Depression

By Hannah Giesbrecht

I. Definition:

Depression is defined as a mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life.

II. Biblical perspective

Depression comes in a variety of different ways and it affects different people differently. Depression can become a debilitating state that comes as a result of spiritual or physical infirmities. The Bible views depression as a trial, a time of suffering that, if viewed with an eternal perspective and treated in a biblically way, will ultimately increase our faith. Depression results as a lack of biblical hope and trust in God. However, depression can be the result of physical imbalances, so regular doctor’s visits are crucial for someone who may be struggling with depression. Our physical body does affect our spiritual and mental health. Depression is characterized by hopelessness, joylessness, guilt, shame, sadness, and worthlessness. Whenever anything or anyone other than God is the focal point of our worship and desire, this kind of idolatry impacts our behavior, our thoughts and our emotions. Romans 5:14 says, “For whatever was written in former days was written for our instruction, that through endurance and through the encouragement of the Scriptures we might have hope.” The Scriptures are sufficient for our every need and that includes battling depression; God’s Word is overflowing with truth that brings hope and peace.

Counseling that skillfully employs and applies God’s Word is a necessary duty of Christian life and fellowship. Scripture is superior to human wisdom and the Word of God is a more effective discerner of the human heart than any earthly means. Our Heavenly Father is the only effective agent of recovery and regeneration. All the treasures of wisdom and knowledge are found in Christ Himself. It is the job of biblical counselors to point counselees to the everlasting hope found in Christ and His Word, because Scripture is sufficient.

III. Secular perspective

  1. Diagnostic criteria for depression based on DSM-IV:[1]

Based on the 9-item depression module from the MINI participants are classified in the following way:

  • Major depressive episode: 5 or more symptoms, including of the key symptoms.
  • Sub-threshold depressive symptoms: 2-4 symptoms, may or may not include a key symptom.
  • Non-depressed: 0-1 symptoms

Symptoms:

  1. Depressed mood*
  2. Loss of interest*
  3. Significant weight loss or gain or decrease or increase in appetite
  4. Insomnia or hypersomnia
  5. Psychomotor agitation or retardation
  6. Fatigue or loss of energy
  7. Feelings of worthlessness or excessive or inappropriate guilt
  8. Diminished ability to think or concentrate, or indecisiveness
  9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or suicide attempt or a specific plan

*key symptoms

  1. Depression is the persistent feeling of sadness or loss of interest that characterizes major depression can lead to a range of behavioral and physical symptoms.

Therapies recommended to those with depression:

  1. Cognitive Behavioral Therapy
  2. Behavior Therapy
  3. Psychotherapy

Secular treatment consists of antidepressants. Medication often prescribed to depression patients includes:

  1. Bupropion
  2. Venlafaxine
  3. Mirtazapine
  4. Duloxetine
  5. Amitriptyline

Recommended specialists:

  1. Clinical psychologist
  2. Psychiatrist
  3. Primary care provider (PCP)
  4. Emergency medicine doctor

IV. History

Many scholars think that depression was first recognized as early as the time of the Ancient Greeks. The Greeks thought the disease was due to an imbalance in the four basic bodily fluids, or humors. Later, Aretaeus of Cappadocia noted that sufferers were dejected and stern, without any real cause. The name given to depression then was known as Melancholia, which was a far broader concept than today’s depression. In the 11th century, Persian physician Avicenna described melancholia as a mood disorder. Avicenna’s work, The Canon of Medicine, alongside the work of Hippocrates and Galen, became the standard of medical thinking in Europe. In the 18th century, German physician Johann Christian Heinroth argued that melancholia was a disturbance of the soul due to moral conflict. The term depression was derived from the Latin verb deprimere, which means, “to press down.” In the 19th and 20th centuries, English psychiatrist Henry Maudsely proposed a general category of affective disorder. Depression and reactive depression came to refer to a mood and not a reaction to outside events. In the 21st century, humanistic theories of depression have represented a forceful affirmation of individualism.

Depression has also been called clinical depression, major depression and major depressive disorder. Current treatment of depression implies that depression is a biomedical disease, which is why most psychiatrists prescribe antidepressants. The expert panels for treating depression (Depression Guideline Panel 1993; Katz and Alexopoulos 1996; Ballenger et a. 1999; WHO Collaborating Centre for Mental Health Research and Training 2000) recommend a clinical approach can be summarized as follows. Providers should:

  1. Recognize the presenting symptoms of depression and its causes.
  2. Make an explicit diagnosis of depression.
  3. Educate the patient and family, and stress that depression is treatable.
  4. Engage the patient and family in choosing treatment.
  5. Assess patients’ progress regularly.

Usually, treatment of depression begins with a patient visiting a health-care provider and reporting symptoms that suggest a mood disorder. Oftentimes the emotional symptoms of depression are hidden behind physical symptoms like complaints of fatigue.

V. Evidence of the Problem

Common themes and patterns observed in the lives of those who have been diagnosed with depression are extreme sadness, anxiety, listlessness, and feeling blue. Those who struggle with depression are often fatigued, over time becoming restless and irritable. Sleep is often restless, tossing and turning all night. Nightmares occur frequently, making restful sleep even more difficult. Another common theme is utter hopelessness. Many of those who are depressed are also suicidal. Depression is a despair that consumes you.

Severe depression can be debilitating, and there are several key expressions, recognizable as symptoms of depression. some cases where the activity level is as minimal as possible. Depression can have severe long term effects on one’s daily functions, as well as relationships with friends and families. Guilt and feelings of worthlessness overcome the counselee. Everything is negative, dwelling on past sad experiences, sins, failures and disappointments. Minor problems become major problems as one imagines the worst possible scenario. Some people lose unhealthy amounts of weight, while some people struggle to eat at all. People lose interest or pleasure in what used to interest you. Many people have trouble concentrating, feeling as though thoughts and movements have been slowed down; like your brain is fuzzy and in slow motion.[2] Depression takes a big toll on one’s physical self as well as one’s spiritual self. Many believers struggle to pray when they are feeling depressed.

VI. Etiology

Depression is an issue that affects people physically and spiritually. There isn’t an over arching “rule of thumb” for theories of depression. It manifests itself differently in different people. However, hope is found in the Person of Jesus Christ, not a pill. Sometimes the source of the problem is physical, then spiritual, sometimes vice versa. There are several spiritual symptoms and physical symptoms that can be seen in most cases of depression.

  1. Spiritual symptoms
    1. Hopelessness
    2. Continual lack of peace
    3. Not trusting in God
    4. Feelings of despair
    5. Discouragement
    6. Disappointment
    7. Despondency
    8. Lack of motivation
    9. Difficult to focus
    10. Diminishing prayer life

2. Physical symptoms

  1. Restlessness, unexplainable unhappiness
  2. Drastic change in weight
  3. Headache
  4. Brain fog
  5. Blurred vision
  6. Excessive crying
  7. Sadness
  8. Lack of concentration
  9. Irritability
  10. Social isolation

 

VII. Examining the Heart

  1. Heart themes
    1. Incorrect view of the faithfulness of God
    2. Hopelessness
    3. Incorrect view of the sovereignty of God
    4. Fear of man – guilt that others will think of you differently if they knew you struggled with depression.
    5. Lack of trust in the Lord (control)

2. Idols of the heart

  1. Pride
  2. Control,
  3. Self – reliance,
  4. Comfort
  5. Selfishness

 

VII. Biblical Solutions

  1. Counseling Agenda

Depression of one of the common temptations of man. 1 Corinthians 10:13 says, “No temptation that have overtaken you but such as is common to man.” One of the first steps a counselee can make towards change is admitting that God is capable of helping overcome depression. Another practical step a counselee can take is to commune with God through His Word. Lamentations 3:17-24 says, “I still dare to hope when I remember this: The faithful love of the Lord never ends! His mercies never cease. Great is his faithfulness; his mercies begin afresh each morning. I say to myself, ‘The Lord is my inheritance; therefore, I will hope in him’” God is faithful, capable, sovereign, eternally good and we desperately need hope every day of our lives! Christians struggling with depression need to fix their eyes on the Lord, the Author and Perfecter of faith. Romans 8:28 says, “And we know that for those who love God all things work together for good, for those who are called according to his purpose.” There is a reason and a purpose for the trial of depression, but believers are called to depend on Him through it all. Hebrews 6:19 says, “We have this as a sure and steadfast anchor of the soul, a hope that enters into the inner place behind the curtain.” Christ is our sure and steadfast anchor, which offers hope through Him and His Word.

Recommended Resources:

Adams, Jay E. A. The Theology of Christian Counseling. Grand Rapids, MI: Zondervan,

1979.

Adams, Jay E. The Christian Counselor’s Manual. Grand Rapids, MI: Zondervan, 1973.

Bridges, Jerry. Trusting God: Even When Life Hurts. Colorado Springs, CO: NavPress.

Busenitz, Nathan. Living A Life of Hope. Uhrichsville, OH: Barbour Publishing, 2003.

Lane, Timothy S., and Paul David Tripp. How People Change. Greensboro NC: New

Growth Press, 2008.

Somerville, Robert B. If I’m A Christian, Why Am I Depressed? United States of

America: Xulon Press, 2014.

Welch, Edward T. Depression: Looking Up from the Stubborn Darkness. Greensboro,

NC: New Growth Press, 2011.

Welch, Edward T. Depression: The Way Up When You Are Down (Resources for

Changing Lives). Greensboro, NC: New Growth Press, 2011.

Tada, Joni Eareckson. A Place of Healing: Wrestling with the Mysteries of Suffering,

Pain, and God’s Sovereignty. Colorado Springs, CO: Wolgemuth & Associates,

Inc. 2010.

Mack, Wayne A. Out of the Blues: Dealing with the Blues of Depression and Loneliness.

Minnesota: Focus Publishing, 2006.

Mack, Wayne A and Deborah Howard. It’s Not Fair! Finding Hope When Times Are

Tough. P & R Publishing: 2008.

Adams, Jay. What Do You Do When You Become Depressed? Phillipsburg, NJ:

Presbyterian and Reformed, 1975 (pamphlet).

Bridges, Jerry. Trusting God. Colorado Springs, CO: NavPress, 1989.

 

 

 

Recommended homework resources

Sample 1(taken from Robert Somerville’s book: If I’m a Christian, Why Am I Depressed?[3])

Somerville recommends journaling what you’re going through, as you’re learning and growing.

  • Journal a paragraph or two describing the anguish you feel.
  • Write out 1 Corinthians 10:13 in your journal and on a 3×5 card.
    • Memorize it.
    • On the back of the card write out a prayer, paraphrasing the verse as a prayer back to God. It might look like this: “Father, I thank You that You are faithful and that all our problems are common to man. I thank You that You never give us a temptation, test, or trial that is greater than we can handle. I thank You that You always provide a way through the problem so that we can handle it. Lord, as I face my depression today help me to look for the way out that You have provided so that I might be able to endure.”
    • Review the card and pray it back to God several times each day.
  • Read 1 Corinthians 10:13, Hebrews 4:14-16, and 1 John 1:9 and answer the following questions on each verse:
    • What has God promised you?
    • What hope and encouragement do you get from these three passages?
    • How will you respond to God’s promises in your situation?

 

 

[1] Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, by the American Psychiatric Association.

[2] Somerville, Robert B. If I’m A Christian, Why Am I Depressed? United States of America: Xulon Press, 2014.

[3] Somerville, Robert B. If I’m A Christian, Why Am I Depressed? United States of America: Xulon Press, 2014.