Dear friends,

We need to change the way we perceive mental illnesses and depressive illnesses or they will remain just as debilitating and deadly. Depression has become an epidemic. So has autism and other disorders.  You and I live in a rapidly changing world and it might take awhile to pinpoint the cause, but in the meantime we need to learn all that we can so we can help those suffering.

I may be a dreamer, but I am also a realist.  I like solid evidence.

Six years ago I wrote about depression, here. I find that I still stand by what I wrote then, but in that last six years I have had much more experience with this horrid, deadly, misunderstood and very treatable illness. The majority of my personal experience is with postpartum and major depression, which are basically the same thing, different causes. You can read about some of my personal experience, here.

I find that most who think this is not a medical illness usually admit that they have never researched depression, (and they carelessly throw out their unfounded and very strong opinion) or they are the sufferers themselves who doubt because it is hard to see past the dark cloud and perceive things realistically.

What if people treated physical illness like mental illness? Read this thought provoking article, here.

I am not saying we can’t get depressed from life choices—we can. That can be fixed by changing our ways.  I am talking about depression, caused by a chemical imbalance*, that is no fault of our own. The human body does not end at the neck, as our pastor notes, and our brain is subject to sickness like the rest of the human body. Depressive illnesses are disorders of the brain.  You can read about it here and here and here and here and here and a thousand other places.  It is common knowledge in the medical world. You can reject this knowledge, but you will need to reject facts about heart disease, cancer, diabetes and other common illnesses to be consistent.

Here is a very simple, informative video on how depression and other illnesses and treatments affect the brain:

Some of the most bothersome symptoms I observe/experience are hopelessness, insomnia, ruminating and intrusive thoughts.  Insomnia increases the hopelessness and hopelessness increases the insomnia, but both are caused by a chemical imbalance.  The hopelessness is always unreasonable and often requires medical intervention. A depressed mind is not capable of good feelings—that is why it is called depressed. If it was capable of good feelings this illness would not be an issue—we would simply think happy thoughts and be on our way. I have never found any amount of spiritual or natural treatment that has cured severe clinical depression and we have tried many.  As soon as medication was started, symptoms improved, and eventually disappeared. I thank God for medicine and doctors.

“Talk therapy” is very important while waiting for the medicine to do its job.  Talk therapy is simply filling their head with truth to combat their faulty perception. It is reassuring the sufferer that this is just a medical illness and it will get better. The same way you would reassure someone who was suffering with diabetes, except in the case of depression, reassurance is a key part of healing—it can be a matter of life and death. The wrong words can kill.

Here is one example of proof that depression is a medical illness: my sister had an episode of postpartum depression that cycled. It went something like one week of wellness and two weeks of depression, one week of wellness, two weeks of depression. It was like clockwork. You will never convince me that every other week she needed to repent or chin up and “mind over matter” her way through it. She suffered depression after two of her six babies and was successfully treated with antidepressants and sleep aid both times and is now medicine free and doing excellent.

Below is a simple, quickly thrown-together, survival guide for the critical breakdown stage.  This is meant for the loved ones of the depressed because at this crisis stage they need others to stand up for them.

First—-get to a trusted medical doctor for an evaluation.

If you think you or a loved one might have depression, go to the doctor. It won’t hurt anything to get an evaluation and professional advice. Studies show that the earlier treatment is started the better it works.

The risks of leaving depression untreated:

The hopelessness increases as you try things that you think ought to work, but do not.  Insomia and hopelessness become a vicious cycle until you reach the breaking point. This stage is life threatening.

Did you know that 90% of suicides are done by people suffering mental illness of some kind? Did you know that 40,000 Americans die from suicide each year? That is an average of 1 every 13 minutes. It is the second-leading killer for ages 15-34. SECOND-LEADING. Did you know that war is not the leading cause of death in the military? Suicide is.  More than 3000 service members have taken their own lives since 2011.  That is staggering.

Understand how antidepressants work:

You can watch the video above for a simple illustration of how they work, but I want you to know that often they take time and take work to get them right. Sometimes you get lucky and the first medication and dose will do the trick. Antidepressants are not miracle pills that you can swallow and be immediately cured. I wish. Antidepressants take time to do their job and sometimes have side effects. They take 6 weeks to reach full effect, though there is usually progressive improvement starting the first week.  Sometimes you may experience severe anxiety or other side effects the first days of treatment, but in our experience it was temporary and evened out quite quickly. Sometimes the one you try won’t work and you’ll have to try another kind. Often the dose will need to be adjusted. This all takes time. Sadly, so many give up before finding the right medication and dose and are left untreated. This makes me sad. I have heard so many depressed people say “oh, I tried antidepressants and they do not work for me”, but they didn’t really take the effort to get them right. If my loved ones didn’t have us to help and encourage them to keep trying they would have come to the same conclusion and I hate to think of how that would have turned out. They do work and are so worth the effort.

Understand rumination.

Rumination is the compulsively focused attention on the symptoms of one’s distress, and on its possible causes and consequences. Rumination is similar to worry except runimation focuses on bad feeling and experiences from the past.  I call it being stuck in a rut. The mind spins and spins and gets more and more stuck. We are used to being able to think our way out of things and it just isn’t possible during severe depression. Again, depression would not be a problem if we could simply think our way out of it. Here is an example of ruminating thoughts: “I shouldn’t feel like this”, “I am just a hopeless person”, “I am a burden to everyone”, “I will never get better”. When the depressed person is sitting in silence this is likely what they are doing and it isn’t healthy.

Understand intrusive thoughts.

Intrusive thoughts are unwelcome involuntary thoughts, images, or unpleaseasant ideas that may become obsessions, are upsetting or distressing, and can be difficult to manage or eliminate.  The keyword being “unwelcome”.  They can be sudden intense thoughts and images of ending life or violence toward others. It is important to understand that these are a SYMPTOM of an illness and in no way reflect the person’s character. It is also important to note that these thoughts, though disturbing, are harmless if you are not experiencing severe depression or psychosis. If you are anxious about the thoughts and tell others about your thoughts you are not likely at risk of suicide.  You can read more about intrusive thoughts, here.

Understand placebo effect.

1. a beneficial effect, produced by a placebo drug or treatment, that cannot be attributed to the properties of the placebo itself, and must therefore be due to the patient’s belief in that treatment.

In other words, your mind thinks it will work, so it does for awhile. We have personally experienced placebo many times. It would kick in on the way to the emergency room or doctor’s office.  The mind would react to the possibility of help and the sufferer would experience temporary relief.  I found it frustrating because they would then gloss over the symptoms once in the emergency room and think “perhaps, I can do this without help” or “maybe it isn’t as bad as I have been thinking” and wouldn’t get the help they needed.   We also experienced placebo effect with inefficient medicine.  The mind would get a burst of happy as soon as the medication was started and then if the medicine wasn’t actually working properly the letdown was brutal.  Proper treatment should be progressive relief. If not, any limited relief is probably placebo and the medication needs to be changed or adjusted.

(I would love if placebo alone was an efficient treatment, but for severe depression, it is not. In my experience it is very short-lived)

Keep it simple.

Another major symptom of depression is being easily overwhelmed.  A child may simply need a shoe tied and the depressed mother will be instantly overwhelmed.  The already weary mind cannot handle much and this makes it hard to cope and help yourself. Decision-making is very difficult at this stage. It is so helpful if they have someone that can take charge and make all of the decisions so the mind can rest and heal. If they are being properly treated the crisis stage shouldn’t last long and all they need to know is that they are going to get through it.

Here is a list of how to help a mother suffering PPD during the crisis stage while waiting for the medicine to work:

(this list could also help anyone suffering a depressive illness breakdown)

1. Someone needs to take care of the house and children so that she can focus on healing and avoid a breakdown (bathtub is already full so let’s not overflow it).
2. Monotonous distraction is okay and can be helpful to keep from “getting stuck inside the mind” (like folding clothes or washing dishes).
3. No extra activities, no extra kids, no extra visitors, no grocery shopping (unless she is going alone with another adult and will not have to make decisions) no lunch or dinner dates (often well-meaning friends will think—-with their healthy minds—-that bringing the unwell friend out to lunch or shopping will be helpful, but it actually will greatly add to the stress)
4. Please do not suggest that she find a quiet place to listen to soothing music and relax—-perhaps that is helpful with mild depression, but it doesn’t touch severe depression. I tried that with my sister and realized real quick that it didn’t work and actually hurt because when the soothing music and relaxation didn’t work she came to the conclusion that she was indeed hopeless.
5. Nurturing, adult supervision is so important. NEVER NEVER NEVER leave her alone during the critical stage EVEN IF SHE SAYS IT IS OKAY. Even if she is feeling well for a moment, the hard, dark moments come out of nowhere and can be deadly. Feeling exaggerated guilt about everything is another symptom so she will often tell you she is okay because she doesn’t want to be a burden. Keep all medicine and potential weapons in a safe place. The caregiver should be handling all medications and giving them to her as the doctor prescribes.
6. Please do not suggest she stop her doctor prescribed medicine and try your method of treatment unless you want to kill her. The crisis stage is no time to experiment.
7. Avoid long drawn out conversations and explanations and keep your words of comfort simple.  She is in survival mode and simple encouragement is so important. (example: “you WILL get better”  “follow doctor’s orders” “we love you”,  “take one moment at a time”,  “this is temporary and you will be back to normal soon”, “you are NOT alone, thousands of mother experience the same thing as you”, “this is not your fault”) Tell her these things calmly and confindently throughout the day because this is truth.
8. If she becomes quiet and withdrawn, draw her out. Never let her sit inside her own mind. Ask her what her thoughts are so you and your healthy mind can help her process them. Often when they are quiet their unwell mind is trying to sort it all out and that NEVER EVER comes to a good end.  I have NEVER known a seriously depressed person that successfully thought their way out of depression.
9. In our experience mornings were the worst. Nights were pretty bad, too, but mornings were definitely the worst. If you know this is normal you can brace yourself and get through it with less suffering.
10. Realize that you will not be able to talk her out of her medical depression, your words will not give her happiness because a depressed mind is unable to feel happiness but your words of comfort will keep her from going under.
11. Don’t panic. This stage is really hard to feel or watch, but I have learned not to panic. Everything they are feeling has been felt by countless others and is a very normal symptom. Just help them through moment by moment and you will be on the other side before you know it. Time keeps ticking and morning always comes.
12. Please accept support from others. God gives you resources. Use them and thank HIM.

“We know that Jesus will return and those of us who follow Him will find ourselves safely home to enjoy him forever, but we still pull off to the side of the narrow road gasping sometimes—-knowing the adventure ends well doesn’t lessen the hardship of the journey. This is why we travel together, loved one. Do you feel like pulling over? Let me know. I’ll sit with you awhile and we’ll find a way to help regain your strength for the narrow road.” Lori Stanley Roeleveld.

I don’t want anyone else to die. We can help. I went to doctor’s appointments with my sister and my son so that I could be an advocate—-so that I could help them when they could not help themselves. I sat with them through their dark hours even though it was heartbreaking and exhausting. Let us sacrifice our time for each other. Let us love like Jesus.

(As I sat through those dark hours with them I knew that despite it they could still die from suicide because I am human and could not care for them perfectly. I fell asleep when I didn’t want to. But I also want to know that I gave all that I could and they fought as hard as they could and if they die it will be the illness that takes them and that gives me peace.)

 *I realize that saying “chemical imbalance” might be simplifying a more complex disorder, but it seems that whatever the true cause a chemical imbalance is present and fixing that helps