Pine Rest Mission Statement
Pine Rest Christian Mental Health Services is called to express the healing ministry of Jesus Christ by providing behavioral health services with professional excellence, Christian integrity and compassion.

Depression: More Than a Chemical Imbalance

By Carey A. Krause, D.O.

“I’m just suffering from a chemical imbalance, right, doc?”

I have become used to hearing this as I work to treat individuals seeking treatment for their depression. They ask the question in a hopeful way, and I think I know why. For many, it has been a struggle just to get to my office. Depression has robbed them of the willpower necessary to take care of tasks as straightforward as getting to the doctor. Every waking moment is a form of misery: nothing is enjoyable anymore, it is difficult to concentrate on work, and the future seems hopeless. They arrive desperate for some relief from their misery, and the idea of a chemical imbalance suggests their suffering is definable and treatable. It suggests a problem with a solution. Fix their chemical imbalance, they hope, and their depression should improve. And what are medications but chemistry in pill form? If depression is nothing but a chemical imbalance, then relief from suffering should be just a prescription away.

CIRCUITS AND EXPERIENCES
What causes some people to experience the weight and misery of depression, while others do not? If brain circuits that carry emotion are involved, why are some people affected and others not?

Depression researchers have long known that individuals with depression are somewhat more likely to have close relatives who also have suffered from depression. That suggests a tendency toward depression can be inherited; there is a genetic trait that contributes to it. Recently, a gene was identified that functions poorly in some people, causing them to have difficulty regulating serotonin. These people are more likely to develop depression than others. Clearly, there is the risk that one’s biological make-up can contribute to developing depression. But inheritance and genetics only explain part of the depression illness.

We like to compare the human brain to a computer, and often it is a useful analogy. A computer is made up of millions of circuits, too. But all of the connections within a computer are made before it is turned on for the first time. At best, computer circuits stay the same during the life of the computer; at worst, they become old and break down with use.

Unlike a computer’s circuits, the circuits in the brain are constantly undergoing change and renewal. Even though most of the nerve cells that make up the brain are present shortly after birth, the connections between those cells can change and become more complex throughout life. In fact, the act of using brain circuits actually strengthens them over time. Repeated firing of brain circuits causes the nerve cells to change the number of chemical receptors on their surface and to “fatten” the connections that link nerve cells together into complex circuitry webs. The more a brain circuit is used, the stronger it becomes.

At the same time, brain circuits that do not get used become less effective over time. The phrase “use it or lose it,” applies particularly well to brain circuits.

Some people lead unhappy lives. They are in abusive relationships, or work in unfulfilling jobs, or struggle with inadequate income, to name a few reasons. Repeatedly, day after day, the circuits that give rise to negative emotions are stimulated. These circuits tell the individual to be on guard for trouble, to avoid unpleasant experiences, to stop wasting energy on unhappy interactions. Other individuals may experience an overwhelmingly sad event, like the death of a child, or feel trapped by events too big to avoid. For them, the repeated firing of these negative emotional circuits strengthens them until their activation becomes routine. From then on, it is hard for them to escape having the experience of negative emotions. The circuits are so strong they fire almost continuously. On the other hand, circuits designed to experience positive emotions, such as joy or attraction, anticipation or excitement, have been shut down for so long they rarely fire. Clearly, a state where negative emotional circuits are much stronger than positive emotional circuits can leave an individual feeling profoundly depressed.

Everyone who suffers from depression has a unique story to tell. Some people have trouble identifying any events from their life that have contributed to their depressed mood. Other people can suffer tremendous losses and not develop evidence of a clinical depression. Of course, everyone's brain is unique, as well. Depression is a complex interplay between inheritance, brain circuitry, and life experience. The combination of biological and social circumstances that lead to depression is as varied as the individuals who suffer from it. Fortunately, there are treatments that have been proven to be beneficial to almost any depression sufferer, regardless of the uniqueness of their experience.

THE FUTURE
Major depression has become one of the largest causes of disability in the United States. More and more, employers and health insurers are recognizing the tremendous loss of productivity and the social costs of depression and are looking for the most effective treatments available. Exploration of what are called the somatic therapies has generated considerable interest. Trans-cranial magnetic stimulation seeks to re-create the benefit of ECT without the need for general anesthesia or a seizure event. Vagal nerve stimulation takes advantage of an implanted electrical stimulator that affects one of the largest nerve bundles running to and from the brain, and helps improve the mood of a portion of patients who have not responded to any other treatment.

As marvelous as these new treatments may prove to be, they are superfluous until we have attempted to treat the majority of depression sufferers with solid, proven therapy techniques as well as safe, modern medications. Unfortunately, too many depression sufferers are still trying to live their lives without having experienced effective treatment. In some cases they have not even sought help, perhaps due to the stigma, or because they thought they just needed to show more willpower. For others, treatment has been ineffectively applied. Hopefully, every day we get a little closer to the goal of effective, efficient, and widely available treatment. The golden age of psychiatry will begin, not with new technology, but when most everyone who suffers from depression is receiving effective, scientifically proven therapy and medication treatment.

(Excerpted from "Today" magazine's "Depression" issue. Look for the complete magazine online soon!)

Dr. Carey A. Krause received a Doctor of Osteopathy degree from Oklahoma State University College of Osteopathic Medicine and completed his residency at Michigan State University in psychiatric and internal medicine. He is Service Chief of Pine Rest’s Adult Inpatient Unit, as well as a Staff Psychiatrist at Pine Rest City Clinic. Dr. Krause also serves as Psychiatry Clerkship instructor and Assistant Professor at MSU Colleges of Human and Osteopathic Medicine.

What Is An Eating Disorder?

by Dr. Susan Zonnebelt-Smeenge

Eating disorders occur when the focus of a person's everyday life revolves obsessively around food and weight.

Some people try to starve themselves. This disorder is anorexia, an emotional illness in which a person refuses to eat to maintain a body weight normal for his/her height. The word "anorexia" means without appetite, but this is a misnomer. These individuals may actually be extremely hungry most of the time.

Self-imposed starvation is a serious, life-threatening disorder. If left untreated, it has a mortality rate of 5-18 percent. Chiefly adolescent females (1 in 100 between 12- and 25-years-old) from middle to upper-middle socioeconomic status families develop the disorder. In the U.S., estimates say anorexia affects 1,000,000 people. Anorexia occurs 20 times more frequently in females than in males.

One third of those becoming anorexic may be mildly overweight before the onset of the illness. Individuals don't begin by trying to starve themselves. They may start dieting after a stressor occurs such as a breaking up of a relationship, parents divorcing, failing grades, or some other loss.

By restricting food intake through dieting, some people gain a sense of autonomy and control. Dieting is something they can do by themselves without asking anyone for help. In an overly close and protective family environment, it may be a way to rebel and take control.

Signs/Symptoms of Anorexia

1. Thinness; loss of 15 percent or more of ideal body weight
2. Continued dieting when not overweight
3. Distorted body image/preoccupied with body size
4. Preoccupation with food and calories
5. Denial of hunger
6. Excessive exercising
7. Frequently weighing of oneself
8. Loss of menstruation (amenorrhea)
9. Feeling nauseated or bloated after eating normal amounts of food
10. Intense fear of becoming fat

Other individuals compulsively overeat (binge) and then purge by vomiting, using a laxative and/or diuretic, or exercising excessively. This disorder is bulimia, which means "ox hunger." Uncontrollable periods of overeating occur as a means to suppress or numb out feelings. The act of purging symbolically flushes feelings away and produces a cleansing effect.

Often bulimia begins as a convenient way to eat whatever one wants and not gain weight because of the purging. What may have seemed an ideal dieting technique initially, becomes a pervasive, self-destructive, habit-forming emotional crutch with many medical problems.

Primarily women ages 13 to 40 develop bulimia. Thirteen percent of college-age women have this disorder. Typically people with bulimia desire achievement, perfection, and acceptance. This causes pressure and stress. Food serves as an escape and emotional anesthetic.

Signs and Symptoms of Bulimia

1. Binges, minimum twice a week for three months
2. Purging
3. Menstrual irregularities
4. Swollen glands
5. Frequent fluctuations in weight
6. Inability to voluntarily stop eating/feeling guilty or ashamed about eating
7. Depressive moods
8. Persistent overconcern with body shape and weight
9. Overeating in reaction to emotional stress

Eating disorders are a sign of the times. The 1990s consist of high levels of stress and many pressures. People often use food as a temporary, unhealthy way to soothe or divert attention from their problems. It is important to develop well-patterned healthy eating methods and not use food to handle life's stressors. Perhaps the most significant healthy means to cope is to learn to identify, express, and deal directly with feelings.

As a society, we must de-emphasize body size as a means to value people. We must rather accept and acknowledge individual strengths and uniqueness regardless of appearance and weight. Food, eating and weight do not make for a healthy focus. Let's work together to change that distorted perception.

(Excerpted from "Today" magazine's "Depression" issue. The complete article is available online at: http://www.pinerest.org/education/today/eating/default.asp)

Dr. Susan Zonnebelt-Smeenge is a clinical psychologist who has worked at Pine Rest since 1988. She provides psychological services in the Outpatient Department at Pine Rest as well as at Butterworth Health Connections. Dr. Zonnebelt-Smeenge’s background as an R.N. facilitates work with clients dealing with eating disorders as well as clients with other medical concerns. She also specializes in treating marital discord, sexuality problems, sexual abuse, depression, and loss/grief issues.

October 2, 9
PREP Couples Communication Workshop
PREP is a skills building program designed to help committed couples of any status (married or unmarried) and any age learn to communicate more effectively, manage conflicts, and solve problems without damaging intimacy and trust. It has been featured on national shows such as Oprah, 20/20, and 48 Hours.
For more information click here.

October 24, November 7, 14, 21
Pine Rest's Anger Management For Teens
Led by Ryan LaRue, MSW, LMSW, ACSW, outpatient therapist at Pine Rest Campus Clinic. 4:15 -5:30 p.m. in the Van Andel Center on Pine Rest's main campus, 300 68th Street, SE, Grand Rapids. Open to male and female teens ages 12-17. Cost: $75/person. Call 616/222-4584 for more information or to register.
For more information click here.

November 7, 14, 21, 28
Anger Management Classes for Adults
Led by Jim Bottenhorn, MA, LLP, Director of Pine Rest’s Contact Center. 7 p.m. to 8:30 p.m. on Pine Rest's main campus, 300 68th Street, SE, Grand Rapids. Open to adults and older teens. Registration is required. Cost: $65/individual or $95/two family members. Class fee due at first class. Call 616/493-6033 for more information and to register.
For more information click here.

October 4
Pine Rest Family Institute Marriage and Family Building Series
12:00 - 1:30 p.m. on Pine Rest' main campus, 300 68th Street, SE, Grand Rapids. "Good Marital Therapy: Look Before Referring," featuring William Doherty, PhD. This series of speakers and topics equips pastors, church, and lay leaders with the tools and resources for strengthening marriages and supporting families in their congregations. Cost: $5 (includes lunch).
For more information click here.

October 4
The Overscheduled Family
Hosted by Ada Bible Church, 8899 Cascade Road SE, Grand Rapids. Open to the Public – All are Welcome to Attend. Cost: Free of Charge. Co-sponsored by Christian Counseling Center and Pine Rest Family Institute. To register by September 27, call 616/455-5279, email familyinstitute@pinerest.org, or visit www.healthymarriagesgr.org.
For more information click here.

October 5
National Depression Screening Day
Nine Pine Rest outpatient clinics will be hosting free confidential screenings for "National Depression Screening Day." Services offered will include a one-on-one assessment with a trained mental health professional, on hand to answer questions. Educational materials will also be available for participants interested in helping themselves or family members who may be suffering from depression.
For more information click here.

November 6
'It’s Bigger Than You Think – Daring to Address Addiction in Your Church'
Conference co-sponsored by Pine Rest Christian Mental Health Services and EverGreen Ministries’ Bridge 2 Life Recovery.
For more information click here.

October 9, November 13, December 11, January 8, February 12
Pine Rest’s Southwest Clinic To Host 'Family Connection' Support Group
"Family Connection" helps spouses, parents, siblings and other caregivers more effectively deal with the stresses created by the symptoms or behaviors associated with mental illness. The support group offers guidance through shared experiences, sharing effective coping strategies, and gaining knowledge about various disorders in a safe and confidential setting.
For more information click here.

November 8
Professional Lecture Series
"Treatment Planning: Improving Documentation Skills and Clinical Use of the Treatment Plan." Featuring David Mee-Lee, M.D., M.S. from 9 a.m. to 4:00 p.m. in the Mulder Center Gymnasium on Pine Rest’s main campus, 300 68th Street SE, in Cutlerville. Call 616/455.6500 or
For more information click here.

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Copyright © 2006, Pine Rest Christian Mental Health Services. All rights reserved. The contents of Mental Health News & Information are for informational purposes only. The content is not intended to be a substitute for professional medical or mental health advice, diagnosis, or treatment. It cannot and should not be used as a basis for diagnosis or choice of treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical or mental health condition.