UNDERSTANDING DEPRESSION

What is Depression: Depression is a prolonged emotional tone dominating an individual's outlook and mood. Normal moods of sadness, grief, and elation are typically short-lived and part of everyday life, but these can progress into a depressed mental state. Other symptoms often accompany depression but the most common symptoms of major depression are:1

• deep sadness or emptiness,

• apathy, loss of interest or pleasure in usual activities,

• agitation or restlessness, physical hyperactivity or inactivity,

• sleep disturbances,

• weight/appetite disturbances,

• diminished ability to think or concentrate,

• feelings of excessive guilt, self-reproach or worthlessness,

• feelings of fatigue or loss of energy, and

• morbid thoughts of death or suicide.

If a person experiences at least five of these symptoms for one month they have major depression. Mild depression would typically be defined as having two to four of these symptoms for over one month. Bipolar disorder (manic depression) includes swings from deeply depressive moods to wildly manic moods (elation, irritability, hostility, inflated thoughts of self, boasting)—with many intensities and variations.

When asked "what brings you pleasure in life" most unsaved, depressed people will look down and finally say something like "nothing." The saved are more guarded because they fear if they admit "nothing" they will be thought unspiritual, so they say something like "being saved" or "knowing Christ." The saved, depressed person generally knows about their eternal and heavenly blessings, for which they are thankful, but they feel trapped now by inexplicable emotional tones and moods. Consider this man trapped by depression's grip.

"I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would be not one cheerful face on earth. Whether I shall ever be better, I cannot tell. I awfully (regretfully) forebode (foretell) I shall not. To remain as I am is impossible. I must die or be better it appears to me."—Abraham Lincoln

Biblical Occurrences: Depression is the ascendancy and tyranny of our emotions over our lives. Thus, Proverbs 15:13 says, "A merry heart maketh a cheerful countenance; but by sorrow of the heart the spirit is broken." Often an initiating discouragement leads to sadness, which leads to prolonged grief, and then into a downhill spiral to depression. Depression is a universal problem, but no one really knows if Biblical characters had what we call depression, or if it would be more appropriate to say they suffered emotionally. However, Paul in I Corinthians 10:13 says, "There hath no temptation taken you but such as is common to man; but God is faithful who will not suffer you to be tempted above that ye are able...". Temptation can mean trial, calamity, or affliction. Accordingly, we should understand that our present day afflictions were also common to the great Bible characters.

David was overwhelmed with grief and sadness, his heart was desolate, and his tears fell all night (Psa. 61:2, 77:2-3, 142:4, and 143:4). Jonah, Jeremiah (Jer. 15), Job, and Elijah (I Kings 19) are other examples. Whenever characters express rejection, loneliness, self-pity, hopelessness, overwhelming grief, and wish they had not been born, it seems they are expressing more than temporary sadness but classic symptoms of major depression. Paul had classic symptoms: his flesh had no rest, he was troubled on all sides, he was cast down, he had fears within, and he despaired of life (II Cor. 1:8 & 7:5-6). Hannah (I Samuel 1) had many of the symptoms of depression and her spiritual leader instantly and incorrectly accused her of a spiritual problem.

It seems there is a universal truth concerning depression, that is, the non-depressed rarely understand the unrelenting pain involved, the feelings of hopelessness (in this life, not once delivered from this body), and think the person should just pick themselves up and get over it. It is not that easy. In fact, when that part of the brain that mediates emotions is not functioning properly, medical help (not criticism) is often needed.

Depression Considerations: Each year depression strikes ten million people in the United States. Older Christians have more depression than younger; does this mean that spiritual maturity is of no avail? No, what this indicates is that older people have more biochemical and brain malfunctions as they age; depression is a natural consequence. Similarly, more women (two to three times) have depression than men. Women do not have more spiritual problems than men, but they do process adverse events differently than men, and, they have a complex body chemistry that can get out of balance, both leading to depression. Women tend to take adverse events and internalize them and take the blame—this is a thought-processing problem. Men tend to react to the same events with escapism (sports, TV, sexual obsessions, alcohol); which can later result in heart disease, hypertension, diabetes, etc.—again, a thought-processing problem but with different results. There is another difference: women tend to feel their depression (sadness/guilt) while men act it out in their behavior (rage, hostility and frustration).2

Causes: Understanding the causes of depression is very helpful to finding the solution. It is rare that there is only one causative agent, generally there are several at work. Listed below (no specific order) are some factors known to contribute to depression:3 4 5

• nutrient deficiency or excess

• drugs (prescription, illicit, caffeine)

• hypoglycemia (low blood sugar)

• hormonal imbalances

• allergies

• heavy metals

• sexual abuse as a child

• microbial overgrowths/toxins

• medical conditions (stroke, heart disease, cancer, Parkinson's, diabetes, thyroid)

• natural light deprivation

• psychological factors (generally poor thought-processing)

• spiritual factors

Depression can have its source in our body, soul or spirit. Our body can affect our soul and spirit and vice versa. For example: if one has a low thyroid function it may affect the soul (for example the emotions) leading to depression which then affects one's spiritual life. Affecting our spiritual life does not mean it changes our standing or position in Christ, it means things like a less productive outreach/ministry and a more self-oriented prayer life.

Research since the 1990's has helped clarify this whole issue and there is now better understanding on the causes and solutions. The brain's frontal lobe (behind the forehead) is now known to be intimately involved in emotional well-being. It is recognized that one of the characteristics of virtually all depressed people is a significant decrease in the frontal lobe's blood flow and activity. The main cause of impaired frontal lobe function is a harmful lifestyle—the same cause of most of our physical diseases.3

There is now no question that reductions in frontal lobe function lie at the core of depression. Complimenting this research is the finding that depressed children have significantly smaller frontal lobes than non-depressed children. The evidence indicates that frontal lobe problems are the cause and not the effect. The frontal lobe's proper function requires adequate blood flow and nerve chemistry.

As fog veils a beautiful meadow, so depression clouds life itself; existence becomes dreary and dark. It has been described as darkness visible. One can go to bed feeling fine only to wake with an overwhelming gloom that cannot be explained or escaped. With proper nutrition, lifestyle changes and a renewed way of processing the events of our lives we can break through that fog into a sunny day.

"A merry heart doeth good like a medicine; but a broken spirit drieth the bones" (Proverbs 17:21).

Consequences: Now that it is clear that depression is related to many factors, primarily to frontal lobe malfunction, let's consider the consequences of depression. Depression weakens the immune system's power to attack cancer cells, increases the risk of fatal stroke by 50%, increases the risk of sudden cardiac death in heart attack survivors by 250%, and increases the complications of pneumonia.3 It has been found that depression increase stress hormone levels, hypertension, and headaches; it complicates diabetes and is the leading cause of suicide (its close relative). The point is clear, depression should be addressed early or it may lead to fatal consequences. However, because of their illness depressed persons have diminished ability to combat their own disease, so help is often needed to lift them out of the pit of despair.

How the Brain Works: By God's design, all brain activity (every thought, feeling and emotion, every order the brain sends to the organs and cells) is the product of electrochemical signals. The brain's electrical signals require a chemical to carry the signal across a small opening (synapse) between cells. The chemicals used to do this are called neurotransmitters. To have a properly functioning system we need an adequate amount of neurotransmitters. The neurotransmitter most commonly associated with depression is serotonin.

Depressed people have low serotonin levels. Thus, they have impaired brain message sending, especially relating to emotions and mood. Serotonin is produced in the brain from tryptophan (a protein), which is converted into 5-HTP, and then into serotonin. Some serotonin is converted into melatonin, the hormone needed for proper sleep (thus the connection between depression and sleep disorders). One cause of low serotonin is the lack of an enzyme that converts tryptophan to 5-HTP.1 Before proceeding, just think how unfair it would be to tell a depressed person that is missing this needed enzyme that they have a spiritual problem. As a doctor told a dear sister in Christ who just could not understand why she could not get over her depression, "quit beating yourself up about it, your body just does not produce enough serotonin."

THERAPEUTIC CONSIDERATIONS
This article will consider botanical medicine, medications, proper lifestyle, nutrition, thought processing, and spiritual direction—the most common causes of depression. Some consider botanical or pharmaceutical medications for depression to be "mind-numbing" or "feel-good" drugs. This is unfortunate because such medications only help a depressed person feel more "normal" (a non-depressed person would feel worse or no change).

If depression were primarily spiritually induced, people should not get better from medications because medications do nothing about the spiritual problem. If the medications merely treat the symptoms and do not get to the root spiritual cause then the depression should always come back once the medications are stopped, which is not the case.

Botanical Medicines: The Scripture makes it clear that because of sin the earth today is not yielding its strength (Gen. 4:12). As a result of this Romans 8:22 says, "For we know that the whole creation groaneth and travaileth in pain together until now." Knowing this, the Lord has made special provisions for us. Psalms 104:14 says, "...and herb for the service of man:...", which means the botanical (herbal) kingdom was designed for the many services of humans, including medicine.

Often herbal products are slower acting than pharmaceutical medications, but the advantages of herbal supplements is that they can often affect a cure (rather than just address symptoms) and the side effects are minor compared to pharmaceutical drugs. Herbs can be considered the medicine from God's pharmacy. The most important and well tested herbs to consider in connection with depression are:1 4

• St. John's Wort (SJW): relieves depression, anxiety, apathy, sleep disturbance, anorexia, and feeling of worthlessness. All these symptoms are caused by low serotonin and SJW increases the level of serotonin in the brain.

• Ginkgo biloba: improves blood flow and function of the frontal lobe. Ginkgo increases the ability of serotonin to do its job in the brain.

• 5-HTP: a plant extract that is just one step from becoming serotonin—the brain readily makes this conversion. It raises the level of serotonin and other brain neurotransmitters. This product overcomes the genetic problem that does not allow for the conversion of tryptophan to 5-HTP.

Pharmaceutical Medications: There are times when medications can save a person's life. If botanical medicines do not work (in conjunction with the lifestyle, thought processing, and consideration of other causes) then medications are an option. A short-term use of antidepressant drugs may be needed in order to get the mind operating sufficiently well so that a person can function. Medications generally work by keeping serotonin (or other neurotransmitters) at adequate levels in the brain's synapses. They do not help create increased blood flow or frontal lobe function.

Nutrition: A deficiency of any single nutrient can alter brain function and lead to depression, anxiety, and other mental disorders. The most common deficiencies are folic acid, vitamin B12 and B6. An insufficiency of Omega 3 fatty acids (oils) has been linked to depression. Low Omega 3 oils result in cells throughout the body and brain that do not function correctly, and the mind suffers. The needed Omega 3 oils are found in fish oils and flaxseed oil.1 3 4 5 6

The diet for helping to prevent and correct depression is based upon Biblical insights:

• Increase the consumption of fiber-rich plant foods (fruits, vegetables, grains, legumes, and raw nuts and seeds).

• Avoid alcohol, caffeine, and other stimulants; also avoid foods that cause allergic symptoms.

• A good diet is: low protein, high fiber, low-moderate fat, and high complex carbohydrates. Complex carbohydrates do not include simple carbohydrates (processed foods, snack foods, white bread, soda). Raw fruit has simple carbohydrates but is good because of the fiber, enzymes and antioxidants.

• Atkins type diets are poor; they actually lead to depression since carbohydrates are needed to get tryptophan into the brain.

• Foods high in tryptophan should be consumed regularly: soy flour, meats/poultry (turkey and chicken), tofu, pumpkin seeds, sesame seeds, raw nuts, eggs, lentils, and garbanzo beans.

• A good snack before going to bed would be a turkey sandwich on whole grain bread (there is tryptophan in the turkey and the whole grain bread will help keep sugar levels stable and help get the tryptophan get into the brain).

Rule to live by: Eat foods as close to the way God created them as possible: raw, whole, and unprocessed. He created vegetables, fruit, nuts, seeds, etc. He did not create processed foods or animal meat full of antibiotics and hormones. Humans cannot improve upon God's bounty!

Lifestyle: Regular exercise and sleep are essential to combat depression. Exercise at least 30 minutes four times a week. One does not have to jog: but walking, biking, tennis, swimming, gardening, active house/yard work are great. Regular exercise takes time for the effects to be felt, sometimes weeks.

We each have an internal clock that operates on a roughly 24-hour schedule (circadian rhythm). Even mentally healthy people can become depressed if the circadian rhythms are significantly disturbed. Seasonal Affective Disorder is common in the winter months in northern climates because the lack of natural sunlight disrupts these rhythms. Direct exposure to bright full spectrum light can help, or, the serotonin boosting botanical medicines.

A common factor leading to depression is hypoglycemia (low blood sugar); the brain requires a constant supply of blood sugar to function properly. Thyroid insufficiency also causes depression. Women with post-partum depression and those approaching menopause (symptoms often start by mid-30 age) are subject to hormonal disturbances that lead to depression.1 5 7

Biblical Thought-Processing: How we handle bad or disappointing news has a profound effect upon our mental well-being. As long as we believe we are victims, we are not able to achieve full mental health.9 Positive thinking is more important for overall health than almost anything else. Negative thinking, on the contrary, can destroy the good done by correct diet and lifestyle.10 Many depressed people have a tendency to look at the down side of life. It has been said that it is a positive duty to resist melancholy and discontented thoughts as much as it is our duty to pray. Certainly there will always be things in this imperfect world that give us cause to complain. Often we are helpless to personally do anything about many of these negative things. However, we can focus our mind on the enjoyable and wonderful things of life; this is scriptural, uplifting and therapeutic.

In our self-talk (how we silently talk and think to ourselves) we must replace the negative/compulsive thoughts with Philippians 4:8. But each person must search-out those things that are true, honest, just, pure, etc.—that is the purpose of meditating on God's Word. As soon as the conscious awareness of an unconstructive negative thought is realized, a positive thought must immediately replace it. This takes practice and preparation, but brings our thinking into captivity. The instruction of II Corinthians 10:5 & 6 is, "...and bringing into captivity every thought to the obedience of Christ. And having in a readiness to revenge all disobedience, when your obedience is fulfilled." Applying these words to ourselves, we cannot allow ourselves to entertain negative thoughts, even if true, even if we have been wronged (Prov. 12:25, 15:13, 18:14). Nor can we entertain compulsive thoughts (thoughts that just keep running over and over again in our mind even though they may not be negative in nature).

In the world of secular counseling there has been a shift away from psychoanalysis which was aimed at uncovering "unconscious" reasons for depression. Time was spent on how the individual was raised as a child, and other past events that may have shaped a person's feelings and behavior. Going through the maze of a person's past life was thought helpful to present-day healing or identifying causative agents. This therapy has proven less successful than desired. So, a shift has been made toward cognitive behavioral therapy which focuses on the interpretation of life's events. This is mentioned because secular therapy has, over time, become more closely aligned with what Paul teaches about our thinking, that is:1

• erroneous interpretations of events and negative automatic thoughts may initiate or perpetuate the depressed mood and

• our focus should not be on the past (finding circumstances or others to blame) but on what one can do differently.

The essential basics of cognitive behavioral therapy are shown below; each person should provide their own verses to make them more personal and meaningful. Whether in the natural world or in the realm of the mind, science comes to the same conclusion as revealed in the Bible 2000 years ago.

1. Locate and identify the negative thoughts or misbelief in your self-talk. "I am no good because things are not like what I expect or want."

2. Argue against the negative thoughts. "I am not a failure just because I do not meet unrealistic expectations of myself or others."

3. Learn how to avoid rumination (the constant churning of thoughts in one's mind) by immediately changing your thoughts.

4. Replace the negative thoughts the very second they occur with the truth and with empowering positive thoughts and beliefs. "In spite of the sorrow, disappointments and feelings I experience the Lord will help me carry on."8

Most depression-causing negative thoughts or misbeliefs enter the flow of self-talk after some loss has occurred. Temporary disappointment or sadness at loss is natural, but it cannot continue long-term without consuming a person.

Don't get caught in the trap of thinking that God has promised us perfect peace at all times; that will come to those in the Kingdom (Isa. 26:1-3). The instruction and blessing of Philippians 4:6 & 7 are applicable for today. Always understand these verses in light of Paul, who had plenty of struggles and afflictions but God brought him through and kept his heart and mind in the process.

Finally, Philippians 3:13 & 14 says, "...but this one thing I do, forgetting those things which are behind, and reaching forth unto those things which are before, I press toward the mark for the prize of the high calling of God in Christ Jesus." Paul is using a runner's analogy to put the past and future in their proper perspective. He says that runners in a race cannot look back to see where the other runners are, for if they do they may stumble or get out of their lane and be disqualified. A runner can only look ahead and stretch forward, making the focus the finish line, not what may be behind.

We are on a track, running life's race. The most incredible thing is that each Christian is the only person on his/her track. One does not have to be all that fast, but steady. The only thing that is behind us on our track is our past (forgetting those things that are behind), with its failures, abuses, hurts, regrets, accomplishments, or fame. If you have your eye on the prize the past cannot hurt/catch you. The past contains the thoughts that Paul says to forget about, certainly do not ruminate about them, if you do you will stumble (have mental problems). He implies a Christian's greatest point of failure in running the race is letting the past keep him/her from running well. Look ahead, stretch forward toward a new day and thank God for all you have in Christ Jesus our Lord.

Spiritual Direction: Depression can have a spiritual source if we live in sin, harbor anger or resentment, etc. We have to be willing to forgive (make the unnatural decision to let someone "off the hook" even though they do not ask or deserve it) just as God for Christ's sake has forgiven us, Ephesians 4:32. (Note, we forgive because we already have been forgiven, not to be forgiven as is the case in the Gospels.)

Regular spiritual exercise (reading, studying, praying, meditation on the Word) requires use of the frontal lobe of the brain and emphasizes communion with God, thinking His thoughts, sensing His presence, and knowing His will. This is active worship and produces the type of brain waves in the frontal lobe that are very helpful for us all, including the depressed. Hypnosis and the trance-like state of Eastern religious meditation are very harmful; they produce the wrong type of brain waves and information bypasses the frontal lobe, leading to possible mind control.3

Sometimes a believer is living for the Lord, serving and honoring Him in all parts of his/her life. Over the years, the Lord blesses that person and they are happy, enjoy good health, etc. Certainly there is nothing wrong with enjoying the blessings of the Lord. But, it can all be taken in a moment, not because of spiritual problems, but because it may be that God is taking (or because of the situation He will take) that person to the next level of maturity—it is perplexing and it hurts. Often growth requires loss or brokenness.9 Paul says, "...I count all things but loss for the excellency of the knowledge of Christ Jesus my Lord for whom I have suffered the loss of all things..." (Phil. 3:8).

Romans 12:2 says, "And be not conformed to this world: but be ye transformed by the renewing of your mind, that ye may prove what is that good, and acceptable, and perfect, will of God." Transformed in Greek is metamorphosis and means a change in form; it implies a struggle like when a chrysalis morphs into a butterfly. If we do not become changed from the inside-out—if we do not morph—we will be tempted to find external things to satisfy our needs. Transformation is not an instantaneous act of God, it is a life-long process (journey). One does not get transformed by just praying, asking or believing; there is no "microwave" (quick and easy) way to spiritual maturity.

The passive voice in Romans 12:2 means the Holy Spirit will do the transforming for us if we cooperate with Him (listening, yielding, relying...). Expect spiritual advancement, you can always mature more, Philippians 3:15-16. Your imperfections will be revealed by the Holy Spirit so that you may continue to grow and become more complete (not sinless, but well-rounded). Maturity versus infancy is the issue. God loves you just the way you are, but refuses to leave you that way; He wants you to be made conformable to Christ, II Corinthians 3:18.

Our Lord stripped himself of His glory and "...made himself of no reputation, and took upon him the form of a servant, and was made in the likeness of men...and became obedient unto death..." (Phil. 2:7 & 8). His life reminds us of our spiritual growth which often imposes tough lessons, sometimes so tough we shrink back from learning them. It seems we have to learn from actual experience that whatever we depend upon in this life (for joy, comfort, acceptance, etc.), ends up controlling us. God allows and uses life's events to teach us about misplaced dependencies, so that we finally grasp the concept that Christ is our one true sufficiency.

Endnotes
1. Textbook of Natural Medicine, 2nd Edition, J. Pizzorno, ND & M. Murray, ND, Bastyr University.

2. Unmasking Male Depression, Archibald Hart, PhD, Word Publications.

3. Depression the Way Out, Neil Nedley, MD, Nedley Publishing.

4. 5-HTP The Natural Way to Overcome Depression, Obesity & Insomnia, M. Murray, ND, Bantom Books.

5. Endocrinology and Naturopathic Therapies, 4th Edition, D. Powell, ND, Bastyr University.

6. Naturopathic Gastroenterology, E. Yarnell, ND, Naturopathic Medical Press.

7. What Your Doctor May NOT tell you About Premenopause, J. Lee, MD, & J. Hanley, MD, Time-Warner Publishing.

8. Telling Yourself the Truth, W. Backus, MD, & M. Chapian, Bethany House Publ.

9. The Blessings of Brokenness, Dr. C. Stanley, Zondervan Publishing House.

10. Your Health Your Choice, M. T. Morter, DC, Lifetime Books, Inc.