There are so many different topics that we read about in books and magazines and other fine literature. Some of what we read about can even give us a pretty clear picture and understanding of what is being written about. For example, fictional story books can give us a good picture of what is happening just by us using our imagination. We can also do that with many how-to books and magazines. We can read this various literature and feel that we are now “experts” or even pretty good at it and know a lot about it, and we can be quite right. However, one topic, I believe, that we can read a lot about and not fully understand is depression. You may have read numerous books and other literature about depression, but how much do you really understand and know about it? I have talked with a handful of people who have gone through depression (and are still going through it), and what they have all told me is, that, you can not fully understand depression until you have gone through it yourself. I am certainly not wishing that anyone have that kind of knowledge and experience with it, but I do want people to better understand it and know what they can do to help someone who is going through it—that is my whole purpose of this article. It is to inform and educate people who are not really aware of what depression is and how much it can affect a person and their family.
By God’s grace, I pray that this may open some eyes of the uninformed and those who think they know “all about it” because they have a cousin, nephew, etc. going through it, even though they do not see that person very often. Even though you may have a close relative that you live with that suffers with depression, you can still have much difficulty in grasping the whole idea of it. While reading this article, take into consideration that I wrote this with first-hand experience. Not to say that I personally have suffered from major depression—although I have gone through some depression in my lifetime—but I speak of my sister Julie, who I currently live with. She has suffered from major depression for much of her life, howbeit, she is (to my knowledge) better than she was. In a way, I thank God for the experience of witnessing a person close to me go through such a difficult illness. It has really opened my eyes, hence the writing of this article. It helped remind me of the words the Apostle Peter wrote in his first epistle. “Humble yourselves therefore under the mighty hand of God, that he may exalt you in due time: Casting all your cares upon him; for he careth for you” (I Peter 5:6, 7). I have certainly been humbled.
I will try and lay out what depression is, some signs and symptoms associated with depression, the many faces of depression and some of the risk factors. The next parts of the article will deal more with the help and recovery aspect of depression. Remember, this article is but a drop of the ocean of knowledge and information that is available on depression. It is more common than we might want to admit, so I pray that all who read this may be better aware of what to look for and have more empathy for the depressed individual. So, whether you are suffering from depression yourself or have a loved one who is suffering from it, I pray that these words may be of help and comfort to you and those around you.
Of all the health conditions in the world, one of the most common is depression. Estimates vary considerably, but today depression appears to occur in 15 to 20 percent of all people over the course of a lifetime. Furthermore, in any given 12-month period, somewhat under 10 percent of the population experiences an episode of significant depression. And at this very moment, an estimated 121 million people are suffering from depression throughout the world. (Estimates taken from Depression for Dummies, 2003)
Estimates on depression are only rough approximations. Because most people with depression fail to seek treatment and many people with depression don’t even realize they’re depressed, reliable statistics are few and far between. Whatever the real figures are, huge numbers of people suffer from depression at some point in their lives. And depression has all kinds of costs associated with it. Joshua Wolf Shenk, in his book Lincoln’s Melancholy wrote, “Affecting more than 100 million people a year, depression is the world’s leading cause of disability. In 2000, about a million people worldwide killed themselves—about equal to the number of deaths from war and homicide that year put together. Adjusting for population growth, unipolar depression (another name for major depressive disorder) is ten times more prevalent that it was fifty years ago.”
According to the Mayo Clinic, depression is not a weakness, nor is it something that you can simply “snap out of.” It’s a medical illness that involves the mind and body. It affects how you think and behave and can cause a variety of emotional and physical problems. You may not even be able to go about your usual daily activities, and depression may make you feel as if life just isn’t worth living anymore—that is where our family and friends and the rest of our support group comes in. But, more on that a bit later.
We all know that it is not possible to escape life’s ups and downs. It is normal to feel unhappy or sad in response to disappointment, loss, frustration or a medical condition. Many people use the word “depression” to explain those kinds of feelings, but that is really situational depression, which is a normal reaction to events around us. Clinical depression , though, overwhelms and engulfs your day to day life, interfering with your ability to work, study, eat, sleep, and have fun. It is unrelenting, with little if any relief.
There’s a vast difference between “feeling depressed” and suffering from clinical depression. Some people describe it as “living in a black hole” or having a feeling of impending doom. They can’t escape their unhappiness and despair. However, some people with depression don’t feel sad at all. Instead, they feel lifeless and empty. In this apathetic state, they are unable to experience pleasure. Even when participating in activities they used to enjoy, they feel as if they’re just going through the motions. The signs and symptoms vary from person to person, and they may wax and wane in severity over time.
Signs and Symptoms of Depression
Depression symptoms can vary greatly because different people experience depression in different ways. For example, a 30-year-old man with depression may not have the same symptoms as a 75-year-old man. For some people, depression symptoms are so severe that it’s obvious something isn’t right. Others may feel generally miserable or unhappy without really knowing it.
Depression is a loaded word in our culture. Many associate it, however wrongly, with a sign of weakness and excessive emotion. This is especially true with men. Depressed men are less likely than women to acknowledge feelings of self-loathing and hopelessness. Depression is expressed in men, frequently, by it coming out in more “socially acceptable” forms. Anger, aggression, reckless behavior and violence, along with substance abuse, can be signs of an underlying depression. You might hear complaints about fatigue, irritability, sleep problems, and loss of interest or sudden excessive interest in work or hobbies. Even though depression rates for women are twice as high as those in men, men are higher suicide risk, especially older men.
Here are some signs and symptoms to look for in someone that you suspect might be suffering from depression: Loss of interest in normal activities; feeling sad or down; feeling hopeless; crying spells for no apparent reason; problems sleeping; trouble focusing or concentrating; difficulty making decisions; being easily annoyed; feeling fatigued or weak; unintentional weight gain or loss; irritability; restlessness; feeling worthless; thoughts of suicide or suicidal behavior; unexplained physical problems, such as back pain or head aches. If you notice any of these signs or symptoms, contact your family physician or someone you think would be able to help.
What Causes Depression?
It is not known specifically what causes depression. As with many mental illnesses, it’s thought that a variety of biochemical, genetic and environmental factors may cause depression. As Dr. Brian Decker wrote in “Dealing With Depression: A Christian Perspective,” a pamphlet published by the Faith Protestant Reformed Church Evangelism Committee, “It would be convenient if we could simply say that depression is a chemical imbalance, but it is not that easy.”
“In fact,” writes Joshua Wolf Shenk, “major depression, in people who are vulnerable to it, can be set off by all manner of circumstances. What would appear to a nondepressed person to be an ordinary or insignificant stimulus can through a depressive’s eyes look rather profound.”
He goes on to say that of those who’ve had a single episode of major depression, more than half will have a second. “Major depressive disorder, recurrent,” he adds, “is a illness that is characterized by two or more major depressive episodes, separated by at least a month. More broadly, it suggests an underlying problem that can be expected to surface in various ways throughout a person’s life.” He says to consider that someone with two episodes of major depression has a seventy percent chance of experiencing a third. And someone with three episodes has a ninety percent chance of having a fourth. (The phrase “clinical depression” can be applied to any incident of major depression or to people who experience major depressive disorder.)
Different Faces of Depression
In some people who suffer from depression, it can persist at a low level for months and even years. In others, the symptoms can be stronger and severe enough that it makes suicide a real concern. There are a number of faces of depression. Let’s take a moment and look at those different faces of depression.
Clinical (major) depression is characterized by the inability for life to be delectable. The associated feelings of this depression normally persist for at least two weeks in order to be considered a major depressive episode. In dysthymia (recurrent, mild depression) , the depressive symptoms are not as strong as in a major depressive episode, but are lengthy, lasting at least two years. With this face of depression, more times than not, you may feel mildly or moderately depressed, although you may have some temporary mood lifts. Then there is postpartum depression, which is experienced by new mothers just after they have given birth. What many call, “the baby blues,” are normal; postpartum depression, however, is longer lasting and more serious. One thing that can be especially dreadful to mothers suffering from postpartum depression are feelings of wanting to avoid the baby or even cause it harm. Postpartum depression does not always happen right after delivery. It can happen up to a year after childbirth. There is one type of depression that is more common in climates with more severe winter weather patterns and limited sunlight, like the northern climates (Michigan would certainly count). And that type is Seasonal Affective Disorder (SAD). There is also manic depression, which is also known as bipolar disorder—of which I will not go into more because it is a whole other topic in and of itself. However, it is characterized by cycling mood extremes, and, when depressed, a person with bipolar disorder exhibits the usual symptoms of major depression. Howbeit, the treatment for bipolar disorder, especially using medications, is normally different.
Depression Is Complicated
Some medical illnesses have a specific biological or chemical cause, making treatment, like a medication or surgery, more straight forward. Unfortunately, depression is more complicated. It is not just a result of a chemical imbalance and is not simply cured with medications. That is not to say that medications don’t work or are not a good idea. What makes depression so difficult to treat is that what seems like depression may actually be something else. If you are stuck in a work position where you feel as if you’re not going anywhere and feel hopeless and helpless, for example, the best treatment might be to find another job which challenges you more. In a case like this, the depression is situational and is remedied by changing the situation.
Being aware of what depression is, knowing the warning signs, and learning how to handle it is so crucial because it will often lead to a solution and cure. Do not despair, for, let us remember the words of David that he wrote in Psalm 34:18-19 & 22. “The Lord is nigh unto them that are of a broken heart; and saveth such as be of a contrite spirit. Many are the afflictions of the righteous: but the Lord delivereth him out of them all. …The Lord redeemeth the soul of his servants: and none of them that trust in him shall be desolate.”
Although precise statistics are not known, depression is considered relatively common. In any given year, about 12 million adults in the United States have depression. Depression goes through all racial, ethnic and economic divides—no one is immune from the risk of getting depression. Depression typically begins in the late 20s, but it can surface at any age, affecting everyone from young children to older adults. Twice as many women are diagnosed with depression as men, but this may be due in part because women are more likely to seek treatment for depression.
Risk Factors of Depression
Although the precise cause of depression isn’t known, researchers have identified certain factors that seem to increase the risk of developing or triggering depression. Let us now take a moment to look at some of the risk factors associated with depression: having other biological relatives with depression; having family members who have taken their own life; stressful life events, such as death of a loved one; having a depressed mood as a youngster or early childhood trauma or abuse; illness, such as cancer, heart disease, Alzheimer’s or HIV/AIDS; alcohol, nicotine or drug abuse; having recently given birth; loneliness and lack of social support. A key risk factor for depression is isolation and loneliness.
Suicide is a Real Danger
Although, as Christians, we tend to view suicide as sin, it is important to note that depression is a major risk factor for suicide. The deep despair and hopelessness that goes along with depression can make suicide feel like the only way to make the pain go away. Suicidal individuals often give warning signs or signals of their intentions. Suicide is a very real danger in depression, so it’s important to know the warning signs: talking about suicide, dying, or harming oneself; preoccupation with death; expressing feelings of hopelessness or self-loathing; acting in dangerous or self-destructive ways; getting affairs in order and saying goodbye (giving away precious, sometimes valuable, items); seeking out pills, weapons, or other lethal objects; sudden sense of calm after a depression. If you think a friend or family member might be considering suicide, one of the best things you can do is to talk to him or her about your concerns—it could very well save their life!
We may not always be aware of the signs or signals related to suicide. That was evident with my sister Julie. She was suffering from major depression and had even considered suicide as an alternative. One reason was because of the voices she was hearing in her head. I was not even aware of it until after she informed me of it. Not to say that there were no warning signs or signals, but I was just not aware of them nor did I know what to look for. My point? EDUCATE YOURSELF! The best way to prevent suicide is to know and watch for those warning signs and get involved if you spot them. One thing that helped prevent Julie from going through with it was that she saw an image of her nephews. Alas, some people may not be so fortunate this way, so we need to do what we can to help prevent them from going through with it. If you are fighting depression and thought about suicide as an alternative, think about these words; “Cast thy burden upon the Lord, and he shall sustain thee: he shall never suffer the righteous to be moved” (Psalm 55:22).
Importance of Awareness
Suicidal thoughts are a symptom of severe depression and must be taken seriously. In the next parts of this article I will be getting into more about what is needed to be done if you or a loved one is suffering from depression and even considering suicide as an alternative. I will also be exploring the different treatment options and tips, various suggestions when dealing with someone who is going through depression, and also some information I received from various people I talked with who have either gone through depression or are medical professionals who directly help others get through it.
It is my prayer that this information has helped shed some light on the issue of depression and the vast need for it to be mentioned. It is also certainly not an issue that should be esoteric, but rather should be divulged to many (if not all); for there’s a large number who are not even aware of the severity or commonness of it.
Now that you are more aware of what depression is and how much of a toll it can take on a person’s life, are you not a bit more inclined to do something to try and help? Do you even feel a bit lugubrious yourself? Do not despair. Let us find comfort in these words we find in the book of Isaiah. “Fear thou not; for I am with thee: be not dismayed; for I am thy God: I will strengthen thee; yea, I will help thee; yea, I will uphold thee with the right hand of my righteousness. For I the Lord thy God will hold thy right hand, saying unto thee, Fear not; I will help thee” (Isaiah 41:10, 13).
Important Link Between Depression and Anxiety
Many people suffering from depression often experience anxiety as well. In fact, as many as 90 percent of people who’ve been diagnosed with depression also have symptoms of anxiety. Depression and anxiety disorders are not the same though, although at first glance they seem very similar. What’s the difference? Depression, as mentioned earlier, generates emotions such as hopelessness, despair and anger. Energy levels are usually very low, and depressed people often feel overwhelmed by the day-to-day tasks and personal relationships so essential to life. A person with anxiety disorder, however, experiences fear, panic or anxiety in situations where most people would not feel anxious or threatened. The sufferer may experience sudden panic or anxiety attacks without any recognized trigger, and often lives with a constant nagging worry or anxiousness. Without treatment, such disorders can restrict a person’s ability to work, maintain relationships, or even cause one to leave the house. Be sure to tell your doctor about all of your symptoms so you will get the right diagnosis.
Although no one knows exactly why, a great number of depressions are also accompanied by anxiety. In one study, 85 percent of those with major depression were also diagnosed with generalized anxiety disorder (GAD) while 35 percent had symptoms of a panic disorder. Because they so often go hand in hand, anxiety and depression are considered the fraternal twins of mood disorders.
Believed to be caused in part by a malfunction of brain chemistry, generalized anxiety is not the normal apprehension that one feels before taking a test or awaiting the outcome of a biopsy. A person with an anxiety disorder suffers from what President Franklin Roosevelt called “fear itself.” For a reason that is only partially known, the brain’s fight-or-flight mechanism becomes activated, even when no real threat exists. Being chronically anxious is like being stalked by an imaginary tiger. The feeling of danger never goes away.
Being both anxious and depressed is a tremendous challenge. Clinicians have observed that when anxiety occurs “comorbidly” with depression, the symptoms of both depression and anxiety are more severe compared to when those disorders occur independently. Moreover, the symptoms of the depression exacerbated by anxiety has a much higher suicide rate than depression alone. (In one study, 92 percent of depressed patients who had attempted suicide were also plagued by severe anxiety.) Like alcohol and barbiturates, depression and anxiety are a deadly combination when taken together. Unfortunately, over 60 percent of major depressions are accompanied by varying levels of anxious feelings and behavior. But, let us remember: “God is our refuge and strength, a very present help in trouble. The Lord of hosts is with us; the God of Jacob is our refuge” (Psalm 46:1, 11).
What Are Anxiety Disorders?
So, I now have a better understanding of what depression is and that there is a distinct link between depression and anxiety, but what about how to better understand what anxiety disorders are? Well, we all surely know what anxiety feels like. Our heart pounds before a big presentation or a tough exam or even a job interview. We get butterflies in our stomach during a blind date—especially when we’re about to hold hands or even get that first kiss. Especially these days, we worry and fret about where the money will come from for the next bill(s), or, if we’re fortunate enough to even have a job in this rough economy, we feel jittery at the prospect of asking the boss for a raise. However, if worries and fears are preventing you from living your life the way you’d like to, you may be suffering from an anxiety disorder. The good news is, there are many anxiety treatments and self-help strategies that can help reduce your anxiety symptoms and take control of your life. I will be exploring those treatments in the next part of this article, along with the treatment options for depression.
It’s normal to worry and feel tense or scared when under pressure or facing a stressful situation. Anxiety is the body’s natural response to danger, an automatic alarm that goes off when we feel threatened.
Although it may be unpleasant, anxiety isn’t always a bad thing. In fact, anxiety can help us stay alert and focused, spur us into action, and motivate us to solve problems. But when anxiety is consistent or overwhelming, when it interferes with your relationships and activities (like not being able to be around people, such as going to church), that’s when you’ve crossed the line from normal anxiety (which is preached about in our churches) into the territory of anxiety disorders.
Identifying An Anxiety Disorder
So how do I know if I have an anxiety disorder? If you identify with several of the following signs and symptoms, and they just won’t go away, you may be suffering from an anxiety disorder: Are you constantly tense, worried, or on edge? Does your anxiety interfere with your work, school, or family responsibilities? Are you plagued by fears that you know are irrational, but can’t shake? Do you believe that something bad will happen if certain things aren’t done a certain way? Do you avoid everyday situations or activities because they make you anxious? Do you experience sudden, unexpected attacks of heart-pounding panic? Do you feel like danger and catastrophe are around every corner?
Because the anxiety disorders are a group of related conditions rather than a single disorder, they can, just like depression, look very different from person to person. One individual may suffer from intense anxiety attacks that strike without warning, while another gets panicky at the thought of mingling at a party. Someone else may struggle with a disabling fear of driving or uncontrollable, intrusive thought. Still, another may live in a constant state of tension, worrying about anything and everything.
But despite their different forms, all anxiety disorders share one major symptom: persistent or severe worry in situations where most people wouldn’t feel threatened.
In addition to the primary symptoms of irrational and excessive fear and worry, other common emotional symptoms of anxiety include: feelings of apprehension or dread; trouble concentrating; feeling tense and jumpy; anticipating the worst; irritability; restlessness; watching for signs of danger; feeling like your mind’s gone blank.
Anxiety is more than just a feeling. As a product of the body’s fight-or-flight response, anxiety involves a wide range of physical symptoms. Because of the numerous physical symptoms, anxiety sufferers often mistake their disorder for a medical illness. They may even visit many doctors and make countless trips to the hospital before their anxiety disorder is discovered.
Common physical symptoms of anxiety include: pounding heart; sweating; stomach upset or dizziness; frequent urination or diarrhea; shortness of breath; tremors and twitches; muscle tension; headaches; fatigue; insomnia.
Anxiety attacks, known as panic attacks in mental health circles, are episodes of intense panic or fear. They usually occur suddenly and without warning. Sometimes there’s an obvious trigger—getting stuck in the elevator, for example, or thinking about the big live performance you’re giving in a few hours—but in other cases, the attacks come out of the blue.
Anxiety attacks usually peak within ten minutes, and they rarely last more than a half hour. But, don’t get me wrong, during that short time, the terror can be so severe that you feel as if you’re about to die or totally lose control. My sister [Julie] certainly felt that way when she had her severe anxiety attacks. So frightening themselves are the physical symptoms that many people believe they’re having a heart attack. After the attack is over, you may be worried about having another one, particularly in a public place where help isn’t available or you can’t easily escape. These attacks even made it difficult for my sister to go to church. It’s certainly hard to watch someone go through it, just imagine how much more difficult it is to personally go through it!
Anxiety Attack Symptoms
You may be wondering what some of the symptoms of an anxiety attack include. They include: surge of overwhelming panic; feeling of losing control or going crazy; heart palpitations or chest pain; feeling like you’re going to pass out; trouble breathing or choking sensation; hyperventilation; hot flashes or chills; trembling or shaking; nausea or stomach cramps; feeling detached or unreal. I know that these symptoms are real because I saw my sister go through some of them. Thankfully she is much better today since she got the help she needed.
Take comfort in these words we find in Deuteronomy 31:8: “And the Lord, he it is that doth go before thee; he will be with thee, he will not fail thee, neither forsake thee: fear not, neither be dismayed.”
There is Hope
Whether you suffer from depression, Generalized Anxiety Disorder (GAD), or both, it is imperative to seek the care of a healthcare professional. Depression and GAD are serious illnesses that require medical intervention. If you suffer from either of these disorders, you are not alone. According to the National Institute of Mental Health, each year approximately 19 million Americans suffer from depression, and about 4 million suffer from GAD. Men and women of all ages are affected. The good news is that depression and GAD are both treatable. That treatment will be discussed in the next part of this article.
You have now seen some of the symptoms and statistics of depression and the linked anxiety. I now ask you to go and educate yourself some more on this whole matter that is so widespread. The more you know the better it will be for you and the one you are trying to help fight through it. Granted, no one will ever completely understand the vastness of depression and anxiety, but we are called to do what we can so that we can better help those who are suffering from it. Pray to God that he will give you the knowledge you need to better understand and help the sufferer, and that God will give you the strength you need to fight through it. Cast your cares upon him, for he careth for his own.