Everyone experiences sadness at times, but some people have something far more serious: clinical depression—long periods of despondency that cripple them physically, cognitively, socially, and spiritually. Depression, which ranges from sadness to severe, persistence depression, is a mental illness, not a character flaw or a sign of weakness. The National Institute of Mental Health estimates that approximately 19 million Americans endure depression each year (National Institute of Mental Health, 2012). Of those, a growing number are college students (see figure 9.7; American College Health Association, 2011).
According to the American Psychiatric Association (2000), a person is clinically depressed if he or she exhibits one of the following symptoms for at least two weeks:
- Sadness or hopelessness
- A loss of interest in activities that were once enjoyed
In addition, four or more of the following symptoms must be present:
- A change in appetite that causes weight gain or weight loss
- Too much sleep or not enough sleep
- Restlessness and an inability to sit still or the feeling that moving takes too much effort
- Persistent fatigue
- Feelings of unworthiness or guilt without any reason
- Significant problems with memory, concentration, or decision making
- Frequent thoughts about death or suicide
Bad moods ordinarily disappear after a day or two, and normal grief after a loved one dies may last for more than a year. These usually do not significantly interfere with day-to-day activities. Clinical depression, however, impairs spiritual life, social life, and academic and vocational life. Young people with this condition see their grades drop, neglect their duties and obligations, and become isolated (Birmaher et al., 1996). Depressed teenagers are more likely than depressed children to have trouble eating and sleeping and to entertain suicidal thoughts and are more likely than depressed adults to be irritable (American Academy of Child and Adolescent Psychiatry, 1998).
The trajectory and severity of depression vary from person to person. Sometimes mild symptoms last for a long time without going away, and at other times severe symptoms last for a short time but recur. The condition often returns, and people who have one episode of depression are more likely to have another.
Most experts believe that depression results from a combination of biological, psychological, and social factors, such as these:
- Chemical imbalances
- Stress or trauma
- Inadequate social support
- Negative and irrational thoughts
Although you won’t find this acknowledged in secular sources, all human suffering, including depression and other forms of mental illness, exists because of sin. Not all suffering, however, exists because of the sin of the sufferer.
As he went along, [Jesus] saw a man blind from birth. His disciples asked him, “Rabbi, who sinned, this man or his parents, that he was born blind?”
“Neither this man nor his parents sinned,” said Jesus, “but this happened so that the work of God might be displayed in his life.” (John 9: 1–3)
It’s true that sinful attitudes and sinful choices can result in depression, but don’t automatically conclude that a depressed person is to blame for his or her condition. Respond instead with compassion and understanding. If diseases that afflict the body are a result of the general distortion of God’s creation by the fall, then so are diseases that afflict the mind. Also, many times the problem is caused by the sin of others. For example, victims of rape and sexual molestation and children of distant, divorced, or abusive parents often experience depression.
Depression runs in families. One in six individuals in the United States will experience major depression at some point in his or her lifetime (Kessler et al., 2005), but the rate is two to three times higher among people who have a clinically depressed parent or sibling (Levinson & Nichols, 2012). Keep in mind, though, that genetic factors increase the risk of but do not cause depression. People with a higher risk are more sensitive to potential triggers, such as the effects of negative or stressful environments.
The neurotransmitters relevant to depression are serotonin, norepinephrine, and dopamine (Garrett, 2003). Their exact role in depression is unclear, but many types of imbalances in these brain chemicals are associated with depression (Kalat, 2001).
Some medications, such as those that regulate blood pressure, can cause depression. After a person stops taking the medication, the symptoms usually disappear.
Stress or Trauma
Significant life changes that cause stress can also lead to depression. Such stressors might be social, such as the death of a loved one or the end of a valued relationship, or stressors of other kinds, such as poverty or long-term illness. The more numerous the stressors a person experiences in a short time, the greater the risk of his or her becoming
Teenagers and young adults experience a lot of separation and loss. They leave home, family, and their old neighborhood to go to college. They begin and end friendships and romantic relationships. Some psychologists believe that separation and loss can lead to hostile feelings toward the lost person—for example, an ex-boyfriend or ex-girlfriend—and that this hostility, turned inward, causes depression. Feelings of loneliness, alienation, and rejection, all common during adolescence, are potential causes as well (Brage & Meredith, 1994).
Inadequate Social Support
It’s a vicious cycle. People who lack the social skills to have fun times, make good friends, land top jobs, and attract the opposite sex can become disappointed and then depressed (Lewinsohn, 1974). Unfortunately, depressed people are depressing. Their irritability and pessimism cause other people to avoid them, and their increasing lack of social support can intensify their condition, particularly in women. Counselors often train these people in social skills to help break the cycle.
Negative and Irrational Thoughts
- “I’m a total failure unless I am liked by every significant person in my life.”
- “It’s horrible when things don’t turn out the way I want them to.”
- “If I’m not sure about an upcoming event, I must worry about it.”
- “Unless I’m competent at everything, I’m worthless.”
Irrational, pessimistic, and self-defeating thoughts like these can cause depression and keep it going once it starts. Depression makes people likely to think negatively about themselves (“I am unattractive and unlovable”), their world (“Nobody cares about me”) and their future (“I’ll never find a spouse or a job, and I’ll never be happy”; Beck, 1970; Sacco & Beck, 1995). Depressed people will assume the worst possible outcome in any situation (catastrophizing), assume that because one event turned out badly others will too (overgeneralizing), and believe that they are to blame for anything bad that happens around them, even when they aren’t responsible (personalizing; Beck, 1967). They think, irrationally, that they can do nothing to improve a bad situation, so they shouldn’t even bother trying. This attitude is called learned helplessness (Seligman, 1974).
When you receive a low grade on a test, do you attribute it to your own stupidity, to insufficient study time, to an incompetent teacher, to unfair test questions, or to something else? What determines your response, other than the simple facts of the matter, is attribution, or the meaning you ascribe to the events and circumstances that occur in life (McFarland & Miller, 1994). A person prone to depression will tend to attribute a poor grade to his or her own ineptitude and believe that he or she will continue to fail for a long time and in many other areas. A person not prone to depression might take a more optimistic view of the event and consider it an isolated incident, the result of a bad day (Abramson et al., 1978; Jacobson et al., 1996). Events themselves are not depressing; what is important is how you handle them. Perfectionism, the habit of tying your self-worth to unachievable goals, can easily make you depressed.
Where do such thoughts come from? Some sources might include examples set by parents and other authority figures, early life rejection, and a lack of understanding of God’s truth.