“Dr. Waldron,” the lady sitting across from me said. “I have been struggling a lot lately.”
“Tell me what’s going on,” I said.
“I don’t know how to explain it,” she hesitated… “I just feel tired most of the time. I can’t concentrate anymore, and I just don’t enjoy most of the things that I used to enjoy. I’m getting through my days, but that’s about it. Do you think I have a thyroid problem or am low in some mineral or vitamin?”
“That could be,” I told her. “We can certainly check those things, but I think something else is going on here.”
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I am a family doctor and probably thirty percent of the people who come to my office to see me have symptoms of depression. This doesn’t mean that they are on medication for it or feel that they need special help, but it does say that these symptoms are widespread in our world.
Even in Christian circles, surveys indicate that about 15 percent of Christians self-report having been diagnosed with depression at some point in their life. This is 25 percent lower than in society as a whole, but it is still higher than we would like to believe.
In the very beginning, God created the world and Adam and Eve. And God saw every thing that he had made, and, behold, it was very good… –Genesis 1:31. Before the Fall, everything was perfect.
I don’t think we know entirely what this meant. Obviously, there were no physical diseases or maladies to afflict either the humans or the flora and fauna of Eden. More than that, Adam and Eve didn’t suffer from anxiety or depression. Their hormones didn’t get out of balance, they didn’t get stressed out (even if there could have been stress in a perfect garden), and they wouldn’t have gotten upset or angry at any point.
Everything changed with Adam and Eve sinning. We see this in the tension between them after they ate the fruit with Adam blaming Eve, and Eve blaming the snake. And the man said, The woman whom thou gavest to be with me, she gave me of the tree, and I did eat. And the LORD God said unto the woman, What is this that thou hast done? And the woman said, The serpent beguiled me, and I did eat –Genesis 3:12-13.
Feeding a family suddenly became hard work. Viruses and bacteria became pathogenic and at some point, in the first families, people would have begun to struggle with emotional and mental health challenges.
Unto the woman he said, I will greatly multiply thy sorrow and thy conception; in sorrow thou shalt bring forth children; and thy desire shall be to thy husband, and he shall rule over thee. And unto Adam he said, Because thou hast hearkened unto the voice of thy wife, and hast eaten of the tree, of which I commanded thee, saying, Thou shalt not eat of it: cursed is the ground for thy sake; in sorrow shalt thou eat of it all the days of thy life; Thorns also and thistles shall it bring forth to thee; and thou shalt eat the herb of the field; In the sweat of thy face shalt thou eat bread, till thou return unto the ground; for out of it wast thou taken: for dust thou art, and unto dust shalt thou return –Genesis 3:16-19.
I would like to explore what depression is as defined by the medical world, some of the sources of it, and then discuss how we can deal with it, both in our own lives and in the lives of our friends and family.
Diagnosing Depression
As mentioned earlier, many people have some symptoms of depression. They may feel more fatigued, cry easily, or have other symptoms that aren’t usual for them. Most of them do not actually have true clinical depression.
Most people do not have all of these symptoms, but when they are continually present without dissipating for two weeks or more, especially if they are strong enough to hinder normal day-to-day responsibilities or the ability to get proper rest, then it is time to do something.
It is important to remember that there is a large or broad continuum regarding depression. Some people have mild discouragement, some have deep feelings of sadness, and some have enough depression that they are at risk to cause harm to themselves or others.
Causes of Depression
There are different examples of people in the Bible who seem to have exhibited symptoms consistent with depression. Two of them stand out to me.
First is Naomi. We know that she went with her husband and her two sons to Moab because of a famine that was affecting southern Israel. She spent ten years in this foreign land and during that time, her husband and both of her sons died.
The book of Ruth tells us that when she returned to Bethlehem, she said to the people, …Call me not Naomi [pleasant], call me Mara [bitter]: for the Almighty hath dealt very bitterly with me. I went out full, and the LORD hath brought me home again empty: why then call ye me Naomi, seeing the LORD hath testified against me, and the Almighty hath afflicted me? –Ruth 1:20-21.
There is no way to interview Naomi and find out all the things that she was feeling, but this seems to be more than simple grief. She had lost all the things that were of value to her, and to her it seemed that even God had turned against her.
As we read the story of Ruth, we see that things did improve for her throughout the book—mostly through the ministry of her daughter-in-law, Ruth, but also, through God gradually restoring things of value back into her life, and through others encouraging her in the Lord’s goodness. And the women said unto Naomi, Blessed be the LORD, which hath not left thee this day without a kinsman, that his name may be famous in Israel. And he shall be unto thee a restorer of thy life, and a nourisher of thine old age: for thy daughter in law, which loveth thee, which is better to thee than seven sons, hath born him. And Naomi took the child, and laid it in her bosom, and became nurse unto it –Ruth 4:14-16.
Another one that comes to mind is the Prophet Jeremiah. Jeremiah was called when he was a young man, and he had a very long career speaking God’s Word to a group of kings and other people who simply weren’t interested in what he had to say.
Jeremiah’s life was constantly under threat. At one time, he was thrown into a dungeon full of mud and was only rescued at the last minute. Jerusalem was besieged three different times before the Babylonians razed it. Through his decades of ministry, Jeremiah told the people what God was asking of them, and the people constantly ignored it.
Perhaps it is no wonder that Jeremiah is known today as the weeping prophet. He said, Cursed be the day wherein I was born: let not the day wherein my mother bare me be blessed. Cursed be the man who brought tidings to my father, saying, A man child is born unto thee; making him very glad. And let that man be as the cities which the LORD overthrew, and repented not: and let him hear the cry in the morning, and the shouting at noontide … Wherefore came I forth out of the womb to see labour and sorrow, that my days should be consumed with shame? –Jeremiah 20:14-18.
It is important to note that in both of these examples from the Bible, sin is not revealed to be the issue (or the reason) that pushed these people into depression. For Naomi it was probably a mixture of isolation from her homeland and loss of people she loved dearly. For Jeremiah, it was the constant stress of trying to serve God in a nation that didn’t care about God.
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Depression is always multi-factorial. That is to say, there are usually a mixture of internal and external factors that break a person down.
There are genetic and hormonal components that come into play here. There is no doubt that some individuals and some families are more prone to depression than others. It is thought by many doctors and researchers that changes in genes which transport the chemical, Serotonin, through the brain can make some people more susceptible to depression than others.
These differences in genetic makeup can help us understand why some people require very little stress to bring them down, while others seem very resilient. Since we can’t change our genetic makeup, there is no sense gloating if we have a more upbeat personality than someone else. And, if we recognize that we have a greater tendency towards depression, we don’t need to feel discouraged by this fact. If God created us in such a way that we tend towards being moody instead of being naturally upbeat, we need to use wisdom in doing what we can to manage as many external factors as we can so as to minimize the risk of debilitating (extreme) depression.
External stressors are often the thing that triggers these sorts of feelings (discouragement). It can be the death of a close friend or family member, or it can be a financial misfortune. It is important to remember that even good events can produce large amounts of stress. Mothers with newborns are often functioning on very little sleep, even while they have large physical changes taking place in their bodies.
Some people may have poor coping skills. Unfortunately, many turn to street drugs or alcohol to try to smother the feelings that they can’t control otherwise.
As a final thing, sin and guilt can trigger depression or make it worse. We can see this present in David and Saul’s lives. (See Psalm chapter 32) This is not to say that all depression is the result of sin—far from it—but sin needs to be dealt with, and repented of, in order to move forward.
Perhaps as a side note, I will mention that in my experience, deeply depressed people often struggle with horrible guilt. They don’t even know what sin they might have committed; they are only certain that God is angry with them, and they must have done something wrong. Fixing the depression will help with the assurance of salvation issues that these people tend to deal with.
This leaves us with the question of how to help someone who is dealing with this sort of thinking.
Listen
Listening is a powerful tool for helping other people. Listen actively and without jumping in to interrupt negative thinking.
You may be able to see that all is not terrible and that there is much positive in the world. The fact that they can’t see these things has more to do with their mindset than with how terrible things really are. A person struggling with depression may know that there are people worse off in the world, but it doesn’t really help them much to point that out to them.
Encourage
Encouragement can simply be saying good things that you see in the life of the person who is struggling. This is something that all of us need more of.
More than this, we need to encourage people to do things that are healthy for themselves. They need to get out of their home, they should try to exercise, and they should make an attempt to eat healthy. We can help them do better in all of these areas. (See Galatians 6:2)
Pray
…The effectual fervent prayer of a righteous man availeth much –James 5:16.
These people need someone to pray with them. They need someone to pray for them. Jesus asks us to pray in secret, but it is also really encouraging for someone who is struggling to hear themselves being prayed for. This helps them to know that there are many people who are lifting them up with prayer support.
Be Willing to be the Initiator
People with depression have very low energy levels. Beyond that, they don’t see themselves as having any value. At least such that someone else would want to spend time with them. They aren’t going to call or text, and they certainly won’t set up a lunch meeting or prayer time.
Even though they crave all of these things, it is just really difficult for them to take the first step to reach out to others. It therefore falls to the rest of us to be willing to do those things.
Don’t Jump to Conclusions
We know the story of Job’s friends. They rode up to see Job after disaster fell on him and sat quietly in shock for several days upon seeing the devastation that had happened to him. When they finally began to speak, it was to judge him for the terrible sin they assumed he had committed.
It isn’t wrong to ask about sin, but there are plenty of times where depression isn’t sin-related. Focusing in on sin prematurely, or if it is assumed, will simply drive wedges that will make it less likely that you can help a person find healing.
What if you are the person struggling with depression? How should you deal with it and what things can help?
Deal With Issues Early
Everyone has moments when they are stressed out and really discouraged. We use terms like “burn-out” and “compassion fatigue” in the medical field when people are heading in the wrong direction. These struggles manifest themselves when we are being irritable with the people around us, when we’re feeling tired most of the time, or when we’re feeling discouraged most of the time. When we see that these symptoms are popping up, it is time to do something to keep things from getting worse.
Maybe a first step is simply knowing our limitations. There are times where we will simply need to say no to work projects or even to church activities because it doesn’t leave us sufficient time to rest. Certain times of the year could be worse—many people struggle more during the winter months because of less sunlight.
Cutting back in whatever areas we can is important when we see that we are on the wrong trajectory.
Don’t Do Comparisons
Everyone is different. Identifying people who seem to “have it altogether” when you are struggling doesn’t help you and it probably will make you feel worse.
Struggling with discouragement does not mean that you aren’t a Christian or that God is done with you. It means that you are human living in a fallen world. You don’t want to continue to live with a depressed spirit, but neither should you believe that you are the only one who has dealt with this. (See 2 Corinthians 10:12)
Exercise
Cardiovascular exercise is really important to boost the chemicals in the brain that are associated with depression. It doesn’t really matter what type of exercise you do. What does matter, is that it increases your heart rate 25 to 30 percent above your baseline heart rate.
Exercise is something that is hard to do, even when you aren’t dealing with depression. It is particularly hard when you are fatigued and feeling down.
Spend Time with Encouragers
People need community. When we are dealing with depressive feelings, we really need other people around to lift us up, to pray with us, and to give us encouragement. None of us is better from spending extended times alone. (See Proverbs 27:17)
Deal with Sin
Sin can make prayer feel ineffective. That isn’t to say that simply confessing sin will suddenly make someone’s depression lift, but it is an important part of reaching healing. Confess your faults one to another, and pray one for another, that ye may be healed… –James 5:16.
Be Willing to Take Medication
Not everyone needs medication. The hope is that if you do the right (helpful) things (some of which are listed above), you can keep things from getting bad enough that you would need medical help. But there are plenty of situations where someone simply needs to start on some medication in order to aid them in a number of ways: to sleep, to rest a weary mind that will not stop, to dull the emotional pain, etc.
People with severe enough depression may be a risk to themselves. They may even be completely unable to respond to counseling or any of the other non-medical treatments for these feelings. These people really need to start on medication with the goal to transition off of those medications down the road when they are thinking clearly enough to continue on the right path.
Unfortunately, the benefits of these medications seem to be short-lived. Long-term use of antidepressant medications really does not seem to improve quality of life for many patients. A recent study looked at patients who took antidepressant medications and compared them to those who did not and found similar levels of health-related quality of life in the two groups. In other words, when comparing two groups of depressed patients, with the one group taking medication and the other group not, after a period of time (approximately 6 months) there were no longer any observable differences in their depression levels. So, while these medications may help to stabilize a person who has severe depression, after a period of time the actual medical “help” of the medication starts to diminish. Hopefully, by this time, the person will be stable enough that a safe taper can be taken towards weaning off the medication.
With this in mind, it is very important to do things other than medication to attempt to improve the situation.
Continue, Even When You Feel Better
Many times, when someone has a medical issue, they will consciously change their diet and lifestyle to improve their situation. The problem is that when the symptoms get better, the tendency is to fall back into old eating and behavioral patterns.
If you have dealt with depression in the past, it is important that you continue a path of healthy choices. Exercise regularly, eat healthy meals, manage your stress level (as much as you can), don’t over-schedule, and make a conscious effort to meet regularly with godly friends for times of prayer and support.
Periodically take an inventory of how you are doing. If you are struggling, figure out what you are going to change to make things better.
Depression is very common in our society and in our churches. We can have victory over it alone, but with God’s help and with the support of Christian brothers and sisters, we can move forward.
You may not be gloriously happy all of the time, but by God’s grace, you will have the joy of the Lord in your heart, even on the most stressful days.
https://www.sciencedirect.com/science/article/abs/pii/S0165032717308819?via%3Dihub
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5430071/
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0265928
