I cry to the Lord; I call and call to him. Oh, that he would listen. I am in deep trouble and I need his help so much. All night long I pray, lifting my hands to heaven, pleading. There can be no joy for me until he acts. I think of God and moan, overwhelmed with longing for his help. I cannot sleep until you act. I am too distressed even to pray! Psalm 77:1-4
David, a man who was called a “friend of God”, wrote the passage above. Even David, a man close to God’s heart, got to the point where he felt isolated, devastated, and alone. It can happen to anyone.
Clinical depression is different than periodic down moods that we all experience from time to time. Listed below are the diagnostic criteria for Major Depression from the Diagnostic and Statistical Manual 5th edition (DSM 5).
- Depressed most of the day, nearly every day as indicated by subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful)
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by subjective account or observation)
- Significant weight loss when not dieting or weight gain (e.g., change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day
- Insomnia or hypersomnia nearly every day
- Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
- Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
In order to have a diagnosis of Major Depression, one must experience five or more of these symptoms in a two-week period, and it also must represent a change from previous functioning. At least one of the symptoms must be depressed mood, or loss of interest in things that formerly brought pleasure.
You will note that some of these symptoms are subtle, and could be attributed to other conditions. You also note that there are significant physical symptoms, such as loss of (or too much) sleep; significant weight gain (or loss); and agitation.
As I suggested in dealing with anxiety, depression too must be addressed in the three dimensions in which we live- physical, spiritual, and emotional. For today, I am only going to briefly discuss the “physical” dimension, and I will address the others in subsequent blogs.
The physical dimension of overcoming depression consists of exercise, reaching out to at least one other person (communicating and initiating connection), and evaluation from a doctor. This is to rule out possible physical causes as well as to potentially initiate medication evaluation. Many physical conditions can cause symptoms which mimic depression- diabetes, thyroid disorders, neurological disorders, and a host of other physical ailments. If you are experiencing several of the symptoms below, I suggest a physical examination first. Your doctor may well refer you to a counselor as a follow-up, and I, of course, recommend that as well.
The hardest step is always the best step. The malaise of depression causes inertia which is very hard to overcome. That is why engaging a partner in the battle against depression is so important. Do not try to do this alone! The insidious part of overcoming depression is that motivation has been eroded. People experiencing depression also have a tendency to isolate, which makes the condition worse. People who are seriously depressed must find the spark to overcome the inertia that seems overwhelming. Here is where the spiritual comes in. At this point, I will add just one spiritual dimension. Pray a simple prayer to “just help me take one step”.
That is more powerful than you can imagine.
Prayer: Father, be with those who are feeling overwhelmed with depression. Help them to take one step, Amen.