What most people associate with depression is a feeling of gloom or sadness, but there is a much more important set of symptoms to keep in mind: depression is usually accompanied by a “slowing down” of the body. A profound lethargy or fatigue is probably a more important signal that you have succumbed to depression than whether or not you feel profoundly sad. The more pronounced the fatigue, the more serious is your depression.
What are the more common symptoms of a major depression? Usually, it is diagnosed when at least five of the following symptoms are present during the same time period, with at least one of the first two symptoms present. In addition, the symptoms must be present most of the day, nearly daily, for at least two weeks:
Reactive depressions can have some or all of the above, but they are usually not as debilitating. Most people with reactive depression can continue their normal work and home duties. With the more serious endogenous depressions, people can become totally incapable of fulfilling normal life responsibilities.
Primary care physicians need to be alert for the signs of depression. Studies have shown that 6 to 8 percent of all outpatients in primary care settings have major depressive disorder. Often, their physical complaints are a mask for the depression.
If you find yourself experiencing any of the following, you may want to ask whether you are depressed:
Lesser forms of depression may produce some or many of these symptoms or the symptoms may not be as persistent. Discuss this with your doctor to see if you are possibly suffering from a “low grade” form of depression.
Tim and Sandra sit close together on their porch swing, holding hands. It's hard to believe that less than a year ago, they'd discussed selling their house, splitting their possessions and sharing custody of their three children. The couple explains that a common but treatable illness nearly destroyed their strong 12-year marriage.
"I remember the day it started," Tim says. "I walked into the kitchen one morning and Sandy was just sitting on the floor. She was still in her bathrobe, and her eyes were swollen from crying."
When Tim asked what was wrong, Sandra told him she honestly didn't know. Their lives were good. They weren't struggling financially or having problems with the kids. She knew there was no reason to cry, yet the tears returned every morning from then on. Her concentration began to slip as well, leading to mistakes that almost cost her a job she loved. Finally, Tim insisted she see a doctor.
"I sure didn't like the diagnosis," Sandra explains, shaking her head. "I expected him to give me vitamins or tell me not to work so hard. I never anticipated what he would actually suggest."
After several tests, Sandra's doctor told her he believed she was suffering from a depressive disorder. He explained that our bodies need to maintain stable levels of the chemical serotonin to function normally — but the receptors in Sandra's brain were blocking its flow to certain areas. When he suggested she try an anti-depressant drug to trigger proper serotonin absorption, she refused.
"I left his office feeling conflicted," Sandra says. "Tim and I were both raised to believe that true Christians were happy, thankful people. I was convinced that my misery was caused by a lack of faith, not a medical condition. But truthfully, I wasn't sure which option scared me more. I couldn't even bring myself to tell Tim that the doctor had called my mental health into question."
Over the next few months, Sandra tried to bury her secret — but her sorrow was too pervasive to hide. Their frightened children began asking what was wrong with Mom.
In the meantime, Tim admits his concern turned to frustration. "I'd ask again and again what was wrong, but she never had an answer," he says. "Not only was I aggravated by my feelings of helplessness, I was angry the life I'd worked so hard to provide wasn't enough to make her happy."
"And the more angry he got, the more he'd withdraw from me," Sandra adds. "Then I'd feel guilty and withdraw even more. We just kept drifting further apart."
Despite her efforts to pray during that time, Sandra admits she found it almost impossible to muster the strength or the words. She felt she was not only losing her mind and her family, but now even God had abandoned her.
Tim and Sandra's story likely rings true for many couples. According to the National Institute of Mental Health (NIMH), one in five adults in America will suffer from a diagnosable mental disorder in a given year. Women face these illnesses twice as often as men, but statistics show men are highly under-diagnosed due to an unwillingness to admit they're struggling.
Stigmas and misconceptions often prevent those with depressive illnesses (which often include anxiety and panic) from getting treatment. For some, words like mental illness and therapy still evoke images of patients in strait jackets or neurotic movie characters with phobias of germs, elevators and their shadows. In reality, depression can be much less obvious. Even so, it still debilitates and destroys its victims if left untreated.
A few key signs of depression are:
If you recognize any of these symptoms persisting in a spouse for more than a few weeks, check with your family doctor.
Flight attendants always tell you to put on your own oxygen mask before helping someone next to you. In the same way, it's important to prepare yourself before attempting to assist others when a spouse is depressed. Deep sorrow can be infectious, and it's not uncommon for caregivers to develop symptoms of depression themselves. Guard against this possibility by eating well, exercising, getting enough sleep, and staying in the Word.
Also keep an eye on your kids. Children are often vulnerable to a parent's anxiety. One study indicates that 20% of 10-year-olds whose mothers suffered from depression were themselves victims within five years.
Don't underestimate the value of caring friends and family at times like this. Let loved ones help you with day-to-day tasks, and allow them to listen to and pray with you. The surest way to intensify your struggle is to isolate yourself and your immediate family from those who love you.
When a care-giver understands that clinical depression is a genuine medical condition, he or she may actually feel empowered. It's encouraging to realize there are a number of tangible ways to help a spouse who is depressed:
Once Tim and Sandra overcame their fears and misconceptions about mental illness, they began to counsel with their pastor each week. Sandra also returned to the doctor. Within a few months, she felt like herself again, thanks to a low dosage of a Selective Serotonin Re-uptake Inhibitor (SSRI). The medication helped bring her serotonin levels back into balance. Their children were thrilled to see Mom smiling again.
The couple, now co-leading a mental illness support group at their church, discovered that they could survive depression with teamwork, education, empathy and a lot of prayer.
"The Lord has really blessed us by allowing this experience to bring us together rather than tear us apart," Sandra says. "When times were toughest, Tim decided not to give up on me — and that decision has radically changed our lives."
Helping families thrive together.
Approximately 25 to 30 percent of the general population fits the description of an introverted personality. That is, they don't need a lot of external interaction to be energized. Their focus is more on their inner world of ideas, thoughts and reflections. It's normal for this to be even more clearly expressed during the teen years.
Isolating himself, on the other hand, is not healthy. Isolation may be symptomatic of depression, drug or alcohol use, anxiety or illegal behavior. Here's how to tell the difference. Symptoms of problematic isolation include secrecy or defensiveness when asked about his activities, anger, aggressiveness, declining academic performance, lethargy, difficulty concentrating, trouble with authority or pushing away existing relationships. Then it's time to talk with him and/or get help from a youth pastor, teacher or counselor.
If all other aspects of his life seem normal, it's likely that a healthy introverted personality may simply be manifesting itself. But better safe than sorry. If you're still uncertain, talk with him about your concerns.
In the beginning, it seemed we had the perfect life. Earle was a youth pastor, loved for his zany humor and yet so serious about his commitment to Christ. I was Earle’s “dream girl,” a former cheerleader.
Together we worked with the kids in our youth group. Soon after our wedding in 1985, Earle took a senior pastorate. I jumped right into music ministry and all the hospitality-related tasks of a traditional pastor’s wife.
God blessed us with three beautiful daughters. Earle eventually left the pastorate to begin working for Focus on the Family. I taught piano lessons from our home. God blessed us in such tangible ways — perfect timing in the purchase of a home, an incredible deal on a grand piano, a teaching schedule that was always full. Yet on the inside, our hearts were dying.
In the spring of 1995, our youngest daughter was diagnosed with IGA deficiency — a condition in which her immune system never fully developed. We were told there was no cure and no hope for improvement. She would be at greater risk of getting cancer or an auto-immune disease, and would be more susceptible to other illnesses (God saw fit to heal her immune system two years later — but that’s another story!).
At the same time, Earle’s dad was fighting a losing battle with kidney failure. A favorite nephew of Earle’s was also dealing with mental illness that ultimately led to suicide.
Earle was also struggling at work. God blessed him with excellent people skills and incredible discernment, and for 13 years he had ministered to the needs of hundreds of people who called in to Focus on the Family. He listened compassionately as people poured out their stories of pain and tragedy, betrayal and heartache.
He thought he was able to let it all go and not be affected by the stories he heard. But the accumulation of so many years listening to peoples’ troubles was taking its toll. The youth pastor who used to stay up all night with his youth group or drive 300 miles for a day of water-skiing, now wanted only to stumble through the door after work and watch TV.
In November 2000, during a belated getaway to celebrate our 15th anniversary, Earle’s world unraveled. He was in tears; hopeless, afraid, unable to eat. He met with a psychiatrist soon thereafter.
We learned that one type of depression is caused by a serotonin deficiency in the brain. Because of the severity of his condition, he was put on medical disability. He remained off work for three months. He was given anti-depressant medication and spent significant time with a counselor.
Here’s how Earle describes this time:
"Mental illness runs in my family, and yet there has always been a lot of denial and shame about it. For a long time, I thought if I just kept focused on God's Word, I'd find relief. But the depression just got worse.
“Spiritually, I couldn’t feel God’s presence. I couldn’t understand why He didn’t heal me. Reading the Bible didn’t help. I couldn’t even pray. Others had to pray for me. Only after I’d received some counseling and started taking anti-depressant medication did I start to feel better.”
According to Earle, “Fom the very beginning, Karen and I talked openly to the kids about depression and why I was the way I was.
“Our youngest seemed not to notice my illness. Our oldest daughter, who was 12 in 2000, also handled things OK. She was busy with her friends and school activities. Our middle daughter had the hardest time. She felt insecure seeing her daddy sick, but she had a particularly good public school counselor who was able to help her through things.”
During his time off work, Earle attended counseling appointments several times a week. He explored his insecurities and fears. He relaxed, made sure to accomplish some small task each day, watched his diet and walked. He and I walked and talked for hours on end. By the end of the three months, he was able to return to work, though never again on the phones.
I would like to be able to say we’ve lived happily ever after. But that’s not the case with clinical depression. When things are not going well, the doctor may try a different medication or a different dose. Sometimes this results in a terrible nosedive that may take weeks to stabilize. But depression is a manageable medical condition.
How has it affected our marriage? In many ways, it has brought us closer together. We have learned to share our hearts with each other. We've learned to look at a situation and figure out why it caused such pain.
It hasn't been easy. There are times when Earle is angry and withdrawn. He is often exhausted. I often feel overwhelmed with having to shoulder much of the responsibility for running the home and family. And I sometimes get discouraged knowing we serve a Lord who could reach down and heal this in an instant — but has chosen not to do so.
Earle and I have learned the meaning of our wedding vows, “in sickness and in health.” We are committed to sticking together and working through this. And we have learned how little most people know about mental illness.
Some friends have withdrawn from us because they are uncomfortable talking about it. Others have told us this is a spiritual issue and that if we just pray more and praise God it will all go away. But by far the most common response has been one of compassion, as people have rallied around us even though they don’t completely understand our situation.
Friends have prayed, listened, brought meals, helped with a variety of tasks, given money, taken the girls when we needed time alone, given gifts and words of encouragement, and just “been there“ for us.
Earle has been incredibly open and honest about his illness. Right from the start, he has been willing to share his story. He is quick to encourage others to get help. He is quick to inform people that this is a real medical condition, something that can be helped through medication and not something to be ashamed about.Earle is living proof that someone depressed enough to be off work for an extended period can regain the health to return to a full-time career.
When Earle was still on disability in early 2001, I tried to be a compassionate, loving wife. I was there at every instant, to talk or listen. While often exhausted and stressed, I gladly carried the responsibilities of the home and children. And I enjoyed the support of friends who rallied around us.
By the summer of 2001, I felt Earle and I had never been closer. I was actually thankful we went through this ordeal, which I thought was basically over.
But the years have been tough on me. Sometimes I feel angry when it’s not clear how I should respond to Earle’s moods. There are times I cry out to God, saying I just can’t take it anymore. And then Earle does something that shows his true character — that of a responsible, godly family man who would die for any one of us. Like him, I ride these ups and downs; and like him, I hope for a brighter future.
Our story is still in progress. But we tackle each challenge as it arises, and thank God that Earle has been able to keep working. And we make ourselves available to others who are struggling, thankful that God can use our trials to help others. We live every day fully aware that there are many godly, Christ-centered families who turn daily to the Lord to gain the strength to win their battle against clinical depression.
Twice, I have seen my father cry. The first time, I was 12, and my sister, Jenny, was 14. She was diagnosed with juvenile diabetes and needed further testing. When we arrived at the hospital, my dad walked around to her side of the car, gathered her into his arms and held her. None of us understood what was happening to my sister's body, but when I heard my strong dad's voice break with tears, I knew we were on a new and unexpected path.
Almost 10 years later, in the fall following my college graduation, I was the one my father gathered into his arms. At 22, I was diagnosed with clinical depression and voluntarily admitted to a psychiatric hospital. At a time in my life when the world was supposed to be opening up to me, I found myself retreating. Apathetic, uncaring, tired, and with no particular vision for any future, I subtly drifted into a world without hope. My family and I knew I needed help.
As a child, I had great passion for life. The simplest of pleasures brought unexplainable joy. I seldom demonstrated a melancholic personality. In fact, my parents learned that birthdays, Christmas and any reason for celebration would find me in a delirium of excitement. I loved life, and I loved being alive. When depression struck, I was dropped into a world where wearing my own skin was foreign and ill-fitting.
My mom says that one of the hardest days of her life was the day I checked into the hospital. My personal belongings were rummaged through, and I headed down the long hallway to doctors and a treatment team that became my “family” for the next month. Her drive home, leaving me behind, was heartbreaking. She was left to wonder and guess at why her daughter was in so much pain and why she couldn't fix it this time.
I was numb, trying to see through a haze that had settled upon what once was vivid and bright. All color had seeped from a life that used to hold such joy. Some people didn't understand my depression. They regarded it as a bad case of the Sunday evening blues, believing that if I tried harder and stopped feeling sorry for myself, I would “get better.” But I wasn't just dealing with apathy toward routine. I couldn't remedy being sick with a strenuous run, a good movie, or simply the passing of time. Depression transcended my circumstances and invaded my soul. It was more like a day terror — like waking up to a nightmare. Clinical depression painted my world black while screaming quietly that I was worthless.
I remember driving home from work the week before I checked into the hospital. My co-workers hadn't noticed any difference in my performance or behavior. I was great at keeping up appearances. I was good at performing. But that evening, I recall wishing I weren't alive, wishing my car would turn down an empty road and I could disappear. Upon arriving home, I headed straight for my room and slipped under my covers, hoping to sleep. I wanted to escape life because it hurt to breathe.
By the end of my first week at the hospital, I had made up my mind to leave. It wasn't working. I packed my bags, headed to the front desk, and announced that I was calling my parents to come and pick me up. But my treatment team told me I needed to stay. Defeated and scared, I returned to my room, unpacked my bags and cried myself to sleep. It was time to get honest with myself.
I was angry. Me, happy Alice, with so much going for her. Stripped of the world's accolades, it didn't matter what school I had attended, where I had vacationed, what awards or pageants I had won. It didn't matter who I knew, didn't know, or thought I knew. What mattered to those surrounding me was that I was honest about my feelings. They didn't have to be pretty. I didn't have to look good. I could just be — and that was enough.
It was the kindness, compassion, love and truth demonstrated in the hospital that began unlocking my wounds, hurts and distorted thinking. I was learning from the worn lives around me. Lives I would have once felt pity for or wanted to distance myself from. They were the ones who possessed strength and courage. They had suffered abuse, neglect, addiction and illnesses. They felt misplaced and forgotten; they were told they didn't matter. I came from a family filled with love, but as I and others in my hospital “family” shared our suffering, I found I needed their love.
When I was depressed, I was completely turned inward. I couldn't see past my own shame. It warmed me, but like a scratchy wool blanket, brought its own discomfort. The irony is, until I recognized my depression for what it was, I wasn't able to turn outward and accept love and love in return.
Getting help and getting rid of the junk cluttering my mind were part of getting better. Hope came gradually, with small steps that slowly returned feeling and clarity. I was changing. My thinking was being altered. I was given a truer sense of who I was: a young woman who needed to be loved for herself, not for what she could offer — not for how she could make you feel. Being honest in the hidden places of my heart. Taking personal responsibility. And slowly, the desire to live, the courage to want to live, began to return. Once truth reveals deception, the lie can no longer deceive unless we choose to let it.
A year and a half after my release from the hospital, I drove along a country road. The moon was bright. The stars brighter. Snow gave a fresh milky coat to the trees, and the night air was full and dark. I felt so alive. I hadn't believed there would ever be something good enough or rich enough to make up for the pain and darkness I had known. My pain had been deep. But on this quiet stretch of road, I knew it had all been worth it. I knew that life was different because of my experience. Suffering had painted color into my life, and I could be thankful.