Persistent Depressive Disorder (Dysthymia)

By David Wong

I. Definition

  1. Biblical Perspective
    1. Persistent Depressive Disorder is “a continuous long-term (chronic) form of depression.”[1] Asher and Asher say that “the primary diagnostic feature is clinical depression (see Depression) that lasts more or less continuously for two years (one year in children and adolescents).”[2]
    2. Persistent Depressive Disorder is similar in nature to Major Depression, but Persistent Depressive Disorder “usually has fewer or less serious symptoms than major depression”[3]
      1. Major distinctive characteristic is the time frame and severity of the disorder.
  2. Secular Perspective
    1. DSM V
      1. “Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years.”[4]
        1. 1 year for adolescents and children
      2. Treatments/Methodologies
        1. One of the significant treatments applicable to those diagnosed with Persistent Depressive Disorder through Psychology is Psychotherapy.
          1. Psychotherapy refers to therapeutic treatment of mental disorders without the use of medication.
          2. Some common therapies include[5]:
            1. Cognitive Behavioral Theory
            2. Interpersonal Therapy
            3. Dialectic Behavioral Therapy
            4. Psychodynamic Therapy
            5. Psychoanalytical Therapy
            6. Supportive Therapy
            7. Other Therapies include:
              1. Animal Assisted Therapy
              2. Creative Arts Therapy
              3. Play Therapy
              4. Yoga
              5. Psychotherapy does not necessarily have to be strict as to the type of psychotherapy being used. Psychologists may combine elements from several styles of psychotherapy, “they blend elements from different approaches and tailor their treatment according to each client’s needs.”[6]
        2. Medication
          1. Psychology also advocates for the use of anti-depressants as medication for depression as well. Some common medicines include[7]:
            1. Selective Serotonin reuptake inhibitors (SSRIs)
            2. Tricyclic Antidepressants (TCAs)
            3. Serotonin and norepinephrine reuptake inhibitors (SNRIs)
            4. Other Types[8]
            5. Atypical Antidepressants
            6. Monoamine oxidase inhibitors (MAOIs)

II. History

  1. DSM III
    1. Categorized as Dysthymic Disorder (Depressive Neurosis) under 300.40 in Affective Disorders.
    2. Dysthymia was originally introduced in the DSM III[9]
    3. Dysthymia occurs when, during the last two years, the “individual has been bothered most or all of the time by symptoms characteristic of the depressive syndrome but that are not of sufficient severity and duration to meet the criteria for a major depressive episode.”[10]
      1. Duration of 2 years for adults
      2. Duration of 1 year for children and adolescents
    4. “The manifestations of the depressive syndrome may be relatively persistent or separated by periods of normal mood lasting a few days to a few weeks, but no more than a few months at a time”[11]
  2. DSM V
    1. Classified as Persistent Depressive Disorder (Dysthymia) under 300.4 (F34.1) as a Depressive Disorder.
    2. The major change from the DSM IV to the DSM V is that Dysthymia is gone, replaced with persistent depressive disorder
      1. This new condition includes both chronic major depression and dysthymia because of the “inability to find scientifically meaningful differences between these two conditions”[12]
    3. Evidence of the Problem
      1. The DSM V says that those experiencing two (or more) of the following are likely to have Persistent Depressive Disorder[13]:
        1. Poor appetite or overeating
        2. Insomnia or Hypersomnia
        3. Low energy or fatigue
        4. Low self-esteem
        5. Poor concentration or difficulty making decisions
        6. Feelings of hopelessness

III. Etiology

  1. Potential Causes of Persistent Depressive Disorder (Psychological View)
    1. The exact cause of Persistent Depressive Disorder is unknown. However, it could be a result of such causes as:
      1. Biological Differences or Brain Chemistry[14]
        1. Scientists have identified many different neurotransmitters that may play a role in depression, and this includes neurotransmitters like[15]
          1. Acetylcholine
          2. Serotonin
          3. Norepinephrine
          4. Dopamine
          5. Glutamate
          6. Gamma-aminobutyric acid (GABA)
  1. Inherited Traits
    1. “Depression does not have a clear pattern of inheritance in families.”[16]
    2. However, “people who have a first-degree relative with depression appear to have a two to three times greater risk of developing the condition than the general public”[17]
  2. Life Events
    1. “Traumatic events such as the loss of a loved one, financial problems or a high level of stress can trigger persistent depressive disorder in some people”[18]
  3. Potential Causes of Persistent Depressive Disorder (Spiritual)
    1. Biblical counselors must recognize that physical, physiological, and biological issues occurring with the counselee do have the ability to influence the response of the counselee.
      1. However, while physical, physiological, and biological issues can influence a person, they cannot force a person to respond with sin.
    2. “Depression unrelated to drugs or a physical illness are often indicative of wrong thinking or other spiritual problems”[19]
      1. The person must respond to their sin with confession to the Lord and repentance from their sin
        1. Persistent depressive disorder is not, in and of itself, a sin
          1. Sinful actions and habits may lead to persistent depressive disorder, and persistent depressive disorder may result in sinful actions and habits
          2. However, Persistent depressive disorder is not, in and of itself, a sin
        2. Spiritual Symptoms
          1. Guilt
          2. Anxiety
          3. Suffering
          4. Feelings of Inferiority
          5. Hopelessness
  4. Physical Symptoms
    1. Poor appetite or overeating
    2. Insomnia or Hypersomnia
    3. Low energy or fatigue

IV. Examining the Heart

  1. Heart Themes
    1. Fear of Man
      1. “Instead of a biblically guided fear of the Lord, we fear others”[20]
      2. The most radical treatment for the fear of man is the fear of the Lord.
        1. The sufferer must first “know that God is awesome and glorious, not other people”[21]
      3. The action the counselee must take to remedy the fear of man is to “need them less and love them more”[22]
      4. Relevant Passages
        1. Proverbs 29:25
        2. Matthew 10:28
        3. Galatians 1:10
        4. Mark 12:30-31
      5. Control
        1. Wrong thinking and belief that control will bring us satisfaction or happiness.
        2. “We don’t know what’s best for us because we’re not the Creator.”[23]
        3. Show counselee that God is in control and that He is working for good
          1. God is Sovereignly in control
          2. God is Good and acts according to His goodness
          3. God is Faithful and always fulfills His promises for our good
  2. Comfort
    1. Obedience to God oftentimes means stepping outside of your comfort zone
      1. John 14:15
      2. 1 John 5:3
      3. Romans 12:1-2
    2. Chief end of man is to glorify God and enjoy Him forever.
  3. Biblical Solutions
    1. Counseling Agenda
      1. Involvement
        1. Seek to build a relationship with the counselee
          1. Enter the person’s world[24]
            1. Includes listening to the counselee to discern where they are struggling[25]
          2. Incarnate the love of Christ[26]
            1. “As Christ’s ambassadors, it’s not just what we say that God uses to encourage change in people; it’s also who we are and what we do”[27]
          3. Inspiration
            1. Provide hope to the counselee that Scripture has answers to their problems and that lasting change is possible
              1. “Hope is more than convincing people that things will get better, or helping them decide what to do”[28]
              2. Hope “helps people who are dealing with the unthinkable to view life from the perspective of God’s glory and grace and their identity as His children”[29]
                1. Romans 15:4
                2. 1 Corinthians 10:13
                3. Galatians 3:26
                4. John 1:12
    2. Inventory
      1. Gather physical data
        1. Sleep
        2. Diet
        3. Exercise
        4. Illness
        5. Medication
      2. Discern their heart through speaking and asking appropriate questions to better understand them
      3. Information the counselor wants to know[30]
        1. The situation
        2. The responses
        3. The thoughts
        4. The motives
    3. Interpretation
      1. Involves “accurately analyzing or conceptualizing the data and explaining it to the counselee” [31]
        1. Discern biblical categories that best describe the counselee [32]
          1. Saved or Unsaved?
          2. Spiritually mature or immature
          3. Unruly, fainthearted, weak?
            1. 1 Thessalonians 5:14
      2. Formulate a Working Interpretation[33]
      3. Determine possible reasons for the problem
      4. Consider the Counselee’s heart
      5. Test the Validity of Your Interpretation[34]
    4. Instruction
      1. Instruction should be biblically based[35]
        1. “Counseling that is faithful to the Bible effectively communicates the original meaning of the biblical text in a way that is relevant to the situation and heart of the person you are counseling”[36]
      2. Specific Instruction as to Depression
        1. Physical and Physiological Issues
          1. The counselor must provide biblical instruction as it relates to the physical or physiological aspects of their lives
            1. The extent of this counsel should be to counsel the counselee against unhealthy actions and habits as well as instructing the counselee to undertake healthy living (i.e. sleeping habits, eating habits, exercising, etc.)
              1. For issues that are medical, or may require more professional attention, the counselor should encourage the counselee to see their medical practitioner
            2. Instruct on the heart
              1. Potential heart themes for those struggling the Dysthymia
                1. Control
                2. Comfort
                3. Fear of Man
              2. The role of feelings
              3. Various problems and issues the counselee may be struggling with[37]
                1. Guilt
                2. Anxiety
          2. Suffering
            1. Inferiority
            2. Hopelessness
            3. Laziness
            4. Self-control
    5. Inducement[38]
      1. Fire up the counselee to make certain decisions and commitments that will facilitate change
      2. “Bring counselees to the realization that biblical change involves personal choice”[39]
      3. Promotes a concern about heart sins as well as behavioral sins[40]
        1. “Nothing less than heart repentance and heart change will please God and produce change that is genuine and lasting”
      4. “Secure a commitment from counselees to put off the desires, thoughts, and actions that hinder biblical change and to replace them with ones that promote biblical change”[41]
    6. Implementation
      1. Ephesians 4 Model
        1. Put off the Old
          1. Identify factors that hinder biblical change and take steps to eliminate them[42]
        2. Renewal of the Mind
          1. Provide practical action for the counselee to engage in, in the hopes that the counselee would be personally engaged with Scripture and contain a renewed perspective pertaining to their issues and problems as well as their heart
            1. Prayer
            2. Bible Reading
            3. Biblical instruction
          2. Put on the New[43]
            1. Should be specific as to the counselee according to the Ephesians 4 model
          3. Homework
            1. Homework should provide specific and practical action for the counselee to take
            2. Assigned Bible Reading for the counselee to do and meditate upon
              1. Ephesians 4
              2. 1 Corinthians 10:13
              3. Romans 15:4
            3. Homework should “assist the counselee to apply the truths learned about God, self, and others to the specifics of his living situation, making biblical corrections and instituting new biblical habits”[44]
    7. Integration
      1. Ensure that they are getting involved in their local Church
        1. Sunday Service
        2. Bible Studies
        3. Fellowship Groups
        4. Accountability
      2. At this point, the counselor would like their local church to be shepherding and guiding this person
        1. This includes ongoing discipleship and accountability within the Church
        2. Ensuring that the counselee is surrounded by strong believers that are devoted to the Word and are committed to discipling and keeping the counselee accountable in their living
      3. Recommended Books
        1. How to Help People Change by Jay E. Adams
        2. Counseling: How to Counsel Biblically by The Master’s College
        3. Instruments in the Redeemer’s Hands by Paul David Tripp
        4. When People are Big and God is Small by Edward T. Welch
        5. The Christian’s Guide to Psychological Terms by Marshall and Mary Asher
  1. Recommended Homework Resources
    1. A Homework Manual for Biblical Living by Wayne Mack
    2. Depression Homework Assignment Samples from IBCD
      1. https://ibcd.org/depression-homework-assignment-samples/

 

 

Bibliography

American Psychiatric Association. 1987. Diagnostic and Statistical Manual of Mental       Disorders : Dsm-Iii-R. 3Rd edition, revised. Washington, DC: American Psychiatric      Association.

American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental       Disorders : Dsm-Iv. 4th ed. Washington, DC: American Psychiatric Association.

American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders:             Dsm-5. 5th ed. Arlington, VA: American Psychiatric Association.

“Antidepressants: Selecting One That’s Right for You.” Mayo Clinic. November 17, 2017.           Accessed April 16, 2019. https://www.mayoclinic.org/diseases-conditions/depression/in-       depth/antidepressants/art-20046273.

Daniel Wiswede, et al. 2014. “Tracking Functional Brain Changes in Patients with Depression     under Psychodynamic Psychotherapy Using Individualized Stimuli.”                     https://doi.org/10.1371/journal.pone.0109037.

“DSM5 Diagnostic Criteria Persistent Depressive Disorder.” 2013.

“Dysthymia – Harvard Health Publications.” 2010. January 6, 2010.                       https://web.archive.org/web/20100106064958/http://www.health.harvard.edu/newsweek/ Dysthymia.htm.

Edward T. Welch, 1997. When People Are Big and God Is Small : Overcoming Peer Pressure,     Codependency, and the Fear of Man. Resources for Changing Lives. Phillipsburg, N.J.: P      & R Pub.

Marshall Asher and Mary Asher. The Christian’s Guide to Psychological Terms. Focus Pub.,        2014.

Moore, Beverly. “The Illusion of Control.” Biblical Counseling Coalition. February 02, 2018.      Accessed April 18, 2019. https://www.biblicalcounselingcoalition.org/2018/02/02/the-           illusion-of-control/.

 “Persistent Depressive Disorder (Dysthymia) – Symptoms and Causes.” n.d. Mayo Clinic.           Accessed February 16, 2019. https://www.mayoclinic.org/diseases-conditions/persistent- depressive-disorder/symptoms-causes/syc-20350929.

Publishing, Harvard Health. n.d. “What Causes Depression?” Harvard Health. Accessed   February 19, 2019. https://www.health.harvard.edu/mind-and-mood/what-causes-        depression.

Reference, Genetics Home. n.d. “Depression.” Genetics Home Reference. Accessed February      19, 2019. https://ghr.nlm.nih.gov/condition/depression.

Robin L. Cautin and Scott O. Lilienfeld, eds. 2014. The Encyclopedia of Clinical Psychology.     Hoboken, NJ, USA: John Wiley & Sons, Inc. https://doi.org/10.1002/9781118625392.

Tripp, Paul David. 2002. Instruments in the Redeemer’s Hands : People in Need of Change          Helping People in Need of Change. Resources for Changing Lives. Phillipsburg, N.J.: P      & R Pub.

 “Understanding Psychotherapy and How It Works.” n.d. Https://Www.Apa.Org. Accessed          February 17, 2019. https://www.apa.org/helpcenter/understanding-psychotherapy

[1] “Persistent Depressive Disorder (Dysthymia) – Symptoms and Causes.” n.d. Mayo Clinic. Accessed February 16, 2019. https://www.mayoclinic.org/diseases-conditions/persistent-depressive-disorder/symptoms-causes/syc-20350929.

[2] Marshall Asher and Mary Asher. The Christian’s Guide to Psychological Terms. Focus Pub., 2014, 143.

[3] “Dysthymia – Harvard Health Publications.” 2010. January 6, 2010. https://web.archive.org/web/20100106064958/http://www.health.harvard.edu/newsweek/Dysthymia.htm.

[4] American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders: Dsm-5. 5th ed. Arlington, VA: American Psychiatric Association, 168.

[5] Daniel Wiswede, et al. 2014. “Tracking Functional Brain Changes in Patients with Depression under Psychodynamic Psychotherapy Using Individualized Stimuli.”  https://doi.org/10.1371/journal.pone.0109037.

[6] “Understanding Psychotherapy and How It Works.” n.d. Https://Www.Apa.Org. Accessed February 17, 2019. https://www.apa.org/helpcenter/understanding-psychotherapy.

[7] Robin L. Cautin and Scott O. Lilienfeld, eds. 2014. The Encyclopedia of Clinical Psychology. Hoboken, NJ, USA: John Wiley & Sons, Inc. https://doi.org/10.1002/9781118625392.

[8] “Antidepressants: Selecting One That’s Right for You.” Mayo Clinic. November 17, 2017. Accessed April 16, 2019. https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046273.

[9] American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental Disorders : Dsm-Iv. 4th ed. Washington, DC: American Psychiatric Association, 209.

[10] American Psychiatric Association. 1987. Diagnostic and Statistical Manual of Mental Disorders : Dsm-Iii-R. 3Rd edition, revised. Washington, DC: American Psychiatric Association, 222.

[11] Ibid.

[12] American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders: Dsm-5. 5th ed. Arlington, VA: American Psychiatric Association, 168.

[13] “DSM5 Diagnostic Criteria Persistent Depressive Disorder.” 2013, 3.

[14] “Persistent Depressive Disorder (Dysthymia) – Symptoms and Causes.” n.d. Mayo Clinic. Accessed February 16, 2019. https://www.mayoclinic.org/diseases-conditions/persistent-depressive-disorder/symptoms-causes/syc-20350929.

[15] Publishing, Harvard Health. n.d. “What Causes Depression?” Harvard Health. Accessed February 19, 2019. https://www.health.harvard.edu/mind-and-mood/what-causes-depression.

[16] Reference, Genetics Home. n.d. “Depression.” Genetics Home Reference. Accessed February 19, 2019. https://ghr.nlm.nih.gov/condition/depression.

[17] Ibid.

[18] “Persistent Depressive Disorder (Dysthymia) – Symptoms and Causes.” n.d. Mayo Clinic.

[19] Marshall Asher and Mary Asher. The Christian’s Guide to Psychological Terms. Focus Pub., 2014, 61.

[20] Edward T. Welch, 1997. When People Are Big and God Is Small : Overcoming Peer Pressure,   Codependency, and the Fear of Man. Resources for Changing Lives. Phillipsburg, N.J.: P & R Pub, 14.

[21] Ibid., 95.

[22] Ibid., 193.

[23] Moore, Beverly. “The Illusion of Control.” Biblical Counseling Coalition. February 02, 2018. Accessed April 18, 2019. https://www.biblicalcounselingcoalition.org/2018/02/02/the-illusion-of-control/.

[24] Tripp, Paul David. 2002. Instruments in the Redeemer’s Hands : People in Need of Change Helping People in Need of Change. Resources for Changing Lives. Phillipsburg, N.J.: P & R Pub, 126.

[25] Ibid., 128.

[26] Ibid., 133.

[27] Ibid., 134.

[28] Ibid., 157.

[29] Ibid.

[30] Ibid., 189.

[31] Master’s College. 2005. Counseling : How to Counsel Biblically,147.

[32] Ibid., 150.

[33] Ibid., 157-160

[34] Ibid., 159-160.

[35] Ibid., 163.

[36] Street, John D. 2013. Men Counseling Men. Eugene, Or.: Harvest House, Chapter 2.

[37] Marshall Asher and Mary Asher. The Christian’s Guide to Psychological Terms. Focus Pub., 2014, 61-62

[38] Master’s College. 2005. Counseling: How to Counsel Biblically, 176-177

[39] Ibid.

[40] Ibid.

[41] Ibid.

[42] Ibid., 190.

[43] Ibid., 193.

[44] Tripp, Paul David. 2002. Instruments in the Redeemer’s Hands: People in Need of Change Helping People in Need of Change, 343.

Post-Partum Depression

By Andrea Johnson

I. Definition

Postpartum depression (PPD) refers to the intense sadness women sometimes experience after giving birth.[1] It must occur within the first four weeks of giving birth and last for a period of two weeks or longer.[2]

II. Secular Perspective

The DSM IV was the first resource to place postpartum depression under the category of major depression. Therefore, PPD is viewed/treated similarly to major depression, with the exception of the use of medication, because some anti-depressants are not recommended for mothers who are breastfeeding. PPD has a prevalence of 13% amongst new mothers[3], and it generally self-resolves within two weeks to three months. PPD often disrupts the mother’s interpersonal relationships, and can even harm child development.[4]

Those who are a part of the feminist camp do not approve of PPD being a specific category at all. PPD is offensive to them because they do not want women to have a specific disorder that does not pertain to men, as this would cause women to potentially appear weak. They argue that because men do not have a specific label for any hormonal or emotional imbalances, neither should women.

Secular treatment for PPD includes interpersonal psychotherapy, short-term cognitive behavioral therapy, pharmacotherapy, hormonal therapy, and in extreme cases, psychiatric hospitalization.

III. Biblical Perspective

Postpartum depression affects both the inner and outer man. Body and soul are distinguished, but they cannot be separated (2 Corinthians 4:16). PPD affects the woman as a whole – her physical body is experiencing hormonal changes, lack of sleep, shock to new motherhood, and physical pain due to childbearing, meanwhile her thinking, attitude, motivations, desires, and reactions are all being affected. Where there is a physical problem, there will also certainly be a spiritual problem.[5] Therefore, a woman who is experiencing PPD should care for both her physical body and her inner heart. 1 Corinthians 6:19-20 says that our bodies are the temple of the Holy Spirit. So the woman experiencing postpartum depression should be cared for as a whole person, both the physical outer man and the spiritual inner man.

Depression/anguish is not seen as a sin in and of itself in the Bible. We see this in the examples of David (Ps. 42, 2 Sam. 12:15-24), Job (Job 2:9, 4:9), and even Jesus (Isaiah 53:3, Luke 22:44). Postpartum depression means that a woman is experiencing real pain that is both physical and spiritual, and she should be cared for equally in both areas.

IV. Evidence of the Problem

Common themes and patterns for women experiencing PPD are lack of sleep, transitional shock, hormonal withdrawal, and previous depression[6]. Common expressions of PPD are crying spells, insomnia, depressed mood, fatigue, anxiety, poor concentration, lack of interest in daily activities, increased or decreased appetite, hypersomnia, phychomotive behavior, feelings of worthlessness or inadequacy about being a mother, guilt about being depressed, and recurring thoughts of death regarding either her or the baby.[7] Women experience these expressions in varying degrees ranging from mild (i.e. the “baby blues”) to severe (i.e. postpartum psychosis). There are several risk factors that greatly contribute to a new mother’s chance of experiencing PPD[8]. These include previous depression, prenatal depression, prenatal anxiety, life stress, poor marital relationship, lack of social support, child care stress, and temperamental or sick infants.

There are consequences for both the mother and the infant that can arise from the presence of PPD, such as behavioral and cognitive development in the child[9], disrupted mother-infant bonding, disruption of interpersonal relationships for the mother, and disruption to the mother’s marriage[10].

V. Examining the Heart

It is important to investigate each scenario to find out what each woman is struggling with individually. PPD is looks different for different women, both physically and spiritually. Sinful heart themes that may be present are: pride in the unacceptance of physical weakness, a wrong view of motherhood, false expectations for motherhood, resistance to connecting with the local church/asking for help. Women who are new mothers may want to prove to themselves and others that they are a capable mother. In addition, their view of “capable/good motherhood” may not be biblical. This may contribute to a depressed state because women will never live up to an unrealistic and unbiblical standard of good motherhood. Motherhood must be learned, it is not simply known. Women experiencing PPD will often ignore their own physical pain in an attempt to focus on their child, when they should also be caring for themselves physically, and asking for necessary help. Sleep deprivation has been found to be one of the leading factors of depression[11], but women are often not aware of the implications of their sleep deprivation and other physical stress they are experiencing. This could be rooted in the pride of not wanting to accept their physical limitations, and not wanting to look like an incapable mother by asking for assistance.

VI. Biblical Solutions

A woman experiencing PPD must ensure she has a biblical perspective of motherhood, humbles herself to admit her physical weakness, and ask for help from the local church. She also needs to understand that it is good to take care of her physical body, as this will impact her inner soul as well. Heath Lambert and Stuart Scott recommend that a woman with PPD should seek help from her husband/friends/the local church, so that she is able to tend to her immediate physical needs of sleep and food. She should study Romans 5:1-5 to be encouraged that her suffering is not pointless, and she has the opportunity to see the Lord’s hand through her depression. She should confess sins of pride and any unrealistic expectations she has placed on herself. Finally, she should gain a biblical understanding of motherhood by learning from other women who have gone before her, as Titus 2:3-5 commands.

Homework would include prayer, studying Romans 5:1-5, meeting with an older woman from church, and setting a daily schedule. Setting a schedule will help the new mother ensure that she is getting rest, food, and daily tasks accomplished, and will help her to find out what areas she specifically needs help in (i.e. meal prep, laundry, house cleaning, etc.)

Recommended books include: Overcoming Fear, Worry, and Anxiety by Elise Fitzpatrick; Women Counseling Women by Elise Fitzpatrick; Depression: Looking Up from the Stubborn Darkness by Edward T. Welch; and Lies Women Believe by Nancy Lee DeMoss.

 

 

 

BIBLIOGRAPHY

Anderson, Gary R. 2017. Postpartum Depression: Prevalence, Risk Factors and Outcomes.         Health Psychology Research Focus. Hauppauge, New York: Nova        Biomedical. http://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=n  ebk&AN=1453453&site=ehost-live&scope=site&custid=s8898283.

Andrews-Fike, Christa. 1999. “A Review of Postpartum Depression.” Primary Care         Companion to The Journal of Clinical Psychiatry 1 (1):        914. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181045/.

Asher, Marshall and Mary. The Christian’s Guide to Psychological Terms, 2nd ed. 2004.

Bernard-Bonnin, Dr. Anne-Claude. “Maternal Depression and Child Development.” US National Library of Medicine. October 2004. Accessed April 13, 2019. https://www.ncbi.      nlm.nih.gov/pmc/articles/PMC2724169/.

Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Washington, DC:    American Psychiatric Association, 2000.

“Interview with Charles Hodges & Jim Newheiser {Transcript}.” 2017. IBCD. March 24, 2017. https://ibcd.org/004-interview-with-charles-hodges-jim-newheiser-transcript/.

O’Hara, Michael W. 2009. “Postpartum Depression: What We Know.” Journal of Clinical           Psychology 65 (12): 1258–69. https://doi.org/10.1002/jclp.20644.

STUART, SCOTT, and MICHAEL W. O’HARA. 1995. “Interpersonal Psychotherapy for           Postpartum Depression.” The Journal of Psychotherapy Practice and Research 4 (1): 18        29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3330386/.

 

[1] Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Washington, DC: American

Psychiatric Association, 2000.

[2] Asher, Marshall and Mary, The Christian’s Guide to Psychological Terms, 2nd ed., 2004, 149.

[3] Anderson, Gary R. 2017, Postpartum Depression: Prevalence, Risk Factors and Outcomes, Health Psychology Research Focus, Hauppauge, New  York: NovaBiomedical, http://search.ebscohost.com/login.aspxdirect=true&AuthType=shib&db=nebk&AN=1453453&site=ehost-live&scope=site&custid=s8898283.

[4] O’Hara, Michael W. 2009, “Postpartum Depression: What We Know,” Journal of Clinical Psychology 65 (12): 1258–69, https://doi.org/10.1002/jclp.20644.

[5] “Interview with Charles Hodges & Jim Newheiser {Transcript},” 2017, IBCD, March 24, 2017, https://ibcd.org/004-interview-with-charles-hodges-jim-newheiser-transcript/.

[6] Asher, Marshall and Mary, The Christian’s Guide to Psychological Terms,

[7] Andrews-Fike, Christa, 1999, “A Review of Postpartum Depression,” Primary Care Companion to The Journal of Clinical Psychiatry 1 (1):914, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181045/

[8] O’Hara, Michael W. 2009, “Postpartum Depression: What We Know,” Journal of Clinical Psychology 65 (12): 1258–69, https://doi.org/10.1002/jclp.20644.

[9] Bernard-Bonnin, Dr. Anne-Claude, “Maternal Depression and Child Development,” US National Library of Medicine, October 2004, Accessed April 13, 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2724169/.

[10] STUART, SCOTT, and MICHAEL W. O’HARA, 1995, “Interpersonal Psychotherapy for Postpartum Depression,” The Journal of Psychotherapy Practice and Research 4 (1): 18 29, https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC3330386/, 20.

[11] “Interview with Charles Hodges & Jim Newheiser {Transcript},” 2017, IBCD, March 24, 2017, https://ibcd.org/004-interview-with-charles-hodges-jim-newheiser-transcript/.

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.