The author of these two articles is well qualified to discuss this particular issue. Being a general medical practitioner himself of some 25 years standing our brother is constantly being made aware of afflictions that confront, and play havoc with, the body and the mind. He brings to his general practice a well researched body of knowledge on physical and psychological disorders, together with a heightened knowledge of relevant Scripture and its bearing on daily life. We commend his thoughts in these two articles with the hope that they may assist us in both understanding and being suitably responsive to a very prevalent malady.

Joy and sorrow are a part of life

One of the many blessings that all of us share as members of the human race, created in the image and likeness of the elohim, is the ability to experience and feel emotion. Our lives would be very sterile and bland if the ability to feel joy and sorrow, laughter and weeping were removed from us. rough our emotions we are able to empathise with others, and we are able to respond to their needs as have been expressed to us by their emotions. To be able to experience both happiness and sadness is a vital component of the sum of what our heavenly Father has created us to be.

knowledge of the Creator’s words to us, and our faithful response to Him, are to be the sources of true happiness. For example, “Blessed is every one that feareth the LORD; that walketh in his ways. For thou shalt eat the labour of thine hands: happy shalt thou be, and it shall be well with thee” (Psa 128:1–2). And again, “He that handleth a matter wisely shall find good: and whoso trusteth in the LORD, happy is he” (Prov 16:20). Psalm 32 takes this thought a step further by stating that there are significant differences between the emotions to be felt by the wicked as distinct from the righteous: “Many sorrows shall be to the wicked: but he that trusteth in the LORD, mercy shall compass him about. Be glad in the LORD, and rejoice, ye righteous: and shout for joy, all ye that are upright in heart” (v10–11). All these verses clearly say that those who fear the Lord, trust in His ways, and walk in them will be happy, glad and joyful.

Where then does that leave our subject? Does that mean that no true disciple of our Lord should ever experience sadness, or sorrow? This is obviously not the case. Even our Lord Jesus Christ is described as being sorrowful at various times of his life. For example, he wept as he felt deeply the sorrow of his friends at the death of Lazarus. Isaiah 53 graphically portrays that he would be a “man of sorrows and acquainted with grief.” The verses quoted previously therefore are to be seen in the context of our overall life experience as sons and daughters of God rather than portraying what our emotional state is expected to be at all times.

A medically defined illness

What then is depression? Of fundamental importance to this question is a realisation that all of us, as mortal creatures, develop illnesses and suffer diseases at various times of our lives. Eventually, until our Lord returns and brings immortality to light, one or more of these diseases will lead to our deaths. Every organ of the body, from the heart, to the liver, to the eye, to the skin, develop illnesses. Textbooks of medicine are very large books because of the staggering array of maladies that affect men, women and children.

The brain is an organ of the body. It is a very special organ; its workings, much of which still remain a mystery to medical science, make us who we are as individuals. It is the organ from which thoughts and emotions come. The brain, though, is still undeniably an organ of the body, and therefore, just like any other organ, it can develop illnesses and diseases. Depression, or more correctly from a medical point of view, “Major Depression,” is an illness in exactly the same sense as any other illness of any other of the organs of the body. As such, Major Depression is a lot more than just being sad. As has been indicated above, sadness is a normal human emotion, as is grief over the loss of something, or someone treasured. It is common to feel ‘depressed’ without suffering from Major Depression, but for simplicity, for the remainder of these two articles, the medical condition will be referred to as ‘Depression’.

Depression is not normal; it is the result of an organ of the body suffering an illness. It is not possible for someone suffering from Depression to just ‘shake themselves out of it’, any more than they could ‘shake themselves out of ’ glaucoma, or shingles, or any other physical illness.

A common illness

Depression is a common illness. It is estimated that 1 in 5 people will experience Depression at some point of their lives, and that approximately 1 in 20 people will experience at least one episode of Depression that will severely impact upon their ability to function on a day to day basis. It is an illness that has always existed. It is a common fallacy that Depression is far more common today as a direct result in some way of our modern lifestyles. The reality is that it is now better recognised, and the gradual reduction of the hurtful and illogical stigma associated with mental illnesses of all sorts has allowed sufferers to be better able to seek the help that they need. In the same way that Epilepsy or Congestive Cardiac Failure, or Menorrhagia are not called by their modern medical labels in scripture, neither is Depression. There is no doubt, however, that the condition existed. Elijah in 1Kings 19, and King Saul in 1Samuel 16 are described as behaving in ways consistent with the diagnosis of Depression. The opening verses of Psalms 13 and 69 indicate that David was at least intimately familiar with the symptoms of Depression: “I sink in deep mire, where there is no standing: I am come into deep waters, where the floods overflow me. I am weary of my crying: my throat is dried” (v2–3). These sentiments would be painfully familiar to anyone who has suffered a bout of Depression.

As with any illness, there are typical symptoms associated with Depression. Also, as with all other illnesses these symptoms vary from one individual to another and not all of the symptoms listed below are experienced by every sufferer.

The symptoms of Depression

The symptoms are many and varied but they include: 

a markedly depressed mood, generally for a period of at least 2 weeks 

a loss of interest or enjoyment 

reduced self-esteem or self confidence 

anxious thoughts, within the context of a significantly and persistently depressed mood as distinct from a Generalised Anxiety Disorder, or other anxiety related disorder

feelings of guilt or worthlessness 

bleak and pessimistic views of the future 

thoughts of self-harm or suicide, which are very common symptoms of true Major Depression, a direct result of the two previously listed symptoms 

disturbed sleep, including waking early in the morning, which if persistent is quite a specific symptom of Depression 

disturbed appetite 

a decrease in energy and activity levels 

a decreased libido 

reduced concentration and memory 

diurnal mood variation, usually demonstrated by feeling significantly more depressed first thing in the morning 

psychotic symptoms (hallucinations and/or delusions).

As mentioned above there is significant individual variation, and no two experiences of Depression are identical.

What else could it be?

It is also important when considering the symptoms of Depression, to understand that there are other conditions which can mimic it by presenting with the same symptoms as listed above. It is always vital that prior to making a diagnosis of Depression a patient’s thyroid function is tested, as a thyroid gland that is no longer producing sufficient thyroid hormone will create many of the symptoms of Depression. Similarly certain infectious diseases such as glandular fever can at times cause a depressed mood, lethargy, and appetite disturbance without the classical sore throat being prominent. Certain medications, such as beta-blockers, which are commonly used for high blood pressure, angina, and heart failure, can cause a flattening in mood and energy.

Other mental illnesses, such as Schizophrenia and Bipolar Disorder, a full description of which is outside the scope of this article, can also present initially as virtually indistinguishable from Depression, even though the treatments of these conditions differ significantly.

Bereavement also needs to be differentiated from Depression, even though, again, the symptoms of loss and grief are in many cases identical to Depression. Bereavement is a normal process that all healthy people experience when a loved one passes away. The process of grieving, however, can become abnormal, and bereavement itself can be a risk factor for the development of a depressive illness.

As the percentage of the population in the western world which is 65 years old and over continues to rise, it is becoming increasingly important that primary health care workers recognise that Depression can mimic Dementia, and vice-a-versa. It is unfortunately easy to assume that an older person experiencing confusion and hallucinations is suffering from Dementia, when in some cases effective anti-depressant treatment will return them to health.

What causes Depression?

When thinking about, or dealing with, Depression, it is important to understand that there is never one single causal factor to explain why it has developed. That this is the case should not be surprising as there are many other bodily illnesses that are the same in this regard. A good example is Type 2 Diabetes Mellitus, where genetic and lifestyle factors such as diet and exercise interact to cause the condition to develop.

Depression is very similar in this way. There is no doubt that the development of the illness is more common in some families, suggesting a genetic predisposition. Stressful life events, individual personality characteristics, and other physical illnesses, or chronic pain can all contribute to the development of the disorder. The fact that medications that increase the concentrations of substances called ‘neurotransmitters’ (such as serotonin and noradrenaline), that enable communication to occur between brain cells (neurons), can elevate mood and successfully treat Depression strongly points to there being a biological basis to the illness. These factors have been succinctly summarised in the following way:

“Despite the lack of clinical evidence about the exact causes of depression, it is reasonable to conclude that depression is a genetic and biological disorder that is affected by life stress and personality style” (Management of Mental Disorders, Vol. 1, 4th Edition, 2004).

Having taken this brief look at what Depression is, the following article will examine some concepts relating to ways to deal with the illness in our own, or a loved one’s life.