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I had a great interview with Greg Wheatley of Prime Time America today. One of the questions he asked me was “How do those of us who are not trained counselors help a friend who is hurting without being cliche’ or flippant.” I thought I would expound on my answer and give a few helpful tips:

1. Provide Comfort. Use words if necessary. When you don’t have the right words, say so. Your presence, your touch, your time, your listening ear, your shared mourning may be enough to provide comfort to someone who is in pain.

2. Ask Good questions! What would you need to know in order to fully grasp your friend’s situation? Rather than jumping in with quick words of encouragement that might be misconstrued, try to put yourself in your friend’s shoes. This is the essence of empathy. What might be a comfort to you may not be to others. Knowing a friend is important to properly encourage them. So what are they thinking, what are they feeling, how have they tried to fix the problem, have they had similar problems in the past? “Now you know…and knowing is half the battle.”

3. Be intentional in your prayers. This is one of the best questions you can ask a hurting friend. “How can I pray for you?” When they tell you, make sure you follow through. This will not only show them that you are genuinely interested, it will also bring you a great deal of joy when you start seeing your prayers answered.

4. Be careful with self-disclosure. One way we can get in trouble with friends is to start talking about ourselves. “Oh, I know exactly what your are going through. When I was…” may not be the best response to someone in immediate pain. Self-disclosure may be important, but if you do this before you have followed step 2, you are making an assumption that you understand when really, you may not. Remember, the focus should remain on the person in pain.

5. Speak true in love. No one can question your motives. If you are genuinely concerned about a friend, they will be able to see it and be more forgiving of any faux pas on your part. Once you’ve shared your heart, check in with your friend to see if there is anything you said that they did not understand or may have taken the wrong way. Be willing to follow up on your words with action. As James 2:16 says, “If one of you says to him, ‘Go, I wish you well; keep warm and well fed,’ but does nothing about his physical needs, what good is it?”

Question: What struggles have you had in trying to counsel or comfort a friend in their pain? How did you handle it?

Our brains and bodies communicate continuously whether we are consciously aware of them or not. In many ways, this continuous communication is good. To breath, pump blood, or digest our food we need not be conscious. Our brains also have the capacity to multi-task. For example, we can drive home from work while we talk on the cell phone or sing with the radio. Our brains store and remember how to respond to environmental cues based on our past experiences. With continuous exposure, our brains react automatically.   

This automatic reaction can occur when faced with stress. The body increases the levels of epinephrine which increases heart rate, the rate and depth of breathing, and helps convert glycogen to glucose to boost energy supplies and facilitate muscle contraction. Even if our initial perception of danger is wrong, the body still prepares itself. How often are we startled by sounds in the night to which we would pay no mind during the day? When was the last time you jumped away from  a “snake” on a forest trail only to realize a few seconds later that it was just a twig? This automatic, preconscious response is the way the brain protects the body from potential harm.

Unfortunately at times our brains’ unconscious reactions can be harmful not helpful.We can learn maladaptive responses to stress that continue even in safe situations. For example, a small child learns to go to his room and hide when his parents begin to fight. By doing this, he protects himself from becoming the object of a larger human being’s unbridled anger. If this pattern is repeated enough, he will grow up avoiding conflict, reacting to it unconsciously by shutting down or “running away”. This will prove harmful in his relationship with his wife, his children, his friends and his coworkers.

These kinds of scenerios happen all the time in our daily lives. How we react to our environment is strongly influenced by engrained experiences from our past. To change, we must work toward conscious awareness of our thoughts, emotions and reactions to stress. Then we can practice changing our responses. Through repetition, we in essence rewire the circuitry of our brains. Psychiatry has developed multiple therapies to help foster this kind of change: Cognitive Behavioral Therapy, Exposure/Response prevention, and biofeedback are a few. Medications can also help as they lower the intensity of the stress signal to the brain and give us more time to react consciously.

Our bodies stress response is a God-given tool for protection, but like anything else, it can malfunction. In times like this, we must remember that pain is not the enemy. It is the signal that leads us to conscious awareness of a problem that needs to be fixed.

Question:     What situations tend to heighten your stress level? How do you respond? Is that response working for you? What other reactions might be more beneficial for you and those around you and how can you begin to practice making a change?

Current Psychiatry recently published a list of research studies supporting the effectiveness of meditation in reducing symptoms of anxiety and depression.  Meditation “refers to a variety of practices that intentionally focus attention to help the practitioner disengage from unconscious absorption in thoughts and feelings.”  There are two main types: concentrative meditation and mindfulness meditation.

With concentrative meditation, a person works to maintain focus on a particular object, word, phrase, or body part. In mindfulness meditation, participants consciously observe objects (such as breath, body, emotions, or thoughts) as they appear in moment-by-moment awareness. The first is like mental exercise or weightlifting and the second is like mental massage or spa treatment. In the physical word, a balance of both are needed to stay fit and healthy.

Sadly, Buddhist and Western psychology have taken the credit for developing the practice of meditation, but in reality, God established the importance of this practice long before man came up with the idea. If you don’t believe me, look up Joshua 1:8; Psalm 1:2; Psalm 4:4; Psalm 19:14; Psalm 119:15, 97; Philippians 4:8. These verses decribe the concentrative type of meditation. We focus on scripture, memorize it, ponder it and allow it to permiate our very being. That way, when difficulties come, those truths will be readily available to our consciousness.

Mindfulness meditation, though not as explicitly described in scripture, can still be found. Psalm 19:1-4 and Romans 1:19-20 speak to the revelation of God through creation. We can learn about God by observing the natural world around us. When was the last time you sat alone and just observed nature, taking it in with all of your senses? A conscious awareness of its beautiful design, even in the normal functioning of our own body can lead us to a deeper appreciation of the awesomeness of God.  The Lord tells us in Psalm 46:10, ”Be still and know that I am God.” It is often in the silent moments of our lives when we have no agenda, no tasks at hand, no distractions that God speaks to us. The question is this: are we training ourselves to listen? 

Not only is a conscious awareness of our external environment important, but so is a conscious awareness of our internal thoughts and emotions. The psalmist asks God in psalm 139 to “search me, O God, and know my heart; Try me and know my anxieties; And see if there is any wicked way in me, and lead me in the way everlasting.” God will not reveal our thoughts, our anxieties, even our sin unless we take time to stop and consciously evaluate them as they come. Setting aside time to do this is important.

Question: What are your thoughts on meditation? How are you practicing it in your daily life?

Clinical risk factors that may be easily identified during routine obstetric examination may help predict depression during pregnancy, according to the results of a review of 57 studies reported in the January 2010 issue of the American Journal of Obstetrics & Gynecology.

The three major risk factors that were consistent throughout the studies were as follows:

1. Life Stress: this is a common risk factor for depression by itself, but when combined with the physical and psychological stresses of pregancy, it can really make women susceptible.

2. Poor social support. Morning sickness, physical exhaustion, and the hormonal changes that occur during pregnancy are just the beginning. Taking on the responsibility for a new life can seem like a daunting task especially when there is no one else around to help. The feelings of social isolation and loneliness can lead to a major depressive episode in women who have no one to support them through their pregnancy.

3. Domestic Violence. Women who are in abusive relationships feel trapped. They are often afraid to speak up or take action against their abuser for fear of repercussions. This leads to less social support and more stress resulting in depression.  

Solutions: be sure to make time for yourself during the pregnancy. Taking care of your body is taking care of your child. Surround yourself with people who are willing to help in any way they can. Don’t keep quiet about how you are feeling. Open up to people who will walk with you through the process. And finally, if you are in an abusive relationship don’t let fear prevent you from setting boundaries. Tell a friend. Get the authorities involved. You don’t have to suffer alone.

Question: Are these risk factors surprising to you or not? If you have children, what were some of the most helpful acts of kindness people did for you during your pregnancy?

I am often asked about the benefits of supplements for improving mental health. May individuals lean toward supplements because they are “natural”, though unless you are getting these natural supplements directly from your diet, they are not really natural at all. They are still manufactured and processed just like everything else. Because supplements are not regulated by the FDA, it is very hard to know exactly what you are getting in any given batch. On top of this, very few studies have shown significant benefit from anything other than a once daily vitamin like centrum silver. Still, it is worth talking to your doctor about if you have specific questions or concerns. We do know that vitamins and minerals play a vital role in our bodies physiology. This is why I always recommend a well balanced diet with at least 30 minutes of exercise each day. Here are a few of the vitamins that have effects on the brain that are in most once daily supplements:

Vitamin B1 (thiamine).

Thiamine deficiency commonly results in psychiatric symptoms including irritability and depression, fearfulness, agitation and emotional instability.  Severe thiamine deficiency induced by chronic alcoholism, referred to as Wernicke-Korsakoff syndrome, is well known to be associated with a large array of psychiatric and cognitive symptoms including disorientation.

Vitamin B2 (riboflavin).

Riboflavin is essential to many pathways involved in the metabolism of protein, fats and carbohydrates as well as for the activity of numerous antioxidant enzymes. Relating to riboflavins antioxidant function, riboflavin deficiency has been associated with oxidative stress. Major depression has also been associated with oxidative stress which may play a role in its development.

Vitamin B6 (pyridoxine).

 Lower levels of pyridoxal phosphate, the biochemically active form of B6, are significantly correlated with higher levels of depression. Irritability and confusion have also been reported as symptoms of B6 deficiency and chronically B6 deficient individuals were also found to be significantly more anxious.

Pyridoxine is required as a coenzyme for the synthesis of serotonin, dopamine and GABA. Pyridoxine is also required for carbohydrate metabolism and other aspects of amino acid metabolism.

Folate.

Depression is a common symptom of folate deficiency. Folates basic functions include methylation and DNA synthesis. Lower central nervous system levels of 5-hydroxytryptamine (serotonin) are also documented in folate deficiency.  The most likely explanation for the association between folate status and psychiatric symptoms is its connection with monoamine metabolism via methylation, although other functions are also likely relevant.

Vitamin B12 (cobalamin).

Depression is a common early psychiatric manifestation of B12 deficiency. Other symptoms include mania and psychosis, slowing of mental processes, confusion and memory defects. B12 deficiency also causes folate to be ‘trapped’ in a form not available to perform its function.

Vitamin C (ascorbic acid).

Vitamin C is a cofactor for dopamine beta-hydroxylase, which is involved in the conversion of dopamine to norepinephrine, and a cofactor for tryptophan-5-hydroxylase required for the conversion of tryptophan to 5-hydroxytryptophan in serotonin production. Vitamin C also has broad-spectrum antioxidant properties and is essential for the mitochondrial metabolism of fats.

Magnesium.

Magnesium deficiency can cause depression, behavior and personality changes, apathy, irritability and anxiety. Magnesium is required by over 300 chemical reactions in humans.

Zinc.

Psychiatric manifestations of zinc deficiency include behavioural disturbances, depression and mental confusion. Within major depression populations, lower zinc levels correlate with higher depression severity.

Zinc is involved in such functions as antioxidant defence, gene expression, nerve impulse transmission, thyroid function, digestion and a large array of other functions. Zinc is found in high concentrations in hippocampal and cortical neurons. Zinc is also an inducer of brain derived neurotrophic factor is an antagonist of the NMDA-receptor  and is required for GABA metabolism.

OMEGA-3:

A number of studies suggest that fish oil supplements may be an effective add-on (adjuvant) therapy for depression. Fish oil is a good source of omega-3 fatty acids. Fatty acids have been shown to play an important role in brain function as well as normal growth and development. Some research has suggested that people who have depression have low blood levels of eicosapentaenoic acid (EPA), a fatty acid found in fish oil.

As I said at the beginning of the post, a daily supplement with a well-balanced diet and exercise is the most natural way to stay healthy. If you are curious, however, about extra supplements, consult your doctor before starting any new dietary or herbal supplement to treat depression, especially if you take other medications.

Mann J & Truswell AS. Essentials of Human Nutrition. 2nd edition. New York: Oxford University Press; 2002.

photo courtesy of Knol

The Holiday season, ironically enough, is a common time of the year for people to attempt suicide.  You may know someone who is struggling with thoughts of death. Here are a few myths (courtesy of suicide.org) you need to be aware of as you try to help them:  

1. People who talk about suicide are just trying to get attention. People who die by suicide usually talk about it first. They are in pain and oftentimes reach out for help because they do not know what to do and have lost hope. Always take talk about suicide seriously. Always.

2. People who talk about wanting to die by suicide do not try to kill themselves. People who talk about wanting to die by suicide often kill themselves (whether intentionally or unintentionally).

3. Suicide always occurs without any warning signs. This is most definitely not true. Look for social isolation, depressed mood, verbalizing thoughts about death, giving away things to friends or family, saying-goodbye behaviors, increased use of drugs or alcohol.  

4. Once people decide to die by suicide, there is nothing you can do to stop them. Suicide can be prevented. Most people who are suicidal do not want to die; they just want to stop their pain. Through professional treatment and a caring community, suicides can be prevented.

5. Suicide only strikes people of a certain gender, race, financial status, age, etc. Suicide can strike anyone, even Christians. In fact, the most concerning individuals are Christians who believe in eternal security and see suicide as just another sin that Christ has forgiven. These individuals must recognize the sovereignty of God in life and death and recognize that if they are still alive, He still has a plan for them, no matter how hopeless their situation may be.

6. People who attempt suicide and survive will not attempt suicide again. People who attempt suicide and survive will often make additional attempts. Continuing to monitor for these thoughts is a must.

7. People who attempt suicide are weak or crazy. Though it is true that many people who attempt suicide have a chemical imbalance that prevents them from thinking rationally about their situation, some people make conscious well thought out plans to end their lives. Many times the strong silent types are the most at risk.

8. People who talk about suicide are trying to manipulate others.  We cannot be the judge of people’s motives for verbalizing suicidal thoughts. Any talk of suicide must be taken seriously.  If you know someone who has verbalized suicidal thoughts, get them to a counselor or physician that can help immediately. This may mean taking them to the nearest emergency room or calling 911. Err on the side of safety. 

9. Talking about Suicide makes someone more likely to do it. Asking people if they are thinking about suicide does not give them the idea for suicide. And it is important to talk about suicide with people who are suicidal because you will learn more about their mindset and intentions, and allow them to diffuse some of the tension that is causing their suicidal feelings.

 10. People who are suicidal do not seek help. Many people who are suicidal reach out for help so keep your eyes and your ears open! You may be able to save a life this Christmas!!

If you or someone you know is contemplating suicide, visit the homepage of the link above and take action. While we still have breath, there is always hope of finding purpose in life through a relationship with Jesus Christ.

Here is a helpful video from  QUEST on KQED Public Media that reviews very briefly the kinds of symptoms I look for in depressed patients and the types of treatment we have available to help. The video reviews the most common medications, procedural treatments like Transmagnetic Stimulation, Light Therapy, and Cognitive Behavioral Therapy. These are all valid treatments we use to help reduce the symptoms of depression.

Three of the most basic helps in overcoming the pain of depression that they failed to mention, however, are a healthy diet and exercise, strong interpersonal relationships, and a worldview that is clearly defined and provides purpose and meaning for an individual’s existence. Without these, all the treatments in the world will only give temporary relief.  Whether you take medications or not, I strongly recommend that you practice these important aspects of mental health.