significantly refined since inception. It can be life-saving in persistent, severe depression.

Additional aids for depression :

A defined support system (family, friends, the church body, a pastor or counselor, etc.) that will provide love, acceptance, an atmosphere of openness for honest sharing of burdens, correction, and encouragement

Regular exercise (This one is extremely important)

Proper diet and nutrition

Humor, fun activities and laughter

Music and music therapy

Creating art and enjoying art

Simple things like changing posture, straightening up, deep breathing

Positive distractions - Getting involved in something which gets the depressed person outside of himself

Journaling aids in processing emotions and identifying needed action

Stress reduction and management

By Tom WIndels, MSE, Ephraim Resources

1. Be hopeful, but realistic. Many people who have depression recover if they avail themselves of helps and treatments, and work to overcome. Reassure the depressed person of this and be hopeful yourself. But as true as this is, it is also true that some depressions are stubborn and difficult to overcome. And some people will simply not take the action needed to improve. Balance hope with realism. Encourage optimism and perseverance.

2. Assess and treat each person as an individual, deserving dignity. Be careful not to judge and stereotype people with depression. Do not assume that they all have the same personality type, problems, and issues. All kinds of people have depression, and there can be a mix of contributing factors. Assess each person with an open mind. Consider issues such as; health and life histories, possible need for physical examination and medical workup, developmental levels, cultural and family factors, spiritual life, willingness to work, exercise and nutrition, stress factors, past efforts to overcome, beliefs about depression, and the possibility of addictions.

3. Educate. Teach about depression and provide educational materials. Encourage researching through books, organizations, pamphlets, the Internet, and the Word.

4. Teach new ways to deal with pain, problems, uncomfortable feelings and other life difficulties. Many people who have depression need to learn new skills and ways to handle difficulties. Depression can become a way of life to some people, even a way of coping with problems. Teach things such as trusting and abiding in God, reaching out for help, emotional honesty, renewing the mind, having wholesome fun, stress management, and suffering well.

5. Include loved ones in your evaluation, education, and counseling efforts. Seek the input of those who live with your counselee. Loved ones often have valuable information to share. Provide them with education. Invite them into counseling. Living with someone who is depressed can be difficult. Loved ones often get frustrated and confused. Let them know you understand. Teach them not to believe they can fix or control their loved one. Warn them not to focus too much on the problem behaviors. Counsel them to focus on changing and improving their own attitudes and behavior, to be a healthy model, and to be supportive of improvements in the attitudes and behavior of the depressed person. Tell them not to ignore remarks about suicide. Advise them to call you or other responsible parties if they hear such expressions. They also need to hear that recovery takes time, and may include setbacks.

6. Listen well. Hear the cry of their hearts. Depressed people need to be heard and understood at the heart level. Your connection and heart felt compassion might be one of God’s chief mechanisms in their healing. Encourage counselees to give voice to their deep thoughts, beliefs, and feelings, even if they fear what you’ll think. What is in their minds and hearts has a powerful influence on all kinds of choices and behavior. Invite them to bring those internal things into the light so you can help.

7. Develop an individual plan of action. Although talk therapy can be beneficial in and of itself, most people who are depressed need a plan of action for outside the counseling room. Written plans help reduce confusion and increase compliance. Help them specify times for prayer, work, rest, meals, fellowship, fun, etc. It’s important to develop a plan that is owned by the counselee. Structure, routine, and timing are also important. And remember to individualize. Each person’s issues vary.

8. Be humble and gentle, but also firm. It is easy to become frustrated, even angry with the depressed person. But having depression can be a humiliating experience, and the counselee is often sensitive to criticism and judgment. Although choices can play a role in depression, the vast majority of depressed people do not consciously choose to be depressed. Depression sneaks up on people and grabs control long before the sufferer even knows what’s happening. Do not pretend to know exactly what they need, when they need it. Offer options, not cures. It’s best to use “I messages” in sharing your thoughts, beliefs, and feelings (i.e. “I have different beliefs about that.” Or, “I think you need to set some limits at work.” Or, “I’m afraid for the choices you continue to make.”).

9. Encourage participation in healthy accountability and support relationships. It is very important that your counselees are connected with others for both accountability and support. You will not be able to provide all the help they require. Suggest that they find a mentor and/or group of people who understand depression. The quantity of accountability and support will vary considerably. Teach counselees to accept the healthy things that an individual or group might offer, and leave the rest.

10. Keep pointing them back to relying on God’s grace and power. Counselees continually need to be reminded that we overcome by God’s grace and power. It’s very easy to fall back into the thinking that we should be able to accomplish things on our own.

11. Encourage both healthy and eternal perspectives, without fostering suppression of grief and other uncomfortable emotions and realities. Help those with depression gain positive and realistic perspectives on their lives, problems, and trials. Depressed people view and perceive things, events and people from negative and diluted perspectives. Offer them more accurate perceptions. Remind believers about the temporary nature of problems and pain. Help them look for the good that could be accomplished in this life’s challenges, disappointments, and difficulties. Emphasize how their choices can make a difference. Also encourage them to look beyond this life’s suffering to the joy and glory of eternal life in Christ. But be careful not to divert your counselee’s needs to do the grief work that will bring some measure of rest, peace, and joy in this life.

12. If needed, refer wisely. If you find that your moderately to severely depressed counselee is not improving with your counseling alone, give serious consideration to referring to other service providers such as a primary care physician, therapist, and/or psychiatrist. A combination of helps and treatments may be needed. If they refuse to seek additional help, and you believe they might be a danger to themselves or others, you may need to initiate an intervention, even an involuntary commitment or notification of civil authorities. Although controversial, such actions may be the only way you can help prevent tragic outcomes.

13. Know your limits. Be sure not to counsel too many depressed people at one time. That can be very draining. And know that depressed people can be critical, even hurtful. Try no to personalize their negative comments or behavior. If you get wounded, deal with it in healthy ways. And do not counsel people with depression if you are struggling with a serious or prolonged depression yourself. You may end up doing more harm than good, for them and you.