In my last post, I introduced my fourth principle for recovery: With the right help, you can live a happy and fulfilling life. For most depressed people, getting the right help begins with testing. I talked about standard testing for depression in the last post. If your depression is bad enough, you may need testing for more specific types. At my mother and sister’s suggestion, I got tested for clinical depression. At the time, I don’t think the standard tests I’ve read about would have caught it in my case, so I’m glad I took their advice.
Getting Tested for Clinical Depression Was Different
If you are considering getting tested for clinical depression, I can tell you a few things you probably won’t find online. I won’t give away too much. Part of the effectiveness of the testing comes from going in fresh. But in many ways it was not what I expected.
It Was Not Talk Therapy or Psycho-Therapy
It did not involve talking about my emotions or childhood. It did not involve my history, or how I’ve been feeling the last few weeks, or trying to determine if there’s a particular reason for depression, or if it is just always there regardless of any reason. Someone observing would not have thought it had anything to do with depression. The psychologist (I say psychologist, but I don’t know exactly what his title was) gave me various tasks to do and questions to answer. After each task, he asked why I did it that way or why I concluded what I did.
The only thing I recognized as “psychiatric” was the Rorschach inkblot test. You’ve probably seen it on TV. They show an inkblot, and you tell them what it looks like. On TV, they usually say a bat or a rabbit or something simple. My answers were much more elaborate. In fact afterwards, I asked if I could get copies of them, because I thought I saw scenes that could be used in a fantasy or sci-fi story. Turns out they are copyrighted, a trade secret, or something like that. In other words, they’re not available to the public.
It Takes More Time
With the standard question-and-answer tests I’ve seen, I can’t imagine them taking long. That kind of testing was made for something more general. It is one step in a process for your doctor to determine if you need treatment for depression or something else. The test I took was to look specifically for clinical depression. It took around two or maybe three hours. The time it takes for each person varies, because there is no time limit for the tasks. So if you took the kind of test you see online, and it only took a few minutes, that was not a test for clinical depression. There is a difference between situational depression, which usually does not take long to identify, and clinical depression.
Trust the Process
Like I said, you might not see what the questions and tasks you’re given have to do with depression. Clinical depression is not about how you feel or how you’ve been feeling the last two weeks or more. It is a condition of the brain. One thing about your brain. It is always with you no matter where you go, what you do, what’s happening to you, or who you’re with. Your brain is unique. But if you have clinical depression, it is there in your brain. And just like your brain, it is always with you, no matter how you feel. Even if you don’t feel depressed at this time in your life, you still could have clinical depression.
After the process was over, I realized the tasks and questions the psychologist gave were designed to give him a window into how my brain works. That is the only way to detect clinical depression. Somehow, the psychologist has to see your brain at work, how it processes information, and how it responds to various challenges and stimuli. That’s why he asked me to explain my thought processes each step of the way. Each answer gave him a little more data about how my brain worked.
When it was over, I set a follow-up appointment to get the results. The psychologist said I could bring someone in with me if I wanted. My sister was happy to do it. She should have been, since she roped me into it in the first place. So she was there when the psychologist gave me the news: “You tested high for depression in every possible way.”
The world stood still. It was so shocking I didn’t know how to respond. If he had said anything else, like I tested moderate to severe in every possible way, or I tested high in half the ways, I would not have been surprised. But high in every possible way? How was that possible? I only felt mildly depressed. How could I have tested high in every possible way? That would not have been the case with one of those standard online tests. I’m not denigrating them. I’m just saying diagnosing clinical depression as opposed to situational depression is much more involved than that.
As I adjusted to the shock, the next thing I felt was shame. Because I am a Christian.
What Will This Do to My Testimony?
I had struggled mightily with depression in the past. But I always thought it was in specific episodes. I was depressed in college. I was depressed during and after my first year of Divinity School. I was depressed when I turned thirty, and I was nowhere near where I was supposed to be in life. And each time, I said, Jesus delivered me from it.
If you are a Christian, you might have picked up the message that you should be able to overcome depression by faith alone, because Christ is all sufficient. He is all you need for peace of mind. You’ve heard others give that testimony. You wanted it to be your testimony.
Do you see the joy on my face? It’s because of Jesus.
Since I found Jesus, I don’t get the blues.
I can’t be depressed, because the joy of the Lord is my strength.
Too blessed to be depressed.
For me, all of that went away with my diagnosis. I wanted that testimony to show people what a difference Jesus made in my life. But I also learned long ago that in my relationship with God, honesty is much more important than having “the right testimony.” Honestly, as much as I wanted it, that was never my testimony. But there was still a part of me that thought it should be my testimony.
Here’s what you need to understand. Christ is all-sufficient when it comes to salvation, forgiveness of sins, and eternal life. When we get to heaven, we probably will never be depressed again. But when it comes to life on earth, we will sometimes need help from people, whether it’s warm bodies to carry things when you move, doctors and nurses to bring you back to health from sickness or injury, or mental health professionals to help you diagnose and treat mental illness. Christ is not at all offended if you need help from a professional, whether your illness is physical or mental.
The psychologist explained clinical depression is a condition of the brain. It means my brain does not produce enough natural antidepressants, like serotonin, dopamine, and norepinephrine. It’s a natural condition and nothing to be ashamed of. A diabetic has a pancreas that can’t produce insulin. There is no shame in that. It says nothing about that person’s faith or lack thereof. If my brain doesn’t produce normal levels of “happy chemicals” (as I call them), I shouldn’t be ashamed of that either. It can happen to anyone, regardless of what kind of faith they have.
Just like there is treatment for diabetes, there is treatment for clinical depression. That usually starts with antidepressant (AD) medication and counseling. Counseling, I had no problem with. But I had some resistance to medication.
***DISCLAIMER: In the medical field, the effectiveness of AD medication is being seriously questioned. Just keep in mind, any psychotropic drug affects each person differently. My experience might be the same as yours, and it might be totally different. You should never take one without a recommendation from a doctor or mental health professional. And you need to pay attention to how it affects your thoughts and emotions, especially in the first few days or weeks. Before you start taking AD medication, be sure you know what to do if your condition doesn’t improve or gets worse.***
With that disclaimer, I’ll tell you why I took it, and why I’m glad I did.
Most doctors seem more reluctant to prescribe AD medication today than when I was diagnosed. Part of the reason is recent studies have indicated it is no more effective than a placebo for anything other than severe depression.
Okay, but remember, I had just tested high for depression in every possible way. The diagnosis of clinical depression meant I had been living with depression my whole life and did not even know it. If that is not severe depression, what is? If my diagnosis had not been so extreme, I would not have even considered it. I would more likely have accepted counseling and tried doubling down on faith confessions, positive thinking, motivational messages, and meditating on scripture. I’m not saying those things were not effective for me. They kept me going in some of my worst and darkest moments. But I had been doing all that for almost two decades, and I still tested high in every possible way. That realization took down most of my resistance.
There was also the comparison with the diabetic. He/she needs to take insulin, because their body can’t produce it. If my brain doesn’t make normal levels of “happy chemicals,” taking medication for that is no different.
She Is So Much Nicer Now
This was also where having my sister there was helpful. She knew some things I didn’t. For example, she knew of a relative who had recently started AD medication. “She is so much nicer now,” I said. Oh, and another who was moody and had a volatile temper. “That was depression?” I had never made that connection before with him or myself.
In the past, I had chalked up my own moodiness to “artistic temperament.” But it had never occurred to me that was a sign of depression. This is one way you can be depressed and not know it. You know some of the signs, but not all of them. Like here, I knew I was moody and temperamental, but I didn’t connect that with depression. And seeing how much nicer that one relative was with medication, I thought maybe it wouldn’t be a bad thing for me.
Perfectly Timed for College
The psychologist also told me clinical depression usually gets its worst between late-teens and early-twenties. Bang! That was totally true for me. At first, that was connected to a crisis of faith. But even after that crisis was resolved, I still had this malaise I couldn’t shake. It was so hard for me to get motivated for anything back then. I thought it was the work of the devil. Finally, I realized, it was the work of my chemically imbalanced brain.
Furthermore, whenever I had a crisis of faith, depression always accompanied it. So how do you know if this is the situational depression of a dark night of the soul, or clinical depression felt more intensely because you’re wondering, “What the hell is God doing to me?” You don’t without getting tested.
What about “Artistic Temperament”?
I wanted to be a writer. Let’s face it. Some of the greatest writers and artists in history were very moody and temperamental. I can’t diagnose them, but it’s likely most of them had clinical depression or similar mental illness. But is that where their genius came from? Was depression the muse that inspired their work that we still celebrate today? What if they could have taken AD medication so as not to be tormented with those dark thoughts and emotions anymore? Would that have made them less creative?
Many times, depression compelled me to write something. It was therapy before I began therapy. If I lose that, will I lose some of my creativity or my urge to write? Can I really be an artist without the temperament?
The psychologist’s answer was, in effect, yes, I could. Since I started AD medication, I’ve been able to go back to some of those dark places when I needed to without being caught up in the darkness myself. I can write about the insanity I experienced without re-experiencing it. And I still feel the urge to write, even when I don’t feel depressed. In fact, the most depressing thing for me is to go a few days without writing. That’s when I really get moody and temperamental. So if you are a creative or artistic type, I can tell you taking AD medication has not dampened my creativity one bit. In fact, now I have so many ideas, there aren’t enough hours in a day for me to write them all.
One More Tip No One Told Me
So I had the results of the test. I had the beginnings of a plan for recovery. I accepted the diagnosis and agreed to medication. The psychologist recommended a pastoral counselor for me, because I knew I would need help with some of the theological issues I still had. I left with a copy of the report, and my sister and I sat down in a coffee shop to talk more about the implications of all this.
One thing I remember from the conversation was the relationship between depression and anxiety. In addition to depression, I seemed to be more anxious than people around me. My sister said that depression and anxiety were located close to each other in the brain. If you have issues with one, it’s common to have issues with the other. That reminds me of Chris Cornell. He took Ativan for anxiety, but in some of his interviews he also talked about depression. The good news is if you treat one effectively, it often helps the other. That has been true of me, and I wish it had been true for Cornell.
Overall, after adjusting to the shock, it was one of the most enlightening days of my life. My recovery began that day. But there was one thing I wish someone had told me. Don’t read the results of your test. Normally, I’m the type of person who would say, “If you have the test, read it. The more information you have about your condition, the better.” This is an exception. That report was the most depressing thing about myself I have ever read.
You don’t need to read it to know what you need to. Ask the psychologist who tested you about the results, what they mean, and what kind of treatment you need. Don’t throw it away. Keep a copy of it in case you need to make a disability claim. But don’t read it unless for some reason you absolutely have to.
Life after AD Medication
Back in college, I had this voice in my head that was so negative and so condemning, it felt like it came straight out of the pit of Hell. I could cast it out in Jesus’ name. Temporarily. But anytime I failed, or my prayers weren’t answered, the voice returned. And in some ways, I felt I deserved it, because I still didn’t have enough faith (whatever that means). In the Word of Faith, they tell you that voice is a demon or the Devil. And then, it changed from the Devil to Jesus, beating me up for not having “enough faith” to get what I prayed for.
Fortunately, I did learn not to associate that voice with either one of them. I had an incredible Epiphany that drove it away for a couple of years. But eventually, it came back. After a few days on medication, that voice went away for me. I don’t know if there really are such things as demons or Satan, but I do know this. If a pill can make it go away, it’s not a demon. For that matter, it’s not Jesus either. It’s a mental illness.
Here’s another thing that happened. I used to think I had ups and downs like everyone else. I could be happy or sad, stressed or at peace, friendly or misanthropic. But even when I was happy, there was this underlying sadness I couldn’t get rid of. I never felt like I belonged anywhere, even among friends. I thought it was normal, because that was how my brain worked. When I started AD medication, those feelings finally went away. From that, I learned that however your brain works, you will think it’s normal because everything about your experience is processed through your brain. If your brain is naturally tilted toward depression, it will color all your experience with that brush. That was why I didn’t recognize it as depression except when it got really bad.
That leads into my fifth principle for recovery: Never believe a chemically imbalanced brain, even if it is your own. I will dive into that in my next post. Until then, here are your takeaways.
- Situational depression is much easier to recognize than clinical depression. Situational depression is about how you feel. Clinical depression is a medical condition.
- Because they are different, the testing for each is different.
- Testing for depression is only one part of a process to determine if you need treatment for depression or something else.
- If your family and friends think you are sad or depressed even when you don’t, you should seriously consider testing for clinical depression.
- Sadness and lack of motivation are not the only signs of depression. Anger, moodiness, and a quick, extreme temper are also signs.
- Like any medical condition, clinical depression has nothing to do with faith or the lack thereof. Don’t believe anyone who tells you faith should be all you need to treat it.
- AD medication is normally for severe or clinical depression. Research has not confirmed effectiveness for less severe kinds of depression.
- If you have severe depression, it’s no sin to try AD medication.
- Like other psychotropic drugs, AD medications affect everyone differently. Before you take it, make sure you know what to do if your depression gets worse after taking it.
- You do not have to read the results of your test. Just follow the advice of the one who tested you, and you’ll be on your way to recovery.
Grace and Peace to you.
P.S. I’ve talked about how my sister and mother encouraged me to get tested. You might be wondering about my father. He recently confessed to me that he thought I had problems with depression too, but he did not know how to talk to me about it. So it’s official. Everyone in my family knew I was depressed before I did (see Takeaway #4). But that in a nutshell is why I’m writing these posts and why I wrote my book Dark Nights of the Soul: Reflections on Faith and the Depressed Brain. I’m sharing what my clinical depression looked like as best I can, in the hopes that A) someone undiagnosed will see themselves in it and be prompted to get help, or B) someone who cares for a depressed person can use it to help share their concerns.