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

In the first two segments of this discussion on the illness of Depression, issues of causes, symptoms, and effects of depression have been examined. In this segment, the different types of treatment will be covered. Since to some extent the type of treatment is determined by the cause, the reader is referred to the initial segment (March 1999) to review the different causes.

Obviously, if there is a primary medical illness which is causing or aggravating the depression, then the most important treatment should be directed toward that condition. For this reason, anyone who has symptoms of depression is encouraged to consult a physician to determine the presence or absence of those medical problems (thyroid disorder, for instance) which might affect the choice of treatment for depression.

There is no easily available laboratory or X-ray test which can determine the presence of a biochemical imbalance which might be causing or accompanying depression. Yet, there are many research studies which indicate that many if not all severe depressive episodes have some element of biochemical imbalance, and treatment with medication designed to correct such imbalance is often part of a treatment program.

Such medications belong to a class called Antidepressants; in the United States, there are currently 24 such medications available, and other countries have more. Antidepressant medications are not tranquilizers, which are designed primarily to relieve anxiety (which may be a symptom of depression); tranquilizers (such as Valium, Xanax, Librium, and others) do not have the ability to alter the biochemical imbalance.

Antidepressant medication does not cover up symptoms, but rather is designed to restore a normal chemical balance to the system. When antidepressants are properly prescribed, 2/3 of patients will improve within 8 weeks, with at least a 50% reduction in symptoms. These are not addictive medications, but may have discomforting side effects, and may take several weeks to begin to have beneficial effect. Some of the newer antidepressants (Prozac, Zoloft, Paxil, Celexa, Wellbutrin, Effexor, Remeron, others) have better side effect profiles.

In view of the high incidence of recurrence in depression, it is very important to continue medication for an adequate period of time. Treatment with antidepressant medication should continue for at least six months for first episodes, and for several years or indefinitely for recurrent episodes.

Non-medical treatments such as psychotherapy or counseling should be used in the treatment of depression. There are different styles or theories of counseling; the more traditional analytically based treatments will focus on an examination of recurrent emotional reactions which may have roots in childhood, cognitive therapy will focus on the tendency to develop erroneous patterns of thinking and behavior which can cause conflict.

A problem for Christians undergoing counseling treatment may be that many of the traditional types of counseling focus on understanding and improving the self, while Christ calls us to deny self. Biblically based counseling seeks to find unconfessed sinful patterns and roots which may interfere with a believer's experiencing the joy of the abundant life Christ promises His servants.

Research studies have consistently shown that the best treatment results are seen with a combination of antidepressants and counseling. Other treatment approaches may be recommended, either alone or in combination: bright light therapy may be recommended if there is a significant seasonal component, and herbal remedies (St. John's Wort, for example) have shown some promise.

Depression is a treatable, recoverable disorder. The person suffering from depression must be persistent, and must hold on to faith, even when feelings might suggest otherwise. A frequent symptom of depression may be hopelessness, but we have reason for hope.

Thousands of years ago, the prophet Jeremiah described his own feelings of hopelessness: "I am the man who seen affliction ... He has driven me and made me walk in darkness and not in light ... And my soul has been rejected from peace; I have forgotten happiness. So I say, 'My strength has perished, and so has my hope from the Lord'". (Lam 3:1ff).

Yet, less than three verses after his lament, Jeremiah proclaims the truth of what we know makes dealing with depression, as well as other worldly stresses and problems, have a hopeful outcome: "This I recall to my mind, therefore I have hope. The Lord's lovingkindnesses indeed never cease. For His compassions never fail. They are new every morning; great is Thy faithfulness. 'The Lord is my portion', says my soul, therefore I have hope in Him." (Lam 3:19, 22-24).

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