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Treatment for Depression, Pt. Two

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Your brain is amazing, sensitive, powerful, complex, and the main resource you possess to allow interaction with God, thus determining not only your life course, but also how enjoyable your life journey will be. We’ve already discussed some basic, but key, lifestyle disciplines which not only help you maintain your physical and brain health, but also either prevent or help treat depression.

Depression has afflicted people since the beginnings of written history, but even though we’ve only had psychiatric medications starting in the 1950’s, people did get better and were healed from their depressions. The 1990’s was declared the ‘Decade of the Brain’ as billions of dollars were invested in so many research studies to examine the human brain – what injures and what heals our precious brain cells.

In this article, we’ll cover the topic of professional behavioral health treatments, which are specifically designed to directly affect brain chemistry for the relief of Depression and it’s various symptoms. These treatments fall into 3 categorizes – psychological, biological, and spiritual.

Psychological: Decision-Making is the Exercise for the Brain

The most powerful and lasting curative intervention for our brain chemistry is Decision-Making. Just like exercising, when we do a good pushup, we don’t see any macroscopic changes in our muscles or physique, but we get microscopic improvements and strengthening in our muscles, bones, ligaments, and blood vessels and future workouts become easier. When we do a pushup the wrong way, we microscopically (and sometimes macroscopically) injure our muscle, bones, ligaments, etc.

Decisions influence our brain chemistry the same way. When we make a good decision, microscopically, our brain chemistry gets stronger and the circuits become more efficient. When we make wrong decisions, our brain chemistry gets injured, warped, or we develop faulty circuitry making it easier to make the wrong decision in the future. Research shows the accumulation of good decisions having a powerful, positive, and healing effect, while an accumulation of wrong decisions injure or hijack our brain chemistry and make it more likely for wrong decisions unless we intentionally override those circuits. Think bad habits, pornography, or other impulsive or unhealthy thought or behavior patterns.

Slowing down the activity in your mind, managing your emotions, being more intentional in situations, and making better decisions is the best long-term solution for renewing, transforming, and healing your brain, mind, and life. 

Psychological: Talk Therapy Actually Changes Brain Chemistry

We’ve all observed in our own lives and in those around us, when we’re able to see life more clearly, have better life management and relationship skills, and make better decisions as discussed above, our psychological health and enjoyment improves and we mature. Over the years, we suspected the healing people got came from better skills and the healthier decision-making helping brain chemistry. But medical science now shows us clear evidence of the powerful changes to our brain chemistry that occur when we develop and implement psychological skills. We call this characteristic of the brain neuroplasticity, meaning our brain chemistry isn’t frozen, but is fairly sensitive to and can be influenced and modified by many factors.

Talk therapy is a term used to describe the various methods therapists use to help people see reality more clearly, identify and purge the misinformation in our memory’s databanks, and manage our emotions, all to make and execute healthier decisions. Simply, talk therapy, when implemented the right way, is a neurobiological intervention, actually changing our neurobiology by helping us be better decision-makers.

Many psychotherapies (talk therapy) are practiced, and I will give a brief description of the main ones used to help all behavioral health issues, and especially depression. Although each therapy has a specific focus and strategy, overlap exists and all therapists weave several together to develop their own combination to help a person overcome psychological struggles and achieve their God-given potential:

  • Cognitive Behavioral Therapy (CBT) helps a person expose and correct faulty cognition (thinking, beliefs, attitudes) patterns to better regulate their emotions and behaviors (decisions). The CBT triad – events precipitate thoughts which evoke feelings – all producing our decisions/behaviors.
  • Dialectical Behavioral Therapy (DBT) is an offshoot of CBT and tries to really slow down, identify, and accept the thoughts and feelings going on in our mind so we can determine which ones are healthy and help us attain our goals and which aren’t.
  • Psychodynamic Psychotherapy is the more fundamental talk therapy practiced the last 50 years and the primary offshoot of classical psychoanalysis which believes our past experiences play a role in our present struggles. This therapy’s core recognizes our present functioning is a result of the unconscious (e.g. thoughts and feelings of which we are not aware) patterns in our minds which are produced by the dynamic interplay of all our past experiences, how we interpreted them, and the coping skills or defense mechanisms we developed to deal with past hurts or to help us achieve our future goals. This therapy helps us explore our past and dig into our mind to uncover, correct, and heal these unconscious thoughts, patterns and coping skills for psychological health and well-being.
  • Behavioral Therapy focuses on identifying, deleting, and correcting our behaviors, which hinder our functioning and lead to problems or depressive feelings. It could be as simple as increasing your smiling behavior when meeting people or as complex as stopping a relational behavior of dating abusive or controlling partners.
  • Motivational Interviewing (MI) identified the problem that people don’t like to be told what’s wrong and what they have to do. So even though MI is therapist guided, MI empowers with motivation to change by having the patient identify their own life-disrupting behaviors, the consequences of continuing those behaviors, and the advantages and goal attainment of healthier behaviors. Then the therapist guides the patient to devise realistic and incremental steps to move away from those dysfunctional decisions and toward healthier decisions. Patient planned so more likely to implement.
  • Meditation focuses on dramatic simplification as the mind is focused on specific items to ward off and escape the clutter and distractions the stressful world and spiritual battle bombard us with on a regular basis. Meditating is used to relax and de-stress, but then we are able to take this skill out into life, and when faced with adversity, we can relax, de-stress, take every thought captive and think more clearly, and then problem solve to make good decisions.
  • Emotion Focused Therapy focuses on the powerful beneficial use of our emotions to help a person change problematic emotional states and uncomfortable inner attitudes and experiences when we understand the role of our emotions and how tolerate, control, and manage them better.
  • Interpersonal (Relationship) Therapy (IPT) believes interpersonal problems are a significant part of depression, focuses on building skills to deal with these problems, and differs from other types of depression talk therapy because it emphasizes external relationships rather than the patient’s internal mindset.
  • Goal Directed or Problem Focused Therapy is short term focusing on pragmatic, concrete, realistic and attainable goals and uses some combination of the above therapies to overcome basic obstacles and achieve goals to overcome depression.
  • Eye Movement Desensitization and Reprocessing (EMDR) focuses on distressing memories, when poorly processed, cause depression. Focusing on these distressing memories, while making certain eye movements, helps the brain to process the memories properly, and this helps to reduce the depression they cause.
Working with a professional who uses these talk therapies helps us work through our thoughts and feelings allowing us to identify, examine, and correct patterns that impact our life. Understanding these patterns helps modify our thoughts, feelings, and decisions to re-circuit our brain, overcome depression, and transform our life.

Biological: Psychiatric Medications Reduce Symptoms

As we discussed earlier, the psychological interventions of being a better decision-maker using the talk therapies do alter brain chemistry, but the effects take some time to impact depression and other psychological struggles. Think of having heart problems and chest pain. Necessary skills to heal the heart are exercise, better nutrition, lose weight, get more sleep, reduce and handle stress, manage conflict, reduce people pleasing, set boundaries, communicate better, express emotions better, etc. But doing all these skills today doesn’t take away your chest pain or high blood pressure. It takes 3-6 months, then the symptoms and illness start to subside. But while we’re waiting, we give blood pressure or heart meds so you don’t have a heart attack or stroke, because meds work a lot faster.

Psychiatric medications, like talk therapy, do alter brain chemistry, but unfortunately, the effects are temporary and our brain chemistry reverts back to previous functioning when the meds are stopped. Many people are afraid of psychiatric medications, so even though psychiatric medications don’t cure any illness, they serve a very valuable role like in the above heart situation, because meds work quicker than skills to change brain circuitry, relieve symptoms, and avert danger.

While the following psychiatric medications don’t cure any depressive disorder, their quick soothing and dramatic reduction in depression symptoms buys time so talk therapy and spiritual growth can produce the decision-making skills that when watered and nurtured into positive habits, bear the fruit of longer term healing for the various depressive disorders

Psychiatric medications to relieve depression come in several categories based on their chemical structure, effect on neurotransmitters (serotonin, norepinephrine, dopamine, gaba), and how they impact the brain’s internal communication circuits.

  • Antidepressants are the most prescribed class of meds for depression as each is helpful about 70% of the time and the newer ones since 1987 are well tolerated with minimal side effects. Common examples are Prozac, Zoloft, Lexapro, Cymbalta, and Wellbutrin.
  • Mood Stabilizers aren’t as effective for deep depressions as antidepressants, but are the primary treatment for Bipolar Depression since they stabilize mood between depression and mania and are less likely to cause a person to flip from depression to mania. Although very effective, patients have a higher chance of experiencing nuisance side effects than on antidepressants. Common examples are Lithium, Topamax, Lamictal, Neurontin, Depakote, and Trileptal.
  • Antipsychotics/Major Tranquilizers are a growing class of meds that are not first line for depression, but are beneficial in combination with either of the above 2 classes. They are very beneficial for the distorted thinking, anxiety, insomnia, and decreased appetite often seen in depressive episodes. Again, nuisance side effects are more common than antidepressants, but for deep and impairing depressions, the benefits are usually worth it. Common examples are Latuda, Abilify, Risperdal, Seroquel, Saphris, and Invega.
  • Antidepressant Augmentors are medications from different classes that have been shown to be beneficial when added to antidepressants. The most studied are Lithium, Thyroid hormone (T3 and Synthroid), and stimulants (Adderall, Modafanil).
  • Alternative treatments are more naturally occurring and non-FDA regulated options. You can find many on the web, but the ones with good scientific data supporting their benefit to alleviate depression are St John’s Wort, Omega-3 Fatty Acids, SAMe (S-Adenosyl Methionine), Vitamin D, Folate, Zinc, Saffron, and 5-HTP (5-Hydroxytryptophan). These can be obtained at general health food stores without a prescription, but don’t be tricked into thinking natural is safe. Many natural substances are toxic, can interact with other medications, or even be deadly. So be sure you discuss these options with your doctor just like you would any other medication.
Remember, if medications were only helpful with no side effects, we would put them in our water supply. So each of the groups I described are incredibly helpful for depression, but also can have potential side effects. Each person needs to discuss with their doctor and weigh the pros and cons to make the safest and long-term healthiest decision for themselves and those they impact. Some people fear medications, but God has provided them through science to help us function better – when they’re prescribed and explained by a professional specialist for depression and then taken appropriately.

Biological: Non-Chemical Brain Treatments

In addition to medication, there are several different therapies shown to have a fairly direct and quick effect on our brain chemistry and functioning and I will describe the ones with good scientific research showing consistent benefit. When used, all of these treatments (except Light Therapy) are used in combination with medications and talk therapy and never used as the only treatment for depression.

  • Light Therapy is exposure of the eyes to bright light emitted from a box or lamp for a suitable duration, often in the morning. Different devices may use different parts of the light spectrum, at different intensities of illumination. Light therapy was originally used to treat Seasonal Depression (SAD), and thought to work by fixing disturbances in the body’s internal rhythms caused by less sunlight in winter. It is now being used to augment antidepressants for non-seasonal depressions, but not effective on it’s own. These devices can be bought over the internet or at medical device stores and are often covered by insurance with a prescription from your doctor. The only harmful side effect is flipping a person from depression to a manic episode for those with Bipolar Disorder.
  • Electroconvulsive Therapy (ECT) uses electrical currents passed through a headband to the brain to cause a controlled seizure in the brain which stimulates deeper emotional centers. To minimize any danger, the seizure (also called treatment) is induced after the patient is given general anesthesia and muscle relaxants. ECT is actually safer than medications, especially for geriatric or pregnant patients. The main side effect is some temporary memory loss which resolves after several months. Seizures are induced every other day for about 2-3 weeks for maximal benefit. Because of the expense of needing a hospital setting, ECT is reserved for severe psychotic or suicidal depression or refusal to eat or drink that has not responded to other treatments. ECT is also known as ‘electroshock therapy’.
  • Transcranial Magnetic Stimulation (TMS or rTMS), being a more refined form of ECT, uses harmless magnetic fields to generate smaller electrical currents to specifically target and stimulate the deeper emotional centers of the brain. Since the whole brain isn’t stimulated, a seizure doesn’t occur, so anesthesia and muscle relaxants aren’t necessary and memory impairment is minimal. TMS is usually administered daily by a trained clinician as an outpatient procedure, mainly for people who have tried other antidepressant treatments with minimal relief. Insurance occasionally covers it.
  • Vagus Nerve Stimulation (VNS) is a type of brain stimulation. It requires surgery to insert a stimulator device (like a ‘pacemaker’) and wiring under the skin in the upper chest and neck. The stimulator is connected to and stimulates the vagus a nerve in the neck that sends electric signals back up into the brain to influence the emotional centers. VNS is used mainly for people with long-term, severe depression and its results are mixed.

Spiritual: Accessing Divine Power

Depression is characterized by hopelessness, despair, sadness, loneliness, shame, guilt, confusion, with a lack of meaning, value, purpose, a distorted sense of reality, and an overwhelming dread of the next minute. Psychological and Biological interventions are helpful, but the most powerful treatment we can access is the healing power of knowing our Creator, the most powerful being of the universe. God’s love, forgiveness, and peace start to melt depression and it’s diabolic tentacles into all areas of our life.

The two ways we connect to God and receive His power, love, forgiveness, and peace are the two most important coping skills and depression treatment needs to incorporate:

  • Reconnecting to God: Some call this being born again, others call it being saved, redeemed, or reconciled. Because of our sin, we are born separated from God. We can never do enough to become worthy of paying the debt for our sins. Thankfully, because of God’s love for us and His desire to reconnect with us, He made a way for the penalty for our sins to be paid in full. Because of Jesus’ love for us, He was willing to die and pay all of our penalty for us. The only requirement of us is to accept this grace gift from God and believe Jesus is your personal Savior and the only way possible to reconnect with God. Upon doing this, the Holy Spirit comes to live in us, bringing so much power, knowledge, peace and influence if we submit to Him. Click here to read more about this powerful step!
  • Confession: Once we become saved and have a permanently restored relationship with God with the Holy Spirit living in us, we still occasionally sin. Sin doesn’t lose our relationship with God, but does put an obstacle in our relationship, and numbs us to the influence, peace, joy, and power the Holy Spirit brings us. God provides a way for us to rebound from that state, remove the obstacle of sin, and access the Holy Spirit and all the help He brings. This powerful rebounding coping mechanism is simple but drastically underutilized, and it’s confession. 1 John 1:9 states, “if we confess our sins, God is faithful and just to forgive us our sins, and cleanse us from all unrighteousness.” This simple act of naming our known and unknown sins to God removes that temporary relational barrier, and restores the Holy Spirit to the throne of our mind. Click here to read more about Confession!

Spiritual: Applying Biblical Truths

Earlier we discussed the power decision-making has to strengthen, re-circuit, or as the Bible says, renew the mind. The many talk therapies focus on helping us understand the thinking, or processing, our mind does when we’re faced with life’s situations, how to identify and manage the emotions produced by that internal processing, then how to determine and carry out good decisions.

Where psychology falls short is determining what defines clear thinking and healthy decisions. The Bible says in 2 Corinthians 10:5, “take every thought captive to the obedience of Christ.” The Bible describes more accurately than any other psychiatric or medical book ever written, not only what life around us is all about, but also and especially, what is going on inside our mind, how it gets broken, and the best way to heal it. It makes sense that the one who created us knows all these truths, and He reveals them to us in His instruction manual, the B.I.B.L.E. (Best Instruction Book for Living Everyday). So applying these powerful truths will both psychologically maximize the skills from talk therapies as well as biologically renew brain circuitry.

The Bible teaches and shows examples of great decision-making. Sometimes they seem complicated or we are uncertain about what they mean or how to apply them. But as we grow our relationship with God, spend time talking to God, studying His instruction manual, and confessing our sins so we have the Holy Spirit guiding and revealing these Biblical applications to our daily circumstances, daily living becomes easier, while joy, peace, and love wash away depression and many other psychological struggles as we excitedly fulfill our God-given potential.

Jesus: The Perfect Role Model

Jesus dealt with sadness and overwhelming uncomfortable feelings many times when: friends died; concerned about His own impending arrest, torture, and death; facing countless extreme rejections and stonings; belittled and mocked; seeing people He loved reject God and go to eternal damnation; and being forsaken and abandoned by His Father on the Cross when He bore the extreme punishment for our sins.

Jesus dealt with these intense emotions as well as more temptations, abuse, and unjust treatment than anyone who ever lived, but was able to maintain perfect thinking and decision-making when adversity was extreme. He did this because He was obedient and submissive to the Holy Spirit and His Father’s influence minute-by-minute and He knew and applied the teachings of the Bible to make Godly decisions.

Jesus’ perfect holistic model: perfectly apply spiritual truths to accurately psychologically process life and make perfect decisions, which formed perfect brain chemistry!

Dealing with depression and other mental illness is a daily battle, but it is one we can fight confidently as Jesus taught and role-modeled for us because of the promises of God: He loves us, He forgives our sin, He has saved us, and He will provide for us. As Christians, we have these same assets as Jesus – a relationship with God, the Holy Spirit in us, and the word of God to teach us. Ultimately, we need power, strategy, and leadership from God in our fight against sin, death, and Satan. The greatest weapons we have are the death and resurrection of Christ, the Holy Spirit living in us, and God’s Word, the B.I.B.L.E. Lean on them and the following passages!

 

John 3:16 For God so loved the world, that He gave His only Son, that whosoever believes in Him should not perish, but have everlasting life.

2 Corinthians 10:4-5 We use God’s mighty weapons (decision-making), not worldly weapons, to knock down the strongholds of human reasoning and to destroy false arguments. We tear down arguments, and every presumption set up against the knowledge of God (God defines reality); and we take captive every thought to make it obedient to Christ. 

1 John 1:9- But if we confess our sins to Him, He is faithful and just to forgive us our sins and to cleanse us from all unrighteousness.

Romans 12:1-2And so, dear brothers and sisters, I plead with you to give your bodies to God because of all he has done for you. Let them be a living and holy sacrifice (Godly decision-maker)—the kind he will find acceptable. This is truly the way to worship him.  Don’t copy the behavior and customs(decisions) of this world, but let God transform you into a new person by changing the way you think. Then you will learn to know God’s will for you, which is good and pleasing and perfect (and do it).