Depression can be a complicated disease to understand because there are so many mixed opinions on how to best go about treating it.
If you’re a Christian it can be even more confusing because many churches simply don’t know how to address mental illnesses like depression. Here are some emails I received from Christians struggling with depression and the various responses they received from people they know.
“Maybe your not praying enough.”
“Have you looked to see if their is any sin in your life that might be causing it.”
“Go see a Doctor, its a brain disease.”
“Have you tried therapy?”
“Its God’s way of punishing you but be thankful you’re still here.”
That last one really tops them all sadly but you can see the confusion here. Hopefully by the end of this article you’ll have a better understanding of depression.
Who suffers from depression?
According to epidemiological studies done by the Centers for Disease Control and Prevention (CDC), a revised report shows that among 235,067 adults in 45 states, 9.1 % met the criteria for current depression and 4.1% met the criteria for major depression.
Depression was classified by either major depression or other depression. Other depression referred to depression that had fewer symptoms than major depression but was still classified as a depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders (4th Edition).
Based on their analysis, people who suffered the most from depression were…
-persons 45-64 years of age
-those previously married
-individuals unable to work or be employed
-persons without health insurance coverage
-blacks, Hispanics, non-Hispanic persons of other races or multiple races
-persons with less than a high school education
As I looked at the results I thought there were some important things to point out.
-People who tend to be older suffer from more depression perhaps due to a few factors: transitional time period in their lives, more isolated, early depression symptoms overlooked, difficulty or unwillingness to express their feelings.
-Those previously married takes into account those who were divorced, separated, or lost a spouse. This would make sense since marriage is a huge commitment before God and the consequences of such a separation, regardless of what happened, can take a huge emotional, physical,and social toll on the individual likely contributing to depression.
-People without health insurance coverage are less likely to seek regular medical care by a medical provider. It makes sense than that those with depression, even minor depression, would be unable to get the proper medical care provided early on.
With the new Affordable Care Act (which is an entirely different article), mental health should be covered which will be interesting to see if this results in any change on the current CDC statistics on depression.
What causes depression?
The reason why opinions on depression are so varied is because depression is more than likely caused by a number of varying factors (not a single factor) such as biological, psychological, social, and spiritual. Lets take a look at these more closely.
1. Biological cause.
Genetic – According to a publication by the Stanford School of Medicine, there is a strong genetic component to depression, especially major depression with heritability rates as high as 40-50%.
This would mean that approximately half of all cases of depression could be genetic with the other half being non-biological factors (psychological, social, spiritual).
If someone has a parent or sibling with major depression, that person probably has a 2 or 3 times greater risk of developing depression compared to the average person (or around 20-30% instead of 10%).
An important study that identified genetics as a possible factor in depression found that people who had the serotonin transporter gene became more depressed after a stressful event than those who didn’t have it (Caspi et al., 2003).
Another study substantiated these findings which looked at depression in children. What they found was that children with the serotonin transporter gene (aka 5-HTTLPR gene) AND no positive supports had nearly twice the depression ratings than those without the gene (Kaufman et al., 2004).
Without going too much into detail, the gene basically produces a protein that has been shown to regulate serotonin, a key brain chemical that regulates things like your mood.
Brain Regions – According to a publication (Journal of Neuroscience) by Harvard Health which reviewed studies that examined the biological causes of depression, women with a history of depression were found to have a smaller hippocampus than those who didn’t have a history of depression.
Another biological implication mentioned in regards to depression is that brain cells in the hippocampus and other regions of the brain associated with depression are sluggish and not as active or lack the branching out of neural networks. One of the current theories is that people with depression have low grade inflammation. This is not to say that this is the cause but merely an association. For example, if you took a sample of your blood people with depression would often have low-grade elevated inflammatory markers like TNF-alpha, Interleukin-6, CRP, ESR.
2. Psychological Cause.
Low self-esteem and insecure attachment have been factors that have been shown to play a role in depression. A study published in the Journal of Personality and Social Psychology found a relationship between adult attachment security, self-esteem and depression.
Basically, people who had unhealthy adult attachments were more likely to have low self-esteem. Once self-esteem was lowered it was directly associated with increases in depressive symptoms.
I want to briefly explain to you what adult attachment (in)security means. Basically, its a psychological term that refers to the quality of your adult relationships, specifically those relationships who would be considered ‘primary attachments’ such as your mother or father or husband or wife.
The person who first looked at attachments was John Bowlby who at the time was actually looking at infants and their attachments to parents.
He found that children who were separated from their parents for an extended period of time would go to great lengths (crying, clinging, frantically searching) in order to reestablish proximity with the parent.
The theory is that these survival mechanisms serve an important purpose in order to help the child survive and be healthy.
How does this relate to adults and depression?
Adults display similar attachment characteristics as babies and those with insecure attachments tend to have less self-esteem and in turn, increases in depressive symptoms.
Its important to note that the nature of your attachments when you were a child can often dictate the nature of your attachments as an adult.
For example, if your father left you when you were a child its very possible that you developed an insecure attachment which made you perceive or even go after men predisposing you to insecure relationships.
What does a secure attachment look like in a romantic relationship (primary attachment)? According to Hazan and Shaver who expanded on Bowlby’s work, a secure attachment is,
-both feel safe when the other is nearby and responsive.
-both engage in close, intimate, body contact.
-both feel insecure when the other is inaccessible.
-both share discoveries with one another.
-both play with one another’s facial features and share a mutual fascination and preoccupation with one another.
The key takeaway here is that there are several psychological causes of depression, two of which I mentioned (self-esteem and nature of attachment) and go hand in hand.
If your more interested in the attachment theory, check out this article from the University of Illinois Psychology.
3. Social Cause.
In the same study mentioned above, children who carried the gene that predisposes them to depression were still able to buffer those effects through quality and expansive social support (Kaufman et al., 2004).
According to a literature review by Gregory S. Beattie, there are a number of different social factors that have been associated with depression.
-Having to build new interpersonal relationships with a child (pregnancy).
-Marital distress. For example, in 30% of all marriage problems, there is one spouse that can be described as clinically depressed.
-Any changes in a family environment due to parental depression increases the risk of developing a mood disorder in children.
-Gender differences. Females after the age of 15 are twice as likely to become depressed as compared with men. Different social expectations between genders are also a potential factor.
For example, traditionally speaking, expectations are lower for females when it comes to education. As a result, women perform worse in K-8 and High School which effects their chances of getting into college and thus a job which can lead to depression.
Interestingly, the more intelligent a female is the more likely she is to become depressed. Beattie hypothesizes that this is a result of females who are outperforming males but being punished for doing so.
If you’re curious in any of the studies used in Beattie’s literature review, you can find them here.
The CDC epidemiological study I mentioned before also gives you a good idea of other possible social factors that play a role in depression.
4. Spiritual Cause.
As Christians, there is no doubt that the spiritual aspect of our lives also plays an important role in depression, whether that means in getting through depression or causing it. I wrote in a previous article how one Christian thinks that depression is a good thing because its sort of a ‘spiritual awakening’ that occurs when someone empathizes and sees how Jesus sees this world.
I don’t agree with this argument. Instead, I look at depression as a natural part of being human in a broken sinful world. In the same way that people get cancer or some other disease often times through reasons we can’t explain. People also get mental illnesses like depression for some reason or another.
The Bible mentions several people who experienced what we today would call depression:
-Job (Book of Job)
-Saul (1 Samuel 16:14-23)
-Elijah (1 Kings 19)
How can depression be caused spiritually?
1. Unconfessed sin.
When Cain disobeyed God, Cain also experienced depression (Genesis 4:6-7). When David committed adultery he was depressed until he confessed his sin (Psalm 32:3-4).
2. Defeats in our life.
In 1 Samuel 30:3-4, David experienced depression after his men reached Ziklag and found it destroyed along with their wives and sons being taken captive.
Anytime we experience a trial in our life that we might view as a defeat, its possible that we can experience depression even if its minor.
When Hannah first realized that she was barren she was overwhelmed with depression and sadness. Jesus no doubt also experienced depression to some extent. For example, when Jesus heard that his good friend John the Baptist was killed he decided to retreat to a solitary place (Matthew 14:13).
3. Oppression of the Holy Spirit through demonic activity, self-defeating lies, or unresolved hurt.
As Christians, there is also a possibility that your depression may be a result of oppression through any of the following above.
What are the best methods of treatment for Depression?
The answer it appears is, it depends.
Pharmacotherapy and talk therapy are the most effective treatment strategy for depression. (National Institute of Mental Health).
Many people are conflicted about the use of anti-depressants, I do think however, the key is that you have to figure out what works best for you regardless of people’s opinions.
According to Aaron T. Beck M.D., a review of the latest studies shows that patients treated psychologically through therapy of some form had a significantly lower relapse rate (39%) for Depression versus those who were treated with standard pharmacotherapy (69%).
Lifestyle modifications are also important. For example, exercise has also been shown to help with depression if you have mild to moderate Major Depressive Disorder.
According to a study published in the American Journal of Preventative Medicine, aerobic exercise that is consistent with the daily public health recommendations was shown to reduce depression scores on the Hamilton Rating Scale for Depression by 47% after a 12 week period.
Supplements with the most literature in helping with depression are SAM-e and Ashwagwandha.
If you’re a Christian looking to help a person suffering with depression…
Then it’s important to educate yourself on depression (maybe thats why you are here :), support them through prayer, make yourself available to them as much as you can, and do your best to encourage them to seek a wide variety of treatments in order to see what works best for them.
Most importantly, show them the love, patience, and understanding that you would want if you were suffering from depression (1 Corinthians 13:4-7).
If you’re a Christian who is suffering with depression…
Understand that several people in the Bible experienced depression and that its important you:
1) Identify the type of depression, 2) Try and Identify the cause of depression, 3) Be compassionate towards yourself in the process, 4) Seek God with all of your heart, 5) Be open-minded to a wide variety of treatments and figure out what works best for YOU.
Do you struggle with Depression? Share your experiences below.