Understanding and Overcoming Depression

Bob was a fifty-four-year-old accounting executive with a life full of success and happiness. He spent time with his family, enjoyed his work, played sports with his friends, and was active in his church and community. But then his employer had financial problems and had to lay Bob off. Bob did a thorough job search but openings were just not available. He even tried finding other types of work but potential employers said he was overqualified.

Over time, Bob became increasingly discouraged and sad. He had difficulty concentrating and his thoughts often wandered to how worthless he felt. He believed everything was his fault and was certain things would never get better again. He no longer enjoyed his family, recreational activities, friends, or even his church and relationship with God. Bob would wake up in the middle of the night and have a hard time getting back to sleep. His family noticed how he had lost weight, slowed down, withdrawn from others, and felt sad or irritable much of the time. Bob told me, “I feel like I’m behind a glass wall. I can see and hear things that used to make me happy, but they don’t any more.” Even reading the Bible and praying did not provide Bob the encouragement they used to, although they sometimes helped a little.

Tonya is a thirty-two-year-old lawyer who feels depressed and pessimistic and has very low self-esteem. She cannot remember a time in many years when she has not felt depressed. She is unhappy with her family, her job, and her entire life. It is as though a black cloud of gloom covers her entire world. Although she has a job in a successful law firm, Tonya believes that she does not measure up to her co-workers. She purposely married a man she considered “average” because she thought he would be less likely to leave her.

Bob and Tonya both suffer from depression. Bob suffers from Major Depression, a condition that causes enormous suffering for the depressed person and often for his or her loved ones. Research studies have found that between 5 to 9 percent of adult women and 2 to 3 percent of adult men in the United States suffer from Major Depression at any given time.1 Tonya suffers from Dysthymia, a rather common form of depression with fewer and less severe symptoms than Major Depression, although it can last for years unless treated. Depression robs people of joy in living, and in its severe forms, drives some to end their lives through suicide. Feeling absolutely worthless and believing they have no hope for a better future, they choose to take their lives in order to find relief from unrelenting sadness and despair.

People who are suffering from depression may experience more pain and physical illness than others and have a more difficult time in social relationships. Depressed Christians can be riddled with guilt, preoccupied with feelings of failure, and have difficulty believing God loves and forgives them. Even though they intellectually know that God loves everyone, they don’t feel as if God cares for them. Fortunately, depression can be effectively treated, and the earlier it is detected the easier it is to treat.

Signs and Symptoms of Depression

Everyone feels sad or down at times. But Depression and Dysthymia are different from ordinary sadness. Ordinary sadness is temporary and a normal part of life. Depression is much worse, lasts longer, and involves terrible feelings toward one’s self. Major Depression interferes with the person’s ability to function on the job, at home, in social situations, or in other important roles for an extended period of time. Dysthymia also interferes with an individual’s ability to function at work or in relationships while normal sadness does not.

Someone with Major Depression will have at least five of the following symptoms most of the time every day for at least two weeks. Someone with Dysthymia will have fewer of these symptoms but will be depressed most of the day, on most days, for at least two years.

• A depressed, irritable, or cranky mood most of the time nearly every day
• Greatly reduced interest or pleasure in daily activities
• Changes in appetite that result in a significant weight loss or gain
• Sleep disturbance (difficulty sleeping or excessive sleeping)
• Agitation or slowing down
• Fatigue or loss of energy
• Feelings of worthlessness or guilt
• Decreased ability to concentrate or make decisions
• Decreased ability to concentrate or make decisions.

Similar Conditions

Several other problems have symptoms or side effects that are similar to depression, but different enough to require a different kind of help. These include:

• Bereavement or grief following the death or loss of a loved one
• Postpartum Depression—around the time a woman gives birth, or shortly after
• Seasonal Affective Disorder (SAD)—a type of Major Depression that develops in winter
• Bipolar Disorders—previously called Manic-Depressive Disorders—characterized by mood shifts from extreme feelings of elation, enormous amounts of energy, irritability, moodiness, increased risk taking, and little need for sleep, to periods of deep depression
• General medical conditions (e.g., Parkinson’s disease, multiple sclerosis, heart attack, stroke, vitamin B12 deficiency, hyper-and hypothyroidism, lupus, hepatitis, mononucleosis, human immunodeficiency virus [HIV], diabetes, certain kinds of cancer, etc.)
• Side effects from certain types of medicines including some for pain, high blood pressure, cardiac conditions, ulcers, and Parkinson’s, as well as muscle relaxants and steroids
• Reactions to metals and toxic substances like paint, lead, gasoline, insecticides, nerve gases, carbon monoxide, and carbon dioxide
• Intoxication or withdrawal from substances, such as alcohol, cocaine, etc.

Spiritual and Existential Struggles

Jodie came to see a counselor because she felt depressed much of the time. She traced the start of her symptoms to the time she began asking questions about the meaningfulness of certain aspects of the Christian faith. This upset Jodie because she valued her faith in Christ and was afraid she might be losing her salvation. She was terrified and feared that she might be doomed to hell for her questioning and doubt.
When Jodie tried sharing her concerns with others in her church, they told her she should just have more faith. One “friend” made things worse by reinforcing her fears that she was losing her faith. Another told Jodie that perhaps she was never a Christian in the first place and that everything she had been doing and saying was a lie. Others did not take her seriously and treated Jodie like a child, saying she was just going through a phase that she would soon outgrow. No one understood her doubts and questions, and Jodie felt all alone. Nevertheless, she could not put away her suspicion that some of the things she had been taught about Christianity over the years were untrue.

As Jodie began re-examining the beliefs she had uncritically accepted as a child, she found that some rang true with the Bible and her experience of Christ while others did not. Some of the things she had been taught seemed to be more a product of her church’s subculture than that of the Bible. And some of the hard questions she was asking had never been discussed in her church or family and seemed threatening for her friends and family even to consider. In time, Jodie’s counselor helped her see that rather than losing her faith, Jodie was actually growing in her Christian faith by examining what she believed and making it hers for the first time.

Like Jodie, many people go through periods of doubt and struggle as they re-evaluate their faith. These periods of questioning occur on a rather predictable basis and have even been written about in books and articles on faith development.3 For some, these struggles are relatively mild and painless. For others it is a lengthy and painful struggle. This happens most often in two types of situations. First, extra sensitive or introspective individuals-especially late adolescents, young adults, people in new subcultures, and people facing great hardship or tragedy-may ask hard questions about the fate of people who have never heard of Christ and those who sincerely follow other faiths. They reflect on injustices that have been carried out in the name of God, realize that some of the things they have been taught are questionable at best, see people who have been hurt or neglected in their church, or wonder why some of their earnest prayers seem to have gone unanswered.They don’t want to lose their faith, but they are too honest to ignore these problems.They wonder if there really is a God. And if there is, is He the God of the Bible?

Second, some individuals and church subcultures do a better job than others of providing encouragement for people with questions and doubts. People who offer quick advice, look down on the person, or who are uncomfortable with those who ask hard questions can make growth and transitions more difficult. This happens even when the person acting this way is trying to help out. Others who do not judge while they listen in an active and caring way to the questions and concerns of the person can help smooth the transition by reducing the isolation and other unpleasant feelings that the person may have.

Another kind of intense struggle can combine with a tendency to be excessively self-critical or to suffer from guilt and discouragement, triggering serious depression. This happened to Carl. At thirty-five years of age, he no longer felt the joy or enthusiasm he used to feel in his relationship with God. Over a relatively lengthy period of time, Carl talked his experiences over with his pastor and a couple of good friends. Gradually, he realized that he was going through a shift in his Christian experience but that didn’t mean he had to “throw the baby out with the bath water.” True, he was outgrowing his less mature sense of excitement and the naïve aspects of his faith. But he found that he had the potential to shift from finding his pleasure in the good feelings he got from his faith to a deeper level of commitment and loving God for who God is, not so much for what God did for him.

Fortunately, Carl’s pastor was spiritually and psychologically sensitive and was able to help Carl navigate through this phase of spiritual life that is so common that it has a name-the dark night of the soul. It is a period of shifting to a deeper type of faith that often requires a time of struggle and apparent loss of intimacy with God.

Jodie and Carl’s spiritual struggles both helped create their depression, and their depression was significantly relieved as they worked through their struggles of faith. Sally was different. She had a Major Depression first, and then noticed that she lost the feelings of joy and enthusiasm in her life with Christ. The guilt and self-condemnation and loss of interest in life caused by Sally’s depression carried over into her relationship with God, leaving her feeling distant from Him and feeling like a failure in her Christian life. She wondered if God could really love someone as worthless as she believed herself to be. Instead of spiritual struggles causing Sally’s depression, depression caused her spiritual struggles.

Some Christians become depressed because they are members of a spiritually abusive group.4 Characteristics of spiritually abusive systems include a preoccupation with power, a primary focus on performance and on how things appear on the surface in order to make a leader or group look good, an emphasis on controlling people through rules, and a powerful unspoken rule that you cannot talk about problems. Effects of spiritual abuse on others can include developing a distorted image of God, a preoccupation with spiritual performance, a distorted or shame-based identity of yourself as a Christian, and having a hard time with grace, personal boundaries, authority, personal responsibility, and trust.

How Depression Develops

Depression can have physical, spiritual, and/or emotional causes.

Physical Causes Some people appear to have a higher genetic predisposition to becoming depressed. They are more likely to become depressed even after a relatively minor loss or stress. Others may have a lower genetic predisposition but develop depression if exposed to traumatic loss or extremely stressful conditions. Some have glandular problems, such as a thyroid disorder. Some people develop depression in winter when there is not enough sunlight. Others develop depression due to lead poisoning, head injuries, strokes, or other medical conditions.

Psychological Causes Robert’s mother died from multiple sclerosis when he was six years old. Her death was so painful for Robert and his father that they never talked about it. They tried to push their feelings deep inside or distract themselves by getting lost in work or school. This left Robert particularly vulnerable to feeling abandoned or left alone. When his college girlfriend suddenly broke off their relationship. Robert’s unresolved feelings of grief, hurt, and abandonment welled up and left him feeling depressed. He was already away from the little security he had left at home and his girlfriend’s rejection was too much for him to handle.

Childhood losses and emotionally traumatic events can make us vulnerable to feeling overwhelmed or depressed if we encounter a similar event or loss later in life. Children are emotionally vulnerable and they typically cannot resolve severe emotional pain, so they shove it out of awareness. But since it isn’t resolved, the painful feelings or expectations of being hurt or abandoned just lie there waiting for a trigger. When an adult experience of rejection or failure stirs up those buried feelings, the person isn’t just dealing with the adult pain. His or her childhood feelings of depression, abandonment, and fear are triggered as well. This is why adult depression can seem irrational or inappropriate to observers in light of what they know about the adult’s actual life. To observers, the depressed person seems to be a fine person and have a lot going for him or herself. But internally, the depressed person is being flooded with unresolved childhood pain.

The loss of a job or meaningful responsibilities, freedom, status, or security, can all trigger feelings of depression. Sometimes childhood losses make someone more vulnerable in these situations. At other times, the loss itself may be severe enough to cause the depression.

Robert was also struggling with unresolved grief, another common cause of depression. Since his father was too upset to talk with Robert and share their sadness over losing their mother and wife, Robert never resolved his grief. Instead, he was left with a lingering expectation that those he loved and needed would ultimately abandon him. The depression he felt was the delayed depression of a sad boy who lost his mother.
When most of us lose a loved one, we go through a normal process of grieving and gradually come to grips with our loss. We may initially deny the loss. Sometimes we may bargain with God to try to bring our loved one back. At other times, we may experience anger and perhaps some guilt over losing our loved one or our lacks in the relationship. But eventually we reach a point of acceptance and healthy sorrow at our loss. Then we are able to hold onto our memories of our lost loved one without being depressed because we have grown stronger in the process. In time, we are able to start moving on with the next phase of our lives. It can be difficult for children to process losses and grieve in such a healthy way, however. This is especially true if adults around them do not model appropriate ways of grieving or do not discuss the loss with the child in a healthy manner.

Repressed anger usually plays a role in depression. In fact, depression can be understood as a melding together of sadness over losses and unresolved anger in such a way that neither emotion can be fully experienced and resolved. The role of sadness over loss is relatively easy to understand, but the dynamic of anger is more complex. It often works this way. The child is angry at the parent for abandoning him or her through divorce, death, workaholism, or physical or emotional separation. But it seems wrong to be angry at a dead or departed parent, so the child represses his or her anger. But shutting his eyes to the upsetting feelings doesn’t make them go away, so the child eventually ends up directing the anger that was originally targeted at the parent toward him or herself. Instead of thinking, I’m angry at you for leaving me, the child thinks, I must be a bad person for my parent to have died or left. This kind of depressive self-hatred and self-blame cannot be resolved until the mixed feelings toward the parent are faced and resolved.

Anger over other things beside loss works in much the same way. Children naturally feel angry if they are punished harshly, ignored, criticized excessively, unable to please their parents, compared unfavorably to siblings, overprotected, motivated by guilt or fear, or abused verbally or physically. Anger can be a useful protective device in situations like these. But anger can also be frightening to a child.

What if I yell at my father and my father gets angry back? What if he punishes me? What if my parents won’t love me if I’m angry? What if they give me away or abandon me? To avoid these frightening imagined reactions to their anger, many children unconsciously push their anger from awareness. But as in cases of loss, the repressed anger doesn’t disappear. Instead, it is turned upon the self. Instead of saying, “I hate Mom or Dad,” the child with repressed anger ends up hating himself or herself thinking, I’m worthless. I’m no good. No one should love me. Can you imagine a person telling someone else, “You’re worthless.” “You’re no good!” “You deserve to die.” No,but that’s the way seriously depressed people talk to themselves all day long. They repeatedly take out their anger on themselves until they resolve it or find acceptable, direct ways of expressing their anger.

Robert was also susceptible to depression because he had never learned to soothe himself or make himself feel better when he faced failures or difficult times. When Robert’s mother was alive, she talked with him and helped him feel better when he was troubled about something. But she died before Robert had developed this ability to soothe himself and make himself feel better on his own. And since his father was not very good at dealing with emotions, he was unable to help Robert handle difficult feelings. This left Robert unable to calm and reassure himself, so he relied on others-especially women-to help him in this area of his life. When his girlfriend broke off their relationship, Robert didn’t just lose a girlfriend, he lost the one person who was helping him feel good about himself in life.

Sometimes individuals can face a series of defeats or situations where they are not able to succeed or get their needs met regardless of what they do. For example, Jill was treated like a scapegoat in her family. At first, her husband treated her very lovingly but he slowly changed over the years. She was blamed if something did not go well regardless of whether it was her responsibility or not. Her children even joined in the criticism. Sometimes she was placed in a double bind. When she did one thing, she was told that was wrong and that she should do something else. When she followed that advice, she was told that she shouldn’t have done that either. She couldn’t win. No matter what she tried, she failed to please her family and to feel good about herself.

Naturally, this made Jill frustrated and resentful. But if she tried to express her feelings or her sense of being treated unfairly, her husband lost his temper. So she pressed her anger deep inside and concluded the problem was really hers. If she was just a nicer, better wife, her husband wouldn’t get so mad. And if she could read his mind and do just what he wanted, her family would be fine. Who wouldn’t feel depressed in an environment such as that? Experiences like Jill’s contribute to people feeling worthless, inadequate, inferior, and resentful. This combination of feelings is at the root of much depression.

Some people become depressed because they lack social support or don’t know how to engage socially with others when they are in a time of transition, crisis, or stress. This can make social situations painful for them, especially if they were already shy or socially anxious in the first place. Sometimes these individuals find that the least painful thing they can do is to isolate themselves and be alone, even though they want to be with other people.

Finally, unrealistic negative thoughts about oneself, the world, and the future are found in most people with clinical depression. These automatic, knee-jerk reactions can develop in childhood, as they did for Robert, or slowly over time in adulthood, as they did for Jill. Depressed individuals often are either not aware of how they beat themselves up with their thoughts or they assume that this just reflects the way things really are.

Spiritual Dynamics in Depression

Does depression mean that a person has a spiritual problem? No more than we all do. Charles Spurgeon, Martin Luther, and many other godly men and women have struggled with depression. While all human problems can be traced back to the Fall of Adam and Eve in the Garden of Eden, and in that sense are caused by sin, depression is rarely due simply to one’s personal sins. Instead, most individuals become depressed when others sin against them, or when they have suffered childhood traumas like the loss of a parent, verbal or physical abuse, rape, betrayal, assault, angry punishment, or other self-esteem destroying interactions. Individuals only complicate their symptoms when they allow themselves to feel guilty for their depression. Some people who intentionally sin on a frequent basis have no depression. And some wonderful people feel quite depressed. There is rarely a direct causal relationship between conscious personal sin and depression.

Christians who are depressed, however, are especially likely to feel completely responsible for their depression. And they are extremely vulnerable to the comments of well-meaning friends who hold the mistaken belief that the only reason anybody feels depressed is because he or she is sinning. Unfortunately, these suggestions, no matter how well-intended, only increase the depressed person’s depression and guilt. Depressed Christians naturally assume that their guilty feelings are proof that they are guilty. But it is one thing to know that you, like others, are a sinner. It is quite a different matter to despise and hate yourself and wish that you were dead. Most of the guilt depressed people feel is false guilt or neurotic guilt rather than true guilt or godly sorrow.

False guilt is rooted in self-blame and self-hatred and lasts for lengthy periods of time-if not for life. True guilt or godly sorrow is marked by appropriate regret or remorse for something that one actually did or should have done but didn’t. True guilt doesn’t blow things out of proportion. It doesn’t take responsibility for the behavior of others or for consequences that are beyond one’s control. And true guilt dissipates with confession, while the harsh self-condemnation of a depressive person’s guilt persists in spite of repeated confessions to God or others. God is a God of love and forgiveness. Christians do not need to be riddled with guilt feelings because they can appropriate God’s wonderful forgiveness through Jesus Christ.

TREATMENT

Fortunately, we don’t have to live with debilitating depression. There are a number of effective treatments. They all work better the sooner one gets help.

Medical Treatments

Medication should always be considered in cases of severe depression. If the problem is biologically caused, medication may be the only treatment needed. More often, good counseling or psychotherapy may be combined with medication.

Four major types of antidepressant medication are currently used to treat depression. They are serotonin reuptake inhibitors (SSRIs), tricyclics, monoamine oxidase inhibitors (MAOIs), and atypical antidepressants. These medications are either used alone or in combination. A psychiatrist usually prescribes antidepressant medications although some general practice physicians may do so as well on occasion.

Sometimes physical treatments other than medications are preferred or necessary. Seasonal Affective Disorder (SAD), for example, usually responds well to treatment using bright lights. Electroconvulsive therapy (ECT) is still occasionally used when a person who is suffering severe Major Depression has not responded to counseling and at least two trials of different types of antidepressants. ECT is also sometimes a safer alternative than antidepressant medications for patients with serious medical conditions in addition to Major Depression because of the side effects or possible interaction of antidepressant medications with other medications the patient needs. Dramatic improvements in the delivery of ECT have occurred in the past few years, making ECT not only more effective than before but also with reduced side effects. You should talk with your psychiatrist about these issues in detail if he or she recommends ECT as an appropriate treatment for you or a loved one.

Counseling and Psychotherapy

If you or a loved one goes for counseling for depression, you should expect your therapist to be a sensitive listener with whom you can feel safe from judgment, criticism, anger, and pessimism. Above all else, depressed people need to feel safe and accepted just as they are. This acceptance is the opposite of the internal self-hatred that is at the root of depression.

If your depression is severe, you should expect your therapist to discuss the possibility of a medical or psychiatric referral to rule out any potential physical causes and to consider an appropriate medication. Your psychotherapist or psychiatrist should discuss the types of treatments that might be best for your particular situation. He or she should explain the treatment options that you have and help you understand the advantages and disadvantages of each option. In some cases, more than one treatment or treatment combination might be the best way to gain relief from serious depression.
Once counseling begins you should expect to gradually explore the sources of your depressed feelings. This includes unresolved grief, recurring patterns in relationships where your needs are not being met, harmful self-talk, or experiences that have undercut your self-esteem. You may see ways in which you try to be the peacekeeper in your family or how you end up taking the blame for too many things that go wrong. You may need to work on becoming more assertive or more expressive of your feelings. You may also learn to identify automatic, negative thoughts that make your depression worse. When disruptive family relationships are related to the depression, marriage and family therapy can be helpful.

At some point you will probably face some painful experiences and some hurt and anger over those experiences. As counseling continues you will begin to understand how your depression works, what causes it, and how you can beak the cycle of self-hatred and self-condemning thoughts.

You may also begin to sort out the difference between false guilt and true guilt or godly sorrow. As a Christian, you may also come to accept God’s love and forgiveness in a much deeper way and find new hope and support in your relationships with God. Scriptural passages on God’s love and forgiveness and complete acceptance of you will take on a wonderful new meaning.

In summary, depression can be effectively treated. If you or a loved one is suffering from depression, don’t hesitate to seek out a well-qualified professional to help you gain relief and resolve the underlying problems. God wants you to have an enjoyable meaning-filled life. Don’t let depression rob you of it!

Helping a Loved One Who Is Depressed

It is painful to see a loved one suffering from debilitating depression. It can also be a helpless feeling since our efforts often seem to be of no avail. But there is much that we can do. Here are some specific steps that you can take to help a loved one suffering from Depression:

• Make sure they get into treatment as soon as you detect that they are suffering from depression.
• Help them comply with their treatment such as going to psychotherapy sessions, taking medications, and making any recommended lifestyle changes.
• Provide emotional support and encouragement. Sometimes you can take them out to an activity. Be careful not to suggest things they should do on their own because they might be too depressed to do that and will only feel worse. Instead, tell them you will come by to pick them up.
• Pray with and for them if they are willing. Treat what they tell you as confidential. Do not provide information they share with you with prayer groups or prayer chains even if the person says it is okay to do so. Too often things feel more out of control for the person when even well-intentioned individuals from prayer groups start asking them all kinds of questions. It is better to just tell the prayer group or chain that you have a silent request. God already knows what the person’s needs are.
• Help them focus on passages from the Bible that provide comfort and support. Depressed Christians tend to focus on the commands or judgments of Scriptures.
• Instead, give them supportive, encouraging passages and passages that point out that God loves us just as we are and that Christ has already paid the penalty for all of our sins.
• Don’t criticize. Individuals who are depressed are overly critical of themselves already. They do not need help identifying their faults or problems. They will only blow your criticisms out of proportion and become even more depressed.
• Don’t add to their burden. Depressed individuals feel too much guilt, shame, and worthlessness. Remember how tender Jesus was with people who were aware of their sins or who felt downtrodden or oppressed. Depressed people need compassion and understanding, not shaming or blaming. Indeed, one of your greatest contributions to a friend who is depressed is to be a real friend and encourage professional help.

FREQUENTLY ASKED QUESTIONS

1. What should I consider when choosing a counselor?

Christian psychologists, social workers, or marriage and family therapists can be a good choice for a counselor. They often understand your beliefs, worldview, values, and background more thoroughly and more quickly than other counselors might.

There are some things to think about when choosing a Christian counselor. First, consider the case of Ralph. Ralph was very interested in his theology of the end times. He valued his position on this part of theology very highly. Ralph directly asked a potential Christian counselor about her position on his theology of the end times and insisted she give a thorough answer. Even though she agreed with him on almost every point, Ralph was concerned that she was “soft” on a couple of points and decided she would not be a good choice for a counselor. This was unfortunate for Ralph because it turned out that this counselor was well-educated, very competent, and had a lot of experience treating depression. Ralph didn’t stop to consider that even though the theology of the end times is important, it just doesn’t come up very often in the treatment of depression. Ralph seemed to be using his theology to avoid dealing with his problems. No Christian counselor will be a “perfect match” in the sense of agreeing with you on every single detail of your beliefs or values. What is important is that they understand, respect, and value you as a person and as a Christian.

Second, keep in mind that just because somebody is a Christian and is a nice person, it doesn’t necessarily mean they are competent to treat depression. It may help to ask whether the potential counselor is licensed, what kind of educational background they have, how long they have been practicing, what is their specialty (e.g., working with adults or children, individual or marriage and family counseling, depression, anxiety, etc.), what kind of treatment they think would work best for you and why, and how long will treatment probably take.5 There are a number of treatments for depression that research has shown are effective and reliable. Most Christian therapists I have known are either competent in practicing these treatments for depression or they can refer you to someone who is. Unfortunately, some small groups of Christian therapists are attracted to passing fads or flashy approaches. These approaches usually do more to meet the needs of counselors to see themselves as extra-special or talented than they do to meet the treatment needs of clients. I recommend not choosing that type of counselor.

Some individuals may be in areas of the country where a competent Christian professional counselor is not available. Others might be in situations when their insurance or HMO does not have any Christian service providers on their list and they are not be able to afford counseling otherwise, even if the fee is reduced. Situations like this raise the question of how can I find a counselor or psychiatrist who will respect my Christian faith and my ethnic heritage?

You can start by asking around with people you know or whose opinion you trust. Often the pastor or one of the staff members of a church might know of a competent professional who would be appropriate. Most psychotherapists and psychiatrists I have known try to be respectful of someone’s religious faith whether or not they share or agree with that person’s faith. Of course, it is possible you might encounter one who is disrespectful. Don’t give up if you run across one of them. Keep looking until you find the help you need.

2. How long does treatment for depression typically last?

Don’t expect the healing process to happen overnight. Research has demonstrated that roughly half of individuals receiving competent psychotherapy show measurable improvement by the end of the eighth weekly session. This increases to 74 percent after the twenty-sixth weekly session.6 Measurable improvement is not necessarily the same thing as resolution. Although minor or sudden bouts with depression may show measurable improvement with medication and 10 to 25 counseling sessions, most clinical depression has been years in the making and will take time to resolve. Serious, deeply ingrained depression can easily take a year or two to work through, and sometimes longer.

Be suspicious of claims that a treatment can cure or heal depression in a couple of sessions or in any other very short period of time. I would be suspicious even if someone made these claims using Christian terms and by quoting all kinds of Bible verses. Occasionally God does heal someone in a quick and dramatic manner. More often than not, however, God works by healing slowly and by helping us deepen and further develop our character along the way. It is not uncommon for self-professed miracle workers to turn and blame the person when the miracle cure doesn’t work. They might tell the person they don’t trust God enough, have enough faith, pray enough, read the Bible enough, and things like that. Needless to say, this does not help the depression get better.

On the other hand, individuals usually begin to experience at least some relief with treatment over time. Although parts of counseling involving the discussion of unpleasant experiences and memories can be upsetting in the short term, people usually begin to feel better as they work through them. It is best to discuss any questions or concerns you have with your counselor if you feel the depression is not getting better. It may be helpful or necessary for the counselor to change approaches. In rare cases where the counselor blames any lack of progress on you, makes sexual advances, or does other inappropriate things, it will be necessary to change counselors.

3. Can children be depressed?

Yes, they can. At one time, it was thought that children could not develop depression because childhood is such a happy time. It turns out, however, that children can become severely depressed, but their depression is often hidden under behavior problems such as throwing things or aggressiveness towards others, or just being cranky most of the time. Sometimes their depression is misunderstood as a conduct disorder or Attention Deficit-Hyperactivity Disorder. Other children with depression are extremely well-behaved, quiet, and compliant at home and school. Some withdraw and stay by themselves whenever they can, so they can cry and feel the sadness they try to hide from others. Parents and teachers are often shocked or surprised when they find out these children are depressed. If your child is almost always quiet, prefers to withdraw from others, or be alone most of the time, or frequently looks teary eyed, you might talk with him or her to see if he or she is depressed.

4. Can elderly individuals with depression be treated?

Yes. As with people in any other age group, a psychiatrist or physician will need to know about any medical conditions the person has, his medical history and medications he or she is taking, to determine what may be causing the depression. Sometimes choices of antidepressant medication might need to be made based on the possible side effects of the medication. This is the same as it is for individuals in any other age group.

5. How is Postpartum Depression different from the “baby blues” that many mothers experience after delivering a baby?

It is not unusual for mothers to experience sudden swings or changes in mood, including periods of both happiness and sadness, in the first several days after having a baby. This is normal. It can be due to extreme fluctuations in hormone levels, the sheer physical exhaustion associated with the birthing process, and all of the changes in her life and the life of her family.

Postpartum Depression is more severe. Sometimes it involves an inability to feel any happiness or joy about the arrival of the baby at all. Sometimes it includes suicidal ideation or obsessive thoughts about violence to the baby. It is even possible in severe cases for someone with Postpartum Depression to lose touch with reality.
It is important to talk with a doctor or a psychotherapist if you or your loved one is concerned about the possibility of Postpartum Depression. Support from others, especially the father of the child, and counseling can be helpful. Severe cases and situations where someone has lost contact with reality (e.g., they have delusional beliefs that are obviously not true, etc.) will require medication and possibly a brief period of hospitalization.

6. What are the warning signs of suicide?

Suicidal thoughts, plans, and attempts are more likely in individuals with depression. While it is difficult to predict whether or not someone will attempt suicide, there are several warning signs.

• First, making sure that one’s will, house and belongings are all in order and ready to be left behind. Any of a number of different things can suggest that he or she doesn’t plan on being around much longer.
• Second, giving away prized possessions or special gifts. Sometimes this serves as a last good-bye to a loved one or indicates that he or she just doesn’t care anymore because of the decision to commit suicide. Ask them why they are giving away these possessions or gifts.
• Third, talking about suicide. You may have heard that people who talk about suicide won’t end their lives. This is not true. Most people who end their lives do say something that shows they are thinking about killing themselves. Some make veiled statements that suggest they might not be around much longer. Others say they wish they were dead. Take these statements seriously even if the person acts as if he or she is joking. Directly ask the person if he or she is thinking about suicide (see below) and make sure he gets treatment as soon as possible.
• Fourth, be especially attentive to a depressed loved one who starts to get better. Often individuals do not have enough energy to attempt suicide when their depression bottoms out. They can be temporarily at a greater risk for suicide or self-harm when they are starting to get better, because they might have the energy then to make the attempt.
• Fifth, be suspicious if someone with depression becomes dramatically better overnight or in a very short period of time. This is referred to as a “flight into health.” Sometimes these individuals have gone through so much emotional pain that once they have decided to end their life they feel better. This is why it is important to talk with someone who exhibits a flight into health. It is good to just come right out and say, “I noticed you seem to be feeling much better very quickly. I want you to feel better but am concerned because I understand that sometimes people might feel this way because they have decided to end their life themselves. Has this happened to you? Are you planning to kill yourself?” It can be embarrassing if the person has not made a suicidal plan, but this is much better than to risk losing him or her to suicide.

7. What should I do if someone talks about suicide?

• Don’t be afraid to talk with the person about it. Listening, asking questions, and talking about it are almost always helpful.
• Make sure the person gets into treatment as soon as possible, preferably within the next 24 hours.
• Ask if he or she has picked a method, a time, a place, or a date for the suicide. If he or she has, immediately contact a suicide hotline, the police, dial 911, or take the person to a hospital emergency room.

Predicting whether someone will make a suicide attempt is extremely difficult even for specialists who have treated suicidal clients for years. If you are going to err, do so on the side of seeking competent professional help and getting it immediately. A little bit of embarrassment over seeking help if it turns out the help was not necessary is better than risking losing someone you love to suicide.

Postpartum Depression is more severe. Sometimes it involves an inability to feel any happiness or joy about the arrival of the baby at all. Sometimes it includes suicidal ideation or obsessive thoughts about violence to the baby. It is even possible in severe cases for someone with Postpartum Depression to lose touch with reality.

It is important to talk with a doctor or a psychotherapist if you or your loved one is concerned about the possibility of Postpartum Depression. Support from others, especially the father of the child, and counseling can be helpful. Severe cases and situations where someone has lost contact with reality (e.g., they have delusional beliefs that are obviously not true, etc.) will require medication and possibly a brief period of hospitalization.

6. What are the warning signs of suicide?

Suicidal thoughts, plans, and attempts are more likely in individuals with depression. While it is difficult to predict whether or not someone will attempt suicide, there are several warning signs.

• First, making sure that one’s will, house and belongings are all in order and ready to be left behind. Any of a number of different things can suggest that he or she doesn’t plan on being around much longer.
• Second, giving away prized possessions or special gifts. Sometimes this serves as a last good-bye to a loved one or indicates that he or she just doesn’t care anymore because of the decision to commit suicide. Ask them why they are giving away these possessions or gifts.
• Third, talking about suicide. You may have heard that people who talk about suicide won’t end their lives. This is not true. Most people who end their lives do say something that shows they are thinking about killing themselves. Some make veiled statements that suggest they might not be around much longer. Others say they wish they were dead. Take these statements seriously even if the person acts as if he or she is joking. Directly ask the person if he or she is thinking about suicide (see below) and make sure he gets treatment as soon as possible.
• Fourth, be especially attentive to a depressed loved one who starts to get better. Often individuals do not have enough energy to attempt suicide when their depression bottoms out. They can be temporarily at a greater risk for suicide or self-harm when they are starting to get better, because they might have the energy then to make the attempt.
• Fifth, be suspicious if someone with depression becomes dramatically better overnight or in a very short period of time. This is referred to as a “flight into health.” Sometimes these individuals have gone through so much emotional pain that once they have decided to end their life they feel better. This is why it is important to talk with someone who exhibits a flight into health. It is good to just come right out and say, “I noticed you seem to be feeling much better very quickly. I want you to feel better but am concerned because I understand that sometimes people might feel this way because they have decided to end their life themselves. Has this happened to you? Are you planning to kill yourself?” It can be embarrassing if the person has not made a suicidal plan, but this is much better than to risk losing him or her to suicide.

7. What should I do if someone talks about suicide?

• Don’t be afraid to talk with the person about it. Listening, asking questions, and talking about it are almost always helpful.
• Make sure the person gets into treatment as soon as possible, preferably within the next 24 hours.
• Ask if he or she has picked a method, a time, a place, or a date for the suicide. If he or she has, immediately contact a suicide hotline, the police, dial 911, or take the person to a hospital emergency room.

Predicting whether someone will make a suicide attempt is extremely difficult even for specialists who have treated suicidal clients for years. If you are going to err, do so on the side of seeking competent professional help and getting it immediately. A little bit of embarrassment over seeking help if it turns out the help was not necessary is better than risking losing someone you love to suicide.