As a mental health nurse, I see the devastating effects that depression has on the person and their family. For those who haven’t experienced it themselves nor known anyone diagnosed, it is often misunderstood, sometimes even ridiculed and written off as ‘all in the mind’. Sadly, this misunderstanding can even come from those closest to the person, with hurtful and unhelpful comments along the way.

With depression, the person may feel hopeless and helpless, fearing they may never escape the darkness; they may feel like a burden to their family and friends; they feel out of control and overwhelmed with life; the energy is drained from their bodies; quality sleep eludes them; their body may be racked with pain; eating becomes either a mood-enhancer causing over-indulgence, or a chore; the thoughts run wild, like a recording playing over and over and over in their mind; negative self- evaluations pervade their mindset leading to thoughts of being unworthy of love, of being pathetic and unable to cope with life. When these emotions, thoughts and physical symptoms envelop a person with depression, it can feel like there is no hope of recovery. This begs the question, is there a way to climb out of that dark hole of despair? Even if there is, can a period of relative wellness last? Or will it just spiral out of control again, and again, and again?

The good news is that depression is a treatable illness. (1) I will say it again – depression is treatable! Most people believe that medications are the main form of treatment. Research tells us, though, that a combination of treatments has been found to be the quickest and most effective for sustaining remission from depression. (2) Of course, medications play an important role, but most don’t find them exclusively effective. (3) In order to work out a combination of treatments, it is worth a closer look at the ‘biopsychosocial’ model. Don’t be put off by the complexity of the word, it’s not as scary as it looks. The word ‘biopsychosocial’ can be understood easily when broken down into three easier parts: biological, psychological and social. Current mental health science says that a majority of emotional problems stem from these three interrelated areas, and are therefore effective to use as a basis for combination treatment. (4)

Let’s take a look at these three areas with examples from each, highlighting some in a little more detail.

1. BIOLOGICAL

Your physical body is a precious gift and looking after it physically is a way to honour God. In 1 Corinthians 6:19-20 it says, “Don’t you realize that your body is the temple of the Holy Spirit, who lives in you and was given to you by God? You do not belong to yourself, for God bought you with a high price. So you must honour God with your body” (NLT). When we consider biological treatments, we need to include medications, exercise, nutrition and sleep, as well as treating other medical conditions that are contributing to depression, for example, pain management.

We all know that these things help us to feel better. Even one good night’s sleep can work wonders for how you feel. Doing exercise lifts your mood and actually gives you more energy (even though we might feel tired immediately afterwards). These improvements don’t just occur for vague, unidentifiable reasons. They happen due to biochemical changes that take place and tangibly improve your mood. (5)

Medications help change your biochemistry and play a role in recovery. Whilst they aren’t the sole answer, they can help lift your symptoms enough that you are able to work on the other things that are required for recovery and maintenance. They can lift you out of that dark pit so that you can at least start moving forward. Some people may need to stay on medications for life, others may be able to eventually remove them once recovery has been maintained for a while. The side effects when coming off medications can be quite severe, so this needs to be done very slowly and only under your doctor’s supervision.

With the internet at our fingertips, there is a lot of information to be found on all these treatments. In recent years, there has been much research and information shared in regard to nutrition and mental health. You may have noticed more news reports, documentaries and articles on the topic. Even on Facebook, you may have seen this topic pop up in your newsfeed. It has been said for many years that ‘You are what you eat’. More than ever this is being proven, with the research pointing to your gut health as a key factor. You may have wondered what gut health is all about and why such a focus on it. And more importantly, you may be wondering how your gut health helps your mental health. Simply put, research has found that there is a link between our brains (mental processes and emotions) and our gut (intestinal functions). (6) In other words, they ‘talk’ to each other. Think about a time when you were feeling excited. Did you get butterflies in your stomach? Or when you were anxious, did you feel nauseous or experience diarrhea or reflux? The emotion is happening in the emotional centre of your brain (amygdala), yet those responses are in your gut.

It stands to reason then, that if your gut is healthy, it contributes to better mental health. (7) It is quite obvious that improving your gut health is therefore paramount.

But how do you do that?

Research tells us that improving gut health is two-fold – increasing gut-friendly (anti-inflammatory) foods in your diet and limiting or removing foods that aren’t gut-friendly (inflammatory). (8) Below are some suggestions from the research, and there is lots of information on the internet that could help too. It is also recommended that you see a nutritionist/health professional who specialises in gut health to ensure you are eating a balanced diet. (Please also be aware of any allergies you may have).

Foods to promote gut health – green leafy vegetables, broccoli, artichokes, beans, legumes, onion, berries, apples, nuts, extra virgin olive oil, oily fish, fermented foods. (10) The addition of a probiotic supplement may be beneficial too (talk to a health professional). Foods to avoid – processed foods, artificial sweeteners, unhealthy fats, refined carbohydrates (such as white bread, sugar), soda, fried foods. (8) As you can see, this is back to basics nutrition. And as a bonus, this same gut health nutrition has been found to assist in other diseases associated with inflammation such as cancer, heart disease, diabetes, arthritis, Alzheimer’s (8) and autoimmune diseases such as Multiple Sclerosis. (9)

2. PSYCHOLOGICAL

There is a well-known verse from Philippians 4:8 that gives a great pattern for us to follow with our thoughts, “And now, dear brothers and sisters, one final thing. Fix your thoughts on what is true, and honourable, and right, and pure, and lovely, and admirable. Think about things that are excellent and worthy of praise” (NLT). Of course, this is much easier said than done, especially when depression overwhelms. However, there are things that you can do to help lift your mood and therefore help you model this kind of thinking.

Psychological treatments include formal therapies (such as cognitive-behavioural therapy), gratitude journals, music, building self-esteem, kindness, prayer, meditation, controlled breathing, and relaxation (to name a few). All these treatments play a role in helping to slow down your thoughts, calm your body and lift your mood through distraction and adjusting the biochemical balance in your body. For example, research tells us that being truly grateful and showing gratitude increases the reward chemicals in your brain and body, helping you to feel better. (12) By writing in a gratitude journal daily, even for a week, it has been shown to lift the mood for up to six months – this is certainly worth turning into a habit.

One of the key things as Christians is our connection with God through prayer. There have been studies done on how prayer affects our wellbeing, both physically and mentally. One study found that practices such as prayer actually thickens the brain cortex which is thought to be a protective factor for depression. (13) We would also do well to remember that happiness is different from joy. We can be unhappy about our circumstances but still full of the joy of the Lord (John 15:11).

3. SOCIAL

The Bible has many verses that talk about our relationships with others. It speaks of who to connect with and how we should manage those relationships. All areas of our lives are covered, from marriage and families to friendships and business partners, to enemies and strangers. Obviously, we are designed for connection!

When someone suffers from depression though, connections can fall by the wayside. The person may not have the energy to connect; they may not feel worthy to connect; they lack the motivation to connect. Sometimes bridges have been burnt, so to speak, and some connections have been irreparably severed. But this social isolation from family, friends and support networks only compounds the problems with depression.

In the biopsychosocial model, the ‘social’ not only relates to relationships but also to environmental circumstances. (4) Avenues for treatment of both of these include social connections/supports (eg family, friends, clubs, church, professionals-doctors etc) and working on issues such as unemployment, housing, transport – many things contribute to one’s social situation and need to be considered to assist recovery.

A key factor to consider for recovering from depression is social supports. (15) There are many ways this can be done, but as Christians, we have a great support network provided to us through the church. In Hebrews 10:25 it says, “And let us not neglect our meeting together, as some people do, but encourage one another, especially now that the day of his return is drawing near.”Being a part of a church family can help in a number of ways. By attending church, you are at least out amongst other people. Even if you don’t feel like talking to anyone sometimes, it is good for you to just be around others instead of isolating yourself. By having a church family, you can have prayer support and practical support when you are not at your best (like meals or transport). Singing lifts your mood (biochemical changes), and even more so when you sing with others. And most of all, you get to worship with other believers (not just through singing, but through hearing the Word, through tithes and offering etc). You need to remember that God is worthy of praise, even when you don’t feel like it. Worshipping will draw you into His presence, and the focus shifts from you onto God. There is no better way to distract your negative thoughts than to be worshipping God.

Whilst we have viewed these three areas individually, it is important to keep in mind that there is a lot of overlap. When you work on one area, the other areas tend to improve also. Just like medications alter your biochemistry, so too do these other treatments. By using a combination of treatments, you can improve your mental health quicker and with a longer lasting effect.

Learn about your triggers/early warning signs
Have you ever found yourself slipping back into depression? Perhaps this has happened many times. Usually, this doesn’t happen overnight, but rather it has been a slow decline in your mental state. Even if you think it has come on rather suddenly, oft times there will have been things happening in the months prior that have contributed to it.

But you don’t have to wait until you have hit rock bottom again to do something about it. Learn your red flags- the warning signs that things aren’t moving in the right direction. By doing this, you can work on things earlier, helping to prevent a complete slide back into depression.

What are some of your red flags? Have you noticed you aren’t sleeping as well lately? Has your appetite changed? Are you isolating, saying no to invitations? Have you stopped enjoying the things you usually enjoy? It may not even be that you are the first to notice some changes. Listen to your family and what others are saying too. They might notice you aren’t as motivated, or that you are irritable. They may comment that you aren’t visiting with them as often. Listen to their comments and let that help you analyse what is going on for you. Whatever you notice happening, start
to work on that area again so that it doesn’t continue on the downward spiral.

Planning ahead is important too. If you know that every year at a certain time you go into depression (eg anniversary of an event), you need to work out ways to prevent the decline. It doesn’t mean you have to ignore the emotions around an event/anniversary, but you need to plan ways to help. Ask a support person to keep you company that day. Arrange an activity that you can use as a distraction. Focus on the happy memories instead of focusing on the negative side (eg if remembering the death of a loved one, look at photos and remember the good times instead of remembering they are no longer with you).

Praying for healing
“But I will restore you to health and heal your wounds”, declares the Lord (Jeremiah
30:17).

Have you ever prayed for healing and thought that God hasn’t answered your prayer?

There are a few things to remember when praying for healing

  • God is the healer (Psalm 147:3)
  • God is the comforter (2 Corinthians 1:3-5)
  • God heals so He may be glorified (John 9:1-12)
  • God’s timing is perfect (Ecclesiastes 3:1-11)
  • His plans are perfect (Jeremiah 29:11)
  • We must pray according to His will (1 John 5:14-15)
  • Afflictions are used for our growth (Psalm 119:71, Romans 5:3)

In God’s perfect will, plan and timing, healing can happen. Sometimes this will be immediate, other times God will have perfect reasons for delaying this and perhaps not giving complete healing. But just as David did in 2 Samuel 12, we can still worship and give God the glory no matter the circumstances.

Advice for someone who wants to help a loved one with depression
Many of you reading this won’t have a diagnosis of depression but will be wondering what you can do to help a loved one who does. You may even have been trying for many years to help but have almost given up because you don’t know what else you can do – even the person with depression doesn’t know what to suggest anymore. Or you may be wanting to reach out to someone for the first time but aren’t sure what to do.

Here are a few practical suggestions to help you be of assistance:

Be a listening ear – at times, this is all that is needed. Understand though,
there may be times they don’t feel up to talking.

Don’t fob off their pain by saying things like, “You’ll be fine” or “Think happier thoughts and you will feel better”. Whilst changing the thought patterns contributes to recovery, it’s not the only answer (remember ‘biopsychosocial’).

Give practical help, using the three areas above as a guide.

  • For example, Are they struggling to prepare nutritious meals or even eat at all due to their depression? Perhaps prepare a few nutritious meals to put in their freezer or offering to run to the shops for them so they have some
    healthy snacks on hand (nuts, fruit etc.). Go for a walk with them so they do some exercise.
  • Set them up so they can easily play some music or listen to relaxation exercises. (When the brain isn’t working well, it’s very difficult to
    arrange even the simplest thing).
  • Take them out for a coffee, call them for a chat, pop in for a visit, offer
    transport if that’s an issue (even if they can drive when they are at
    their lowest, they may not feel confident to drive themselves or to go by themselves).

Let them know if you notice any changes that may contribute to a recurrence of their depression if left unchecked e.g. declining invitations. As a support person, whether you are a close relative or an acquaintance wanting to help, you need to understand that you can’t solve all their issues. You can only be of support. Boundaries are important to all of life, and it is no different when you are being a support person. You need to be mindful of your abilities, time availability and other responsibilities too.

Depression is a devastating illness for the person and this has flow-on effects in all areas of their life and on others around them. By having a multi-faceted approach to recovery, a brighter future can be worked towards and relationships maintained or restored.

Something noteworthy to remember – Your faith and faith practices are necessary as a part of your mental and physical well-being. It should be no great surprise that what science is finding today, was written in the Bible many years ago.

“I waited patiently for the Lord to help me,
and he turned to me and heard my cry.
He lifted me out of the pit of despair,
out of the mud and the mire.
He set my feet on solid ground and
steadied me as I walked along.
He has given me a new song to sing,
a hymn of praise to our God.
Many will see what he has

done and be amazed.
They will put their trust in the Lord.”

Psalm 40:1-3 (NLT)

Shauna Gallagher – Author

References

  1. National Institute of Mental Health
    https://www.nimh.nih.gov/health/publications/depression-what-you-need-to- know/index.shtml#pub4
  2. Medscape
    https://emedicine.medscape.com/article/286759-treatment
  3. PubMed Health
    https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0087089/
  4. Psychology Today
    https://www.psychologytoday.com/au/blog/think-well/201605/why-the-best- therapy-is-biopsychosocial-process
  5. Healthline
    https://www.healthline.com/health/depression/exercise#1
  6. Psych Scene
    https://psychscenehub.com/psychinsights/the-simplified-guide-to-the-gut-brain- axis/
  7. Harvard Health Publishing
    https://www.health.harvard.edu/diseases-and-conditions/the-gut-brain-connection
  8. Harvard Health Publishing
    https://www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation
  9. Healthline
    https://www.healthline.com/health-news/how-gut-bacteria-ease-autoimmune- diseases#1
  10. Healthline
    https://www.healthline.com/nutrition/improve-gut-bacteria#section5
  11. Mayo Clinic
    https://www.mayoclinic.org/prebiotics-probiotics-and-your-health/art-20390058
  12. ABC NEWS
    https://abcnews.go.com/Health/science-thankfulness/story?id=15008148
  13. Psych Central
    https://psychcentral.com/blog/new-study-examines-the-effects-of-prayer-on-
    mental-health/
  14. Mental Health Social Support
    http://www.mhss.net.au/research-and-statistics

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