DEPRESSION
by L. William Lauro, M.D.

There is a well-known scripture that states in part “...men are that they might have joy.”

(2 Nephi 2:25).  Along these lines the Apostle John in his gospel, chapter 10 vs 10 states:

“I (namely Jesus) am come that they (namely us) might have life and that they might have it more abundantly.” And the Doctrine and Covenants  states that if one keeps the commandments and covenants we will find “peace in this life and eternal life in the world to come.”

These scriptures seem to indicate that the rewards for being obedient and following the Savior are joy, peace, and happiness in our lives. If this is the case one might then ask why so many of us, while trying so hard to live the laws of the gospel, still seem to suffer at times from mental anguishes such as depression, anxiety, fear, and worry. Are we are doing something wrong?  Do we suffer from depression and anxiety because we are sinners?  Do we suffer because we are weak or inferior? Of course not! The person who has clinical depression is no more able to control his illness than a person who has diabetes or high blood pressure. Depression is a chemical imbalance in the neurotransmitters in the brain.  This is certainly not something depressed patients would choose to have nor is it something they can control. Certainly there are behavioral and medical therapies that can help patients, and we should do all we can to get better, but just “wishing away depression” or trying to talk ourselves out of a mood disorder will not work.  And feeling guilty because one is depressed can make the syndrome worse. 

Do Latter-Day Saints have more depression than the general population? 

On the surface this might seem to be the case.  Studies have shown that the use of antidepressants and tranquilizers in the state of Utah, where there is a high percentage of Latter-day Saints, is very high compared to other states (among the highest, actually). This, however, does not mean that Latter-day Saints are more prone to depression or anxiety.  I personally believe the higher rate of use of these types of medications is simply because Latter-day Saints don’t drink and therefore don’t self-medicate with alcohol. As a result, they end up using more prescription medications. This is actually a more healthy and controlled approach to this problem than turning to alcohol or illegal drugs as many of our non-member peers do.  So I am not convinced that we as members of the Church have any higher incidence of depression than the country at large. 

Regardless of this, however, depression is a problem in our Latter-day Saint communities and we certainly have our share of mood disorders. There are probably many different reasons why this is the case. We know that many Latter-day Saints feel pressure to be “perfect” in their lives. On a conscious level we all realize this is not possible; yet deep inside we feel it is something we have to achieve in our lives. This creates anxieties and pressures, as it is such an unrealistic goal.  This leads of course to a feeling of failure and guilt, which is out of proportion to what, is reality regarding our attainment of perfection in this life.  And where do guilt and failure lead?  Depression, anxiety, and needless worry.  Wouldn’t it be nice if we all cut ourselves (and others) a little slack?

Another common denominator in the development of depression is chronic stress. Even when stress is mild, it can cause depression if it recurs over and over. There have been some very elegant studies where lab animals (rats) were mildly stressed every day for just a few weeks time. After this time period the animals were evaluated regarding their desire for pleasure by determining their interest in a tasty sugar solution (which was placed within easy reach), and also for sexual drive by placing a really cute rat in an open cage next door.  The control animals (those not stressed) went like gangbusters after the sugar solution and the female rats.  However, the mildly yet continuously stressed rats had no desire for the sugar formula nor for sexual gratification.  Sound familiar in your life?   These studies imply that chronic stress, even when mild, can alter the neuropathways in the brain leading to loss of desire for pleasurable activities, which is one of the hallmarks of depression.

Where do these chronic stressors come from?  Once again, putting too much on our plates, then worrying about not getting our “errands” done, and then beating ourselves up for being such losers.  It is no secret that Latter-day Saints tend to have larger families and thereby have more challenges and errands that must be done. But remember the story of Mary and Martha:  we need to find the most needful things in life which should include seeking the Savior, even if it means letting the dishes sit for a little while.  And when we are feeling pressure to take on yet another responsibility or project we might just have to politely say “no.”

Yes, Latter-day Saints are very active in church responsibilities and all of us must contribute our time, talents, and effort (especially where we have a lay ministry).  But we cannot “work” our way to heaven—we must do what is realistically within our abilities and let the Savior take care of the rest.  Otherwise we are setting ourselves up for chronic stress and frustration, which has been proven to be a risk factor for clinical depression.

How does one know if he or she has developed true clinical depression?

The general rule of thumb is that anyone who feels overwhelmingly sad, frustrated, or “blue” every day for at least two weeks probably has clinical depression. Also, when these symptoms interfere with our normal life activities such as sleeping, eating, sex drive, recreational desires, work and study habits, and interpersonal relations then clinical depression is probably to blame.

Even at this point many people don’t even realize that they are depressed. They will simply tell me that they have been more tired lately, or that they don’t sleep as well as they used to, or that they tend to lose their patience more often than usual. They often report that they don’t seem to have a desire to do pleasurable things any longer; nothing seems to interest them anymore.  Yet they don’t feel emotionally sad or depressed and so don’t even consider that they might have a problem with a mood disorder. Unfortunately these are all symptoms of significant depression and these patients need evaluation.

How do we diagnose depression?

The first step is to recognize the warning symptoms we discussed above.  Having done this the patient would next be advised to see their family doctor or a psychotherapist for an evaluation. It is imperative that the diagnosis of depression is made and other medical conditions, which can mimic depression, excluded. For example, some people who feel like they are depressed might actually have a medical condition like low thyroid, low blood sugar, or anemia. They might even have a more serious illness such as heart disease or cancer causing their depression-like symptoms. So the first thing to do is to rule-out other medical causes.

Next, the clinician would obtain a thorough history involving symptoms, their onset, their severity, other associated complaints, potential causes of the mood disorder, family history, etc.  After this the clinician would probably administer one of several types of standard depression questioners, which are pretty accurate for depression and anxiety screening. Having done this and having discussed the test scores with the patient the clinician will have a pretty good idea about whether clinical depression is the diagnosis.

How do we treat depression?

Once the diagnosis of depression is fairly certain there are several very effective therapies available. Studies indicate that antidepressant medications are effective in over 60% of patients. The newer antidepressants, called the selective serotonin reuptake inhibitors (SSRI), have very minimal side effects, are non-addicting, non-lethal, and are quite effective. These agents usually begin working in about two weeks but might take as long as 6-8 weeks to be fully effective.  Side effects are usually minimal (slight nausea, mild insomnia, minor increase in anxiety initially, mild headache, and a drop in sex drive) and usually disappear as time passes.  

Unfortunately, antidepressant medications don’t work for everyone nor do all patients consent to taking medications.  As I stated above about 35-40% of people will not respond to these meds. These non-responders are not without hope, however.  We know that behavioral therapies (available through qualified psychologists and social workers) can be very helpful.  I always urge members of the church to try and find psychotherapists who are also members of the church, if possible. Psychotherapy (especially cognitive behavioral therapy) can be effective in over 50% of patients.

Some other general ideas that help depression are as follows:  Getting more exercise. This really seems to help. Vigorous exercise releases natural chemicals in the brain, which help depression.  It also causes the person to be more fatigued at night, thereby making sleep easier and more restful. Exercising can also give you energy during the day, which a lot of people lack when they have depression. 

Eating a healthy diet can help. Trying to limit sugar intake so that blood sugar swings are not excessive is very helpful.  Multivitamins can be helpful.  Fruits and vegetables, with all their antioxidants, seem to be helpful. Eating in moderation is very important.  Many depressed patients have either an increase in appetite (which leads to weight gain) or a loss of appetite (leading to unhealthy weight loss). 

Stress reduction is very important in treating depression and anxiety. Taking a look at one’s life in consultation with one’s spouse, a close friend, or a professional counselor and then trying to sort things out so that stresses are reduced or eliminated is very helpful.  Also, some people suffer from intense guilt over past sins and experiences, and unburdening oneself by visiting with one’s bishop can be very helpful. This can also be a positive experience because the church has many resources available, which the Bishop can often suggest, such as L.D.S. Social Services.

The last, but not least suggestion is developing a more meditative life whereby one sets aside some time each day to search the scriptures, to relax, to meditate and contemplate life, and to express ourselves in meaningful prayer. Studies have shown that people who do this, regardless of their religious orientation, seem to benefit greatly.  Faith in God and his ability to comfort us (and even deliver us) is not only helpful but also hopeful.

Turning to our Savior might be the greatest prescription I can offer for he is the greatest physician of all time. It is he who said, “ In this world ye shall have tribulation; but be of good cheer, for I have overcome the world.” With that in mind, we too can overcome our stresses, anxieties, fears and depressions. May God bless us to this end.