Living With Depression

© Rev. Barbara F. Meyers 2006. All Rights Reserved.

A sermon delivered as a guest minister at the Unitarian Universalist Fellowship of Santa Cruz CountyFebruary 26, 2006Sermon – Living with Depression

My name is Barbara Meyers and I’m living with depression. I am a community minister whose ministry is focused on mental health issues. My ministry is largely motivated by my own experience with the subject of this service: the illness called “Depression”.

First, why talk about depression in Church? Depression can rob us of our spirit. In my own personal experience, connection with a spiritual community helps us to find it again. So, in my view, this is exactly where we should be talking about it.

Today, we will talk about the illness, what it is, who gets it, how it is caused, how it is treated and how we live with it.

What is Depression?

The term “depression” can be confusing since it’s often used to describe normal emotional reactions. Everyone feels “Blue” at certain times during his or her life. In fact, transitory feelings of sadness or discouragement are perfectly normal, especially during particularly difficult times. But, a person who cannot “snap out of it” or get over these feelings within two weeks may be suffering from the illness called depression.

Depression is one of the most common and treatable of all mental illnesses. In any six-month period, 9.4 million US citizens suffer from this disease. One in four women and one in 10 men can expect to develop it during their lifetime. According to the American Psychiatric Association, 80 to 90 percent of those who suffer from depression can be effectively treated, and nearly all people who receive treatment will derive some benefit.

Unfortunately, many fail to recognize the illness, and others are ashamed to admit they might have it and hide it – the stigma of being “mentally ill” can be deeply felt, as I can attest from personal experience.

Nearly everyone suffering from depression has pervasive feelings of sadness. In addition, depressed people may feel helpless, hopeless, and irritable. According to the American Psychiatric Association, you should seek professional help if you or someone you know has had four or more of the following symptoms continually for more than 2 weeks:

• Noticeable change of appetite, with either significant weight loss not attributable to dieting or weight gain.
• Noticeable change in sleeping patterns, such as fitful sleep, inability to sleep, early morning awakening, or sleeping too much. [One therapist told me that when you can’t fall asleep, that is anxiety, and when you wake in the middle of the night, that is a symptom of depression.]
• Loss of interest and pleasure in activities formerly enjoyed.
• Loss of energy, fatigue.
• Feelings of worthlessness.
• Persistent feelings of hopelessness.
• Feelings of inappropriate guilt
• Inability to concentrate or think, indecisiveness.
• Recurring thoughts of death or suicide, wishing to die, or attempting suicide. (Note: Individuals with this symptom should receive treatment immediately!)
• Overwhelming feelings of sadness and grief, accompanied by waking at least 2 hours earlier than normal in the morning, feeling more depressed in the morning and moving significantly more slowly.
• Disturbed thinking, a symptom developed by some severely depressed persons. For example, severely depressed people sometimes have beliefs not based in reality about physical disease, sinfulness, or poverty.
• Physical symptoms, such as headaches or stomach aches.

For many victims of depression, these mental and physical feelings seem to follow them night and day, appear to have no end, and are not alleviated by happy events or good news.

Types of Depression

Depression strikes in several forms. When a psychiatrist makes a diagnosis of a patient’s depressive illness, he or she may use a number of terms – such as bipolar, clinical, major or unipolar – to describe it.

When you hear the term “clinical” depression, it merely means the depression is severe enough to require treatment. When a person is badly depressed during a single severe period, he or she can be said to have had an episode of major depression. In bipolar depression, the lows alternate with terrible highs in an often-bewildering oscillation. Unipolar depression is only the down side.

Who gets Depression?

Depression isn’t something invented by 20th century psychiatrists. It has probably existed as long as mankind. The reading we had from I Samuel is a clear description of depression of one of the early Jewish kings more than 2000 years ago. This is a passage from William Styron’s autobiographical book “Darkness Visible – A Memoir of Madness”, Random House, 1990.

Depression afflicts millions directly, and millions more who are relatives or friends of victims… As assertively democratic as a Norman Rockwell poster, it strikes indiscriminately at all ages, races, creeds and classes, though women are at considerably higher risk than men. The occupational list of its patients is too long and tedious to give here; it is enough to say that very few people escape being a potential victim of the disease, at least in its milder form. Despite depression’s eclectic reach, it has been demonstrated with fair convincingness that artistic types (especially poets) are particularly vulnerable to the disorder – which, in its graver, clinical manifestation takes upward of twenty percent of its victims by way of suicide. Just a few of these fallen artists, all modern, make up a sad bus scintillant roll call: Hart Crane, Vincent van Gogh, Virginia Woolf, Sylvia Plath, Mark Rothko, John Berryman, Jack London, Ernest Hemingway, William Inge, Anne Sexton – the list goes on. (pp 35-36)

What Causes Depression?

Scientists do not know the exact mechanism that triggers depressive illness. Probably no single cause gives rise to the illness, and researchers continue to piece the puzzle together.

It is now believed that genetic factors play a role in some depressions. Recent genetic research also supports early studies reporting family links in depression. For example, if one identical twin suffers from depression or manic-depressive disorder, the other twin has a 70 percent chance of also having the illness.

Additional research data indicate that people suffering from depression have imbalances of neurotransmitters, natural substances that allow brain cells to communicate with one another. Other body chemicals also may be altered in depressed people. Among them is cortisal, a hormone that the body produces in response to stress, anger or fear.

Depression can be triggered by stressful situations in a persons life – Childbirth, Death, Divorce, Loss of a job, Loss of something you dearly believe in… It can be magnified by ingrained inappropriate patterns of behavior when stressful events happen.

How is Depression Treated?

Depression is one of the most treatable mental illnesses. Between 80-90 percent of all depressed people respond to treatment and nearly all depressed people who receive treatment experience at least some relief from their symptoms. Along with the great strides made in understanding the causes of depression, scientists are closer to understanding how treatment of the illness works.

Medication Therapy

Since the 1950s, physicians have learned much more about the effects of medication on depression. The effectiveness of a drug depends on a person’s general health, weight, metabolism, and other characteristics unique to that patient. Medication must be used at an adequate dosage level and for a long enough time. Sometimes a psychiatrist will prescribe several medications, or will try a combination of medications to determine what works best. Generally, antidepressant drugs become fully effective within 3-6 weeks after a person begins taking them.

Psychotherapies

Psychotherapy involves the verbal interaction between a trained professional and a patient with emotional or behavioral problems. The therapist applies techniques based on established psychological principles to help the patient gain insights about him- or herself and thus change his or her maladaptive thoughts, feelings and behavior. There are different types of psycho therapy such as Cognitive-Behavioral Therapy, Psychoanalysis and Interpersonal Psychotherapy, that stress various techniques of getting long term relief from psychotherapy.

Electroconvulsive Therapy (ECT)

Scientists believe that ECT works by affecting the same transmitter chemicals in the brain that are affected by medications. As more effective medications have been developed, the use of ECT for the treatment of depression has decreased. However, ECT is very effective for treating patients who cannot take medications due to heart conditions, old age, or severe malnourishment, or for patients who do not respond to antidepressant medication. It can be a lifesaving treatment that is considered when other therapies have failed or when a person is very likely to commit suicide.

Life Style Changes

From my own experience with this illness, I’ve collected a set of life style changes that help me to cope. These suggestions are not professional medical advice, just things that have worked for real people living with depression and their families.

First: What can the depressed person do?

Depression is one of the most treatable of mental illnesses. Here are things that can be done to treat and limit the effects of depression. They have worked for others.

• Psychotherapy with a therapist trained to know how to discover and deal with psychological problem areas.
• Effective medication in an effective dosage prescribed by a psychiatrist. Other kinds of doctors may not know the latest in depression medications.
• Exercise. Elevate the heart rate for 15-30 minutes a day, with your doctor’s permission. Examples: walking, jogging, aerobics, swimming, …
• The physical exercises of Yoga
• Meditation. 15-60 minutes of quiet listening to your heartbeat and breathing.
• Eat a good solid balanced diet.
• No alcohol. Alcohol is a depressant and often interferes with anti-depressant medication.
• Little or no caffeine.
• Avoid getting over fatigued. Get plenty of rest. If you can’t sleep, ask your doctor for something to help you sleep.
• Avoid getting over-committed in time to any activity or activities, so that you feel overwhelmed. Learn how to say “No” and not feel guilty. Learn how to “let it go” when things start to pile up and threaten to overwhelm you.
• Learn how to recognize warning signs of a coming depressive spell and take immediate action to head it off or minimize it. Involve your family so they can recognize onset of a depressive episode and help you.
• Indulge in some creative activity. ex: music, drawing, painting, crafts, creative writing, weaving, …
• Do something to make you laugh, cry, or get angry in a safe place. Example: watch a sad movie and cry.
• Join a depression support group.
• Help someone else, especially someone with problems similar to yours.
• Learn how to love yourself as an individual, spiritually and creatively. There is no one else on Earth quite like you.
• Read and learn all you can about depression.

Next, what can family and friends do?

• Get professional help to learn what your responsibility is.
• Recognize the signs of depression, which may include: Drug abuse (depressed people often self-medicate), truancy from jobs and school, changes in eating or sleeping habits, lack of motivation, avoidance, preoccupation with death or talk of suicide.
• Tell them that you love and care about them.
• Make sure that they get the help that they need, for example, a therapist or a hospital stay. You may have to help make the appointment for them and go with them.
• If they are suicidal, get them immediate attention. Call 911 if there’s an immediate danger.
• Visit them, especially if they’re hospitalized. A smile, a flower, a picture or a short hug can make all the difference.
• Support continuing therapy.
• Support them in their efforts to find the medicines best for them.
• Monitor their medicine intake.
• Encourage physical exercise, good diet, plenty of sleep, creative activities, and sunlight.
• Learn to recognize the warning signs that a depressive episode is going to happen, and help to take action to head it off or minimize it.
• Avoid doing things that trigger their depression, ex: if they become depressed when they are pressured to hurry, don’t try and hurry them up.
• Keep days structured.
• Keep guns out of the house.
• Be patient. Depression waxes and wanes. Cures are rarely instantaneous.
• Join your own support group, formal or informal.
• Have a life of your own. If the depressed person needs monitoring or assistance, get help.
• Make the best of their good days. Drop the housework to enjoy time with your loved one.
• Read and learn all you can about depression.
• Live one day at a time.

My Own Spiritual Journey

I will preface this telling of my story by saying that I wrote much of it about 15 years ago while I was going to the Hayward Church. I shared it with Mark Belletini, the parish minister there, and told him that I would like to do a service on it with him. After setting a date for the service, I started feeling worse and worse, and finally told him I didn’t think I could do it. I put my prepared homily in a drawer and forgot about it. Six years later, we were doing a service on spiritual autobiography at Fremont, and I pulled it out of my drawer and gave it with no problem at all. I was simply ready for it.

I’ve heard it said that there is no one without a spiritual or religious need: a frame of orientation and an object of devotion. The person may not be aware if it as a “religion”, but it exists: animals, trees, idols, invisible God, ancestors, money, success, power, beauty, class, saintliness, … The list goes on.

In my case, my religion was “perfectionism” – everything I did had to be perfect, and nothing I or anyone else did ever met these expectations. I went to school, got good grades, got a PhD in a scientific field, and worked very hard at my job, believing that I had to do a perfect job, and that other than my family, nothing else mattered in life. I was totally analytical and believed that all life could be lived that way. Being raised in an inter-denominational Protestant home, I now had no use whatsoever for religion, and occasionally made fun of people who did.

My first experience with psychiatry was shortly after the birth of my daughter in 1978. I had the perfect husband, perfect child, perfect job, perfect home, etc., but couldn’t live up to my own expectations and couldn’t function. I wanted to die. My psychiatrist quickly stabilized me with a combination of drug and psychotherapy, including a period of hospitalization. I was deeply disturbed by this experience: it was further indication of my lack of perfection; the other patients frightened me; they heard voices, saw visions, etc. I couldn’t accept my ideal for myself, and that I could be like these people in any way. From time to time after this experience, I returned to the psychiatrist for help and medications to get over a difficult time, all the time hating myself because I needed to do so.

More recently, in a book by William Styron “Darkness Visible – A Memoir of Madness”, I recognized many similarities between his case and mine:

• A hereditary predisposition to depression. In my case, postpartum depression.
• A tragic loss early in life. In my case, the death of my first fiance.
• Being helped by other patients.

After several years of hating myself, and having an essentially “joyless” existence, I sat down and took stock of my situation. In the end, I decided that something had to change – I wasn’t willing to live my live this way any more. I didn’t know how or what the change would be, but it had to happen, and I was willing to do anything required for the change. I started to go regularly to my psychiatrist to explore myself. I found this a difficult, emotional and fascinating experience.

As a result of this process, I had a revelation or realization that each person is special and unique – special because of, not in spite of, their differences from the “ideal”. This is something that I felt at the depths of my soul, and that can still bring me to tears. And, I realized that I am a special person, too. This was a completely different way of looking at the world – I didn’t have to be perfect, and neither did anyone else! I began to feel very good, in fact, euphoric. Later I would learn to identify these “euphoric” feelings as the beginning of a manic phase. I thought I didn’t need medications any more and stopped taking them. This was not a wise thing to do. I ended back in the psychiatric ward, this time for depression and psychosis. But this time, I wasn’t afraid of the other patients: these were all God’s children. Like me. After getting back on medication, I quickly bounced back to “sanity”.

After this experience, I had a spontaneous interest in religion. I started going to church at the Hayward Unitarian Universalist church. I originally chose a UU church because I thought that “universalist” was a good description of my new way of looking at the world. It didn’t disappoint. I feel very fortunate to have found a safe place that I could explore my new spiritual feelings. This was enormously healing for me. I also became interested in art, and took a class in weaving, and began exploring my “right brain”, or emotional side, that I had tried to suppress for so many years. I learned to balance my life with both rationality and emotion, something I had never done before. It was as if I had been wandering around lopsided for several years and was now standing tall. I began to be spontaneously happy.

I still have to take psychoactive drugs – in my case anti-depressants and mood stabilizers to continue normal mental function. I feel very fortunate to live in a time and place where I have this alternative.

I’m telling you this, not to convince you about psychotherapy, or to tell you that self-examination brings about stays in the psychiatric ward, but to illustrate that a person can fundamentally change the way that he or she looks at the world – the values that he or she lives by, even the thing most feared, and that this can be a healthy change.

Further, as I have learned on my journey that people with other mental illnesses besides depression can have similar recoveries. That is, they can find a way of living that is positive, fulfilling and productive in the world.

In looking back at this process, I believe I was living life without any healthy spiritual outlet. I was trying to be perfect at everything, and living my life by the principles of science alone. Now, I’m just being me – getting to know who that is, and liking it. It is an adventure – a journey that I am and will always be on.

Summary

In summary I would like to read another passage from Styron’s book.

For those who have dwelt in depression’s dark wood, and known its inexplicable agony, their return from the abyss is not unlike the ascent of the poet, trudging upward and upward out of hell’s black depts. And at last emerging into what he saw as “the shining world.” There, whoever has been restored to health has almost always been restored to the capacity for serenity and joy, and this may be indemnity enough for having endured the despair beyond despair. “And so we came forth, and once again beheld the stars.” [Last line in Dante’s Divine Comedy I – Hell] (p 84)

Witness

Now, in witness to the effect that this illness has on the lives of this community, I invite you to stand as you are comfortable if you or someone you love is affected by this illness.

“You will know the truth, and the truth will make you free. ” John 8:32