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Hope Beyond Tears: Healing for Depression
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By Katia Reinert, PhD, CRNP, FNP-BC, PHCNS-BC, FCN

 
Sharon, a minister’s wife, realized her life was never going to be the same again after the sudden death of her 20 year old only daughter. How could she eat when her child who loved to cook, would never taste anything again? In the months following her loss, Sharon lost 25 pounds. She would lie awake at night for hours and then awaken long before the alarm went off in the morning. As she described her emotional pain she noted,
 
I seemed to see myself on the rim of a bottomless dark hole ready to fall in. I felt if I went there, I could never get out; and I pleaded with God to help me. My heart ached, literally. Sometimes I wondered if a person ever died of a broken heart and wished that I could.

The depression epidemic
Sharon’s loss and complicated grief opened the door for depression. She is not alone. It is estimated that 99 per cent of people by age 70 will suffer from depression at some interval as a result of loss,[i] so that makes all of us vulnerable, doesn’t it? Indeed, depression is increasing drastically today and turning into an epidemic. The World Health Organization (WHO) predicts that by 2020, depression will be the second most debilitating disease and now is the second leading cause of disease burden and suffering worldwide, surpassed only by heart disease.[ii] It is estimated that 350 million worldwide suffer from depression, while more than 20 million of them are Americans. This costs the United States over $70 billion dollars in treatment, disability, and lost productivity each year. In addition, studies show that women are two to three times more likely than men to have depression, with one in four women suffering from clinical depression in their lives, versus one in eight men.[iii]

Depression does not discriminate against race, color, or religious affiliation, and many faithful children of God today are suffering from this disabling disease. Adventist ministerial families deal with depression as frequently as any others. On a recent survey of 353 pastors, 271 spouses, and 121 children in North America, 50.5 per cent of pastors, 59 per cent of spouses and 56 per cent of their children reported some challenge with depression and/or anxiety.[iv]

I have had the opportunity to travel throughout the North American Division (NAD), and to other parts of the world, speaking about depression to women’s groups and ministerial spouses. I have met many who have shared their stories. I also met pastors who struggled and found little help or support from their peers. A common theme I often hear includes how difficult it becomes to find someone they could trust to share their burden. Some feared they would be judged for having a lack of faith or a poor prayer life. There is much stigma and misconceptions about this debilitating disease that has as real physiological causes as any other disease.
 
Removing the stigma
The statistics on depression force us to realize our need to become educated regarding recognition, prevention, and better management of this common illness so we can share hope beyond the pain and tears.

The reality of this great need in our church has become urgent, and we must continue to increase awareness by providing opportunities for conversation to help those who are hurting. A mental health task force has been created at NAD to help find effective ways to increase awareness about mental illness by providing resources for ministerial families and church members alike.[v] 

How can you help? Start by removing your own misconceptions and stigma towards depression and those who struggle, thereby understanding that depression is a disease like any other. The Archives of Internal Medicine states that one in three people who see an internist suffer from depression or anxiety.[vi] In my practice as a family nurse practitioner, I see these patients who come with a rash, stomach ulcer, or palpitations of no apparent etiology but anxiety or depression. As I care for them, I am reminded that we must recognize and treat depression with the same compassion and non-judgmental manner we treat any other disease.

Recognizing depression
The problem can become worse because many do not know that they are depressed. They may think their symptoms to be normal; a way of life as they have known it. Sharon’s symptoms of deep sadness, sleep disturbances, weight and appetite changes, and even morbid thoughts are hallmarks of depression. There are nine main symptoms and someone who experiences a minimum of five of the nine symptoms for at least two weeks has a diagnosis of major depression, whereas the person who experiences two to four of these symptoms may have a mild case of depression.[vii]

Only when one recognizes that what they are feeling cannot be classed as normal will they be able to find help and hope for treatment. Thus, the first step includes identifying depression. You may want to do the following self-assessment to evaluate yourself or share this with someone. [viii]
    
Add up how many of these 9 symptoms below you have:
1. Persistent sad, anxious, or “empty” feelings (every day for over 2 weeks)
2. Loss of pleasure or of interest in activities/hobbies once pleasurable, including sex (every day for more than 2 weeks)
3. Feelings of inadequate guilt, worthlessness, and/or helplessness
4. Irritability, restlessness
5. Fatigue and decreased energy
6. Difficulty concentrating, remembering details, and making decisions
7. Insomnia, early-morning wakefulness, or excessive sleeping
8. Overeating or appetite loss
9. Thoughts of suicide, suicide attempts, morbid thoughts
 
If more than 5 symptoms are present (including either No. 1 or No. 2) you may have major depression. If two to four symptoms are identified, then you may have mild depression. In either case, you should recognize this as critical, and see your health provider for a follow up as this is only a self-screening.
    
Additional symptoms are feelings of hopelessness and/or pessimism for over 2 weeks, every day; and persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment.
 
Conversation Starter:
What are helpful and unhelpful responses to support a loved one experiencing depression?


Secondary complications
Beyond its debilitating symptoms, depression and anxiety also bring about complications that are real and impair the quality of life. We know today that auto-immune disorders, certain kinds of cancer, strange fevers, skin lesions, hypertension, diabetes, migraines, and body aches can all be psychosomatic and related to depression and anxiety. Indeed, over one hundred years ago inspiration noted, “Many of the diseases from which men suffer are the result of mental depression. Grief, anxiety, discontent, remorse, guilt, distrust, all tend to break down the life forces and to invite decay and death.”[9] Treating depression can a powerful way to reduce the risk of these other complications.

Finding hope
Finding hope does not always come easily. Many ask, “Is there treatment beyond pharmacological agents? Is there any hope for a cure?” Often, depression can be so debilitating that the depressed may not even see a glimpse of hope. Will I need to suffer from this all through life?

The good news is that there is hope and sound treatment. Science has, over the years, identified important therapies that can help. The key is to combine therapy, medication as needed, as well as treat the root causes of depression. A successful depression recovery program is one founded by Dr. Neil Nedley who has specialized in helping difficult-to-treat depressed patients. [10] The success of this program is rooted in combining a multilateral approach to treat the root causes or risk factors while applying God’s evidence-based interventions.

Like with any other disease, depression has real factors that create a chemical imbalance; and once these are treated, one can find healing and regain their life back. If these evidence-based interventions are incorporated faithfully, they often prevent and cure depression. Medications may be helpful but without treating the root causes, one may suffer for life.
 
Evaluation of the root causes of depression
According to research, over 100 causes of depression have been documented by science. These causes vary from genetics and factors related to one’s development, to lifestyle (e.g. exercise, sleep patterns, exposure to sunlight), nutrition, addictions, stressors, distorted thinking patterns, or certain medical diagnosis (e.g. diabetes, hypothyroidism). Exposure to only one of these risk factors alone may not necessarily cause depression but exposure to several of them may.

Often when these underlying causes are treated, depression improves. Take the story of Joanne, who secretly shared with me her story of abuse and struggles with depression. Among the causes of her depression, distorted thinking tendencies and lifestyle factors. These were major problems keeping her from finding healing despite her constant prayers and faithful devotional life. She felt ashamed to share her struggle with friends and the church community; only her husband knew her pain. Joanne sought God to help her address the causes of her depression. After attending a depression recovery program that dealt with her root causes for depression, she shared, “I feel much better; the difference is like night and day.”  She is still on her journey for full recovery but now sleeps better, has more peace, uses less medication, and feels happier with her life. Her perceived negative mood and sadness has drastically decreased. 
 
Risk factors for depression in the ministerial family
Ministerial families seem to have common factors that may increase their risk for depression. The NAD survey of pastors mentioned earlier lists some of these risk factors. For example, 41.5 per cent of pastors and 51.1 per cent of spouses listed addictions such as overeating or overindulging as major concerns and 56 per cent of pastors and 60 per cent of spouses listed eating unhealthy foods. Other addictions listed were substance abuse (two per cent for parents, 19 per cent for children); media addiction (42 per cent for parents, 71 per cent for children); and pornography.[11] Scientific studies suggest addictions can be a causative factor for depression in some cases or a resulting comorbidity in other cases. Thus, providing recovery for addictions may actually help prevent or treat depressive symptoms.[12]

Another major risk factor centers on stress. The work demands on clergy are numerous and according to a recent survey of 1726 participants, researchers concluded that extrinsic factors (job stress, life unpredictability) and intrinsic factors (guilt about not doing enough work, doubting one’s call to ministry) contributes to increased emotional distress among clergy.[13] Reality is that church members often turn to their pastor for assistance for all kinds of crises or traumatic life experiences and this can add to the burden of stress.  As a result, pastors often struggle with keeping time boundaries since their members expect them to be always available anytime. These demands.  coupled with the frequent moves from church to church, the difficulty having trustworthy friends with which they can share their burdens and concerns, or the lack of social support free from judgment—all may increase the risk for depression and anxiety.[14]

Finally, another risk factor reported in the NAD ministerial survey is the lack of a relationship or connection with God. Fifty-six per cent of parents and 75 per cent of children reported difficulty with personal prayer, 57 per cent of parents and 85 per cent of children reported struggles with a personal connection to God, and 71 per cent of parents and 92 per cent of children reported struggling with time for devotions.[15]

While depression remains prevalent in many faithful children of God, research does show that people of faith have a quicker recovery and less recurrence of depressive episodes than people of no faith.[16] Thus, one’s poor connection with God can be a risk factor for depression. In addition, a close connection to God can be a source of coping and strength to deal with the stressors of life, and therefore a protective factor.
 
Hope beyond tears
Sharon’s story did not end in tragedy or relentless pain. She did find healing for depression as she went through the grief stages by following interventions that helped her to avoid distorted thinking. At her daughter’s funeral someone who was depressed due to a similar loss, approached Sharon and, in bitterness, expressed, “Your life will never be the same.” As time went by, Sharon found herself depressed and about to lose interest in living, but she was reminded of this lady and she earnestly prayed for God to help her overcome the deep sadness and depressed feelings.

God answered by teaching her three things to do. First, she was to spend more time with Him. She says, “I had already been reading my Bible in the morning, but then I felt impressed to add the Spirit of Prophecy to my reading. Both of these books helped me to stay mentally balanced.” But, “Most importantly,” she adds, “my connection with God is deeper than ever before.”
Secondly, since she would wake up before her alarm went off, she decided to use the early morning to walk two miles in sunshine, snow, or rain.

Thirdly, she says “God impressed me to find ways to help others and be active in my church. This helps me to get the focus off myself.” She started volunteering at soup kitchens on Sabbath afternoons, since that was a lonely time for her, and felt so blessed. “God seems to find all kinds of interesting things for me to do. It is exciting to wonder what He will think of next,” she says.
It has been seven years and Sharon Wilson still misses her daughter, but she has found a cure from her depression by following God’s plan for healing despite her losses. She found renewal in her relationship to Him and joy as she fulfills her mission glorifying His name.
 
El Rapha: the God who heals
God specializes in creating, recreating, restoring, and healing. He created our brain cells as an anatomy for change and renewal. This concept helps us to grasp how depression and mental disorders may be healed bringing us hope for improved mental and emotional health. 

The Bible tells us stories of many children of God who suffered from depression and found healing. Take the classic one, Elijah. He was so depressed that he asked God to take his life. If we look closely, God treated Elijah’s depression, not with judgment or shame, but with patience, love, and understanding. He encouraged him to focus on nutrition and lifestyle interventions such as sunlight and exercise. But that was not all. Elijah had distorted thoughts so God helped Elijah to replace these thoughts with true, accurate thinking, giving him some cognitive behavior therapy.

The result? Elijah’s mind and faith were restored and the depression cured. He was finally translated into heaven after accomplishing his mission and today he stands as an example of God’s power of restoration for the entire universe to see. Like Elijah and Sharon, we also have a mission to fulfill, and sometimes losses and depression may keep us from using all our abilities to complete our mission. If that is your situation today, be of good courage. There is HOPE beyond tears. Hope out of depression. God knows and feels our pain. His prescription alone will improve our mental and emotional health. Lovingly, He whispers,

I know your tears; I also have wept. The grief that lies too deep to be breathed into any human ear, I know. Think not that you are desolate and forsaken. Though your pain touches no responsive chord in any heart on earth, look unto Me, and live.[17]
Dr. Neil Nedley addresses important aspects of depression recovery and prevention by maximizing the brain potential at the NAD Health Summit in New York in 2013 - 3 videos (1 hr long).
http://choosefulllife.org/category/media/maximizing-your-brain-potential-series/
 
[i] Neil Nedley, Depression Recovery Program Workbook (Ardmore, OK: Nedley Health Solutions, 2006), 26-27.
[ii] World Health Organization Publication, Conquering Depression: You can get out of the blues, 2001,  14. Accessed at whqlibdoc.who.int/searo/2001/SEA_Ment_120.pdf on April 30, 2014.
[iii] Nedley, 26-27.
[iv] David Sedlacek et al, “Pastoral Family Stress: A Report to the North American Division of Seventh-day Adventists,” unpublished study to be completed and published at a future date.
[v]   For more information, contact NADHM@nad.adventist.org.
[vi] Rucker L, Frye EB, & Cygan RW. (1986). Feasibility and usefulness of depression screening in medical outpatients.    
  A
rchives of Internal Medicine, 146 (4) 729-731.
[vii] Department of Health and Human Services, Mental Health: A Report of the Surgeon General, 1999, 247.
  Accessed at profiles.nlm.nih.gov/ps/access/NNBBHS.pdf on April 30, 2014.
[viii] National Institute of Mental Health, Depression [NIH Publication No. 08-3561] (Bethesda, MD: U. S.
  Department of Health and Human Services, 2008), 16.
[9] Ellen G. White, The Ministry of Healing (Nampa, ID: Pacific Press Pub. Assn., 1942), 241, and White, Mind,   
  Character, and Personality,
vol. 2 (Nashville, TN: Southern Pub. Assn., 1977), 482.
[10] Nedley, Depression: The Way Out (Ardmore, OK: Nedley Health Solutions, 2005), 31-59.
[11] Sedlacek.
[12] See www.AdventistRecovery.org for a helpful resource.
[13]Proeschold-Bell, RJ. Miles, A., Toth, M., Adams, C., Smith, BW. & Toole, D. (2013). Using Effort-Reward
    Imbalance Theory to Understand High Rates of Depression and Anxiety Among Clergy. 
[14]Proeschold-Bell, RJ. Miles, A., Toth, M., Adams, C., Smith, BW & Toole, D. (2013). Using Effort-Reward
      Imbalance Theory to Understamd Jogj Rates pf De[ressopm amd Amxoetu A,pmg C;ergu
 
[15]  Sedlacek
[16] Harold G. Koenig, Michael E. McCullough, and David B. Larson, Handbook of Religion and Health (New    
     York: Oxford University Press, 2001), 135.
 
[17] White, The Desire of Ages (Nampa, ID: Pacific Press Pub. Assn, 1940), 483

Katia Reinert, PhD, CRNP, FNP-BC, PHCNS-BC, FCN is the North American Division Health Ministries Director and is a Family Nurse Practitioner and Public Health Clinical Nurse Specialist with training in depression treatment and the integration of faith and health.