Last week we discussed the symptoms of depression as well as the differences between reactive depression and clinical or chemical depression. Since nearly everyone experiences some degree of reactive depression at some point of their life, and since more than 10 percent experience serious clinical depression over the course of the their lifespan, it seems important that we all have some basic understanding of depression, its impact, and some basic treatment strategies.

Most people don’t like to admit to depression. They may think they “should” be able to deal with life, be able to pull themselves up by their bootstraps, or be able to get over it on their own. We have found that people with a religious faith can be even harder on themselves, blaming their lack of faith or trust in God for their misery. Or they believe that if they really trusted God, they would not suffer with depressive symptoms.

For these folks, we try to point them to the multitude of scriptures and personalities portrayed in the Bible to demonstrate that depression is a universal response to trauma, anger, frustration, grief, and hurt. Principal Bible characters such as Moses, Elijah, David and Jonah struggled with the “dark night of the soul,” those desperate feelings of hopelessness. Listen to David’s cry in Psalms 69:1-3.

One way of evaluating depression is based on severity — from mild to severe — or in terms of impairment of a patient’s functioning. Many counselors use a variety of scales, questionnaires and measuring devices to aid in the evaluation of a client’s depression.

When dealing with people suffering a depression, we always recommend a thorough medical evaluation by their health practitioner in order to rule out hormonal, neurological and physical causes. Many of our local physicians are sensitive and sympathetic to their patients suffering with depression. Several have recommended natural or herbal remedies such as St. John’s wort, blue-green algae and other formulations in an attempt to stabilize the mood. Carefully monitored antidepressant medication may be necessary.

Typically the health practitioner will recommend counseling in addition to the medication, both as a means to evaluate progress, and to work through any underlying issues that may contribute to depression “stuckness.”

Frequently people benefit from the accountability that weekly counseling provides. Practical suggestions for actions that attack depression may include establishing a daily routine that includes eating, exercising, socializing and praying, whether you feel like it or not. Our motto here is “Feelings count; but don’t let them power your train.” In other words, emotions are important, but you cannot trust them to help you make healthy lifestyle choices. People who let their emotions dictate find themselves on a roller coaster.

Other strategies involve doing things to boost the mood such as playing upbeat, uplifting music, going to a favorite park, meeting a friend for coffee, joining a support group, renting a comedy, walking the dog and doing a good deed for someone else. Visit a friend with whom you can cry and pour out your heart. Visit with a friend who won’t make you talk about your problems.

Find and hang out with healthy people. Let your family or roommates know what you are feeling and what you need from them. If your friends and family think they can “help” you by scolding and criticizing, confront them with your thoughts and with a book or brochure to help them understand. Do not succumb to your longing to stay in bed after the first day.

Another important, but more long-term, strategy is learning to deal with anger in a constructive, healthy way. An old aphorism says, “Depression is anger turned inward.” Lots of folks who have not learned assertion skills, boundary setting, and healthy self-care tend to turn their resentments and discouragement into unworthiness, guilt, and depression.

We have been amazed and pleased to observe people respond so positively to the simple truth that it’s OK to say no. They have operated for years under the misbelief that someone feeling sad makes them bad. We call it the pretzel syndrome when people contort themselves to accommodate others.

Changing the way you talk to yourself can alleviate some depression. Helping people uncover their own self-talk, what they silently say to themselves, can be very revealing. We have found the nicest “pretzel-people” say amazingly rude, berating, contemptuous things to themselves. They would not say the same to a friend.

Try this exercise. What do you say to yourself when you spill your coffee or burn your dinner? Hopefully you could repeat it to a preschooler or a depressed person if they did the same thing. If scolding helped depression, I would recommend it, but it does not. It only drives people further down.

Learn to say positive, optimistic, encouraging comments to yourself and others. Don’t go through depression alone. Reach out for help from God and others.

(“Relationships” questions can be sent to Craig and Arla Ford, 3803 Vista Court, North Bend, OR 97459; or e-mail to the Fords at counsel@charter.net or by going to their Web site at www.craigandarla.com. Questions cannot be answered individually.)