When are antidepressants appropriate for treating depression?
In my opinion, antidepressants can and should be tried as an intervention for depression when people are suffering some of the following symptoms for over two weeks, which hinder their functioning and ability to live a normal life:
- Poor concentration
- Difficulty sleeping and eating
- Loss of weight
- Poor work performance
- Continual fatigue
- Thoughts of suicide or "I wish I were dead"
- Crying spells
Are a physical examination and mental health consultation needed?
I encourage clients to get a complete physical examination to rule out any underlying physiological disorders which may be causing the depression such as hypothyroidism or hormonal problems. Then, I recommend that they go to a psychiatrist, to get an evaluation to determine the need for medication since a psychiatrist specializes in diagnosing and treating mental health disorder, while a physician only sometimes treats mental health problems. Many people today opt to be treated by their family physician because it is more convenient and less expensive.
When an antidepressant is used, then the person needs to be followed up by his/her doctor to see what the results are and if there are any side effects from the medication. Usually, the doctor or psychiatrist wants to see this patient within two weeks after starting the medication. The patient and doctor need to talk about any other current medications he/she is taking which might be contraindicated for use with an antidepressant. Many other factors must be assessed such as: is the person dealing with an alcohol or drug addiction, or is the woman pregnant, looking to become pregnant, or breast-feeding? These patients may not qualify to use an antidepressant.
I encourage clients to manage their own health care by getting the drug insert which gives information on side effects, complications, and when it is contraindicated. When clients are on medication, they tend to start feeling better and then, stop going to counseling. Unfortunately, they avoid dealing with the real issues which are causing the depression. So, the doctor and the counselor need to encourage them to continue in counseling to learn better coping skills for the situations or relationship issues they face.
What about natural ways to increase neurochemicals?
Clients need to learn to increase their neurochemicals through natural ways such as exercise and taking time to grow spiritually. The medication will boost their neurochemicals, ie., serotonin, catecholamines... but it doesn't change the fact that one has to work through the loss of a loved one or still has to deal with past sexual abuse. Those crises and losses need to be dealt with, processed and grieved.
Is there a spiritual dimension to depression that gets overlooked when we rush into taking medication?
There most certainly is always a spiritual dimension to depression. David writes in Psalm 42:5-6 5, "Why are you downcast, O my soul? Why so disturbed within me? Put your hope in God, for I will yet praise Him, my Savior and my God." Nearly every person who walks in my office feeling depressed has an issue with God. Most Christians who are depressed have a general sense of disappointment with God. They struggle with periods of doubt about God’s love for them and begin to question whether he will help them through their problems. Non-Christians express anger towards God wondering how a good God can allow suffering. Believing that God does not exist, might not exist, or doesn't care actually is the basis for some of the hopelessness and despair causing their depression.
Perspective and beliefs about God and Who he is change one’s feelings and perspective on life. When people know that there is a God of the universe who loves them and has a plan for their lives, they begin to feel more hopeful and experience the comfort and peace they need to work through any trial or disappointing circumstance. They begin to pray and read the Bible, which changes the false beliefs underlying their depression.
Since human beings are very complex, it is necessary as well to look at all the underlying causes of depression such as: low self-esteem, losses, physical pain, relationship or financial issues, guilt, shame, trauma, dysfunctional family issues, along with the spiritual and physiological reasons.
Most importantly though, people need to discover a relationship with Jesus Christ so they can be forgiven and be assured of spending eternity in heaven. Experiencing that relationship with Christ, freedom from sin, and hope for eternal life makes one’s life on earth more bearable and even joyful. Medication can give people more motivation and energy to get through a depressive period in their life, but it will not be a cure-all for depression.
One must take steps to fight depression on all fronts: spiritually, mentally, physically, emotionally, and relationally.
What can people learn spiritually when going through depression?
God is there for them. That God can bring real wisdom and help for their needs (Proverbs 3:5-6).
There is& hope for the future both temporarily and eternally. Why? Because Jesus Christ can bring strength and wisdom to make the right choices to face any trial and he promises everlasting life to people who trust him alone for their salvation (John 3:16, 10:10).
To fix their eyes on Jesus, the Author and Perfector of their faith (Hebrews 12:1-2).
To build character by learning perseverance and endurance in hardships (Romans 8). And yes, people will miss out on the spiritual learning experiences of depression when they look for a “quick-fix” vs. working on the core issues which are causing their depression. People can work out of depression with God's help and the resources (he provides!) which are available medically and psychologically.
All of life is a spiritual learning experience. God is there for people who are suffering. People can really experience God's help and presence in the valley of depression.
To pray fervently.
- **_Surrender your life to Christ and his will.
- Admit any sins you have committed (1 John 1:9). Guilt can play a part in causing your depression. But, remember, that Jesus died for our sins and has already paid for our sins (Colossians 3:13; Ephesians 1:7; 4:32). But, you need to admit and repent of any sin which may be part of the cause of your depression.... such as resentment, bitterness, or anger.
- Admit any fears you may have. Ask God for the courage to face these fears and to take any steps you need to take to overcome them. Pour out your fears and feelings to God. He can take it! Read some Scriptures on fear and anxiety, such as Phillippians 4:6-7, 13 and Isaiah 41:10. They will remind you that Jesus can provide the inner strength and peace you need and that the Lord is your helper.
- Offer yourself as a sacrifice to God (Romans 12:1-2). Ask him for his wisdom (James 1:5) in handling the problems of the day, his perspective on people and your life. Invite him to fill you with the Holy Spirit, and trust him to do so.
- Ask God to help you serve him and others today. Think of one thing you can do. Reaching out to others is a blessing and you even get something in return: a sense of achievement and satisfaction. Ask him to help you do one or two things which will help lift your spirits today and give you hope such as: reading your Bible, exercising, or listening to Christian music. Ask God if you need to set boundaries in some relationships so that you can be renewed.
In summary, pray fervently, fix your eyes on Jesus, persevere in trials, and surrender your life to God. When you ask for wisdom, faith, hope, and peace, you will see God work! He is able to do above all that you ask or think because he is the Almighty God! (Ephesians 3:14-21)
©2004 by Lynette J. Hoy, NCC, LCPC
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