Portraits

Each morning Angela struggles to find the energy to get out of bed. She feels listless and down. Her kids need her, but she can’t summon the energy to even interact with them—much less prepare meals or clean the house.

George is having a hard time thinking clearly. He lost his job and just can’t seem to crawl out of the hole he feels like he’s fallen into. He doesn’t interview because he’s so down, so he sits around at home and plays on the computer. And he just keeps spiraling downward.

Definitions and Key Thoughts

• Depression is on the rise—people born after 1950 are ten times as likely to experience depression than their predecessors. Those between ages 25 and 45 have the greatest percentage of depression, though adolescent groups possess the fastest rate of depression growth.
  
  
• Women are twice as likely to experience depression than men.
  
  
• Depression causes inestimable pain for both those enduring the disorder and persons closest to them. It is said that depression destroys the lives of the victims and of their family members unnecessarily. Most sufferers do not seek treatment or believe their depression to be a treatable illness.2
  
  
• Depression differs from sadness, which is a God-given reaction to loss that serves to slow people down so that they may process grief. When one is sad, self-respect remains intact, intrinsic hope is maintained, and relief comes after crying and receiving support. 

Types of Depression

• Clinical/Major Depression is distinct in that symptoms are so severe that they disrupt one’s daily routine.
  
  
• Dysthymic Disorder is a chronic, low-grade depression.
  
  
• Bipolar Disorder, previously known as “manic depression,” is a type of mood disorder with severe changes in effect. A person may have periods of euphoric elatedness contrasted with periods of severe major depression.
  
  
  
• Seasonal Affective Disorder (SAD) is a severe onset of “winter blues” where one experiences depression, most often believed to be due to lack of sunlight (or Vitamin D).

Causes of Depression

• Depression can be caused by many life issues including: anger, failure, rejection, divorce, abuse, fear, feelings of futility, lacking control over one’s life, grief and loss, guilt or shame, loneliness or isolation, negative thinking, destructive misbeliefs, or stress. This is sometimes referred to as “reactive depression.” With this, depression symptoms may be lowest in the morning and increase throughout the day.
  
  
• Medical and biological factors can also facilitate depression: inherited predisposition to depression: thyroid abnormalities, female hormone fluctuations, serotonin or norepinephrine irregularities, diabetes; B-12 or Iron deficiencies, lack of sunlight or Vitamin D, a recent stroke or heart attack, mitral valve prolapse, exposure to black mold, prescription drugs (anti-hypertensives, oral contraceptives), or recreational drugs (such as alcohol, marijuana, cocaine). When rooted in the biological, it is sometimes referred to as “endogenous depression.” With this, sufferers often feel worst in the mornings. Note: Persistent reactive depression (above) will change one’s chemical balances and may lead to endogenous depression.
  

Symptoms of Depression

• Symptoms are many and include decreased energy, fluctuating body weight, depleted concentration, irritability, bouts of crying, hopelessness/despair, a disinterest in pleasurable activities, social withdrawal, and thoughts of suicide.
  
  
•  The Bible is replete with examples of depression for a variety of reasons and results:

David wrote that his depression was caused by unconfessed sin (Psalms 38; 51).

God used depression to get Nehemiah’s attention (Nehemiah 1–2).

Job’s devastating losses led him to curse the day he was born (Job 1–3).

Elijah was so depressed over the situation with Israel’s leaders that he wished to die (1 Kings 19).

Assessment of Depression

Rule Outs (Ask yourself these questions to "rule out" whether you are struggling with this issue.)

• Q1 If 10 is extreme sadness, and 1 is feeling well, where are you today on a scale of 1 to 10? (If you are on the low side, try to identify what is causing the sadness. The issue to address may not be depression, but other concerns.)
• Q2 Are you using drugs or alcohol?
• Q3 Are you currently taking any medications?
• Q4 When was the last time you had a thorough physical examination? (If you haven’t seen your doctor recently, it may be time to schedule an appointment.)
• Q5 Do you have significant mood swings?

General Questions to Consider

• Q6 How long have you felt depressed?
• Q7 What was happening in your life when you first became depressed?
• Q8 Have you been depressed before?
• Q9 Do you have a family history of depression?
• Q10 Do you have difficulty concentrating?
• Q11 Have you lost interest in pleasurable activities?
• Q12 Have you noticed changes in your eating or sleeping patterns?
• Q13 Are you dealing with guilt or fear about anything? (Fear is prevalent in many kinds of depression—anxiety is present in 70% of those diagnosed with depression.)
• Q14 What do you see in your future?
• Q15 Have you had any thoughts about injuring yourself, or suicide? (Sometimes the thoughts are vague, such as “It would be better if I were not here.”)

Wise Counsel

The most dangerous symptom of depression is suicidal ideation. If, as a result of our questions, you discover that you may desire to hurt yourself, do not hesitate to involve other family members or a mental health professional. See also the section on “Suicide.”

If you are thinking about making an appointment with your physician, know that it is OK to take medications if needed to get depression under control. Using medication doesn’t mean that you are weak or that you lack faith.

Action Steps

1. Watch Physical Health

• Research shows that thirty minutes of moderate daily exercise is very helpful in elevating mood. If there would be no health risks, try to incorporate moderate exercise such as a brisk walk.  Try to get a partner to walk with—it makes it harder to avoid the activity if someone is waiting for you.
  
  
• You should have a medical checkup and should work with a doctor on a diet program. Better eating habits (for example, less sugar and more vitamins) can be a big help.
  

2. Behind the Scenes

• Try to think about what situation(s) might be behind the feelings of depression.
  
  
• If you have recently suffered a significant loss, acknowledge that loss and grieve. Give yourself permission to feel upset, but also find ways to come back to the light, acknoledging both the pain of the loss and the opportunity for future happiness in Christ.
  
  
• Try to think honestly about what might be other deep sources of the depression.
  
  
• Keep a journal in which to write down thoughts that occur over the next couple of weeks regarding what is behind the depression.
  
  
• Carry a “daily mood log” and record times when you feel most depressed, what is happening, and what you are thinking at those times.
  

• Challenge your negative statements and beliefs.
  
  
• For example, if your thought is, “I’m totally worthless. I have nothing to give to anyone.” Try to write a list of ways in which you do indeed have value.
  
  
• Prepare a list of ten things you like about yourself over the next week—and three of them have to be physical characteristics. Tell someone else what those ten things are.
  
  
• Remind yourself that very few things are really hopeless, and very few situations are “all bad.”
  

• Who are your friends? Are they people who help you counter the depression?
  
  
• What social groups are you currently involved in? (Social isolation will only further your depression.)
  
  
• What is your level of church involvement? Who at church could be of help and support?

5. Pay Attention to Spiritual Issues

• Do you have any unconfessed sin that is promoting the depression?
  
  
• Do you need to forgive someone as a means of moving toward personal health?
  
  
• Are your motivations toward connecting with Christ? (When one’s motivations are on something other than God, frustration and depression can ensue.)
  
  
• Do you believe that God can both remove your depression and provide complete happiness or joy?

Biblical Insights


But [Elijah] went a day’s journey into the wilderness, and came and sat down under a broom tree. And he prayed that he might die, and said, “It is enough! Now, Lord, take my life, for I am no better than my fathers!” —1 Kings 19:4

• Life has highs and lows, and as in a mountain range, the lows often come right after the highs. Like Elijah, we may scale the heights of spiritual victory only to soon find ourselves in the dark valley of depression.
  
  
• While certain forms of clinical depression should be professionally treated, many depressed feelings are part of life’s ups and downs.
  
  
• Like Elijah, we should listen for God’s “still small voice” (1 Kings 19:12) to comfort us.

Then as [Elijah] lay and slept under a broom tree, suddenly an angel touched him, and said to him, “Arise and eat.” Then he looked, and there by his head was a cake baked on coals, and a jar of water. So he ate and drank, and lay down again. — 1 Kings 19:5-6

• Depression can drain energy, twist values, and assault one’s faith.
  
  
• Depression can affect anyone.
  
  
• God provided care to Elijah on many levels. He provided food so that Elijah regained his physical and emotional strength. An angel touched Elijah, confirming to Elijah that he was not alone. Also, twice, God encouraged Elijah to rest.
  

Why are you cast down, O my soul? And why are you disquieted within me? Hope in God, for I shall yet praise Him for the help of His countenance. — Psalm 42:5

• Depressed feelings sometimes cause some people to turn away from God. Others like David, allow those disquieted, depressed feelings to make them “hope in God,” remembering His goodness.
  
  
• During such times, living by faith takes on new meaning.
  
  
• Depressed people must learn to trust what they cannot feel or see. They must understand that happiness comes from communion with God, not anything on the earth.
  

To console those who mourn in Zion, to give them beauty for ashes, the oil of joy for mourning, the garment of praise for the spirit of heaviness; that they may be called trees of righteousness, the planting of the Lord, that He may be glorified. — Isaiah 61:3

• The Bible recognizes the heaviness of depression. God’s love and understanding reach out to those who are depressed and discouraged.
  
  
• God promises to give consolation, beauty in place of ashes, oil of joy in place of mourning, and a garment of praise instead of a spirit of heaviness.

 Recommended Resources

The Feeling Good Handbook, by David D. Burns

Happiness is a Choice: The Symptoms, Causes, and Cures of Depression, by Frank Minirth and Paul Meier

Unveiling Depression in Women: A Practical Guide to Understanding and Overcoming Depression, by Archibald D. Hart and Catherine Hart Weber