Category Archives: Depression

Alternative to talk or pharmacological therapies for depression?

For many of my clients, medications are necessary for their moderate to severe depression. With SSRIs or mood stabilizers, they are able to function at home and at work and can better benefit from talk therapy. But in every case my clients report side effects from their meds. It is always a bit of art-form to balance benefits and side effects. That is the world we live in and the best we can do now. One of the key problems with all psychopharmacological interventions is that drugs provide a systemic solution when often we may need a targeted approach. Consider a person with ADHD who takes a stimulant that will help them focus in class yet must deal with increased blood pressure, heart rate and potential for insomnia. The stimulant does not just target the frontal lobe but impacts the whole body.

Wouldn’t it be great if we could target an intervention to a particular part of the brain?

“The brain is not a bowl of soup and you add the chemical and you stir,” she says. “Chemicals work within networks, within systems, within pathways. And where in the brain a chemical may be working is as important as knowing what chemical you should use.”

I read the above quote in this news item about the problem of rumination in treatment resistant depression. Helen Mayberg, author of the above quote, is researching Broadman Area 25 and its connection to the problem of rumination–where a person struggles to turn off negative thoughts about self and the world. She and other researchers are wondering why some people do well with talk therapy while others seem not to benefit. Instead of looking at the possibility of a less helpful form of talk therapy, they wondered whether the problem is that the person cannot get away from their negative thoughts enough to engage in the work of counseling.

One of the interventions being tried is to practice disconnecting from ruminations by paying attention to what is going on in the present. To help with the learning of this skill one researcher is testing whether 5 sessions of having an electrode on your wrist create an itching sensation while the patient practices paying attention to a decreasing amount of electrical stimulation.

Sound crazy? It just might be. I am always wary of any “5 sessions or less” advertisement. But before we toss out the idea, if a targeted treatment could help turn down the volume on a rumination, wouldn’t that be a help to many?


Filed under Depression, news, Psychiatric Medications, Psychology, Uncategorized

Suicide education and prevention in the church

Suicide is in the news these days. Military suicides are off the charts. Bullied teens are in the news this week along with a nationally known pastor’s son. Suicide is an important topic! We need to talk about why, for some, suicidal thoughts (fairly common across the population) become plans and actions. We need to explore what helps reduce suicide as a desirable option. We need to talk about how to care for those left after the horror of suicide.

But here’s a question: Have you ever heard a sermon or a Sunday School lesson on the topic of suicide?

I can’t say that I have.

This week I was sent a survey about graduate theological education and suicide assessment and prevention training. Our counseling students get a bit of education on suicide assessment in a couple different courses. They read an article or two on the topic. Not really enough but our challenge is to know what to cut in order to fit more suicide material into the program.

The result is that most learn in the middle of a crisis. Not really the best plan.

If you are looking for materials, let me point you to a few:

1. National Action Alliance for Suicide Prevention.

2. CCEF. Use their search tool to find their resources in this packed website (some free, some cost a bit). Jeff Black’s article on understanding suicide is helpful. There are several blogs that are free.

3. Al Hsu’s book, “Grieving a Suicide.”

4. American Foundation For Suicide Prevention.

If you google suicide and christian, you will notice that the vast majority of material is about whether or not suicided individuals can still go to heaven. While this is an important question, it appears that we have spent more time on this topic than on that of prevention and intervention.

Maybe we can do a bit better than this? Let’s commit to talking about it rather than being afraid.


Filed under Depression, Psychology

The cure for mental weariness?

Check out this thought by George Matheson, a blind 19th c. Scottish Presbyterian minister:

What a strange cure for mental weariness…I should have expected an invitation to mental rest….The weariness of the body is cured by slumber, but the weariness of the mind can be cured only by stimulus.

He said this as he was meditating on Hebrews 12:3 (Consider him who endured such opposition from sinful men, so that you will not grow weary and lose heart). He suggests that an active meditational life on the work of Jesus will help promote rest and protect from mental weariness.

Quote found in Leaves for Quiet Hours, p. 141 (1904)

[reblogged; first published 2/8/07]


Filed under Depression, Despair, Great Quotes

When all you see is brokenness…what then? A thought from Jeremiah 29

As a counselor and a Christian it is easy to see that the world is breaking. Suicides. Shootings. Affairs. Cancer. Addiction. Corporate Greed. Abuse. In addition, we hear about

  • Christian leaders who either perpetrate abuse or fail to protect when they hear of it
  • rampant immorality
  • political corruption

When we face these kinds of things, it is easy to fall into one of two unhelpful patterns. For some of us, we fight. We try harder. We attack others with sarcasm. We lay blame at the feet of others. While fighting harder to correct injustice is a good thing; while pointing out blame where it should lie is not a bad thing, the pattern of fighting may reveal a dangerous value system: if I can control my little corner of the world, things will get better. Sometimes this is true but most of the time, the “getting better” motif is an illusion. The wrong kind of fighting usually leads to embitterment.

Others of us choose a pattern of giving up.We stop trying to make a difference because it won’t. We turn down the volume on suffering. We avoid others who are obviously suffering. We move towards embittered discontentment. Now, it is not wrong to turn off the 24/7 “news” and to not read up on every tragedy. It is good not to fill our brains only with brokenness. But, giving up can sometimes lead to lamenting that the “good ole days” were better.

Enter the Prophet Jeremiah

In chapter 29, he writes to those who are experiencing brokenness. Israel is no more. A mass of Jews have been carried off into captivity. They live in a land that is not theirs as foreigners and likely without rights, privilege or land. They have lost connection with the promised land, with family, with language, with custom. Around them would be idol worshippers and a society not built on the Torah. There are some individuals who have been prophesying that in 3 years they will return home to Israel in triumph.

Jeremiah says, “Not so fast. No, you guys will die in captivity.” Well, no, he doesn’t exactly say that. He says it will be 70 years and then you (meaning your children and/or grandchildren) will get to return to the Land.

Nice. Jeremiah responds to their suffering and says, “Yup, it’s bad. And it is going to stay that way.”

But read on because he tells them God has a message for them to hear: (in Phil’s loose translation)

Obey me [the Lord, not Jeremiah]. Because I love you dearly, I will protect your soul. I will be blessing you even though there are dire consequences happening to you. Here’s what I want you to do:

  1. Look for the blessings I am sending you NOW. Don’t overlook them. They are really there for you to find.
  2. Live holy lives, not out of fear, but in confidence that I am keeping my promises to raise of a kingdom for my people.
  3. Live. Don’t put your life on hold. Build houses. Plant gardens. Harvest. Marry. Have kids. Help your kids get married. Enjoy your grandchildren. Be present and rooted where you are at. Live. Enjoy it.

Notice that to live, you have to move, act, have impact, even as you are accepting that you cannot avoid the consequences of living in a fallen world. I think this can be helpful for us in a season of much brokenness. Without denying the suffering that is everywhere, we can also choose to notice the little and the big blessings. We can simplify our lives to, “What do you want me to do today?” We can be mindful of the small activities of life. The grocery store is drudgery. Laundry is never-ending. And yet, we have the opportunity to act in our world and to pray for the peace of the city (as Jeremiah gives encouragement to do).

Maybe your joy is pretty tiny these days. That is okay. Just find it and savor it as a gift from God for the few minutes you have. Not all is broken. In a few days, hours, years, God will indeed put all to rights. Every heartache will become untrue. Still, even now, hang on to the signs of life and growth.


Filed under Biblical Reflection, Christianity, Depression, Despair, Meditations, suffering

Depression and your internet usage?

Have you seen news articles suggesting that one might be able to predict depression on the basis of how you use the Internet? If not, read about it here in a very brief essay. Bottom line, the study may find that depressed college students use more P2P (peer-to-peer) file sharing than their non-depressed counterparts. The depressed group may also do far more application switching (e.g., check email, look up sports scores, open other apps, etc.) suggesting an appearance of bored surfing for something to stimulate them out of their negative mood.

On the one hand, these possible results make some sense. Depressed people may be looking for stimulus and social connection to raise their mood. They may have less focus on more mindless activity on the net. However, as this essay reminds us, there are a number of problems with the research that show up in many of the “newsy” items that show up on the Internet or on television news.

Despite the caveats we must place on such “news”, it does provide a great opportunity for each of us to evaluate our Internet habits.

What are we doing on-line…really?
What do our habits say about what we are looking for, desiring, etc.?
What are we avoiding while we are on-line?  What are we trying to fill?

I can tell you that my usage, at times, tells me I am not wanting to engage some bit of work that I have on my plate. Far better to check email than to write a difficult section of an upcoming lecture. Far better to read an important blog than to go talk to my kids about something that I’ve been avoiding. Or…so it seems at the moment.

What does your Internet usage tell you about you?


Filed under counseling, counseling science, Depression, Psychology

New drugs for depression?

This morning, NPR’s Morning edition ran a news report on some medicines that may help in the fight against depression. What makes this an interesting story is that the drugs are not typical (a street drug and a motion sickness drug) and that they work quite quickly–some even in one day! In addition, these drugs do not appear to work on the neurotransmitters serotonin or norepinephrine–the focus of most of our current antidepressants–but on glutamate, another neurotransmitter.

Listen to or read the story here.

Ketamine (known on the street at Special K) may have some capacity to form new connections between neurons. The assumption is that those who suffer with depression have had significant loss of neural connections.

Like with every drug, there may be some serious side effects with Ketamine: experiencing light trails (hence why clubbers use it) and foggy memories.

Findings, however initial, should (a) encourage us that better relief may be possible for millions of people, (b) remind us how little we really know about the brain, and (c) remember that those who suffer from serious depression and who seek medical treatment also must suffer with the experience of being a guinea pig of practitioners. This last point cannot be underscored enough. Medicines are never a panacea. And, we rarely can tell why one drug seems to work with some and doesn’t with others. In fact, much of what we know about drugs is shrouded in theory. Give a serotonin boosting compound to depressed people and they seem to get better suggests that the problem is that depressed people have too little serotonin in their synaptic clefts. Of course, this is mostly theory since some data may suggest that some have lower levels of serotonin and are not depressed at all.


Filed under Depression, Psychiatric Medications, Psychology

Godly depression?

Last night my psychopathology class focused on the topic of depression. We covered the usual stuff: various experiences and features of depression and bi-polar disorder, potential medical causes, common medical and psychological treatments, etc.

Depression, as you most likely know, comes in all sizes and shapes and is multifactorial in etiology. Depression involves the body, the mind and spirit, and the environment. Thus, treatments should also cover the gamut, focusing on thoughts, faith, body, and environment. I ended the class pointing briefly to the fact that the English Puritan treatment of depression covered pretty much the same. They encouraged their parishioners to treat their despair and melancholy with these ideas,

  1. Seek the benefit of “Physick” or medical interventions
  2. Accept the comfort of Scriptures and in community with friends (and they also counseled others to avoid over-use of exhortation)
  3. Be mindful of God’s present and past mercies
  4. Utilize the sacraments and other spiritual disciplines
  5. Avoid too much time in introspection, but
  6. Examine oneself to see if there are also hidden issues to be dealt with

Notice the “heart surgery,” as one of my students put it in her paper, doesn’t happen til much work has been done to stabilize and comfort the despairing individual.

KEY QUESTION: Is there such thing as Godly depression?

If so, what would it look like? This question comes out of the view that depression and accompanying hopelessness reveals, to some degree, that a person is failing to trust the Lord.

Or does it? Is it possible to be depressed and spiritually mature? I believe so. So, what signs might you look for to determine that the person in front of you was experiencing a Godly depression? Was St. Paul despairing to the point of death but wholly trusting the Lord at the same time? (2 Cor 1:8f)


Filed under christian counseling, christian psychology, Christianity, counseling, counseling science, Depression, Doctrine/Theology

Are congregants at fault for pastor burnout?

I’ve written here several times on the topic of pastoral burnout and the need for prevention and renewal for ministry leaders. I came across this opinion piece in the NY Times suggesting that congregants may be a big part of the problem. Consider some of the following quotes by the author (a pastor who may have had problems in his own congregation that bias him a bit). Emphases are mine.

The pastoral vocation is to help people grow spiritually, resist their lowest impulses and adopt higher, more compassionate ways. But churchgoers increasingly want pastors to soothe and entertain them. It’s apparent in the theater-style seating and giant projection screens in churches and in mission trips that involve more sightseeing than listening to the local people.

As a result, pastors are constantly forced to choose, as they work through congregants’ daily wish lists in their e-mail and voice mail, between paths of personal integrity and those that portend greater job security. As religion becomes a consumer experience, the clergy become more unhappy and unhealthy.

Ouch. His words about the demand for experiential highs are pointed, especially the ones about missions trips as sightseeing events.

The unspoken message in such instructions is clear: give us the comforting, amusing fare we want or we’ll get our spiritual leadership from someone else.

I suspect this is one part of the pie. But let us not blame the congregants too much. They want to be part of something great and most pastors want to be something great. The two sides mutually support this kind of problem.

If you read the full-text you will see a link for another recently published editorial about clergy burnout. You can read that one here. There are a number of other resources you can find as hot links embedded in that essay. One factoid is a recent study of North Carolinian Methodist pastors are found to be significantly more obese than the general population of the state. Makes you go hmmm.


Filed under Christianity: Leaders and Leadership, Depression, Evangelicals, pastoral renewal, pastors and pastoring

Gardening illustration that works for persistent problems in life

5 years ago a friend of mine asked if I wanted some purple cone flowers for my flower garden around my house.

Having admired them in other gardens, I said yes and promptly planted them in a spot next to some other flowers. Turns out they were Brown Eyed Susans, a relative of the intended flower. And, further, they spread terribly. I enjoyed them the first summer but began ripping them out the next year as they spread through the iris and choked out some other plantings.

Now, some five years later, I am still pulling these plants. They grow and spread quickly. I never let them flower but pull them as soon as I can make sure I get them and not another plan that might be right in the same spot. When I pull them I know that some little root fiber remains and so I’ll be back pulling again in a week or so.

The truth is I will never be free from these plantings. I do have some choices:

  • ignore them and let them take over the garden (BTW, they would be fine in an isolated spot surrounded by grass so they couldn’t take over another planted area)
  • be irritated that I can’t get rid of them and thus fail to see the beauty around them
  • stay vigilant but enjoy the garden
  • try shock and awe by killing everything in that spot.

I find this is much like our persistent life problems. Whether by naive choice or by something beyond our control, we develop persistent struggles with things like anxiety, depression, addictions, relational challenges, etc. While God sometimes provide miraculous removal of these struggles, we rarely find complete freedom from these kinds of struggles. We may not be in crisis mode forever, but total relaxation and assumption of no return of the problem is rare also.

So, we too have some choices:

  • be angry and bitter that the problem continues to have some place in our life
  • blame others for our problems
  • ruminate on why only we seem to have these problems
  • try shock and awe and so destroy lots of other things
  • accept the need to stay vigilant, going after the roots and shoots as soon as we notice them.

Does this illustration work for you?


Filed under addiction, Anxiety, christian counseling, christian psychology, Christianity, counseling, Depression

insomnia and suicidality

Counselors need to keep regular watch over the insomnia of their clients. Untreated or unresolved insomnia predicts poor recovery and lesser benefit from therapy. It ought not be treated as a secondary problem. But a recent abstract sent to me via email suggests that insomnia may also be a significant factor in suicidal ideation and action. Some researchers at Wake Forest followed 60 adults with both insomnia and major depression for 9 weeks. All received antidepressants but some received a sleep aid as well. Both were assessed by using the Hamilton Depression Scale and an insomnia severity scale.

Their findings suggest that insomnia is a factor in suicidal ideation independent of depression or lack of pleasure. Insomnia leads to more intense suicidal thoughts. Thus, counselors ought to redouble their efforts to ask about insomnia, to track it and to especially follow-up with questions about suicidal ideation or plans when complaints of insomnia increase.

Interested readers may find the abstract of the research here.


Filed under christian counseling, counseling, counseling science, counseling skills, Depression, Uncategorized