Portraits 

• Angela is frightened. Each morning she struggles to find the energy to get out of bed. She feels so listless and down. Her kids need her, but she can't summon the energy to even interact with them, much less prepare meals or clean the house.
• George is having a hard time thinking clearly. He lost his job and just can't seem to crawl out of the hole he feels like he's fallen into. He can't interview because he's so down, so he sits around at home and plays on the computer. And he just keeps spiraling downward.

Definition and Key Thoughts of Depression

• Depression differs from getting the "blues" and general sadness. When people are sad, they keep their self-respect, they feel better after crying, and they confide in others and it helps. With depression, self-respect fades, crying does not help, and depressed persons often feel alienated because other people cannot seem to understand how they feel.
• Depression is a mood disorder and can be caused by difficult situations, unhealthy thought patterns, or can have a physiological cause.
• Symptoms include: sadness/depressed mood or loss of interest in enjoyable activities, plus 4 or more of the following: marked weight loss when not dieting or weight gain or change of appetite; insomnia or excessive sleep; slowed movements or agitation; decreased energy or fatigue; feelings of worthlessness or inappropriate or excessive guilt; indecisiveness or decreased ability to concentrate; recurrent thoughts of death or suicide; must last 2 or more weeks, or more mild symptoms for at least 2 years
• Depression is often undiagnosed and untreated in older adults and can be viewed as a natural result of aging.
• Women are twice as likely to be depressed as men.
• One in eight individuals may require treatment for depression in their lifetime. Despite the progress in detecting and treating depression, the majority of depressed people never get treatment.
  

Causes of Depression

• Inherited predisposition to depression
• Hormonal or chemical imbalance
• Feelings of failure or rejection
• Grief or loss
• Family problems; separation, divorce, abuse
• Thinking one has no control over any part of life; feelings of futility
• Negative thinking
• Isolation or loneliness
• Substance abuse
• Side effects of prescribed medications

Symptom Assessment of Depression

Rule Outs

1. If 10 is extreme sadness, and 1 is feeling well, where are you today on a scale of 1 to 10? (If the client is on the low side, find out what is causing the sadness. The issue to address may not be depression, but other concerns.)
2. Are you using drugs or alcohol?
3. Are you currently taking any medications?
4. When was the last time you had a thorough physical examination? (If the client hasn't seen his doctor recently, give a medical referral.)
5. Do you have significant mood swings? (Ask about the existence of mania or hypomania and if they exist, give a psychiatric referral.)

General Questions

1. How long have you felt depressed?
2. What was happening in your life when you first became depressed? (Someone who is depressed needs acceptance and gentleness. He may already be feeling as if he has failed in some way. Begin by listening to his story without judgment.)
3. Have you been depressed before?
4. Do you have a family history of depression?
5. Do you have difficulty concentrating?
6. Have you lost interest in pleasurable activities?
7. Have you noticed changes in your eating or sleeping patterns?
8. Are you dealing with guilt or fear about anything? (Fear is prevalent in many kinds of depression; anxiety is present in 70% of those diagnosed with depression.)
9. What do you see in your future?
10. Have you had any thoughts about injuring yourself, or suicide? (Sometimes the thoughts are vague, such as "It would be better if I were not here." Pay particular attention to the means for carrying out these thoughts. Someone who is suicidal and imagines having an automobile accident has both a plan and a means to carry it out.)

Spiritual and Biblical Insights for Depression

But [Elijah] went a day's journey into the wilderness, and came and sat down under a broom tree. And he prayed that he might die, and said, "It is enough! Now,Lord, take my life, for I am no better than my fathers! 1 Kings 19:4
Life has highs and lows, and as in a mountain range, the lows often come right after the highs. Like Elijah, we may scale the heights of spiritual victory only to soon find ourselves in the dark valley of depression.  While certain forms of clinical depression should be professionally treated, many depressed feelings are part of life's ups and downs.  Like Elijah, we should listen for God's "still small voice" (1 Kings 19:12) to comfort us.

Then as [Elijah] lay and slept under a broom tree, suddenly an angel touched him, and said to him, "Arise and eat." Then he looked, and there by his head was a cake baked on coals, and a jar of water. So he ate and drank, and lay down again." 1 Kings 19:5, 6
Depression drains energy, twists values, and assaults faith.
Depression can affect anyone.
God responded mercifully. He did not castigate or condemn Elijah for his condition; something that many depressed Christians expect from God. Even in the depths of depression God shows loving concern and a way out.

Why are you cast down, O my soul? And why are you disquieted within me? Hope in God, for I shall yet praise Him for the help of His countenance.  Psalm 42:5
Depressed feelings sometimes cause some people to turn away from God.
Others like David, however, allow those disquieted, depressed feelings to make them "hope in God"