Depression - Part I
Barney M. Davis Jr., MD, Godspeed Missionary Care

"A king once said: "How long must I wrestle with my thoughts and every day have sorrow in my heart? My life is consumed by anguish and my years by groaning ... I am weary with my sighing; every night I make my bed swim, I dissolve my couch with my tears.
Ps 13:2, 31:10, 6:6

"A wealthy man once said: "Why did I not perish at birth, and die as I came from the womb? I have no peace, no quietness; I have no rest, but only turmoil.
Job 3:11,26

"A prophet once said: "I have had enough, Lord. Take my life; I am no better than my ancestors.
1 Kings 19:4

"A missionary once said: "O, Lord, take away my life, for it is better for me to die than to live.
Jonah 4:3

What did David, Job, Elijah, and Jonah experience that would bring them to make such statements as those above? We do not know whether these men of God suffered from the condition that we call "Depression", but it is evident that even for such giants of faith, there were times when circumstances left them feeling great emotional pain. The same can happen today, even to men and women who have been called to serve God. Depression and stress-related disorders are the third most common reason for missionaries having to return home early. In this and the next installments of Missionary Medical Moment, we will explore the different facets of the condition called "Depression".

The "official" name for the condition that we call "depression" is a mood disorder. There are a number of subtypes of mood disorders, but the more pervasive and severe type is known as major depressive disorder. This condition, which we will call "depression" in this discussion, may occur as a single or as recurrent episodes.

Some people experience a particular subtype, with mood that cycles between depressed and elated ("manic") or restless irritability; this is known as a "bipolar disorder", the newer term for what used to be called "manic-depressive disorder". Causes of depression are usually multiple. Situational factors often contribute: stressful circumstances, relationship difficulties, and recent losses can all lead to depression.

Psychological factors may also be involved; these arise from problems which may occur in childhood and early development: deprivation, abuse, neglect, and loss during childhood can emerge as depression in later years.

Biological factors may also play a significant role, in two separate ways. First, there are "typical" medical problems which can mimic, aggravate, or create symptoms of depression; examples would be thyroid disease, medication reactions, hormonal changes, and even certain types of surgery.

Second, it is known that biochemical imbalances can occur in particular regions of the brain (collectively known as the "limbic system") which accompany more severe depressive symptoms.

Spiritual factors can be causative as well; obviously, if one does not have the assurance of forgiveness and salvation which comes with a personal relationship with Jesus, then the consequences of sinful behavior can lead to profound depression. But even for believing Christians, issues of unconfessed sin can work to cause depression symptoms: "When I kept silent about my sin, my body wasted away through my groaning all day long. For day and night Thy hand as heavy upon me; My vitality was drained away as with the fever heat of summer... " (Ps 32:4).

It is unusual to see someone with a depression that can be traced back to just a single cause; usually, most or all of these four areas are involved.

A study of who gets depression finds that it can effect anyone, at almost any age. Women are twice as likely to have the illness of depression, and the highest incidence is in the 25-44 year old age group. Estimates vary showing from 10-25% of women will experience a clinical depression in their lifetime (men have a lifetime risk of 5-12%). At any given time, 5-10% of all women and 3-5% of men are suffering from depression.

Other factors may increase risk; having other family members with the illness, the use of alcohol or other drugs, and even the absence of adequate amounts of sunlight make depression more likely.

Depression, Part II

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