Understanding Depression Podcast Series

Part 1

Hello everyone. This is Matt Kaufman, host of the Breaking Bread Podcast, brought to you by Apostolic Christian Counseling and Family Services. Before we get to today’s episode, I want to announce that the Abide three-week training is now open for registration. The discipleship training will be May 11 – 31, 2024 located in Peachtree City, Georgia. 

This discipleship training is an intentional time to cultivate your discipleship to Jesus and be equipped with the tools to invite others to be his disciples. You can learn more and register on our website. Go to our website at accounseling.org and put in the search menu ABIDE. There are limited seats available, so if you’re interested, check it out today. 

The thing about it, what it says is, I feel maxed out. I feel like the stress load I’m under is bigger than my coping resources. And so, the more that happens, the bigger the weight is and the less coping resources, the more somebody feels that that help.  

Welcome everyone to Breaking Bread Podcast brought to you by Apostolic Christian Counseling and Family Services. Kathy Knochel and Ted Witzig Jr. are with me here today. We are going to talk about depression. Yes, because it’s not an isolated condition. So, speak to the prevalence, speak to the topic. Matt, depression is one of the most common things that are treated in counseling centers and in primary care physician offices. 

And it’s one of those things that’s been referred to as the common cold of mental illness because it is the most common thing that people experience in this space. It can sometimes occur by itself, so somebody can come with depression as a primary issue, but it also tends to tag along as a result of other things, result of addiction, result of trauma, result of an anxiety disorder. 

And so, it’s oftentimes a passenger, at least, if not a co-driver in the things that people are experiencing. And so, it affects people across life and lifespan. And Kathy, why don’t you talk a little bit about that. Yeah. Help us get a feel for what a person that endures depression is experiencing, what might they be experiencing? 

So, I think the thing to note too, is that we see depression in kids as well as adolescents, teenagers, young adults, all the way to old age. And depending on life stage, it may look a little bit different. It’s going to come across differently depending on where you’re at. 

I think that perspective is helpful. Both the prevalence as well as this is not isolated to certain age groups but is throughout the lifespan. One of my goals I would like to have for this podcast is for us to articulate depression in a way that those who experience it say, yes, thank you. 

That’s helpful, to be understood like that. And for those who have no experience of depression to say, okay, now I have a growing empathy for that situation. Right. I think the picture that I like to use it’s like trying to drive through life with the brake pressed on. 

Everything is a little bit more difficult for the person who is experiencing depression. Things that were once enjoyable to them, or the things that they just did out of habit or as part of their regular schedule. Everything gets just a little bit more difficult. It takes longer to complete something that they normally did in a specific time. 

And there’s also just this sense of the types of interactions that used to feel renewing to them don’t feel as renewing. There’s hopelessness, loss of interest in the activities. And then also a lot of times we’ll think of depressed means you’re sad. Certainly, an individual facing depression is sad. 

There are also so many other emotions, like the hopelessness I talked about, and sometimes it can come with some agitation or even some of that anxiety can still be felt. There’s just a range of symptoms that can be there. Depression can also show up as mild, moderate, or severe. Okay. 

And so, it can be like gray over somebody’s life, and they just feel a gray cloud weighing down on them all the way to someone isn’t able to function and even suicidal. That’s correct. Yes. So, we have this term clinical depression.  

And so, are you looking for those symptoms? What does it mean to be clinically depressed? So, I’m going to go through the major, the main symptoms that we use to make a diagnosis of depression. It has to have at least five of nine symptoms for at least two weeks. 

Okay. So, this is more of a steady state. It is. And two weeks isn’t long necessarily. I’m not saying it’s a long period of time, but we’re not talking about a passing mood or a shift or waking up on the wrong side of the bed. So, there are two symptoms that you have to have either of or both in order to get a diagnosis. 

The first one is sad or depressed mood, and that’s what most people think depression is. That might be tearfulness, it might be sad, it might be just discouragement and that outlook. The other one is loss of interest in things you would normally find pleasurable. That’s called anhedonia. And what’s interesting is a lot of times people with that second one, that loss of interest, might not even realize they’re depressed. 

Okay. And so, they’re feeling this heaviness, this gray lack of enjoyment in life and things like that. But when we say as counselors, I think you’re dealing with depression. They’ll say, well, I’m not crying and I’m not sitting around. Well, that’s because they have a caricature of what depression is. 

So first one, you know, as you mentioned that one, there’s a certain amount of empathy that comes to me when you mention that precise one. Yeah. Not only are there dark clouds, but there is no sun. That’s right. Absolutely. And I think that one of the things that happen is that when you think about life, there are painful things that happen, but then there’s also the absence of joy, the retraction of those good things. That’s exactly right. And that’s why with depression to get a diagnosis, you just have to have one or the other of those. But oftentimes, and again, the more severe that somebody is, they’ll likely have both. 

The next thing has to do with appetite or weight loss or gain. And so, some people will gain weight and eat and eat and eat when they’re depressed. Some people will lose their appetite and will lose weight. So, this is an interesting thing about depression. The same diagnosis can have different symptoms in different people. 

And so, loss of weight or gain. The same thing is true here with sleep. Sleep is often affected by depression. So, some people have hypersomnia, meaning they want to sleep all the time or sleep too much. And then other people have insomnia, and they just can’t sleep. And sleep escapes them. Or a very common one is called early morning waking. 

Or they’ll wake in the middle of the night and then lay awake and ruminate. Another one that has both sides is feeling agitated. Okay, so feeling this agitation inside or feeling that feeling slowed down. And so one is a keyed up feeling. One is a sluggish feeling. Loss of energy is very common. And so, people’s motivation is oftentimes affected by that. And then one that I want to call special attention to are these feelings of worthlessness or excessive or inappropriate guilt, and that’s where somebody has lower self-esteem or just feels lower about themselves when they’re depressed. 

That one makes sense. The reason I want to highlight this one is because this is the one where people will oftentimes feel more detached from God, and they’ll feel dry in their spiritual walk. In fact, they’ll say, I just don’t feel like my prayers go up. I don’t feel much in that. And so, there’s a disconnection. 

So, for the Christian, this one’s especially acute. That’s right. And because it’s a symptom, they will oftentimes read it as a problem of their spirituality, which then feels cut off from God instead of seeing God as their resource. There are just two more here. The next one is decreased concentration, and these people’s memory, their concentration, can be impacted so they can’t focus at work and at church and just things like getting their schoolwork done. So, you see secondary problems like grades starting to drop and things of that nature. And then lastly, the thoughts of death or suicide, wanting to die. And again, that could be passive in the sense of I just wish that I would die all the way to active in the sense of this is how I will hasten that. 

And I think we need to see Matt, is that suicidal thoughts? The thoughts of death? The thing about it, what it says is I feel maxed out. I feel like what I’m under, the stress load I’m under is bigger than my coping resources. And so, the more that happens, the bigger the weight and the less coping resources, the more somebody feels that helplessness and overwhelmed feeling. 

So, you just gave us about nine different ear markers. That’s right. Nine. And to be clinically depressed, you need to flag how many, five of nine? Five of nine for a period of two weeks. Yep. So, I think if you take all those symptoms and just get this picture here. 

So, when an individual is feeling a loss of interest in going and doing the things that they used to do, and then they become so they stay home, they become disconnected from the groups that they’re usually a part of. And so, then that feeling of worthlessness and overwhelming starts. And what I like to say is you just see this downward spiral. 

You feel too bad to go out and do the things that you need to do and catch that joy that really would help in this moment. And then it’s a difficult loop. Yes. So, it just builds on itself, and it is a vicious cycle. People that are not familiar with depression will oftentimes just see the emotional component. They’ll think, oh, it means sad mood, like crying and things like that. But depression affects people’s moods, but it also affects their thinking, the thoughts they think. They can feel more hopeless, discouraged, frustrated, irritable, those kinds of things can come out in their thoughts and emotions. 

It affects their behaviors, their motivation, their wanting to get a project done or even being able to muster the energy to go out and exercise or do those things that we know are good for us socially. People will oftentimes start to either step back from their social connections or when they’re with people, they’ll still feel alone. 

And so, it’s that, I’m surrounded by people, but I’m very lonely, kind of thing. And then another aspect is that spiritual disconnect. And I want to make clear here that obviously if somebody is living in sin and, and they’re far from God and they have a heavy conscience and all those things, yes, that’s going to bear down on them and they’re going to feel the heaviness of that. 

In major depression, what you have is somebody who is not in a bad place spiritually, but who starts to feel like God is far from them, isn’t listening to them. And then, it’s interesting how our adversary, Satan, kicks people when they’re down, they’re dealing with depression, and then he starts to dredge, you know, well, what about this sin from your past and were you really forgiven? And those kinds of things.  

I want to put my finger on the heartache, and I think probably a unique heartache of this particular condition, and that is, it’s very nature makes it worse. It’s very nature makes it worse. A broken arm doesn’t, by its nature, beget more broken arms. It’s not the way it works. That’s right. A cold by its nature doesn’t beget more colds. You know what I’m saying? Yeah. I think this is really unique and I think it’s important that we understand this. And so now I really am interested in what does good care look like?  

And I’m really thinking about two people here in the audience. Right. Those who are very near to the experience of depression. And also, to those who encounter and live with and engage with those who are depressed. Right? So, I want to handle both of those listeners. Yep. I might just speak to the people around an individual who’s struggling with depression or that you’re starting to notice some signs of it. 

I think that because you are not inside the other person knowing exactly how they’re thinking or feeling, it can feel really confusing and it can feel like, why can’t they just be happier? Or why don’t they just leave their house? Or why don’t they just, you know, fill in the blanks? 

And so, I think that the first thing I would just say is just remember the piece of compassion is really important. We don’t know everybody’s stories. We don’t know exactly what it is that they’re struggling with. And so being able to have more of a, help me understand perspective with those that are struggling is important. 

And then I think too, just knowing the right things to do or the right things to say are really important. Telling somebody to smile more or stop crying and I know that’s obvious. We don’t say those things, but sometimes the most helpful thing can be, I can just come be with you if you’re having a hard time coming out, or I’m going for a walk. I’m going to walk by your house. I’m going to come with you because what the person needs that’s depressed is they need that person to come alongside and do it with them until they can do it themselves. Yep. I really appreciate that coming alongside is really important because depression is very isolating. 

And it does feed on itself in that way. I do also want to say that when you’re in a relationship with somebody who’s depressed, if it’s your spouse or a child or whatever, that can be stressful. Right. It’s because you’re trying to go about life and even, you’re trying to encourage them and you might feel like it falls flat, so it impacts the family system. 

I think that that one of the things that Cathy said is probably one of the biggest keys for helpers, and that is along with compassion. It is doing things with the person. Okay. And so I remember I’ve worked with a numbers of cases where young mothers or mothers dealing with postpartum situations where they’ve had difficulty during that time caring for the children and keeping the family going. 

And what they need is families and friends to come and help. But here’s the problem. If someone is depressed and they’re feeling like a bad mother already. Okay. And then somebody comes in and does all those things and the person’s looking and going, they can do it. I can’t do it versus being able to say, here, let’s fold some laundry together just for a little bit. Let’s fold a few things together. And so that’s just an example. And if it was a teen, you might say, hey, let’s shoot some baskets together. Or it’s going to be way more helpful with the coming alongside and helping to lift up than it is to give directions. 

This was very helpful. I think Ted and Kathy gave us a framework for which to understand this very common mental and emotional condition of depression. And this will conclude part one, but when we return, we’re going to look to the hope through depression. And I hope you can join us. 

Part 2

Hello everyone. This is Matt Kaufman, host of the Breaking Bread Podcast, brought to you by Apostolic Christian Counseling and Family Services. Before we get to today’s episode, I want to announce that the Abide three-Week training is now open for registration. The discipleship training will be May 11 – 31, 2024 located in Peachtree City, Georgia.

This discipleship training is an intentional time to cultivate your discipleship to Jesus and be equipped with the tools to invite others to be his disciples. You can learn more and register on our website. Go to our website at accounseling.org and put in the search menu, Abide. There are limited seats available, so if you’re interested, check it out today.

It is really a beautiful thing, sometimes I can start to see just the shifting and thinking or emotions even before they’re able to see it or feel it, but it’s just a beautiful thing when you start to see that start to change. I think that’s beautiful. I think that’s the hope that we want to hear, and that’s exactly what we’re going to hear in this episode of Breaking Bread, the podcast brought to you by Apostolic Christian Counseling and Family Services as I air the second part of my conversation with Ted Witzig Jr. and Kathy Knochel on the topic of depression. Glad to have you along. I think that’s really, really helpful. And now I want you to speak to those who experienced depression very nearly, once depressed, always depressed.

Answer that question, give some perspective because I can imagine if the sun is not out, probably think it will never come out. Oh, for sure. So, you’ve got experience walking this road with people. What’s your experience, Ted? I would say certainly once depressed, always depressed is definitely not a true statement.

While depression can come and go in somebody’s life, or it can be felt, we kind of talked about this already, but that it can be milder, or it can be more severe at times. But there is hope through it. And so, I think probably the most important thing to know is that it is important to make sure that the right tools are being built up and the skill sets and the support, which we just talked about, but all of those things help in the journey of depression.

Yeah. If you were to give some benchmarks, Ted, about here’s what health and returning health looks like, what are some of those you would mention? Yep. What I tell people is this, what most people would like is for their feelings to change first. Okay. Then their thoughts would change and then their behaviors would change.

Kinda like a train. Okay. But what they want to change first is mood. Unfortunately, the mood is likely to change last. So, we want to flip that around. We change behavior first. Then thinking, then the feelings will change. So, what I mean by that is we start with doing something we call behavioral activation.

And behavioral activation has three components. And those three components are physical activity. Okay? So, it’s moving your body, okay? And it might be early on very simple. It can be making walking around the backyard, okay?  Doesn’t have to be doing a marathon. Doesn’t have to be a lot.

But just moving your body. Okay. Pushing against that nature to become sedentary. Number two, social interaction. Okay. It is making sure that there are people and engaging, and again, it doesn’t have to mean that you go to an event with a thousand people, but it may be, for example, let’s say somebody says, I don’t feel like I can make it to church.

Okay, can you make it a half day? Would it be okay if I came and sat with you at home while you’re watching the church? You know, whatever those things are. So social connection and number three, meaningful activities. When I say meaningful activities, I mean small but doable things because one of the things that happens in depression is a lot of helplessness and a lot of spinning, and so doing small meaningful activities can help the person start to develop a sense of competency. So, this idea of being overwhelmed because I have a thousand things that I need to get done. What you’re saying is do one. That’s right. Yes. And we really encourage it done by setting up a schedule for it so that it can be happening consistently over many days.

So, I think you said in the beginning, sometimes it is just the only thing you’re doing this morning is taking that five-minute walk and giving them permission for that. I think for as far as sticking with the schedule, I always encourage that there is somebody that helps keep them accountable or like we’ve talked about, does it with them in the beginning until it gets easier.

I’ve heard the phrase, we have to do it even when we don’t feel like it, in order to get to a place of it being meaningful or helpful. Well, to your point, behavior giving rise to thinking correctly, giving rise to the mood change, which we want to happen quickly, but that overwhelming that happens can really be difficult.

And I use this analogy, I’ll say, so if you had a sink full of dishes, dirty dishes, how do you clean a sink of dirty dishes? And the person looks and like, oh man, that’s horrible. The answer is you pick up the first cup. Okay. We have to break it into pieces.

The other thing that, as Kathy said, there is much hope around the treatment of depression. There are many different options for treatment and so really one of the things we have to do is match the right treatment to the person. We started with the behavioral activation piece, those things.

Another thing, and we do a lot here, is counseling. And with that, we’re trying to help people get behavioral activation going, trying to help them be socially connected, but a big part of what we do is try to engage their thinking. Okay. And so, we use some tools. One’s called Truth Talk, which is a positive self-talk script that’s based on Scripture for the person to read and reread.

I like people to read it every day, sometime before noon. That’s my instruction. And at the beginning, you’re not going to feel it. But we have to have some kind of positive self-talk to challenge the negative and there are other tools that we use to help deal with thinking as well.

You got any thoughts? Yeah, I would say just like with that truth talk piece, I think also my recommendation is to not make a lot of judgments on it. Like we’re asking you to do these things, read these things, and even if it doesn’t feel like it’s connecting. Your ability to just continue to do it for many days over a period of time helps produce good results.

Yeah, and we’re trying to help people change their thinking by seeing things like their cognitive distortions that they might have, like all or nothing thinking and perfectionism. So, we’re going to be working with those things as well as we go along. And so, counseling is going to follow the contours of what symptoms the person has and where they’re at in their life.

And it’s going to look different in working with an adolescent as working with a young mother with a new baby. Yeah. I think once an individual is able to start doing things behaviorally, the more they’re able to participate in some activities, opens up the channels to start doing some of the therapeutic approaches, like helping with thinking and then changing thinking patterns and like you had said, unhelpful thoughts.

So, that’s what we can do in the counseling office and then, which ultimately helps with that, the mood shift. Yeah, that’s really helpful. Ted, you mentioned this self-talk, which is based on Scripture. I want to talk a little bit about this concept is posture, this opinion that says if they just believed the Bible.

Doesn’t it say rejoice and so speak? I know you’ve got a thought deeply about the intersection of this mental health crisis as well as the Christian faith. How have you sorted those things out? Yeah, I think two things is that we want to remember here that even in the Bible and throughout the Bible, we get a picture of real people experiencing real things.

You see somebody like Elijah who was on the mountaintop, you know, a mountaintop experience. Who then not too long after is crushed, was suicidal, and saying, Lord, just take my life from me. Yeah. So, we see those ups and downs. You see David in the Psalms; you see all these different kinds of things that happen.

I think one of the things that I would say is absolutely that we want people to be able to rejoice and those kinds of things. I would encourage people to remember this. There are easy statements that you can say that actually have the opposite effect. And so, the comments and people that mean it well, but it isn’t helpful at all. And that is like, oh, a Christian should never be depressed, or Christians should always be happy. And I would say I get where people are going with those kinds of statements.

But they’re not helpful or reflective of life. I do think that when, like I mentioned earlier, if somebody is walking far from God and living in sin and they have a guilty conscience and the consequences of sin, that’s going to beat down heavily on them. Even David said that before he confessed, he felt it in his bones. Well, that’s going to drag on somebody’s system. But that’s why we come and work in community together because sometimes the most important thing that you can tell somebody is  if you feel depressed right now then right now you need to trust that God has you in his arms.

And right now, you need to rest in my faith that God is holding you. We have to meet them where they’re at and walk them forward. You know what I really like about that is if I had a broken leg or something, we definitely have a picture for coming around that person and saying, let me be your physical strength.

Yeah, because you simply can’t carry yourself right now. That’s correct. What I hear you are doing is doing that both mentally and spiritually. Yes. You’re going to need to borrow my faith right here. Yeah. God loves you. Yeah. You don’t feel that. Yep. But if you can allow my faith to be yours in this moment. That would be a good help.

Yes. Very important. Because Satan is brutal at these times. He is, he doesn’t look at somebody who’s depressed and go, ah, you know what, hey, give him a break. He says, there’s somebody depressed. It’s time to pour it on. So that’s where prayer, that’s where checking in, texts, those kind of things, being willing to go with somebody, do a counseling appointment or a doctor’s appointment, go on a walk are so important. The community of faith and family is so important. Yeah. I think one of the other things to remember with this, when we talk about both the importance of the community of support that is important, there’s also, we’ve talked about the therapeutic approach and engaging in therapy to learn tools and skills.

I think it’s helpful to remember that there are tools also through the route of medication that can be really helpful. I see a lot of times in my clinical work that the ability for somebody to connect with some medication in order for their body to be responding in the way it needs to be responding actually helps them then engage in the clinical work more.

That’s correct. And I think one of the things is that we would really remind everyone to not view a human being as just either biological or psychological or relational or spiritual, but all those things were biopsychosocial-spiritual, and I would say this, if somebody hasn’t gotten a physical with blood work, that’s a really important piece because sometimes, because I’ve worked with people, Matt, who were just sure they were condemned by God. Okay. And really, really felt depressed and life was just going to pieces. When they went for that physical, they found out that their thyroid was way off.

We get their thyroid worked out and guess what happens? All of a sudden, these other things. So, they felt like their spiritual life was off, their thyroid was off. The flip side is we’re not putting all of our hope in any particular medication or any counseling or whatever, but it’s generally all of it together.

It’s holistic and that’s the thing. We need the prayers, but having things checked out with a physician and I would say this, and this is probably for another podcast we can do, but different kinds of depression are treated differently. And so, some kinds of depression, like bipolar depression, medication becomes a central focus.

Where with other kinds of depression, it may or may not be as much of a focus. And so, what I would like to do is remind people that it’s a tool, medication’s a tool in the toolbox. It doesn’t have to be shameful, and it also isn’t the only solution we have.

So, we’re just trying to take a balanced view that biology’s important. Counseling, thinking, and emotions are important. Social relationships and community are important and spiritual hope is so important as well. Ted and Kathy, thanks. Thanks for shedding light on this important topic that so many of us walk with and deal with. I think you’ve given some real handholds in terms of what does good next steps look like. Cast hope in a dark place that why don’t you go on record? Do you see people on the other side of depression? What does that look like? Absolutely.

Yes, without a doubt. And I would imagine it’s surprising for them to be at a place that they thought never was possible. Yeah. I sometimes write a note to them early on and if I was writing to you, I would say, dear Matt, you will feel better again and I hand that to them and they look at me and they shake their head like, I don’t know if I ever will.

And then we rejoice when we get there. It’s really a beautiful thing. Sometimes I can even start to see the shifting and thinking or emotions even before they’re able to see it or feel it. But it’s just a beautiful thing when you start to see that starts to change. I think that’s beautiful.

I think that’s the hope that we want to hear. So, thanks, both of you and to our listeners. We trust that this helps us love people. And hopefully that is something that this podcast puts forward and gives us the tools to do more and  love people well.

So, thanks each one for being on.