Everyone has felt sad or down at one point or another as life can bring challenges to our lives. Even well-known people such as Abraham Lincoln, Alanis Morisette, Audrey Hepburn, Axl Rose, Ben Stiller, Catherine Zeta-Jones, Edgar Allan Poe; Emily Dickinson, Princess Diana, DMX, Robin Williams, Sigmund Freud, Vincent van Gogh, and Winston Churchill experienced depression (Cobain, 2007, pp. 8-9).
According to the Anxiety and Depression Association of America (n.d.), approximately 1 in 10 Americans experience depression. It is the leading cause of disability for ages 15-44-year-old’s.
DefinitionThe American Psychiatric Association (2017) defines depression as a common but serious medical illness that negatively affects how a person feels, thinks and acts. Depression is inescapable and has long-lasting effects. Depression is treatable. It often begins in adolescence and continues into adulthood, although it can occur in children (often presenting as anxiety).
Depression can negatively affect the biological, psychological, social, and spiritual aspects of a person’s life. It is not a sign of weakness, personality problem, or character defect. It is a dysfunction in the brain’s biochemistry. Depression is triggered by a person’s genetics, chemical imbalance, physical illness, and emotional, mental stress (Hammerly, 2001, p.25).
Causes of Depression
Wiesenberg (1996) provides 205 possibilities as to why one might become depressed: problems at home, school, and work; problems with finances; moving houses; illness; the death of a loved one; worry; media; trauma; accidents; natural disasters; local, national, or international news; substance abuse; disabilities; pain; aging; school; self-defeating behavior; guilt; shame; negative self-image; low self-esteem; feeling of being hopeless, helpless, lonely, unloved, friendless, powerless; not feeling heard or understood; instability; violence; unrealistic expectations of self; loss of relationships (friends or marriage); loss of jobs; loss of freedom; loss of traditions; children growing up and leaving home; weather; perfectionism, or prolonged stress.
Symptoms of Depression
Depression can present itself in numerous ways. Symptoms of depression include:
- being guarded
- digestive problems that don’t get better
- feelings of anxiety
- engaging in risky behavior
- feelings of guilt, worthlessness, helplessness, pessimism, hopelessness
- insomnia, early-morning wakefulness, or sleeping too much
- lack of motivation
- loss of interest in things once pleasurable
- loss of interest in sex
- no longer believing in Higher Power/ loss of spirituality
- overeating or appetite loss
- panic attacks
- persistent feelings of emptiness
- persistent feelings of sadness
- physical ailments: aches, pains, headaches, or cramps that won’t go away
- remembering details of past experiences
- substance abuse
- suicidal thoughts or attempts
- trouble concentrating
Depressed people do not have to experience every one of these symptoms. Some will only experience one, while others experience many. The severity, frequency, and length of symptoms vary depending on a person’s history, experiences, perceptions, and genetics.
What the DSM-5 Has to Say about Depression
According to the DSM-5 Diagnostic and Statistical Manual of Mental Disorders (2013), people must meet the following criteria in order to be diagnosed with major depressive disorder:
Five (or more) of the following symptoms fo depression have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to another medical condition.
- Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation.)
- Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
- Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
- The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The episode is not attributable to the physiological effects of a substance or to another medical condition.
- The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.
- There has never been a manic episode or a hypomanic episode.
Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance induced or are attributable to the physiological effects of another medical condition (p. 160-162).
Types of Depressive Disorders
- Major depression: Severe symptoms that interfere with the ability to work, sleep, study, eat, and enjoy life. An episode can occur only once in a person’s lifetime, but more often, a person has several episodes.
- Persistent depressive disorder (dysthymia): A depressed mood that lasts for at least 2 years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for 2 years.
Some forms of depression are slightly different, or they may develop under unique circumstances. They include:
- Psychotic depression: occurs when a person has severe depression plus some form of psychosis, such as having disturbing false beliefs or a break with reality (delusions), or hearing or seeing upsetting things that others cannot hear or see (hallucinations).
- Postpartum depression: is more serious than the “baby blues” that many women experience after giving birth when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.
- Seasonal affective disorder (SAD): is characterized by the onset of depression during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not get better with light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy.
- Bipolar disorder is different from depression. The reason it is included in this list is because someone with bipolar disorder experiences episodes of extreme low moods (depression). But a person with bipolar disorder also experiences extreme high moods (called “mania”).
Warning Signs of Suicide with Depression
Depression carries a high risk of suicide. Suicidal thoughts or intentions are serious. Warning signs include:
- Giving possessions away.
- A sudden switch from sadness to extreme calmness, or appearing to be happy.
- Continuously talking or thinking about death.
- Deep sadness, loss of interest, trouble sleeping and eating that gets worse.
- Partaking in risky behavior that could lead to death.
- Making statements about being hopeless, helpless, or worthless.
- Putting affairs in order, such as tying up loose ends or changing a will.
- Making statements as “It would be better if I weren’t here”; “I’m done”; “I just can’t anymore”;
“I want out”; Life is too painful”.
- Talking about suicide.
- Visiting or calling close friends and loved ones.
If you or someone you know shows any of the above warning signs, call your local suicide hotline, the national suicide hotline at (800) 273-8255, contact a therapist right away, and/or go to the emergency room.
Treatment for Depression
There are many ways to treat depression, the sooner you reach out for help, the more effective:
- Set realistic expectations for yourself-you will not begin to feel better overnight or even in a week. But the more you work on healing, the more steps you are taking getting out of the water well. Understanding that there will be lots of ups and downs along the way will allow you to be gentle with yourself. Stay committed toward your self-improvement.
– CBT (Cognitive Behavioral Therapy) helps a person identify a negative or false thought and replace it with a healthier one. These negative thoughts will then no longer negatively affect your emotions and behaviors.
– DBT (Dialectical Behavioral Therapy) helps a person accept uncomfortable and unhealthy behaviors and thoughts instead of fighting them. By working on mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness skills, a person can address negative aspects of their lives.
– EMDR (Eye Movement Desensitization Reprocessing) helps a person deal with previous trauma through an eight phase approach. EMDR unfreezes stuck or stored material so the brain can integrate and desensitize it.
- Antidepressants (if chemical imbalance and if suggested by professional).
- Make sure to eat five small healthy meals a day.
- Get approximately 8 hours of sleep daily.
- Reduce your stress.
- Combination of calming skills:
- Physical activities
- Talking and spending time with trusted people (friends/family)
- Counting by 3’s
- Taking deep breaths
- Draw or journal about your emotions then let go.
Christian Counseling for Depression
Depression negatively affects all aspects of our lives. Everything becomes tinted, less enjoyable, less important, and less interesting. Life as we once knew it (exciting, pleasurable, satisfying, worthwhile, and to be adventured and treasured) is all of sudden taken away.
Instead, we spend hours in bed; we stop taking care of ourselves; we stop eating; and intrusive, horrible thoughts about being failures and unworthy get in our head.
The worst part is that we just can’t seem to shake the feeling off, no matter what we do. It’s as if every bit of us is covered in cement and is keeping us down in every aspect of our lives. We can’t seem to catch a break or get out of this debilitating cycle. It’s just too much.
The wonderful thing about it is that happiness is achievable. Right now, you are sitting deep down inside a well where you cannot see any light. Please reach out to me so that we can build stairs inside the well and into the light.
Together, we can walk up those stairs by making you stronger and addressing what is holding you down. Despite the load you are carrying inside you, I will sit with you unconditionally and nonjudgmentally. I will come alongside you and provide you with the desperately needed tools you deserve and need to learn. You are not alone. You are worthy. You are deserving of love and acceptance.
Heavenly Father, please hold the person reading this in your arms. Let them know that they are not alone, that you have always been by their side. Let them know that you love, accept, forgive, and care for them always. Please rebuild their heart. I pray that you take their feeling of despair, weakness, fear, helplessness, hopelessness, grieved, and distress; and instead, encourage them to fight for their lives. In Jesus’ name, Amen
American Psychiatric Association. (2013). DSM-5 Diagnostic and Statistical Manual of Mental Disorders. Arlington, VA: American Psychiatric Association.
Anxiety and Depression Association of America. (n.d.) Facts and Statistics. Retrieved from https://adaa.org/about-adaa/press-room/facts-statistics#
Cobain, B. (2007). When Nothing Matters Anymore: A Survival Guide for Depressed Teens. Minneapolis, MN: Free Spirit Publishing.
Hammerly, M. (2001). Depression: How to Combine the Best of Traditional and Alternative Therapies. Avon, MA: Adams Media Corporation.
Wiesenberg, D. (1996). Conquer Depression Now: From Sad to Glad at Home, School, and Work. Brooklyn, NY: Meadow Mountain Press.
“Tearful”, Courtesy of Kat J, Unsplash.com; CC0 License; “Working”, Courtesy of Rawpixel, Unsplash.com; CC0 License; “Krisis”, Courtesy of Stefano Pollio, Unsplash.com; CC0 License; “Light at the End of the Tunnel”, Courtesy of Wil Stewart, Unsplash.com; CC0 License