Forgiveness, part 3

When we forgive, it is not so much for the benefit of the offender as it is to release ourselves from the prison of anger, bitterness, and depression. 

Have you ever met this poor woman?  Have you ever seen any other expression on her face than this one? Hard to deal with, isn’t it?  No matter what you do, she’ll always spot the error, always bring it loudly to your attention, always be angry. The sad thing is, she doesn’t even know why she’s so unpleasant and hard to please. 

When I was working on my master’s degree, I did a year of practicum in a nursing home.  I was a case worker, which meant that I had a regular list of residents that I looked after.  Sometimes it was just a matter of going in and spending some time talking with them.  There were other things to deal with, too, like family members who had questions or complaints; convincing a resident that she needed to stop ringing her bell every minute all night long; convincing them to eat, to tend to hygiene when they could, and so on. 

There was one man that I was warned about. “He’s a real grouch, Linda.  He’ll complain incessantly, and his language turns the air blue.  You’ll have to handle him carefully.”

Well, good grief.  This should a fun! 

The first time I went to see him, he greeted me with,”Well, finally!  I heard they were sending me someone new, and it’s about time you showed up.  Where have you been, anyway?”

“I’ve been avoiding you, Mr. Z, that’s where I’ve been.  And if you’re going to continue with this attitude, I’m leaving.”

He was stunned, speechless.  After a few seconds, though, he got his second wind and started in on a tirade ranging from his childhood to his most recent meal.  I gave him about ten minutes before I interrupted him. 

“Okay, Mr. Z, I think I’ve heard enough. It’s clear you’ve been mistreated, misunderstood, and abused all your life. I’m sorry you feel that way, but I’m just not going to come here every day to listen to you complain.  So here’s the deal. Tomorrow, when I come, you need to have a story to tell me about something good that happened to you when you were a kid. No griping, no complaining.  One positive story, and that’s all. If you can’t think of anything, I’ll come again the next day and the next until you come up with something positive. Understood?”

Again, he sat on his bed gaping at me, with nothing at all to say.  Finally–“You can’t do that!  I’ll report you!  I’ll have your job! I’ll—“

“See you tomorrow, Mr. Z.”

What he didn’t know was that I’d already informed all the appropriate people about my plans for Mr. Z, and they were all curious to see how it would go.  He’d been terrorizing the caregivers for months, and they dreaded having to go into his room.  I wasn’t worried at all. 

He had a positive story for me the next day. As time passed, we actually became friends.  Finally, I was able to talk with him about spiritual things, and I suggested to him that he would be much happier if he would learn to forgive those who had hurt him over the years.He was astonished at the idea, believing sincerely that the only possible reaction to mistreatment was anger.

The trouble with that, of course, is that the anger was eating him up from the inside, and it wasn’t affecting those he hated in any way. 

Anger itself is not sin.  What we do in our anger is another story, and often the greatest sin we commit in anger is against our own hearts and spirits.  Years ago, I read Tim LaHaye’s book How to Win over Depression. He wrote that offense leads to hurt and anger, leads to self-pity, leads to bitterness, leads to depression.  The only way to break that progression is after the hurt/anger part, and the thing that breaks the chain is to choose to forgive.  It is to realize that you yourself are far more hurt by your bitterness than is the person who hurt you. Even more important, your bitterness spills out like acid over all the other people in your life, who have no idea why your tongue is so sharp and your attitude is so critical.  They don’t understand that you learned those behaviors as a defense against mistreatment. They only know you’re hard to deal with, and they try to avoid you when they can. 

Mr. Z was transferred to another facility about halfway through my year.  I don’t remember why. But he left me a note, since the transfer was made over a weekend when I wasn’t there.  The note said, “Hey, smartypants, you won’t have to see me again.  But I’ll remember  you.”

 

Are You S.A.D.?

One of the suggestion I received this past week was to write something about Seasonal Affective Disorder (SAD).  Since we are just now starting to come out of the darkest days of winter, it’s an appropriate topic for today’s Friday Depression post, which I’m going to start categorizing simply as “Counseling Issues.”

I remember my parents mentioning someone being “shack happy” or having “cabin fever.”  We’ve all heard of “being in the Doldrums,” which relates back to the days of sailing ships that would be caught sometimes for weeks in a completely still part of the tropics–not a wisp of a breeze, like being caught in an endless moment of time. Hot sun, no clouds, no rain, no wind, and a ship that wasn’t nearly large enough to keep men from grinding on each other’s last nerve.

The other two terms, cabin fever and shack happy, derive from a time in our history when people endured long, lonely, cold and dark winters in the confines of a small cabin–and I use the word cabin quite loosely.  Often, their dwellings were a single room used for everything, with perhaps a curtain of some sort concealing a small bed.  Close quarters, unbearable cold, tons of snow–we’re talking about the Great Plains here–wind howling day and night, the necessity of caring for livestock, and using a chamber pot or an outdoor privy, made those long winter months a time to dread.  Travel between pioneer homes was restricted, so often there was no companionship other than the husband, wife, and the children they had.

We read often about the incredible strength of the pioneer women, and it’s all absolutely true.  They were incredible, in my opinion, and often did the work of the husband while he traveled to a place where he could find a job to tide his family over until the next planting and harvest.  These women were tough, strong, and dedicated.

However, they also suffered terribly from what we now recognize as SAD.  They got through it most of the time, but some of them did not. Some died.  Some packed up and went back East. Some simply retreated into their own minds and never came back out.

Here’s an article you can read about SAD.  I found it informative and I hope you will, too.

http://www.wisegeek.com/what-is-cabin-fever.htm

So what can be done?  Several things, actually.  There are lamps you can buy that simulate sunlight.  I’ve never used one, but I have clients who say they’re very helpful.  Here’s a link to help you with that:

http://www.mayoclinic.com/health/seasonal-affective-disorder-treatment/DN00013

Exercise outdoors whenever you can.  Even a short walk will help, even if it’s a cloudy day.  Sunlight does penetrate cloud cover, and it will help you.

Take vitamin D3.  Talk with your doctor about this if you have any questions.  I take 2000 IU’s daily with my calcium supplement.  We’re learning that D3 is very helpful with a lot of things, including fibromyalgia.

Keep your drapes/shades/curtains open as long as there is any light coming into the house.

Stay warm.  Wear thermal underwear.  Bundle up when you go out.  Wear sunglasses if your eyes are light sensitive–if there is snow on the ground, it hurts my eyes.  Sunglasses are a year-round necessity for me.

Exercise.  I have a mini trampoline, a stationary bike, and a cable weight machine in my basement.  I need to use them more.  Exercise is helpful for ALL types of depression, and especially weight resistance because it helps the body produce its own endorphins.

Eat lots of fruits and veggies.  In this incredible era of year-round availability, there is no excuse for us to suffer nutritionally.  Look for the deep, dark-colored and bright-colored produce. Avoid preserved foods as much as is reasonable.

Medication may be indicated, depending on the severity of your depression.  Talk with your doctor.

And remember, the sun will shine again.  It will be warm, and the days are already getting longer.  And here’s something to make you smile:

Funny Seasonal Ecard: I miss hating the summer heat.

 

Depression and the Bible

(First posted January 18, 2013)

 

Hoo boy.  This can be a really hot topic, and I’m sure there are many who would not agree with some of the things I’m about to say.  The attitude that depression is simply a sin problem is still alive and well out there.  Those who ascribe to that position will tell you that if you will confess your sin, forsake it, and get right with God, your depression will lift.

Is that ever really true?  Sure, I suppose it can be.  Clearly, living with hidden or overt sin in your heart will make you unhappy and out of sorts with both God and man if there is any sense of right and wrong in you.  The Holy Spirit moves in our hearts to convict us of sin.  When He does, we need to confess, repent, and forsake that sin if we are to be right with God and able to sleep peacefully.

However, I disagree strongly with the idea that all depression is simply a sin problem.  That’s an over-simplification.  I have known people both personally and professionally who have struggled with terrible depression and have begged God to reveal their sin to them, only to fall more deeply into misery when they hear no answer, drowning in a quagmire of guilt.

It seems to me there has to be a more balanced explanation, and I believe there is.  If you will go back and read my other posts on depression, you will better understand what I’m about to say here.

Let’s look at the story of Elijah in I Kings 18: 17-19:15.  Please read it for yourself.  What you’re about to get here is my condensed version of this great story.

Image

King Ahab had told Elijah that he, Elijah, was “troubling Israel.”Elijah’s response was direct and condemning;  Ahab and his ancestors were the ones to blame for the present drought, because they had forsaken God and turned to idols. Elijah then challenged Ahab to gather up all the   people of Israel, along with the prophets of Baal, the false God, and send them to Mount Carmel for a little contest.

When everyone had arrived, Elijah proclaimed himself to the only true prophet of God who remained.  You want to talk about lonely?

He then challenged the false prophets to make an offering, and to lay it on an altar stacked with wood, but to lay no fire under the altar.  He would do the same.  He then instructed them to call on the name of their god, and he would call on the name of the Lord.  The God Who answered with fire would then be proclaimed the true God of Israel.

Well, you know what happened.  Baal’s priests cried and prayed, moaned and wept; they even cut themselves so blood would flow, to impress their god.  Elijah mocked at them in 18:27, suggesting that perhaps Baal had taken a little nap, or was on a vacation.   It was all to no avail. They jumped up onto the altar, bleeding “copiously,” while Baal did nothing.  Silence.

Then Elijah ordered the people to come closer to him, and he built an altar with twelve stones to represent the tribes of Israel. He dug a huge trench around the altar, and commanded that four barrels of water be poured over the offering.  The water would be captured in the trench.  Then he told them to do it again.  Four more barrels. A third time, and the trench was filled, the meat sodden, the wood soaking wet.

At the time of the evening sacrifice, Elijah prayed.  He said, “Lord God of Abraham, Isaac, and of Israel, let it be known this day that Thou art God in Israel, and that I am Thy  servant, and that I have done all these things at Thy word. Hear me, O Lord, hear me, that this people may know that Thou art the Lord God, and that Thou hast turned their heart back again.”

And the fire of God came down and consumed the sacrifice, the stones, the wood, and the water!  Wouldn’t you love to see the video of that? The people repented, and Elijah told them to gather up all the false prophets, and he took them down to the brook Kishon, and he killed them all there. Not one of them escaped.

Do you think Elijah may have been a little weary after such a busy day?  Do you think he was spent emotionally, physically, even spiritually?  Sure he was.  We all would be.  This was a day-long trial.  He was exhausted, even though God had given him such a victory.

So what happens next?  Well, Elijah told Ahab to go get some lunch, because it was going to rain, children.  And Elijah went back up the mountain, sat down, put his head between his knees, and while his servant watched, he waited for the rain. When it came, God strengthened Elijah and we are told that he tied up his robe around his waist and raced Ahab, who was riding, and went to visit Queen Jezebel.

I’ve always wondered why he did that.  Jezebel wasn’t overly fond of Elijah.  When Ahab told Jezzie what had happened, she sent a message to Elijah that told him she would have his life by the next day. Our great man of God, who had won the day and conquered evil, then turned back around and ran for his life, fleeing to the wilderness.

Finally, he sat down to rest under a juniper tree and begged God to let him die.  He was weary to the bone, sick at heart, defeated and dejected because the queen wanted his head. The rest of the story tells how God revived him, spoke quietly to him, and set him back on his feet.

What was Elijah’s great sin?  I suppose you could say he lost his faith that God would protect him, and that would be true as far as it goes.  However, I believe that lapse of faith was based on more than simple unbelief.  Elijah’s great faith is clearly apparent in the preceding events, after all.  No, I think there was physical exhaustion, emotional emptiness, spiritual depletion that all played in to a  time of depression.  He wanted to die!

How quickly we can forget what God has already done for us, and fall into a period of wanting to give up, to just drift into nothingness, and leave all our worries and troubles behind!  When this happens, it is of course partially  spiritual.  But we cannot discount the impact of being completely physically spent.  When our bodies wear out, so does our ability to think biblically and logically.  We can be consumed with our emotional reactions, and lose sight of our faith for a while.

Even Jesus went aside to rest when he was constantly ministering to the crowds.  If He needed a time apart to restore His spirit, how much more do we!

Causes of Depression: Part 3

Friday came awfully fast this week!  It was my first week back to work since I took my sabbatical starting just before Thanksgiving.  The days have gone  well, and very quickly.  I’d say I’m about 80% better right now, which is a lot of improvement.  Rest, medication, and straight thinking are all doing their work.

Today I want to mention several things that can trigger or contribute to depression.  Most of this information is already flooding the internet, so I’m not going to write anything you can find elsewhere.  I just want to bring these things to your attention, and if they are applicable to you or someone else in your life, then that’s all for the good.

Image

Postpartum Depression

Here is a reliable website that will give you lots of good information:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004481/

Some important things to be aware of with postpartum depression:

1.  It can occur immediately after the birth or up to six months or more after the birth.  Some women think it started for them even before the baby had come.

2.  It’s not your fault.  Pregnancy does a complete upset of hormones and chemicals in a woman’s body, including her brain.  Somewhere, I don’t remember where now, I read that during pregnancy a woman’s brain shrinks by about 10% of its normal volume.  It goes back to normal after the birth; when that fails to happen, there is almost certainly going to be postpartum depression. Modern imaging techniques have shown this change clearly.  Maybe it’s the explanation for what women refer to as “pregnant brain.”

3.  There is a difference between postpartum depression and postpartum psychoses.  The latter is far more serious, and can result in bizarre behaviors that can harm the baby, the other children, and the mother herself.  Tragedy such as the Andrea Yeager case is rare, but it does happen.  If the mother had mental health diagnoses prior to pregnancy and childbirth, she and her husband and/or family need to make sure she follows up with appropriate medical treatment.

4.  What about the dangers of psychopharmacologic drugs for a baby who is nursing?  That absolutely needs to be considered.  If the depression is mild, I would suggest that the mother stay in talk therapy and try to develop a safety net of friends and family to give her the time she needs to recover without medication.  This, of course, is the ideal.

Not everyone, however, has the ideal situation.  Sometimes the risk to the baby of the mother taking antidepressants has to be measured against the danger of a deeply depressed new mom hurting her child.  That is something that needs to be discussed with a knowledgeable medical person.

It is vitally important that a new mother get the rest she needs as her body slowly returns to normal.  I can hear all you new moms out there laughing hysterically at that statement, especially if you have other young children.  I’ve been there.  I had four, all about two years apart.  I’m not speaking just from academic knowledge here, but from personal experience.  My mom and mother-in-law both lived long distances away; I had no sisters, aunts, or relatives to help us out. Thank God, we did have a wonderful church family, and precious friends that I could count on.  One of my friends had children about the same age as mine, and we used to trade babysitting 1/2 day each week, just to give each other time away from the demands of a very young family.

There are resources out there.  If you are truly cut off from such sources of help as I’m describing, then speak with your ob/gyn or family doctor and see what kinds of help are available in the community.  Most hospitals sponsor some type of program for new moms, especially single moms.

5. In my opinion, spiritual help is the best help during postpartum depression.  A close relationship with God will give any new mom a safe retreat and a source of encouragement.  Regular Bible-reading is vital.  I give my clients what I call my Scripture Doses.  It  is a collection of my favorite “hope and peace”  passages. I ask them to use the list any way that works best for them, but especially to try to memorize Phil. 4:7, and rely on it to find the peace that passes understanding. 

Postpartum depression does pass.  Things will get better.  The important thing is to know that it’s normal; you are not alone; there is help.

Other Disorders

Depression can be a big part of other disorders, including Bipolar Disorder, Anxiety Disorders, and even learning disorders such as ADD.  All of these disorders can involve mood swings which may lead a practitioner to suspect or even diagnose Bipolar, but mood swings do NOT always mean the person has Bipolar Disorder.  Mood swings are a big part of Attention Deficit Disorder, for example.  Also,  we are learning more clearly all the time that anxiety drives depression, so if someone is by nature a very anxious person who tends to have a lot of worries and fears, there will almost surely be depression at some point until or unless the person can learn to control the anxiety.  Yes, it can be done 🙂  It’s not easy, but it IS do-able.

If there is a question I have left unaddressed in these last three posts, please leave a message either on this blog or on my Facebook page Study God’s Word.  I would be more than happy to address any question you may have that I have not already mentioned. This is a huge topic; I have merely brushed the surface.  Again, there is already a wealth of material online, at your library, and in bookstores.  Just be careful that anything you read is balanced and biblically correct.  There is a lot of misinformation out there, too.

Depression affects the mind, the body, the emotions, and the soul.  It is serious, and nothing to ignore or take lightly.

What Causes Depression: Part Two

Image

Last week we talked a little bit about a possible genetic connection; we also discussed the melancholy personality that is more prone to depression than the other three main personality types.  However, those two things are by no means a complete picture of the causes of depression.  Today, I think I want to talk about trauma and how it can play into depression. I don’t think I’ll be able to cover the whole picture, so hang on.  We may have to finish this one next week.

Let me remind you, if I may, of my own personal journey.  I’ve been taking Effexor for about six weeks now, and my husband tells me there’s no comparison, that I’m getting back to my “normal” self now, whatever that means 🙂  Because he had his own depression journey 16 or more years ago, he’s very sympathetic and supportive.  I’m blessed.  Not all spouses give that kind of support.

So where it started with me is hard to pinpoint, but I suspect the seeds were sown some years ago. I deal with trauma every day that I work in my counseling office.  The trauma can range from the loss of a child through miscarriage, illness, or suicide to divorce or death of a spouse; from a job loss to sexual and or physical abuse at the hands of a stranger or a spouse.  Someone, years ago, made a table of “stress numbers.”  One side was bad stress, like divorce. The other side was “good stress,” like a wedding.  The stress number of each was 100.  Isn’t that interesting?  I do remember, after my own wedding and honeymoon, going through a period of listlessness, complete physical exhaustion.  I had graduated from college one week, and was married the next.  Probably foolish, looking back, but I wasn’t willing to wait one minute longer than I had to.  Was my reaction depression?  I don’t know.  I just remember needing to sleep a lot, and having very little initiative and physical energy.  Maybe I had mono.  That’s something else that has surfaced since I was 50, almost 16 years ago.  My doctor told me that the mono test clearly indicated I’d had it before. Huh.

All right, back to trauma.  You may say, “But I’ve never had any real trauma in my life.”  That may be true, by your own definition.  But there is “Big T” trauma, like loss of a child or spouse, severe physical illness or accident injury, or financial loss.  Then there is “little t” trauma, like the stress of going to college for post-graduate work, or even the daily care of an ill child or parent.

Military veterans are often diagnosed with Post-Traumatic Stress Disorder. If they have seen their buddies die horribly, or been severely wounded or, worse, captured and imprisoned, their trauma is severe.  Part of PTSD  is severe depression, often incapacitating enough that it totally changes their lives.

The lesser traumas tend to be cumulative. A part of my family moves far away; I deal daily with the painful problems of my clients; relatives die in auto accidents; my mother lingers painfully for nearly two years before she takes her last breath.  Life is just hard, and  I’m no longer young. The depression creeps up subtly; it doesn’t develop into full-blown pathology overnight.

The accumulation of trauma has affected my entire system, including my brain, which is the source of the “feel good” chemicals we all need in order to maintain a “normal” state of mind.(Since I wrote this four years ago, studies are showing clearly that about 85% of serotonin is actually created in the gut, not the brain)   I use the word normal carefully, because my normal may not be your normal.  That’s an important thought to keep in mind.

So, could I have prevented this at some point?  Maybe.  Maybe if I’d come home from my mother’s funeral and NOT jumped right back into work.  Maybe if I’d grieved more openly when my nephew, and then later my brother, both died within 19 months of each other, instead of keeping it buttoned down tight.  Maybe if I’d taken a vacation somewhere in that two-year period. Maybe if I were better at compartmentalizing. Maybe. . . .but I’ll never know.

One thing I do know is that my faith in God has never wavered, even through another deeply personal loss that I cannot discuss here.  I honestly do not know how people survive such losses without God to sustain them; without His Word to comfort, encourage, and ground them.  I am so thankful that even when I would forget to “take my burdens to the Lord and leave them there,” He always found a way to remind me to do so.

Trauma wears us out; physically, emotionally, intellectually, and spiritually drains us of our energy and will to go on. When the physical body becomes depleted, ALL of it is affected, including the brain. The brain is the source of serotonin, along with several other mood-stabilizing chemicals. Both the brain and the body need time to heal. When we don’t take that time, we can suffer depression.

Depression: Why Did This Happen? Will it Come Back?

There are so many factors that can play into depression.  Today I’m going to cover as much as I can in a reasonable amount of space.  This could well end up being a multiple-part topic.

Let’s look at genetics first.  One of the questions I always ask a new client who presents with depression is, “Who else in your family, in your own generation or your parents’ or grandparents’ generations, has had a “nervous breakdown,” or been given some sort of medication for nerves, such as Valium?”  Almost without fail, there is someone.  Typically, there will be more than one in the family tree who has suffered from depression.

So, is there a “depression gene”?  Honestly, I don’t know.  I found some articles on the subject.  Here is one link you may find interesting.  Just remember, this whole topic is in a very new state of research:

http://www.msnbc.msn.com/id/40908471/ns/health-mental_health/t/depression-gene-really-exists-new-study-claims/#.UN3FjOTAeSo

What I do know is that some people are more resilient about how they handle stress than others are, and there is a personality type that can “run in the family” that does not handle stress well without some help.  This is why I look for the genetic connection; it helps me understand if there is a generational tendency toward depression, and knowledge helps me know how best to help my client.

What personality type am I talking about?  The Melancholy, according to the study I like best.  There are other studies that call it by different names, but the traits are the same.  Here is one thumbnail sketch:

Image

Much more can be said about this personality.  It is the deepest, richest, most complex and most contradictory of all the four basic temperaments.  Often, the Melancholic is richly gifted in some way.  Many of our most beloved writers, poets, composers, artists and other creative people are/were deeply melancholy.  They are indeed perfectionists, and they are world-class worriers.  While they can be super organized, to the point of OCD, they can also live in utter chaos because they want to be orderly and neat, but they think they have to make that happen all at once.  It’s so overwhelming that they simply walk away from the task and start some other project–or go read a book 🙂  Melancholics are sentimental, holding on to relationships even after they are cold and dead. They are almost always the “dumpee” rather than the “dumper” in relationships.  They are deeply introspective, always looking inward to see how they’re measuring up to their own often unrealistic expectations.  That in itself is depressing.  Melancholics are born with a strong sense of guilt, although they’re often not sure what it is they’re guilty of doing/thinking/feeling that is so wrong. They tend to allow people to use them, then complain about how no one appreciates them. “I’ve given up everything for my kids/husband/friend/work and no one appreciates/understand/knows what I’m going through.  No one loves me.  Everyone takes advantage of me.  I’ll never be understood/appreciated/happy.”

It’s a self-fulfilling prophecy.

At the same time, these folks are tremendously generous and others-oriented. Yet, they can be unbelievably critical, narrow, self-righteous, and unforgiving.  Unforgiveness turns to self-pity turns to bitterness turn to depression. Tim LaHaye wrote a wonderful little book many years ago titled How to Win Over Depression.  It’s an excellent resource.  I also like his book on the temperaments.  The latest rewrite that I know of is called Why You Act the Way You Do. I read his first temperament study years ago, and it’s been a most valuable resource ever since.  It’s title is The Spirit-Controlled Temperament. 

All right.  I suspect that’s about enough for this week.  There is a great deal more to say on the how and why of depression, but I guess we have lots of time now that we don’t have to worry about the Mayan Calendar any more!

More on Medication for Depression

There is a third class of antidepressants known as MAO Inhibitors, or MAOI’s.  You can read all about them here: http://pharmacist.hubpages.com/hub/What-Are-MAO-Inhibitors.

As with the others, the targets of this class of medication include serotonin, dopamine, epinephrin–all the so-called “feel-good” chemicals that the brain produces.

The question I’d like to address today is, “If depression can be treated without medication, then why take the pills?  Wouldn’t it be better to get to the root of the problem instead of just masking it?”

There are some assumptions in those questions.  I hear the questions a lot, because unfortunately, there is still stigma attached to taking medication for “nerve problems,”  or “emotional problems.” People of faith worry about depending on medication instead of God, believing that if they could just pray enough, read the Bible enough and deal with whatever their lack of faith is, they’d get better.  What follows is how I answer all that in my office, usually in a first or second visit with someone who is typically depressed, anxious, and embarrassed to be sitting in a “shrink’s” office.  This could take several posts to really get the job done, I’m not sure.  We’ll see!

So, let’s pretend you’re sitting in my office, we’re getting to know each other, and I’m seeing clear indications of depression.  The first thing I’m going to do is reassure you that you’ve made a good choice to find some help; that you certainly are not alone in your misery, and that it WILL get better. About this time, I will point out that there’s a box of tissues sitting right behind you on the back of the little sofa you’re sitting on.

Once you’ve told me your story, or at least enough to get us started, I’m going to ask you about the stressors in your life.  That question always gets me a wide variety of responses, from floods of tears to anger to uproarious–but sad–laughter. The reason I ask that question is that more and more clinical evidence is pointing to the reality that anxiety comes first, then depression.  Anxiety is just another word for fear.  Every single one of us deals with some level of anxiety at some point or points in our lives. It can stem from marital relationships, extended family, an obnoxious neighbor, illness, financial stress, job stress– to just about anything else you can think of. These are anxious times we live in, but that’s nothing new.  The folks who lived through World War I  thought it was Armageddon.  It was supposed to be the war to end all wars.  Those who endured through the Holocaust thought nothing could ever be worse, and then the atom bomb and nuclear warfare became something new to fear.

On a much smaller, but far more personal scale, most of us experience anxiety just in the routine of our daily lives, rarely thinking about the predictions of world-wide disaster.  The disasters at home are far more consuming. So you, sitting in my office, begin to tell me that you can’t sleep, that you often have sweaty, heart-pounding moments when you think you’re going to die; you can’t get a deep breath, you feel buzzy and faint, and then it passes and you’re terrified of the next attack.

Which takes us to a conversation about anxiety, panic attacks, anti-anxiety meds, and whether or not to use those meds. Please understand that not everyone who experiences depression will experience extreme anxiety and panic attacks.  It can be a part of the total picture, but it doesn’t have to be.  Sometimes, people who live with panic attacks have some deep trauma that has never really been addressed.  This can be Post-Traumatic Stress Disorder, common among military veterans and victims of childhood sexual abuse and/or rape; victims of natural disasters like tsunamis, hurricanes, and so on.  There are special treatments for this type of problem, including EMDR, which is a specialty of mine.  You can google it to find out more about it.

All right.  Just a quick note about anti-anxiety meds and then we’re done for today.  Here is a list of the most common medications:

  • Alprazolam (Xanax) – approved for GAD, panic disorder; used off-label for agoraphobia with social phobia
  • Chlordiazepoxide (Librium) – approved for anxiety (in general)
  • Clonazepam (Klonopin) – approved for panic disorder; used off label for anxiety (in general)
  • Diazepam (Valium) – approved for anxiety (in general)
  • Lorazepam (Ativan) – approved for anxiety disorders (in general)
  • Oxazepam (Serax) – approved for anxiety (in general)

GAD, by the way, stands for General Anxiety Disorder.   These medications are almost always prescribed “as needed” and can be helpful in calming you down if you suffer from panic attacks. Also, several of the common antidepressants are considered anti-anxiety as well.  Sometimes a physician will prescribe both, suggesting the anti-anxiety be used only when absolutely necessary.

And yes, I know there’s a lot of controversy about all this.  Be patient.  I’ll get there eventually!

Depression and Medication

 

(Second in the series of posts about depression, this was originally written on Dec. 7 , 2012. I’m recycling this series because I still get questions about this topic.)

******************

This, believe me, is a very hot topic!  There are many who object strongly to the use of antidepressants, claiming that they only mask the problem without resolving it.  There is much to be said in their favor.

The other side of that argument is that true clinical depression comes with a depletion of, typically, serotonin.  Serotonin is manufactured in the brain; also, we now know that about 85% of our serotonin is manufactured in the gut. That makes digestive health even more important than we thought. In any case, serotonin is one of the first chemicals we target in prescribing medication.   There is a wealth of information on this topic all over the internet.  I’m going to give you a link you can look at, and follow some of the links on that page to find out more.  I do want to remind you that just because it’s on the internet that doesn’t mean every word is gospel truth 🙂  However, I have a lot of confidence in what I read on this site, and I do have a lot of study and experience behind me in this area.

There is a family of medications known as SSRI’s.  These are the most commonly prescribed meds for depression.  The letters stand for Selective Serotonin Reuptake Inhibitors.  The theory behind the medication is that the serotonin manufactured in the brain is taken back up (reuptake) by the neurons before it can be properly processed. The result is a shortage of the chemical, resulting in a depressed mood.  SSRI’s inhibit the reuptake.  Commonly-known meds in this family are Zoloft, Paxil, Celexa, Prozac, and Effexor.  There are several others.

There is an older family of medications, known as the Tricyclics, that are also very effective.  They include amitriptyline (brand names Elavil, Endep) among others.  Some doctors are finding that they actually work better than the SSRI’s for some people. The fact is, of course, that the pharmaceutical companies want to sell their newest “best” products, and the tricyclics pretty much got pushed into the corner when SSRI’s hit the market.

Probably the most controversial treatment for depression is electric shock therapy.  Back in the day, it was pretty dreadful, often leaving the patient in a zombie-like condition.  The good news today is that we know a lot more about where the mood centers of the brain are, and we can pinpoint them very specifically for treatment.  Imaging technology has come a very long way, and there are fascinating studies about how the mood center shrinks and cools down during depression. The bad news about shock therapy is that it’s expensive, and not all insurances will cover it.  Also, nothing is guaranteed to cure depression.  We can do a lot, but we can’t do miracles.

So what about the spiritual aspect?  As believers, should we even ever be depressed? Again, this is a very controversial topic.  All I can do here is offer you what I’ve observed, experienced, and what I believe the Bible shows us.

First, I’d like to point out that there are many biblical characters who showed strong symptoms of depression. David said that he “wept all night upon his bed until his bones were dry” (Ps. 6:6). There are many other places in the Psalms that describe his depression. Jeremiah was “The Weeping Prophet.” Elijah needed God to put him in a cave near the brook Cherith and send him meat via a raven while he recovered his equanimity after a great spiritual victory and a threat from Jezebel.  Jonah pouted under a vine after his success at Ninevah. The great Apostle Paul often shares his heart in a way that shows he understood depression; likewise, the Apostle John. And the words of Jesus Himself resonate for those of us who have experienced depression: “His soul was exceeding sorrowful, even unto death” (Matt. 26:38).

Perhaps the greatest historical example, in the Christian realm, who suffered deep depressive episodes was Charles Haddon Spurgeon.  Abraham Lincoln, David Brainerd, Edgar Allen Poe, Earnest Hemingway. . . . the list is endless, really, including great artists and composers that we all admire.

Was there sin in the lives of all these people?  Of course, except for Jesus; and the Bible tells us that there is nothing we experience that He hasn’t also experienced, and that there is deliverance (I Cor. 10:13).  But was sin the one and only cause of their depression?  I don’t think  so. If that were the case, the solution would be so simple as to just confess, repent, and go on your happy way.  No.  I’ve seen too many godly, sincere believers suffering agonies of guilt because they’ve been told to “just trust the promises of God; just confess your sin and get forgiveness; just pull out of it!”  The word just actually trivializes the depression, and the recipient of this well-meant advice often feels much worse for not being able to just  get over it.

I can see that this topic needs more time and space.

Here’s the link I promised you: http://www.ehow.com/how_6174922_serotonin-levels-checked.html

More on this topic next week.

Spinning in the Wind

I wrote a series on depression back in 2012 for my Friday Counseling Issues.  Back then, I didn’t know how to publicize, and I’ve had a whole bunch of people tell me they never saw these posts before.  I’ve published two of them over at The Cow Pasture Chronicles. Sheila asked me to be a guest contributor for her while she undergoes some surgery and physical therapy. There are half a dozen of us filling in for her.

Anyway, I’ve decided to bring this series  back to the forefront, only this time I will use the publicizing tools I’ve learned over the years.  If you haven’t seen these before, I hope you will take a look.  I’ll probably do one or two each week.

12/12/2016

_____________________________

Here’s the first official post  under the new category Depression. 

First, you’ll see me refer often to the difference between how we feel and what is truth. This is extremely important.  It is what we believe that motivates our emotions, words, and behaviors.  If you believe snakes are inherently evil (I do!)  you will avoid them at all costs.  If you believe they are beautiful and fascinating, you will look at pictures, watch movies, go to the reptile house at the zoo.  Without me.  The difference is in what we believe about snakes; it is not in what is true about snakes.

So.  One of the things I hear the most often when I’m working with depressed clients is, “I just feel so alone.  No one I know has ever experienced anything like this.  No one understands.  Everyone thinks I should just suck it up and get on with life. Everybody always acts as if I just need to get a grip, pull myself up by my bootstraps.  So I do a lot of pretending in order to keep everyone happy, when all I really want to do is crawl into a hole and pull it in after me. But nobody understands.  I’m all alone.

Do  you get it?  Look at the red words.  One-hundred percent words, with no room for argument.  This is called “universal thinking”  in cognitive therapy.  One or two incidents become a 100%, universal truth.  With that weight of negativity in our heads, no wonder we feel depressed and, above everything else, alone.  Isolated. No one gets it.  No one.  Hear the echo in that empty chamber of your head and your heart?

I went to lunch with two good friends the other day.  They know my present struggle.  They assured me that I’m not alone, that people care and are praying for me.  In my head, I know they’re telling me the truth.  It just doesn’t feel like it yet.  But it will, because I believe it.

Most important, I believe that God is right beside me.  Again, I’m having a hard time feeling His presence right now, but I know that what I feel is not necessarily what is true.  For me, music is an invaluable tool.  I started playing my Christmas music yesterday, and it helps me.  Scripture, of course, is the most valuable tool I have, and here is my favorite passage (for today, at least!)

Isaiah 43:1-4. “But now thus saith the Lord that created thee, O Jacob, and he that formed thee, O Israel, Fear not: for I have redeemed thee, I have called thee by thy name; thou art mine.

When thou passest through the waters, I will be with thee; and through the rivers, they shall not overflow thee: when thou walkest through the fire, thou shalt not be burned; neither shall the flame kindle upon thee.

For I am the Lord thy God, the Holy One of Israel, thy Saviour: I gave Egypt for thy ransom, Ethiopia and Seba for thee.

Since thou wast precious in my sight, thou hast been honourable, and I have loved thee: therefore will I give men for thee, and people for thy life.”

Do you see how different the red words are in this passage?  That’s where I need to focus.  The truth is, I’m never alone. He will never leave me nor forsake me.  He is always the same.  Through the valley of the shadow of death, He is with me.

If you’d like some homework, use these verses and the others I’ve mentioned but not referenced to start a list of what you know to be true about God.  Not how you feel, but what you know to be truth. Add to your list whenever something comes to mind.  Let me get you started:

Truth About God

1. He is always with me

2. He loves me

3. He calls me by my name–He knows me!

4.  He gave Himself for me

See? Once you get started, it will flow.

Please let me know your thoughts about this post. It will help guide my direction for the next one.