In May 2016, the Library of Congress and the John Kluge Center hosted a symposium on Can Depression be Cured? at which four of the top medical researchers into depression and its treatments presented their latest research findings. A full unedited transcript of the presentations can be found here and the video is here. 

The first presentation was given by Dr. Philip Gold who has been a member of the Library of Congress’s  Scholars Council since 2004. He received his undergraduate medical degrees at Duke University and his post-graduate medical training at the Harvard Medical School.  He has been at the NIH Clinical Center since 1974 where he served as chief neuroendocrine research in the NIMH intramural research program. I’ve summarized his address below and over the coming days, I’ll try to do the same for the other addresses, before summing up with a reflection on the research.

The main findings in Dr. Gold’s research are really quite stunning and should result in a major re-evaluation of the understanding of depression. Here’s a simplified summary of the findings followed by a brief explanation of each one:

1. Depression is a disorder of the human stress response.

2. Depression is a disease which involves brain tissue loss and damage. 

3. Anti-depressants work by increasing the growth of brain cells and the connections between them.

4. Depression causes serious damage to the rest of the body

5. The best treatment for depression at present is a mix of talking therapies and medication

Main Finding 1: Depression is a disorder (dysregulation) of the human stress response

The stress response is our reaction to stressors in our life (physical, psychological, spiritual, etc.). For example, if you are being chased by a bear the stress response should kick in to maximize chances of survival. The stress response includes:

• Fear-related behaviors and anxiety.
• A decreased capacity for pleasure (in order to focus attention on the threat).
• Inflexible mood and cognition.
• Stress hormone production (especially of cortisol and norepinephrine).
• Redirection of fuel to the bloodstream and the brain through development of insulin resistance.
• Increase of inflammation and coagulation (blood clotting), both priming the system to respond to possible injury.
• Inhibition of neurovegetative program, meaning suspension of appetite, rest, sleep, sexual desire.
• Increased neuroplasticity (the brain’s ability to form new neural connections) and neurogenesis (growth of brain cells).

In melancholic depression (which affects 35% of those with major depression), the stress response is disordered in that when triggered it does not terminate quickly enough or sufficiently enough. It gets stuck in the “on” position, resulting in:

• Increased and prolonged fear-related behaviors and anxiety.
• Inhibition of the capacity to anticipate or experience pleasure.
• Inflexible mood and cognition (mood and thinking patterns are in a rut).
• Increased and prolonged stress hormone production.
• Increased insulin resistance in order to redirect fuel to bloodstream and brain.
• Increased and prolonged inflammation and coagulation.
• Increased and prolonged inhibition of neurovegetative programs (appetite, rest, sleep, sex).
• Decreased neuroplasticity and neurogenesis.

Main Finding Two: Depression is a neurodegenerative systemic disorder rather than a chemical imbalance.

There is chemical imbalance in depression but the primary cause is a loss of brain tissue in key areas (and abnormal increase of brain tissue in one key area).

A number of areas in the brain are physically changed in this disorder of the stress response.

1. The subgenual prefrontal cortex is reduced in size by as much as 40% in patients with familial depression. The subgenual prefrontal cortex:

• Regulates and restrains the brains fear system.
• Plays a large role in self-assessment.
• Estimates the likelihood of punishment or reward.
• Modulates the pleasure and reward center.
• Restrains cortisol secretion.

When the subgenual prefrontal cortex is decreased in size all of these functions are similarly decreased resulting in excessive anxiety, feelings of worthlessness, decreased pleasure, and increased production of stress hormone.

2. The amygdala increases in size and goes into overdrive in depression and this further restrains the working of the subgenual prefrontal cortex.

3. The ventral striatum is significantly reduced in size during depression. This area is the pleasure and motivational center.

4. The hippocampus serves multiple memory functions and is the main place where neurogenesis (growth of new brain cells) occurs. Its size is significantly reduced in depression.

Summing up the loss of or damage to brain tissue, Dr. Gold said: “There’s more loss of tissue in depression than there is in Parkinson’s disease!” “Depression as a full-blown disease,” he warned, “a systemic full body disorder with neurodegenerative aspects and is a progressive disease, much more serious, I think, than we had previously appreciated.”

Main Finding Three: Anti-depressants work by improving neuroplasticity and neurogenesis

Almost all antidepressants significantly improve neuroplasticity and neurogenesis.  There are few other (if any) compounds which actually increase neurogenesis, and people are experimenting using antidepressants to try to treat disease of the retina, for instance, to get neurogenesis active there and other sites of the body. The challenge for the next generation of anti-depressants, then, is to develop compounds that promote neurogenesis and neuroplasticity.

Main Finding Four: Depression damages the rest of the body

The pathological losses or gains in tissue in specific sites set into motion pathologic changes outside of the brain:

• They’re responsible for the premature onset of coronary artery disease, stroke, diabetes, and osteoporosis.
• Increased cortisol (growth hormone) secretion affects every cell in the body.
• Increased insulin resistance and cholesterol levels increases inflammation, produces bad lipids, and increases clotting.
• Premenopausal women with major depression have much higher incidence of osteoporosis
• Depression is really the tip of the iceberg. The syndrome is serious and systemically widespread.
• Patients with untreated depressive illness lose approximately seven years of life, much as untreated hypertension predictably shortens a life.

Main Finding Five: The best treatment for depression at present is a mix of talking therapies and medication

Depression is a serious disorder that impacts the whole body, it is progressive, and it needs to be treated.

60% of people with depression in the United States remain untreated.

The most effective way to treat depression at present is a combination of talking therapies and medication.

Data shows that people who successfully respond to talking therapies have positive physical changes in the three key areas of the brain that are affected in depression: the subgenual prefrontal cortex, the amygdala, and the ventral striatum.

As for the future, there are trials ongoing of new medications (like ketamine) which are producing rapid remission of depression (within 1-2 hours).

There are also psychosurgery trials involving the implanting and stimulating of electrodes in the subgenual prefrontal cortex which are producing immediate and sometimes lasting response.

Magnetic resonance treatments (MRI) are also being used to treat areas of depressed patients brains in a non-invasive way.

Training in resilience is also proving helpful:

• The American Psychological Association defines resilience as the process of adapting well in the face of adversity, tragedy, trauma, threats, and even significant sources of threat.
• Mild to moderate controllable stress early in life can have an inoculating effect.  Such experience leads to increased neuroplasticity and neurogenesis, and increases the size of the subgenual prefrontal cortex.
• An enriched, nurturing environment in early life with exposure to manageable novelty increases resilience later in life.
• Positive emotion, optimism, loving caretakers, flexibility, the capacity to reframe adversity, and strong social support also increase resiliency.
• Altruism, commitment to a valid cause, a capacity to extract meaning from adverse situations, and a tolerance for emotional pain and sadness promote resiliency as well.

Blogs

Having Transgender Parents Will Hurt Kids Like It Hurt Me
“The children of transgender people will have to struggle with the knowledge that their mother is also their father, or vice versa. It hurts them. I know, because I was that child, too.”

7 Tips on How to Survive Your Ordination Exam | Canon Fodder
“Although seminary is a challenging experience in and of itself, something more formidable (at least in terms of stress) awaits most students.  The dreaded ordination exam.”

Race in America: Four Critical Reminders As We Move Towards Healing | The Exchange
“How do Christians respond to the heightened attention and attendant vexation about the crisis of race in America today? Allow me to offer at least four ideas on how we might begin.”

A Transatlantic Elegy For An American Hillbilly | 20schemes
One of the most powerful pieces of writing I’ve read in a long time.

Birth control linked to depression, new study says | CNN.com
“We have known for decades that women’s sex hormones estrogen and progesterone have an influence on many women’s mood. Therefore, it is not very surprising that also external artificial hormones acting in the same way and on the same centers as the natural hormones might also influence women’s mood or even be responsible for depression development.”

And here are a few articles on various aspects of burnout — personal, pastoral, and congregational.

3 Major Downsides of a Busy Church Calendar | Eric Geiger
“Many church leaders have wisely encouraged people to slow down, not to sign up for every sport, and not to commit to every extracurricular activity. Ironically, and painfully so, is that many churches don’t follow their own counsel. So while many church leaders have bemoaned the busyness in their communities, they have failed to bemoan the busyness in their churches. Here are three major consequences of a busy church:”

Give Him a Break | TGC
“I don’t think pastoral ministry is harder than any other job. On most days, I feel like I have a better job than almost anyone else in my congregation. I love being a pastor. But it is hard work. And a unique work that doesn’t allow for weekends off or even two consecutive days off. Pastoral ministry requires a lot of head work and a lot of heart work. Both need times of renewal and rejuvenation.”

Autopsy of a Deceased Pastor } ThomRainer.com
“Autopsies are not a pleasant topic. I get that. But I would be negligent if I did not share with you about the numbers of pastors who are dead in ministry. You need to know. You need to grasp this reality. You need to pray for them. You need to walk alongside them.”

3 Easy Ways to Burn Out Your Team | Eric Geiger
“A burned out team blesses and benefits those they are designed to serve less and less because those who are burned out live with muted passion and numb affections.”

Kindle Books

For your non-Kindle book buying needs please consider using Reformation Heritage Books in the USA and Reformed Book Services in Canada. Good value prices and shipping.

The Religions Next Door: What we need to know about Hudaism,Hinduism,Buddhism and Islam and what reporters are missing by Marvin Olasky $0.99.

Suffering Well by Paul Grimmond (FREE).

New Book

Pursuing Health in an Anxious Age by Dr. Bob Cutillo. This is an excellent book that explores the Christian’s  relationship to health and healthcare while submitting to providence, aging, etc.

Video

How to reach across the racial divide

Although I’ve read quite many parenting books in my life, I still try to read at least one a year in order to challenge myself and to keep growing in this vital area. Although it’s becoming harder to pick up anything new, sometimes I come across a book that surprises me with its fresh and stimulating content. That was my experience this past weekend as I started reading The Disciple-Making Parent by Chap Bettis. As I said, I wasn’t expecting much, but quickly grabbed my Macbook and started jotting down some of the most memorable quotes. I thought I’d finish the book in a couple of days, but I’ve only read 20% of it and found much to think about and do. Below are some of the most thought-provoking quotes from the first 50 pages, which I hope will not only encourage and challenge you in your own parenting but also move you to buy the book. I’ll share more of my thoughts about this book in coming days.

The Great Commission is a call for followers of Jesus Christ to reach out to our world, to our towns, and to our neighborhoods. But, in the Great Commission there is also a call to make disciples in our own families. (6)

Our job is not to raise good kids who pursue the American dream with a little Christianity (and eternal “fire insurance”) sprinkled in for good measure. (6)

The truth of the gospel is transferred through relationships. Disciples are not mass-produced. They are crafted with individual attention. (6)

What better discipleship unit than the family? What better model, teacher, and shepherd over a little one than a parent? God’s desire for your family is to be a Trinity-displaying, God-glorifying, disciple-making unit. (6)

The word Christian only occurs three times in the New Testament, while the word disciple occurs 269 times…Disciple implies a lifelong commitment to seek after, learn from, and stay close to our rabbi, Jesus. (7)

58% of young adults who attended church every week when they were teens did not attend church at all by the time they were 29…Up to 50% of young people did not stick with their faith once they were in college. (9)

I know numerous earnest followers of Jesus Christ in their fifties and sixties whose children are not walking with the Lord. They carry this ache in their hearts like a heavy ball and chain. Charles Spurgeon comments on this burden when he states, “No cross is so heavy as a living cross.” (10)

God’s most effective Shepherd – YOU! (13)

Though the family is not the exclusive means of discipleship it is meant to be the primary one. (15)

The most important social influence in shaping young people’s religious lives is the religious life modeled and taught to them by their children. (15)

Your family is a tiny discipleship unit. (15)

No one can take the place of Mom or Dad building spiritual truth into the lives of their children. (16)

While we may give lip service to discipling our children, the reality comes when we start prioritizing activities [e.g. soccer, hockey, music lessons, etc.]. (17)

The first battleground of family discipleship is not my child’s heart; it is my heart. (17)

Each parent must decide whether he is more concerned that his child is accepted into Heaven or “Harvard.” We all have “Harvards,” – those worldly successes we desire for our children. (17)

The best thing you can do for your child’s soul is to become actively involved in a gospel-preaching, gospel-living church community. (21)

Shepherding of our children changes with their maturity level. Physically, they move from total dependence to total independence. Similarly, the goal in discipleship is to move from command to persuasion, from discipline to discernment, from external controls to internal controls, from parent control to Spirit control. (29)

Most common reasons why prodigals left the church: the role of hypocrisy in the home and church, a lack of proactive explanations of the reason for the Christian faith, and a legalistic rather than clear understanding of the gospel and Christian living. (31)

There is no way to be a perfect parent, but there are a thousand ways to be a good one. (33)

The number one reason why young people walk away from the faith is they see their parents and say, “Why would I want to turn out like this?” (40)

God has given us sinful children to shine a floodlight on ways we need to grow. (43)

Discipleship is not a project, it’s a transfer of life. That transfer happens in the context of loving affection. (50)

Martin Luther: “Marriage is a better school for character than any monastery; for it’s here that your corners are rubbed off.” (51)

Child training is a misnomer. It’s really parent training. Children are sent by God to make us more like Jesus. (51)

My children’s greatest need is not a parent who pretends to be perfect. Much more important is a parent who sense his need for the Savior to cleanse and the Spirit to empower. (53)

The Disciple-Making Parent by Chap Bettis.

I’ve had a few conversations with fathers recently about the challenge of raising teenage boys. Similar to my own past experience, these Christian Dads have been struggling to get their boys to study, to do homework, to respect their mother, and do a few chores around the house. They are easily distracted, often moody, and totally obsessed with digital media. I usually try to share some of the hard-won lessons from my own parenting, most of them learned through many painful failures. These include:

1. The vast majority of teenage boys were not made to sit at desks for hours and hours at a time. It doesn’t matter if it’s homeschool, Christian school, or public school, it’s completely unnatural to confine the primal force of male teenage energy within a few feet of desk space for five, six, seven and more hours a day. Their testosterone-fueled bodies are yelling “Let me out of this cage!” We shouldn’t therefore be surprised at their frustrations. I sometimes think most classrooms and pedagogy were invented by boy-hating women with studious girls in mind!

2. It’s normal to have these parenting struggles. Very few teenage boys transition smoothly from childhood to adulthood. I know of one boy who never gave his parents a moment of trouble in his teens. But he sure made up for it in his twenties! Dads need to know that the same battle is being fought in just about every other Christian home. It would help if we were all a bit more transparent about this, and pastors could help a lot by admitting their own parenting struggles.

3. Dads need to try and get time with their teenage boys. My relationships with my teenage sons always went better when I spent time with them in the evenings, and especially on Saturdays. Ideally we would try to do something physical outside, whether it was working in the yard, going fishing, swimming, playing soccer, cycling, skiing or something like that. Time with them plus physical activity greatly improved our relationships. These were also opportunities to chat with them in a casual, informal, non-threatening way about spiritual and moral issues.

4. Be patient. This is perhaps the greatest challenge to us today. We expect instant results from our teaching and our discipline, but usually the fruit takes many years to even show a little green shoot. In the meantime, impatience, anger, and bad temper can destroy relationships and communication. We might modify their behavior for a time, but we lose their hearts. My “boys” are now young men whom I love and deeply respect. Looking back, I see that I worried way too much because of my impatience.

5. Try to find things to praise. Sometimes it can be really difficult, especially when there is so much to criticize and discipline for. However, our discipline is never going to work if we never identify areas where they are doing well and encourage them for that. The ideal is probably at least two or three praises for every criticism we dish out.

6. Paid work outside the home. This goes back to #1 and all the pent-up energy in the male teenage body. We found that getting our boys out to work a couple of hours a day or a few times a week did them (and us) a world of good. They got out of the house, they did work that tired them out, they felt responsible and “grown-up,” they earned money, they got correction from bosses and co-workers, and we got some quiet time! It doesn’t matter how menial the work is – just get them doing something physical.

7. Clear rules. The two areas that we focused our rules on were technology time and bed time because these were the areas that we found most influential in their lives. When these areas got out of control, so did our boys. The more time they spent on phones, videos, computers, etc., the more nutty they became. The more sleep they got, the happier they were. We had clear rules for how long they were allowed to use any digital media each day and clear rules on bedtimes, with different times for weekdays and weekends. We didn’t just set rules, we followed up with discipline if they were breached.

As anyone who knows us will tell you that we are by no means the perfect parents. I could write a much longer blog on my parenting fails. But, looking back, these were the things I wish someone had told me before getting on this rollercoaster.

Thankfully, next up for me are two young teenage daughters. Somebody tell me it’s going to be easier.

Articles on the challenges of technology used to start with a long list of statistics proving the seriousness of the moral, spiritual, relational, and cognitive problems resulting from the digital revolution. I hardly need to waste ink or space on such matters now. Everyone knows by personal experience and observation how many and how massive the problems are. And the vast majority of Christians are concerned enough to want to do something about it. But what can we do?

No Technology

There are probably a few people left who are still trying the “no technology” approach. They say: “The dangers are too great; the consequences are too awful. Therefore, we’ll keep separate from the world by rejecting technology. We won’t buy it, and we will ban our children from using it, too.”

This approach is admirable and understandable, but impossible. Digital technology is so pervasive that trying to avoid it is like trying to avoid breathing. And even if we succeed in avoiding contamination, our children certainly won’t. They will find it, or it will find them. They will then be using it without our knowledge and without any training and teaching—probably the worst of all worlds.

More Technology

Other people try the “more technology” strategy. That’s what I used to focus on most, the idea being that we use good technology to defeat bad technology. So, we use blockers on cable TV channels, we set up passwords and time limits on home computers, we add tracking apps to our children’s cell phones, we install accountability software on our laptops, and so on. All of these things are good and can certainly be helpful parts of an overall package of caring for ourselves and our children.

There are some problems, though, if we are relying on the “more technology” approach alone. The first is that we can never get enough good technology to beat bad technology. Teens are especially adept at circumventing controls and finding loopholes in the most secure systems. Sure, we can slow them down, we can make it more difficult by putting some obstacles in the way, but if they are determined enough, they are going to beat us. They can always find more technology to beat our “more technology” battle plan.

Also, even if we succeed in securing their devices, as soon as they walk out the door, they can access anything they want on friends’ devices. Or, they can simply get another device and hide it from us. This approach also tends toward legalism and undermines relationships by creating a sort of “cat and mouse” scenario, resulting in suspicion on the one side and hiding on the other. We need more than “more technology.”

More Theology

The longer I’ve wrestled with this problem in my own family, the more convinced I’ve become that the ultimate answer is not “no technology” or “more technology” but “more theology.” If we want a deep, lasting, and spiritual solution, we need to learn and teach deep, lasting, and spiritual truths. Sound digital theology is the answer to digital technology; the oldest truths are the best rebuttal to the newest challenges. More Trinity is more effective than more technology.

To find out how more Trinity is more effective than more technology, read the rest of the article at Ligonier.

Blogs

Three Sleep Aids from Psalm 3
Some biblical advice for insomniacs.

The State of Theology: An Interview with Chris Larson and Stephen Nichols
Chris and Steve discuss the significant findings of a recent religious survey of the population.

Five Benefits of Regular Family Worship
Tom Ascol: “Over the years I have asked groups of Christian adults how many of them grew up in homes where there was regular family worship. Early on it was rare to find people (typically of my generation or older) who answered affirmatively. In recent years the number of positive responses has increased dramatically—almost exclusively with younger generations of believers. This is a hopeful and encouraging indication of biblical reformation taking place.”

Preacher’s Toolkit: How Long Should It Take Me to Prepare a Sermon?
“The time allotted to develop sermons becomes a blending of proficiency and providence, of work and wonder; we must live in the tension between our well-ordered rhythms and variables not entirely controllable.”

What Is Biblical Stewardship?
R C Sproul explains how stewardship is about “exercising our God-given dominion over His creation, reflecting the image of our creator God in His care, responsibility, maintenance, protection, and beautification of His creation.”

Ligon Duncan on Why ‘No Creed But the Bible’ Is a Lousy Creed
“What does it mean to be a confessional church? When making our case for a particular doctrine, is it fine to reference our confession of faith, or would it be best to just stick to Scripture? Isn’t the Bible enough for Christians in establishing our doctrine and practice? Should we demand church members subscribe to a particular view of a third-level doctrine? ”

Kindle Books

For your non-Kindle book buying needs please consider using Reformation Heritage Books in the USA and Reformed Book Services in Canada. Good value prices and shipping.

History of Israel by Walter Kaiser  $2.99.

Joni: An Unforgettable Story $1.99. I imagine everyone over forty has read this inspiring story but maybe some younger readers haven’t.

The Envy of Eve: Finding Contentment in a Covetous World by Melissa Kruger $2.99.

Beating the College Debt Trap: Getting a Degree Without Going Broke by Alex Chediak $2.99.

Video

Singing Man: The Story Behind the Viral Video of Ben Ellis

Watch the video then click the link above to read the story.

Here’s the original video.