Missionary
Medical
Moment
A brief summary of a current topic of medical interest to missionaries.
Topics are updated frequently; if you have a topic or question, let us know!
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MISSIONARY MEDICAL MOMENT
Depression - Part Three
(Depression - Part One and
Part Two)
In the first two segments of this discussion on the illness of
Depression, issues of causes, symptoms, and effects of depression
have been examined. In this segment, the different types of
treatment will be covered. Since to some extent the type of
treatment is determined by the cause, the reader is referred to
the initial segment (March 1999) to
review the different causes.
Obviously, if there is a primary medical illness which is causing
or aggravating the depression, then the most important treatment
should be directed toward that condition. For this reason, anyone
who has symptoms of depression is encouraged to consult a
physician to determine the presence or absence of those
medical problems (thyroid disorder, for instance) which might
affect the choice of treatment for depression.
There is no easily available laboratory or X-ray test which can
determine the presence of a biochemical imbalance which might be
causing or accompanying depression. Yet, there are many research
studies which indicate that many if not all severe depressive
episodes have some element of biochemical imbalance, and
treatment with medication designed to correct such imbalance is
often part of a treatment program.
Such medications belong to a class called Antidepressants;
in the United States, there are currently 24 such medications
available, and other countries have more. Antidepressant medications
are not tranquilizers, which are designed primarily to
relieve anxiety (which may be a symptom of depression);
tranquilizers (such as Valium, Xanax, Librium, and others) do not
have the ability to alter the biochemical imbalance.
Antidepressant medication does not cover up symptoms, but rather
is designed to restore a normal chemical balance to the system.
When antidepressants are properly prescribed, 2/3 of patients
will improve within 8 weeks, with at least a 50% reduction in
symptoms. These are not addictive medications, but
may have discomforting side effects, and may take several weeks
to begin to have beneficial effect. Some of the newer
antidepressants (Prozac, Zoloft, Paxil, Celexa, Wellbutrin,
Effexor, Remeron, others) have better side effect profiles.
In view of the high incidence of recurrence in depression (see
Missionary Medical Moment, Part 2), it is very important to continue medication
for an adequate period of time. Treatment with antidepressant
medication should continue for at least six months for first
episodes, and for several years or indefinitely for recurrent
episodes.
Non-medical treatments such as psychotherapy or
counseling should be used in the treatment of depression.
There are different styles or theories of counseling; the more
traditional analytically based treatments will focus on
an examination of recurrent emotional reactions which may have
roots in childhood, cognitive therapy will focus on the
tendency to develop erroneous patterns of thinking and behavior
which can cause conflict.
A problem for Christians undergoing counseling treatment may be
that many of the traditional types of counseling focus on
understanding and improving the self, while Christ calls
us to deny self. Biblically based counseling seeks to
find unconfessed sinful patterns and roots which may interfere
with a believer's experiencing the joy of the abundant life
Christ promises His servants.
Research studies have consistently shown that the best
treatment results are seen with a combination of
antidepressants and counseling. Other treatment approaches
may be recommended, either alone or in combination: bright
light therapy may be recommended if there is a significant
seasonal component, and herbal remedies (St. John's Wort,
for example) have shown some promise (see Medical Missionary
Moment, February 1999: Herbal Treatment of
Depression).
Depression is a treatable, recoverable disorder. The person
suffering from depression must be persistent, and must hold
on to faith, even when feelings might suggest otherwise. A
frequent symptom of depression may be hopelessness, but
we have reason for hope.
Thousands of years ago, the prophet Jeremiah described his own
feelings of hopelessness: "I am the man who seen
affliction ... He has driven me and made me walk in darkness
and not in light ... And my soul has been rejected from
peace; I have forgotten happiness. So I say, "My strength
has perished, and so has my hope from the Lord".
(Lam 3:1ff).
Yet, less than three verses after his lament,
Jeremiah proclaims the truth of what we know makes dealing
with depression, as well as other worldly stresses and problems,
have a hopeful outcome: "This I recall to my mind,
therefore I have hope. The Lord's lovingkindnesses indeed never
cease. For His compassions never fail. They are new every
morning; great is Thy faithfulness. 'The Lord is my portion',
says my soul, therefore I have hope in Him. (Lam 3:19, 22-24).
View Other Missionary Medical Moments
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