C - How Did This Happen&;#063;

"How did this happen?"

The first of a long line of questions refused to be shaken. "If they're
right, if I'm a mental case, how did this happen?" Both my parents
worked very hard to reassure me, constantly telling me it wasn't my
fault. But they didn't know that. What else would a parent tell a
child? None of us knew what caused depression, and a few minutes in the
doctor's office wasn't enough. And that isn't the doctor's fault. In
that moment, I was too stunned to ask any questions. I wouldn't have
understood the answers. But after days of tears and staring at the
walls, or the flames in the fireplace, the question wouldn't go
away.

My first therapy session gave me a few answers, at least all that I
could comprehend at the time. Personal research in the months since had
given me a much clearer picture of my illness, and the possible
causes.

To fully understand the various causes, a basic knowledge of the brain
and its working is helpful. The brain cells communicate with each other
by electrical impulses. There are chemicals, called neurotransmitters,
that carry the impulses from one brain cell to receptor sites on the
other cells. Research has discovered that there are three primary
neurotransmitters that affect mood: seretonin, norepinephrine, and
dopamine. A shortage of one or more of these chemicals can cause any of
the mood disorders.

That shortage is the biological cause of depression. It is also the
reason my doctor suggested medication. We will get into medication
types and effects a little later on. Closely associated with the
biological cause is that of genetics.

While they have not yet identified the specific chromosome(s) involved,
research has found that two-thirds of those suffering from depression
have family members who have as well. Also, close family members run a
greater risk of developing dysthymia. Children of depressed parents are
three times more likely to suffer at least one major depressive
episode. Now, keep in mind that while the risks are higher, it is not a
certainty. Everyone is different, and while acknowledging a
predisposition can make you more aware of your responses to stress, it
is not a life sentence.

Genetically, I was loaded, and we didn't know it. Both my parents had
"rough seasons" in their middle years. But nobody called it depression
and it's never spoken about to this day. Looking beyond them, we found
instances on both sides of the family. If the doctor's labeled them as
depression, that was never communicated to anyone else. Depression was
the pink elephant we stuffed in the linen closet.

Perhaps the most widespread cause is environment. Another biological
process is at work here, the "fight or flight" response. It's not only
useful, it can literally save your life. That's its purpose. Anytime we
are faced with a stressor, our body reacts with a literal rush of
adrenaline. All our internal systems shift into high gear, preparing us
to deal with the challenge. The stressor can be positive or negative;
the physical response is the same. In the brain, the neurons release a
flood of neurotransmitters, preparing to send their signals at an
increased rate. This allows us to think faster, and more clearly.

With a limited amount of chemicals to work with on short notice, the
brain has its own recycling program. The cells reabsorb the
neurotransmitters to use again, and that system speeds up as well. If
that speed is sustained for any length of time, it can result in a
shortage of the neurotransmitters, creating depression. The stressor
can be physical, emotional, or intellectual. It doesn't even have to be
real; perception is enough.

Along the same lines, medication can cause the onset of major
depression by affecting neurotransmitter levels. Medications for
hypertension and oral contraception are the most common culprits, but
there are many others as well.

Substance abuse, either of alcohol or drugs, can trigger depression by
altering body chemistry. According to Dr. Peter Whybrow, M.D.,
"Studies estimate that over 50\% [of people with mood disorders] will
be caught up in such [alcohol or drug abuse] at some point in their
illness."

The last possible cause is illness. This most often occurs in the
senior population, as they are more likely to develop incapacitating
illness. However, Dr. Whybrow notes,
"Just about any physical trauma or debilitating illness, especially if
it lasts a long time and limits physical activity and social
interaction, increases our vulnerability to depression."

Strictly speaking, any major depression caused by environmental factors
is considered reactional. As I mentioned earlier, reactional depression
is the most common. Clinical depression is defined as spontaneous and
entirely biological, with no identifiable trigger. That definition is
misleading until you look at chronic, or clinical depression in depth.
When there is a strong genetic predisposition, and the brain chemistry
is severely abnormal, a truly spontaneous onset is possible. This
happens most frequently in the case of bipolar disorder, also known as
manic-depression.

Every instance of major depression affects the body's limbic (nervous)
system, the endocrine (hormonal) system, and the vascular system.
Hormones, especially cortisol, affect the neurotransmitter levels in
the brain, and it is another hormone, adrenaline, that begins the
"fight or flight" response, raising blood pressure, and redirecting
blood flow away from the extremities and to the internal organs. Blood
flow is also reduced to the emotional center of the brain.

When the stress response continues indefinitely, due to multiple
stressors or to a unrelenting stressor, such as serious illness, a
pattern can develop. Dr. Whybrow states, "Chronic arousal induced by
recurrent stress increases the irritability of the limbic brain." This
irritability can mean it will take less stress to set off another major
depressive episode. Dr. John Nelson agrees.

There is mounting evidence to believe each episode of depression
physically predisposes an individual to the next, rewiring the
structure and chemistry of his brain, undermining his resistance to
stress, rejection, or loss.]

I don't know about you, but that information tends to scare me. I was
as far in as I could go, short of being suicidal, and the thought of
going back to that black pit is horrifying. I hesitated to include that
information, because depression talks, and I know that it will be
saying, "See, there is not hope, no real way out. Even if you manage to
struggle out this time, I'll be back. It'll be easier the next
time!"

That is depression talking and not reality. Romans 8:28 tells us that
"And we know that in all things God works for the good of those who
love Him, who have been called according to His purpose." (NIV) That is
not an offhand quote to me. It helped me to hold on to God, and He held
on to my sanity.

I need to take a moment to be certain you have what I believe is the
most important tool for recovery. I am so thankful that I was a born
again child of God, and had been for years. I am sure that had I not
been able to hold on to the promises of Scripture, I would have fallen
deeper into the depression, perhaps even becoming suicidal.

The Bible tells us in Romans 3:23 that "for all have sinned and fall
short of the glory of God" (NIV). Romans 6:23 continues, "For the wages
of sin is death, but the gift of God is eternal life in Christ Jesus
our Lord." (NIV) But Romans 10:9 promises, "that if you confess with
your mouth, "Jesus is Lord" and believe in hour heart that God raised
him from the dead, you will be saved." (NIV) If you have never asked
Jesus into your heart, to be your Savior and Lord, that is the first
step towards finding a hope. Simply say,

"Lord Jesus, I know I've sinned, and that you died on the cross to
save me. Please come into my heart as Savior and Lord. Help me learn to
walk in your ways. Thank you. In Jesus name I pray, Amen."

I believe the Holy Bible to be the infallible Word of God. It is the
instruction book for living as a child of God, and every word was
divinely inspired. Hence it is the source of all truth. Sometimes,
especially when we are in the midst of a major depression, we do not
think that anything will ever improve. But Jeremiah 29:11 says, "For I
know the plans I have for you, declares the Lord, plans to prosper you
and not to harm you, plans to give you a hope and a future." (NIV) No
matter what you are feeling, God has not given up. He has a plan for
your life, and if you will trust Him, He will bring it to pass. Paul
wrote in Phillipians 1:6, "Being confident of this, that He who begun a
good work in you will carry it on to completion until the day of Christ
Jesus." (NIV)

I am not saying that accepting Jesus as Savior and Lord will prevent
relapses, anymore than it would cure diabetes or high blood pressure.
God can, and does, heal, when it is part of His plan. What I am saying
is that your relationship with the Father and belief in His Word can
give you ammunition to return fire when the depression starts
talking.

Knowing the causes helped my intellectual curiosity, and it even took
the edge off my self-blame. But it didn't answer the other
questions.

What now? Where do I turn?

Who do you turn to when you feel like you are losing your mind? I was
blessed. My general practitioner was involved from the very moment I
learned I was depressed. Over eighty percent of those suffering from
depression are never diagnosed, so odds are, you haven't been yet
either. But you read the symptoms, and they fit. Or, someone you know
has all the symptoms.

The best place to turn first is your family doctor. You thought I was
going to say your Pastor, didn't you? He's next, but first you need to
get the biological, physical needs met. The first step in diagnosis
needs to be a complete physical, to rule out illness or medication side
effects. You doctor may be able to begin medicinal treatment, or refer
you to a local mental health professional.

Your next contact should be your pastor. While I have taken pains to
assure you that depression is not a spiritual shortcoming, I need to
acknowledge work of the Holy Spirit in the life of a believer. You may
take an antibiotic for an infection, but that does not mean no one
should pray for your healing. Everything that touches the life of a
believer should include their spiritual life. Many pastors are trained
in counseling, and can fill that important area of treatment. If they
are not qualified, they are often the best source for Christian
counseling resources in your area.

While it is not essential to find a Christian counselor, I cannot
recommend it strongly enough. This is a personal bias, but I believe it
is also wisdom. After an earlier episode, I saw a psychologist for a
short time. I was cautious then, but he assured me that he was also a
believer. While he did not recognize my symptoms of depression, he also
recommended some measures that were blatantly unbiblical. I pointed
this out, and he insisted it was the best answer. That's what shortened
our relationship.

Some psychological theories fall completely into line with Scripture,
but others clearly do not. Under no circumstances would I advise
following any course of treatment that falls outside of Biblical
guidelines, no matter how "beneficial" it promises to be. In all
things, we are called to be obedient to the Word, and our Father will
bless that obedience. By finding a Christian counselor, you will find a
partner in your recovery, rather than another obstacle.

My general practitioner was comfortable beginning a drug regimen, but
he also wanted me to contact a psychologist or psychiatrist in my area.
If your medical doctor is not willing to oversee the medication portion
of your treatment, you will need to consult a psychiatrist. A
psychiatrist is a physician, and is able to prescribe medication, where
a psychologist is trained in psychological testing and evaluation, and
is not a physician. Due to my previous experience with therapy, I was
hesitant to set an appointment with an unknown counselor. Mama and I
decided to call one of my pastors first.

God has blessed me with an incredible church home, Tabernacle Baptist,
in Decatur, Illinois. With a membership of over 1200, we are one of the
larger churches in the area. Now, congregational size is not important,
but it has allowed us to have a well-rounded pastoral team. One of my
six pastors, Roger Daniels, Ph.D., is not only a seminary trained,
ordained Minister of the Gospel, but also a licensed psychologist. As
head of our Pastoral Counseling ministry, he is constantly in demand.
He agreed to begin therapy with me once a week, and I was relieved. I
have great respect for my pastors, and trust them completely. I was
confidant he would give me wise, Biblical counsel.

Some people do not feel they can disclose their struggles to their
church leadership out of fear, distrust, or privacy issues. It is
imperative that you find a safe place to turn for guidance. The
important thing to remember is that help is out there. It can be
difficult to reach out of the darkness, especially when you're
terrified of the possible reaction, but it's worth the effort.

It's also important to realize that you may need support in taking
that first step. A close friend or family member that you trust can
make a world of difference, just by sitting next to you. They could
also prove to be valuable to the counselor as a source of information
untainted by the depression. I wanted the pain to stop, but the
helplessness, the hopelessness kept me from actively pursuing other
possibilities. I would still try new treatments, but I wasn't pushing
for any, because I didn't really believe anything would work. A family
member or friend may have to be your strength for a while. Don't let
this discourage you. It does get better.

The week between seeing my family practitioner and Pastor Roger was one
long week of tears, questions, fear, and dread. I was going to have to
face how "sick" I really was, and if I couldn't deal with normal, every
day circumstances, how was I going to deal with my failings? I had
obviously lived in a blissful state of denial about my personality.
That's what was wrong. And how had anybody stood to be my friend? I was
clearly a nut case. It was a wonder they didn't just lock me away.
Would I ever be able to live as an adult for any reasonable length of
time, or would my parents and eventually my younger brother wind up
having to take care of me forever? Christians aren't supposed to get
depressed, let alone clinically depressed. I'd prayed and prayed. What
hadn't I turned over to God? What was I hanging on to? I thought I was
in the middle of God's will for my life.

Depression talks. What started as a fairly normal question spiraled
down until I was incapable of living outside an institution. And it
only took seconds to sink that far. I have since learned that what I
went through that week, and for weeks well beyond that first
appointment, was perfectly normal. Most people doubt themselves when
something goes wrong in their life, and this was a big something wrong.
We talk about the joy of the Lord, and letting go to let God. It all
comes out of our mouths so easily. I had said the same things to
people, never realizing how wounding that could be. I was blessed. My
Sunday School class had long before moved from a class to close
friends, and they could tell what I was going through was not the
Stacey they knew so well. No one offered quick fixes, or questioned my
walk with God. They loved me, and prayed for me daily, even during the
weeks I could not face leaving my home and entering the church.

I cried so much those first few weeks. I'm not sure if the tears came
because of the questions, or if the questions were my mind's excuse for
the tears. I felt like the real me, the one I knew and really kind of
liked, was sitting in this tiny space at the back of my brain, watching
what was happening and knowing that nothing made any sense but unable
to do anything about it.

I knew when I crossed into unreasonable and even when I continued into
unfounded panic. I couldn't stand quiet. The questions got louder. And
trying to fall asleep was near to impossible. I sat on Mama's couch and
stared at the moving colors on the television, but I couldn't follow a
story line for half an hour. Maggie, our dachshund puppy was the only
source of comfort my addled mind would accept. She would lay beside me
or on top of me, licking my hand and looking up at me like I was the
most wonderful thing in the world. I didn't feel broken with her. She
liked me the way I was. I was going to have to learn all over how to do
what Maggie did by instinct.

That first meeting with Pastor was still nerve-wracking, but it helped
answer more of my questions, and calm some of my fears. Pastor Roger
asked a series of questions to determine the severity of my symptoms.
He agreed I was depressed and gave me some basic information about
treatment, including what he thought would be best in my case. Pastor
Roger also consulted with my doctor about his diagnosis and medication.
This was the basis of my treatment team. Together we began to battle
the depression that had overwhelmed me. Both my doctor and Pastor Roger
agreed that medication was an appropriate measure in my case.

He also made a statement that started me thinking. He said, "Sometimes
depression is allowed by God, so we will slow down and heal what is
damaged. While I'm not sure I can say that God gave me depression, I
can't say that He didn't. At this point in my journey, I had accepted
that there was a chemical imbalance causing my symptoms, and that
imbalance was caused by the numerous stresses in my life. But the
genetic link means that I was born with a susceptibility. It had always
been there.

I've found that, for some reason, when we think of a purely physical
disease, like high blood pressure, or diabetes, that has a genetic
component, we think of it as separate from ourselves. But when the
disease involves our minds, for some reason, that isn't separate from
ourselves anymore. Since we tend to view the brain as the center of who
we are, anything that effects it becomes part of who we are.

In a way, I was standing on a cliff, swaying and uncertain which way I
would fall. Would I give in to the disease, accepting it as part of me
and reconciling myself to the life of a mental invalid, or would I
reject the depression and try to go on as I had been, pretending
nothing was wrong with me. If left untreated long enough, this is where
anyone suffering from depression will find themselves.

In the next chapter, I want give you the basic understanding of
medications that I have gained. I found this information very
reassuring. Anyone can tell you depression is a physical disease, but
understanding how antidepressants work will make it a reality.