An illness of the brain

Having seen in the previous article that Depression is a biological illness of the brain, the key to dealing effectively with it, either as a sufferer, or as a carer of a loved one suffering from it, is to accept that this actually is the case.

Major Depression, as defined in the previous article, is not a character defect, nor a personality weakness; it is a medical illness, and needs to be treated as such. In an important and fundamental way, Depression, like other mental disorders, poses a far greater management challenge than other illnesses. When someone develops diabetes, or a cancer of some sort, or breaks a bone, it is their brain that helps them to come to terms with the illness or injury. It is the brain that enables them to plan their lives around the change in life circumstance.

In short it is their brain that does the coping. How much harder it is for the sufferer of a mental illness when it is the organ of their body that otherwise would be helping them to ‘cope’ is the organ that is not well, and is not functioning properly.

Another important concept for Christadelphians as disciples of our Lord Jesus Christ to understand is that the symptoms of Depression can often affect the sufferer’s outward expression of their faith. Three of the symptoms of Depression listed in the previous article included ‘lack of motivation’, ‘poor concentration’, and ‘excessive feelings of guilt and worthlessness’. A lack of motivation can make attending ecclesial activities, or even reading the Bible very difficult. Poor concentration can also impair one’s ability to effectively read the Bible, or pray, while sitting and listening to a talk becomes very problematic. Excessive feelings of guilt and worthlessness can impact upon how an individual reacts to sin and the concept of forgiveness and grace, as well as their ability to interact with their brothers and sisters.

An appropriate response

It is so important therefore within the brotherhood to try to avoid seeing only the outward appearance that might superficially indicate a lack of faith or spiritual integrity. It is so much better where possible to be able to discern those who are suffering from Depression, or other mental illness, and offer to them love and support and compassion. In exactly the same way that a brother or sister with Glandular Fever is not blamed for being tired, the brother or sister with Depression ought not be blamed for having a poor concentration, or having an apparent lack of motivation.

If the above is a challenge to the disciple of Christ, a distinct advantage that the same disciple has is the example of his Lord, and the ability to draw strength and comfort from knowing that he has a mediator who can be touched with the feelings of his infirmities, and a heavenly Father who is attentive to His children’s needs. For example, “Come to me all you who labour and are heavy laden, and I will give you rest. Take my yoke upon you and learn from me, for I am gentle and lowly in heart, and you will find rest for your souls. For my yoke is easy, and my burden is light” (RSV Matt 11:28-30). The Psalmist writes, “Hear my cry, O God; attend to my prayer. From the end of the earth I will cry to thee, when my heart is overwhelmed; lead me to the rock which is higher than I. For thou hast been a shelter for me, and a strong tower from the enemy. I will abide in thy tabernacle for ever; I will trust in the covert (shelter) of thy wings” (Psa 61:1-4). It is a great blessing to have these and many other equally comforting messages of hope and assurance in the pages of God’s Word, which are a tremendous source of support and strength for the brethren of the Lord Jesus Christ.

What treatments are available for Depression?

The importance of accepting Depression as a medical illness is also fundamental to gaining access to appropriate treatment. Few would hesitate to seek medical assistance for any number of significant diseases or illnesses, and Depression should not be dealt with any differently. Fortunately recovery is the rule, not the exception. Treatment is generally effective with a number of different options that are not mutually exclusive. The goal of treatment is to get well and stay well, although it is important to realise that there is a high rate of relapse. Picking up the early warning signs of a relapse and seeking early treatment can greatly minimise the severity of the recurrent episode.

The main treatments for Depression include the following:-

Supportive Counselling – It is surprising to just what an extent being able to talk through stressful life circumstances can help to make sense of what initially can seem insurmountable. Being able to ‘offload’, or to be able to gain a different perspective on a situation, even to be reassured that what is being experienced is not unheard of, can all be very beneficial. Prayer could be seen as a very special form of ‘supportive counselling’.

Psychotherapy – this form of treatment is usually undertaken with a psychologist. (A psychologist is a non-medically trained person who has tertiary qualifications in psychology. A psychiatrist, who can also provide psychotherapy, is a medical doctor who has specialised in the management of mental illness.) Two common forms of psychotherapy include ‘cognitive therapy’, where an individual is helped to identify and correct distorted and negatively based thoughts, and ‘behavioural therapy,’ which is designed to help an individual identify and change aspects of their behaviour that may be contributing to the cause or maintenance of their depression.

A combination of supportive counselling and psychotherapy is an extremely effective form of treatment for mild to moderate Depression.

Medication – The medical management of moderate to severe Depression has improved enormously in the last 25 or so years. There is now a range of medications that are not addictive, nor likely to produce significant drowsiness or other side effects, which specifically alter the concentrations of ‘neurotransmitters’ in the brain. These neurotransmitters are released by one neuron, travel across a gap to the neighbouring neuron, and are ‘taken up’ by the second neuron. In this way brain cells ‘talk’ to each other. It is known that increasing the concentrations of chemicals such as serotonin, noradrenaline, and dopamine in the spaces between neurons reduces the symptoms of depression and anxiety.

It is worth noting that, as with all medications, there is individual variation in response, and that clinical improvement in symptoms often takes at least two weeks to begin to be seen.

ECT (Electroconvulsive therapy) – ECT is a treatment used rarely by psychiatrists, but contrary to an historical stigma, modern ECT is a noninvasive procedure, performed under general anaesthesia, which can be literally lifesaving, particularly in an older person with very severe Depression. In tandem with these professional forms of treatment, what can the individual suffering from Depression, and their family and friends do to assist with recovery?

Living with Depression

The persisting stigma associated with Depression is as much a personal problem for sufferers of the condition as it is for much of the general population. It is vital that the person with Depression initially accepts that they have a problem, and allow themselves to accept the help that they need. For example:-

The brain does much of its self-repair during sleep; therefore getting enough sleep is an important factor in preventing and managing Depression.

  • Learning and practising relaxation or ‘mindfulness’ techniques can be useful
  • Keeping active through regular age and fitness appropriate exercise can be a difficult goal to achieve, but is a very useful means of reducing symptoms of anxiety and depression and increasing feelings of general wellbeing
  • Alcohol is a direct brain depressant, and therefore its use is best minimised.

As discussed earlier in the article, prayer and Bible reading can be very difficult for the sufferer of a severe depressive illness. However, depending on the severity, these two God-given sources of support and guidance should not be forgotten, and as recovery occurs, their benefit is incalculable.

How to help – the dos and the don’ts

Prayer for help and guidance is also the most important support for the carer of the person with Depression. Caring for a loved one with any severe illness is exhausting and very stressful, and seeking help and guidance from the “rock of our salvation” is very important. Awareness of the condition, and as for the sufferer, acceptance of it, is also very important. It is very easy to play down the symptoms of Depression, and either deny that it could possibly be happening, or rationalise the symptoms along the lines of, “they are just run down at the moment.” Other emotional responses to seek to avoid include guilt, e.g., “what have I done wrong” and anger, “why are you acting like this?”

Having noticed and accepted that there is a problem, broach your concerns with the person; talk to them about how they are feeling. Listening is extremely important. Allowing the person to unburden is likely to be far more important and useful than feeling obliged to give advice. If possible, empathise, without dwelling on or compounding the negatives. Gently encourage a more balanced view and focus on the more positive aspects of life, without giving the impression that you are underestimating the pain that they are experiencing.

Often just spending time with the person lets them know that someone understands and cares for them. A source of frustration can be minimised if it is realised that someone with severe Depression will find decision making very difficult. Therefore important life decisions are best left until their symptoms diminish.

At times a person with severe Depression will find leaving the house, or even getting out of bed in the morning very difficult. Encouraging them to slowly increase their activity levels, both through physical exercise and pre-planned enjoyable outings can be very helpful.

Part of the acceptance of the condition is the realisation that just as a friend or relative does not feel obliged to ‘_ x’ a person’s high blood pressure or diabetes or any other illness, nor should there be any perceived responsibility to ‘fix’ a loved one’s depressive illness.

Encouraging the person to initially seek the help of a general practitioner or community mental health worker is a very important step to take, and often the first step towards recovery. Do not underestimate how difficult it is, and how brave someone needs to be, to admit that they are suffering from a mental illness!

It is also important, and not selfish, to realise that to be able to care for someone else effectively, it is important to care for yourself. Taking ‘time-out’ for personal relaxation and exercise and reflection is very necessary.

(Many of the thoughts expressed in the two sections above can be found at www.beyondblue. org.au, which is an excellent resource providing information on Depression and Anxiety).

In summary

Depression is a medical illness that is caused by a combination of genetic, biological and life event factors, which can have a devastating effect on the life of an individual and their family and friends. Fortunately we are living at a time when it can be recognised as such, and when there are a range of effective treatments that are available, and ways that both those experiencing the illness, and those who are supporting them, can alleviate the distressing symptoms that are associated with the diagnosis.

The wonderful blessing of God is that transcending all of the difficulties and suffering that at times are part of man’s current dispensation is the sure hope of the near return from heaven of the Lord Jesus Christ, who, at his Father’s behest, will usher in the time when “the ransomed of the LORD shall return, and come to Zion with songs and everlasting joy upon their heads: they shall obtain joy and gladness, and sorrow and sighing shall thee away” (Isa 35:10).

Even so come Lord Jesus.