| A manic episode finds a victim suffering from an uncontrolled, elevated mood for many days. He or she may work feverishly, sleep little, talk excessively, describe grandiose ideas, and become easily distracted by unimportant matters. Victims are often over-exhibitionistic and engage in increased, inappropriate sexual conduct. They get too close to people too fast. Treatment involves three things: placing a patient in a less stimulating environment, administering medication, and providing compassionate care. Manic patients are often argumentative and noncompliant. It is often necessary to stop them immediately from making unwise investments, giving money away, or committing embarrassing social acts. Friends and family members often need to get involved, and they need great amounts of patience.
Lithium carbonate is usually given to victims of an acute manic episode. Sometimes the drug needs to be taken for two weeks before its full benefits are in effect. Meanwhile, a patient tends to forget or ignore the need for the drug.
Severe depression, like mania, is an "affective disorder," and the two problems are closely linked. In fact, the term "manic depressive" is used frequently to describe the combination of the two.
Depression has become a major problem in America and many other countries. Its victims are unable to live productive lives, and they often slip into suicidal patterns. It is estimated that an American male's chances of developing depression at some point in his life are about 10%, and an American female's lifetime risk is a little more than 20%. Those are relatively high percentages! If a depressive episode continues unabated for a month or more, a victim enters a high risk category for suicide.
The following are signs and symptoms of depression. At least four of the following symptoms must be present almost every day for fourteen days to fulfill the criteria for clinical depression:
- Decreased appetite; unusual loss of weight (or overeating and unusual weight gain)
- Sleeplessness (or too much sleep)
- Agitation (or unusual slowness)
- Loss of interest in things that usually bring pleasure to the sufferer, including decreased sex drive.
- Fatigue
- Strong feelings of worthlessness and guilt
- Lack of concentration, slow thinking, indecision
- Recurrent thoughts of death or suicide
There seems to be some kind of relationship between severe stress and depression. We all know of people who have slipped into deep depression after the loss of a loved one. Some scientists believe that certain personality types are more prone to depression: people who have low self-esteem, who are dependent, or have compulsive traits. But depression can strike almost anyone. Generally, the victim loses interest in things that were formerly very important to him or her. The victim is quiet about the problem, withdrawing from activities rather than making loud complaints. An untreated episode seems to last from three to six months, and it can strike young and old alike.
Research is uncovering a hereditary link between depression among family members. This link seems to be biochemical. In other words, the chemistry of the brain has much to do with this kind of mood disorder. Ironically, it is often hard to convince people in the grip of major depression that chemicals are the cause of their problem. They seem to insist that their own actions have brought the problems on their own heads. Self-doubt, guilt, and a feeling of worthlessness make them unable to see things objectively.
Drug therapy for depressed patients has made great strides in the last three decades. Imipramine-type drugs (tricyclic antidepressants) have been used successfully since the 1950's, and now newer compounds, heterocyclics, are extremely useful. Problems that used to be incurable, or else last for years, now can usually be cured within one month. Hope burns more brightly than ever before. Every few months research seems to uncover new, important information about the biochemistry of depression. Perhaps, with God's help, a total cure will be found.
At this point, I should add a thought about Christians and drug therapy. It is important for a patient to take medication faithfully. Benefits of drug therapy may not appear immediately, and there is a temptation to become lax in taking the drugs. Sometimes I need to convince patients (including many well-meaning Christians) that they are not surrendering their free will when they begin to take drugs. There seems to be an attitude among some people that all strong drugs are bad, and to become involved in long-term drug therapy is something like becoming a heroin addict. I try to explain that drugs are a gift from God, and when used conscientiously, they produce great good. It is better to suffer a little from a drug and its side effects than be crippled by anxiety, a phobia, strange behavior or some other problem. It is a little like using surgical thread to sew up a wound. The stitches are unnatural and sometimes painful, but they help hold things together while healing takes place.
Meanwhile, it is important for victims of depression and their families to recognize that you can't "snap out of it" through sheer force of will. If they realize the seriousness of the problem and can get a victim to a doctor, his or her chances of recovery are very good. More than 70% of all patients respond favorably to antidepressants within two weeks.
I believe Jesus understands the chemistry of depression, even though we human beings are still learning how to treat a depressed (sometimes suicidal) sufferer. The Bible doesn't refer to brain chemistry in conjunction with the miracles of Jesus (and readers of the Bible for the last 1,900 years wouldn't have understood such references anyway), but I think that among the miracles of Jesus there were chemical alterations.
Many conversion experiences are accompanied by sudden relief from symptoms of anxiety or depression. We all know of stories about people on the verge of suicide who have an encounter with Jesus Christ and then are set free from their mental burdens. I realize that many variables are involved, and people also receive relief in nonreligious contexts, but I would also suggest that many encounters with Jesus, the Great Healer, are accompanied by internal healings that we can't even begin to understand.
I also firmly believe that Jesus understands the illness of people who commit suicide in the grip of major depression. Many of these suicides are induced by faulty brain chemistry and lead to death in the same way that invasive microbes or loss of blood can lead to death. I have a feeling that some people will be amazed and overjoyed to see "lost" suicidal family members in heaven, although I believe, along with many respected pastors, that suicide without severe brain disorder is a final statement against God that slams the door to heaven. (I don't want to imply that anyone should ever consider suicide to be a shortcut to heaven.)
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