BY NATHAN BROWN
Depression is a difficult topic to tackle-both in print and in our everyday lives. It is an illness that affects many people. The Review staff decided more than a year ago that it was an issue the magazine should address. We also thought it important that a young adult author the piece. We invited several writers to take up the task, and Nathan Brown of Australia responded. After several months of research, Brown wrote the following piece. It was reviewed by medical advisers for accuracy-and they changed very little.-Editors.
EPRESSION IS A COMMON ILLNESS. It is estimated that 17.6 million Americans suffer from depression in any one year.1 Statisti-cally, one in five people will experience depression at some time in their life. So chances are, either you have been affected by depression or you know somebody who has been.
Despite this prevalence, depression is widely misunderstood. Understanding depression can be further complicated in the context of the Christian faith. The spiritual aspects of depression, such as feelings of guilt and worthlessness, often lead sufferers and observers to assume some underlying spiritual weakness. This attitude can impact negatively on sufferers and compound many of their depressive symptoms. A proper understanding of depression enables the sufferer to view their illness as an illness and to obtain appropriate treatment. Well-informed relatives, friends, and fellow church members are more able to provide much-needed support to the sufferer.
What Is Depression?
Depression is not a weakness of mind, will, or spirit. It is an illness. "Depression is a whole-body disorder involving genetic predispositions, biochemical imbalances, melancholy mood, and negative thoughts."2
The physiological cause of depression is a reduced level of serotonin-a neurotransmitter chemical-in the brain. Despite common belief, depression is not just the way a person thinks. The way the depressed person thinks is a result of this chemical imbalance. The chemistry triggers a cycle of negative thoughts, which perpetuate depressed moods, leading to further negative thoughts and feelings.
Depression is a mental illness with a physical basis, and, with or without treatment, depressive episodes usually come to an end. However, an exaggerated swinging of moods between extreme depression and mania is known as bipolar disorder (manic depression). This extreme form, when delusional or psychotic conditions exist, is much more severe than depression and is reasonably rare, affecting less than 1 percent of the population.
Because of its biochemical basis, depression does not need to be the result of any particular external circumstance. Most often it has no obvious cause, which is one reason the illness is so often misunderstood. There can be additional contributing factors based on external events.
Possibilities include unresolved grief or other trauma, such as physical injury or chronic pain. Depression can also be inherited. In all cases, however, the depressed person is suffering from an actual illness.
The medical definition of depression is a consistent state of feeling depressed lasting more than two weeks. Depression affects people in a variety of ways, and individuals are affected differently. There are, however, a number of general indicators. (See "Are You Depressed?" for specific symptoms.)
Typically, when people are depressed, they feel weepy and are tired and unmotivated. Their outlook tends to be negative, and a general feeling of sadness is present. They may think about dying and suicide. In severe cases they will begin to plan suicide and may carry it out. It is important to ask about suicide and to be aware of this risk in depressed people.
Sufferers of depression may not recognize their illness. Often they will complain of physical symptoms such as aches and pains, sleeplessness, diarrhea, dizziness, or nausea. These symptoms can be caused by the fatigue resulting from the constant intense emotions accompanying depression.
Getting Help
The emotional turmoil when depressed can be confusing and overpowering. A lack of hope and motivation often prevents sufferers from taking the initiative to seek help. Understanding the basis for these feelings is an important part of the recovery process. The nature of depression can make even small tasks, such as phoning a doctor or friend, seem daunting.
Depression continues to carry with it a stigma of weakness. This can contribute to an unwillingness to accept the reality of one's illness and to seek and accept help. Seeking help does not demonstrate one's weakness or lack of faith. Being treated for depression is the same as wearing glasses to correct poor sight, putting a broken leg in plaster, or taking insulin to manage diabetes. It is an appropriate response to a manageable illness.
Sometimes talking to an understanding friend or family doctor is sufficient to lift the depressed mood. A doctor will be able to explain the condition, and this will help in regaining perspective. The doctor may also recommend treatments such as counseling, keeping a journal, or regular exercise-or they may prescribe antidepressant medication.
There are a number of antidepressant medications available. These work
to correct the brain's chemical imbalance to restore normal moods. The most commonly prescribed antidepressant medications are effective in about 85 percent of cases of depression. Medication can take up to six weeks to take effect, and treatment can extend beyond 12 months.
There are a number of alternative or additional treatment possibilities, including cognitive therapy, psychoanalysis, and electroconvulsive therapy. Cognitive therapy-a recent development-involves identifying self-defeating beliefs and learning mood-elevating techniques. Psychoanalysis focuses on early life events and unconscious impulses that may shape how the patient reacts to circumstances. Electroconvulsive therapy, or shock therapy, can be an effective treatment for severe depression. It is administered while the patient is under general anesthesia (with its attendant risks) and has a reasonably low complication rate. An electrical impulse is applied to half the brain to stimulate the release of neurotransmitter chemicals.
Individual patients respond differently to the variety of treatments available. However, for the overwhelming majority of sufferers, some form of treatment will be successful. Consulting your doctor is the first step toward recovery.
Helping a Depressed Person
Understanding the nature of depression is important in relating to someone with this illness. An awareness of the possibility of depression-and suggesting it to them-can be a good help. Listen to them if they want to talk to you. Patiently encourage them to seek further help and offer to assist where needed. This may include small things such as making a doctor's appointment, caring for children, or cleaning their house. Show your love and support to them.
Remember, it is not their fault. Accept their condition as a temporary illness, and assure them they will recover. Don't be afraid if you don't understand them at times. Bear with their emotional turmoil. Pray for them and, if comfortable, pray with them.
1 Grant Mullen, Why Do I Feel So Down . . . When My Faith Should Lift Me Up? (Tonbridge, U.K.: Sovereign World Ltd., 1999), p. 7.
2 David G. Myers, Exploring Psychology, 3rd ed. (New York: Worth Publishers, 1996), p. 430.
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Nathan Brown is a freelance writer in Townsville, Australia, where he is also working on a Ph.D. in English.
