Friday, July 26, 2013

Depression, Anxiety and Medication in Hindsight

Awareness of Depression and Anxiety has increased significantly in recent times in recognition of the extent and impact felt by sufferers and the community as a whole. Surprisingly though, largely amongst the Christian community, the discussion seems to arrive at a premature conclusion; the prevailing attitude seems to be that if you’re a believer, ‘why would you need medication for depression or anxiety? Why would you even be depressed or anxious’ in the first place? This is not an open and shut case however. I say largely this is the prevailing attitude, because there are some who do not regard this topic through the judgemental lenses “well, the believer would not need antidepressants”– refreshingly some Christian figures such as Charles Swindoll, John Eldridge, and Mathew Stanford offer a balanced perspective, extending grace to those who have suffered with depression, even to those who arrived at the point of being prescribed anti-depressants.

Whilst many acknowledge the problems and respond with grace, in contrast, still many insist that depression and anxiety are purely ‘spiritual issues’ – thus the person should deal with their spiritual problems if they want to get better – and sadly, this is a commonly held belief in our churches. I remember the time when a woman who had been a regular and highly functioning member of a congregation I attended; during what seemed to be an acute depressive episode, disrupted the Sunday service – at which point the members treated her as if she was possessed with an evil spirit and proceeded with lengthy ‘deliverance’ ministry! I remember discussing this with the pastor and her family - sadly she was misunderstood and therefore unwittingly mistreated despite the best of intentions.

I must admit I was one who presumptuously made the same blanket judgement on the matter in my earlier days of being a psychologist – yes, to my untrained eyes and unexperienced soul, I thought that antidepressants must be for the unbelieving – those who did not have ‘the joy of the Lord’ with them. I remember making a comment to that effect to a couple of colleagues in a conference for Christian psychologists - an older and wiser Christian woman smiled and gently said ‘I’ve had my days on antidepressants’.

I know better now, and it is me saying ‘I’ve had my time on antidepressants’. Not long ago, severe depression and anxiety dominated my existence, and so for the better part of the last couple of years I have struggled to regain ‘normality’. They knew no boundaries – neither night nor day. It was not as if I did not experience sadness or anxiety earlier in life – I think my personality and natural predisposition lend themselves to melancholy and worry at times. Like most of us I have experienced hard times which left me troubled for a season. I had been through a bout of depression following the birth of my youngest child, it lasted a few months then it lifted to make way for happier days.

This time though, my best efforts to function failed. I had been going through severe grief at the time, but the weeks turned into months and the darkness seemed to settle. Sleep left - and my nights just prolonged the nightmare of an anxiety that would not loosen its grip. I could not eat - not only did I not have a desire to eat but I could not taste food. I lost weight rapidly, had no energy, even my physical health (down to my hair and skin) changed. I broke down frequently, in tears and at times in uncontrollable fits of desperation with life. I remember at some points I fell unconscious for a short while following such breakdowns – I believe it was God catching me in his arms of mercy. I tried to shield my children as best as I knew how – but I was unable to live ‘in the land of the living’. I tried to change and just walk through it, but I knew I needed help when my strongest wish and prayers longed for life to end.

I sought help from a Psychiatrist, and he prescribed medication for anxiety and depression as a first line of treatment. In hind sight, the medication was nothing short of a life line. It enabled me to sleep, and my appetite began to return. The frequency and intensity of breakdowns lessened and I was able to hang on to life. It would take many months before I felt that I was going to be well. In fact it was hard to see the progress in some aspects, two steps forward, one step back - but looking back I am grateful to be sure that I am out of the pit.  

They may be overprescribed in some instances, but medication is nothing short of life saving for many who suffer with depression and anxiety – believers are no exception here. I state this as a mental health professional, yet more confidently as a survivor of their darkness. The following are facts to keep in mind, as well as a summary of what I found helpful in survival and recovery.

Biochemical aspects to Depression and Anxiety:

The neurotransmitter Serotonin is the most implicated in depression as one of the vital chemicals that the brain manufactures for normal functioning (Norepinephrine also has a role to play). A lack of Serotonin (at times, the brain’s over processing of the chemical) leaves its supplies chronically depleted inturn leading to depression. The medical world knows this, yet in most instances, so far a test of Serotonin levels is not utilised in diagnosing and prescribing.

What does a lack of ‘healthy brain chemistry’ look like experientially? It can vary between mild low mood (we sometimes mistakenly attribute that to a person’s melancholic personality); to general fatigue and lack of interest in daily activities, decreased sleep, low appetite and a lack of enjoyment of life; to the extreme end of the spectrum where life is an inconceivable burden and ending it seems like the only way out. This is all influenced by a myriad of factors, including life’s circumstances, available family and social support, genetic factors, as well as gender - women are more prone to experience depression and this is attributed to hormonal factors. Moreover, recent research strongly supports the involvement of diet factors, which we will look at later on.

How antidepressants work

Most antidepressants act on one or more of the neurotransmitter pathways such as the one mentioned above. We will look at just one example, a class of antidepressants named Selective Serotonin Reuptake Inhibitors (SSRIs) – well, you guessed it; they inhibit the re-absorption of serotonin, leaving more of it to act in the synapse where it’s needed. They work! While they don’t have a ‘magical effect’ on all there is to depression; depending on what symptoms they are effective with some aspects of functioning. Antidepressants will not make life ‘happy’ again. The individual still lives in, and has to cope with their reality and struggles in life whatever they may be. What they do is lift the level of functioning in basic areas such as sleep, appetite and they lower the intensity of the aversive mood. The person starts to taste food again, he can get a decent shut eye at night, and consequently the days are more bearable – in a real sense, antidepressants are a lifeline, without them, life would be unbearable – no rest at night and so much to face during the day.

A look at Recovery

A firm grasp of God’s love

As believers, we can not afford to detach from the love of our God. The worst of times should be a catalyst for running to God, indeed the biblical testimony is filled with the witness of the believer’s journey ‘through the valley of the shadow of death’, and their God was with them. I can testify that as dark as the darkness got, I knew God’s love as never before. During the worst of times, my Lord was never far from me, whenever I called out to him, he answered and poured out his strength on me. I knew the meaning of the psalmist’s words - ‘My flesh and my heart may fail, but God is the strength of my heart and my portion forever.’ I learned that I can have joy even in the darkness, that this can take the form of a verse in due season, a prayer, or the unmistakable understanding that I am not forsaken. Joy was not in ‘happiness’ or in the acceptance and affirmation from others, but in quietness and rest in Him.

God’s word became my constant companion and source of comfort – my bread and breath. I had been a relatively new born again believer. During this difficult time I was drawn to read the word from cover to cover, for the first time. I started to go to Bible College – predominantly because I wanted to spend more time meditating on his word, for me this was probably the most constructive choice of that time.

Remembering food

Some of us are naturally hard pressed for an appetite, but this is never felt so much as during depression. Eating becomes a chore that one can easily forsake. Food loses its taste along with any associated feeling of enjoyment or pleasure. This makes it hard to maintain consistent meals, and thus medication can help in improving appetite which is essential in supporting everyday functioning and in lifting mood.

Diet and supplements

Good food – particularly rich in the essential nutrients for brain health goes a long way on the road to recovery. Certain types of fish are rich in Omega 3, which is needed for repairing the coating on the nerve cells, thus facilitating nerve signal transmission, among other benefits. In addition, poultry products (particularly chicken meat) contain tryptophan, which is converted to Serotonin – the neurotransmitter discussed earlier. There is also a place for dietary supplements; I would highly recommend sufficient doses of a marine oil (such as fish oil) and also a strong natural anti-oxidant such as Astaxanthin which will aid in maintaining general physical and mental well being.


It’s during sleep that our bodies and minds regenerate, in particular, healthy brain biochemistry relies on the sleep cycle. Getting sufficient sleep is not optional – particularly during acute episodes of depression or anxiety. Often when this line of defence fails, a relapse may be looming. The longer the sleep disturbance continues, the harder life gets and recovery is hindered. If all else fails to restore adequate sleep, medication may be needed in order to aid with falling asleep and staying asleep for a good duration. 

Time for company

My struggle was a private battle for the most part – I did not want people to know, I did not think they would understand, or be able to help. Still I felt some would judge me, and so I kept up an ‘I’m well’ facade in front of most for the sake of my privacy. I withdrew from most company - except for attending non-assessable college classes. I know that the people who were close enough and able to get a glimpse of my struggle prayed and lovingly just offered their presence. Yet some of the closest people did not understand or know how to respond. Their well-meaning efforts translated into advice on how to get better quickly and fix my problems and get on with life - like Job’s friends, at times they were quick to blame and assign remedy. Relationships just became harder, I needed rest and the strain of expectations was too much to bear – sadly, those pressures meant that I was loosing out on fellowship; to withdraw from meaningful relationships was my way of maintaining peace.

It is tempting and often natural to withdraw from company during depression. Very few people have insight or even awareness of the experience of someone suffering from depression or anxiety – therefore being amongst others may feel like one is among complete strangers, and thus withdrawal from family and friends feels like the easiest thing to do. It’s important to prevent avoidance of social contact from setting in, which in the long run affects relationships and results in isolation. Left untreated, this may be hard to change. I know it was easier for me to be amongst people I hardly knew and who hardly knew me because they could not discern my difficulties, and therefore in the absence of ‘expectations’ it was easier to ‘just be’ me. 

Time for solitude and rest

Solitude for the believer never really means being alone. It means that the time is spent wholly with God. There is healing and renewal of strength in time spent in his presence. Jesus spent some time in a solitary place with the Father – particularly in times when he needed comfort and rest. This is never disappointing or fearful; it’s reassuring and full of peace. So finding the balance between good company and times of solitude with God is a way forward in God’s grace.

There are many aspects to depression and anxiety that need to be exposed, talked about, shared, questioned and understood. The way forward is not to deny, dismiss or even judge the experience of the depressed and anxious. A good start would be to weep with those who mourn, pray for the afflicted and seek God in desperate times.

“Praise be to the God and Father of our Lord Jesus Christ, the Father of compassion and the God of all comfort, who comforts us in all our troubles, so that we can comfort those in any trouble with the comfort we ourselves receive from God.” (2 Corinthians 1:4)

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