This post comes is a from a newsletter I did twenty years ago. The fundamental principles and basic treatments still apply today. There have been advancements in medical treatments for depression as well as refined psychotherapeutic approaches to helping people address underlying issues and overcome it.

Have you ever felt sad, empty, unmotivated, and pessimistic for several weeks? Do you know someone who looks dejected and admits feeling hopeless about his/her life? They lack the initiative and stamina to face the day. Have you ever known someone who struggled seriously with feelings of guilt, shame, worthlessness, self-criticism, discourage- ment, and low self-esteem. Depression takes many shapes and forms and varies from one individual to the next.
Depression is worldwide and affects individuals of all ages, including infancy (Collins, 1988). Depression is more than the blues or the blahs, or normal ups and downs. When that down mood lasts for more than a couple weeks, the condition may be clinical depression. Depression is the number one mental health problem in America, affecting 17 million people a year. Women tend to be affected four times as much as men by depression. It is more common in adults, but it is increasing among teenagers.

COMMON SYMPTOMS
Adults:
• Loss of Interest in Normal Daily Activities
• Feelings of Sadness, Helplessness, Hopelessness
• Apathy, Inertia and Fatigue
• Lack of Interest in Work, Sex, Religion, Hobbies
• Low Self-Esteem
• Self-Criticism, Feelings of Guilt, Shame, Worthlessness
• Loss of Spontaneity
• Sleep Disturbances
• Impaired Thinking and Concentration
• Loss of Appetite
• Thoughts of Death
Adolescents:
• Low Self-Esteem
• Tearfulness
• Withdrawal
• Drop in Grades
• Trouble- making At School
• Difficulty Maintaining Relationships
• Reduced Physical Activity
• Morbid Obsession with Death or Dying
• Serious Fingernail Biting
• Self-Destructive Behavior
• Episodes of Irritability for Weeks At A Time
• Disinterest in Hygiene and Personal Appearance
• Eating Disorders
• Sexual Promiscuity
• Drug and Alcohol Abuse
Children:
• Crying, Feeling Sad, Helpless, or Hopeless
• Feeling Discouraged or Worthless
• Loss of Interest or Pleasure in Most Activities
• Takes Much Longer to Finish Homework
• Fatigue and Loss of Energy Nearly Everyday
• Bad Temper, Irritable, Easily Annoyed
• Fearful, Tense, Anxious
• Repeated Rejection by Other Children
• Drop in School Performance
• Inability to Sit Still
• Repeated Emotional Out- bursts, Shouting or Complaining
• Doesn’t Talk to Other Children
• Repeated Physical Complaints (Headaches, Stomach Aches)
• Significant Increase or Decrease in Appetite
• Change in Sleep Habits
• May Also Have Diagnosis of ADHD or Learning Disabilities
• Suicidal Thoughts, Feelings or Self Damaging Behavior
• Abuse or Prolonged Use of Alcohol or Drugs

Symptoms and Causes
There are different types of depression. Reactive depression comes as a reaction to a real or imagined trauma or loss. People with reactive depression usually have high levels of anxiety. Reactive depression is usually short in duration and self-corrective (Collins 1988). Endogenous depression arises spontaneously from within the individual. This depression typically involves intense feelings of despair, self-destructive tendencies, persists for a long period of time, is more resistant to treatment, and has a high recurrence rate. Primary depression occurs by itself and secondary depression results as a side effect of some medication, one’s diet, or an illness like cancer or diabetes. When there is one or more episodes of depression as the primary disorder, it is referred to as unipolar. Bipolar depression involves periods of mania cycling with depressive behavior. Depression covers a wide variety of symptoms that differ in severity, frequency, duration, and origin. It usually involves feelings of gloom or sadness, accompanied by a slowing down of the body (Hart, 1993). The effects of depression range from minor (some sadness) immobilization to a massive shut down of one’s ability to function (complete despair and hopelessness). Severe depression can overwhelm a person with fear, exhaustion, apathy, and inner desperation. Depression can lead to unhappiness and inefficiency. Depressed people
often feel self-critical, and miserable.

Consequently, they are indecisive, lack enthusiasm, and energy to do even the simplest things. Depression involving grief or loneliness often lowers the body’s immune system. These individuals are more susceptible to illnesses, and more likely to get sick. Low self-esteem and withdrawal are also effects of depression. Many depressed people escape into drugs, alcohol, novels and television. Some seriously consider suicide as an escape from life and their intense emotional pain, and try to kill themselves. Suicide attempts, for others, are an unconscious cry for help. Masked depression can be revealed in different ways. It may come out in physical symptoms and complaints, aggressive actions and angry outbursts, impulsive behavior (including gambling, drinking, violence, destructiveness, or impulsive sex), accident proneness, compulsive work, and sexual problems. Depression can mimic health problems involving the central nervous and gastric systems, muscular, heart, respiratory and skin problems (Hart, 1993).

Depression can mask itself with anger, headaches, backaches, fatigue, irritability, and hypersensitivity. Depression is harder to diagnose in adolescents and children than in adults. Adolescents are less likely to realize they are depressed and less likely to seek help. Look for drastic changes in their behavior. Children have more difficulty expressing their feelings in words. Depressed children usually become irritable, act out, and have temper tantrums. There are many causes of depression. Some people have a biological-physical base. Some depression runs in families. Depression can also be physiologically based as in post adrealin depression that comes to people who have just had an emotional high. Developmental, psychological, interpersonal, spiritual, and non-physical influences are at the basis of much depression. Childhood experiences such as separation, abuse, unstable homes, apathetic or volatile family relationships can predispose people to depression. Divorce, death, prolonged separations, failure, life stresses and major disappoint- ments are powerful depression producing life events. Cognitive views of depression believe that a person’s thinking determines how they feel. Negative views of the world, life experiences, oneself, and the future contribute significantly to depression. Hurt and anger that is denied, kept within, and turned in toward oneself can lead to depression too. Personality traits like having low self-esteem, being overly dependent, self-critical, pessimistic, and easily overwhelmed by stress, can predispose a person to depression. Alcohol, nicotine and drug abuse also contribute to depression and anxiety disorders.

Overcoming Depression
No two people experience depression the same way. Rule out physical causes with a good medical evaluation if you get depressed regularly without any apparent cause. If it is a minor depression, accept it and allow yourself to go through it. If you feel your depression is more serious: identify the loss with all its implications; accept the loss; do the grieving; and try to put the loss in some perspective. Move forward with your life at your own rate. Know that this shall pass and that God is walking with you through the Valley of the Shadow of Death. Trust God to bring you through it. Identify and understand your depression, take steps to get help, seek others and professional help, to guide you through the process. Realize that depression is a natural response to stress, loss, and agonizing disappointments. Remain open to the approaches and help offered. Remember that you have had success over depression in the past, and there is a multitude of people out there who can testify that they overcame depression. It
takes work and trusting God no matter what.

Treatment

Eighty to ninety percent of people with depression can be helped. Symptoms can be relieved quickly with psychological therapies, medications, or a combination of both. The most important and difficult step toward treating depression is asking for help. Psychotherapy and counseling focus on making significant personality changes and providing guidance and insight in dealing with problems. This form of treatment addresses the causes of depression. Therapy helps people review their background, past influences and family pressures that create depression. It also helps them process stress emanating from loss, conflict, failure, and relationship difficulties. Counseling helps eliminate anger, guilt, and negative thinking. People don’t just snap out of depression! Effective therapy encourages clients to reevaluate depression-producing thoughts and attitudes toward life. The therapist helps the depressed person look at their expectations, attitudes, values, and assumptions. Medication deals with the physiology. Antidepressant medication for treatment of endogenous and reactive depression can relieve symptoms, help the person process
and deal with the factors and causes of the depression more effectively.

Hope
People in the Bible like Job, Moses, Jonah, Elijah, David, Peter, and the Israelite Nation, all experienced depression. Elijah fled into the wilderness where he plunged into despondency. He wanted to die. David’s songs of despair offer hope in Psalms 69, 88, and 102. He expresses both depression and rejoicing in Psalm 43: “Why are you so 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.” Even Jesus expressed great grief and depression in his agony before daylight in the Garden of Gethsemane. The Bible says He was full of sorrow, to the point of death. (Matt. 26:38). Numerous references to pain and grieving throughout the Bible illustrate the hope in God. Each of the believers who plummeted into depression eventually came through and were renewed with a lasting joy. It is not surprising that Christians experience depression in a fallen world. God often uses depression to bring us into a closer relationship with Him. God brings meaning and healing from depression and suffering. He offers help and hope. Jesus says “Come to me, all of you who are weary and carry heavy burdens, and I will give you rest. Take my yoke upon you. Let me teach you, because I am humble and gentle, and you will find rest for your souls”(Matt. 11:28). Real healing and victorious living come from God. There is comfort in the following Bible verses. “The Lord is close to the brokenhearted, and he saves those whose spirits are crushed” (Psalm 34:18). “Find rest, O my soul, in God alone: my hope comes from Him” (Psalm 62:5). There is hope, because He is Hope. God is our greatest hope in overcoming depression and living a victorious life, now and forever. “May the God of Hope fill you with all joy and peace as you trust in Him, so that you may overflow with hope by the power of the Holy
Spirit” (Rom. 15:13).