Yes. Unless you know what distinguishing signs to look for you might tend to lump them together. That is because people with both problems have ceased functioning in significant areas of their lives. The important difference is their attitudes. The depressed person says such things as "What's the use?" or "People would be better off without me." He has given up. On the other hand, the person with a so-called "nervous breakdown" is saying such things as "What do I do now?", "Which way should I go?" or "How do I get out of this mess?" He is perplexed; stymied.

The word "depression" is used two ways: one use is broad, the other narrow. Many people speak of being depressed when they mean that they are discouraged or, as we often say, "down." That is the broader use of the word. But the narrow use (which is what we more often deal with in counseling) is when the person is "down and out." He has thrown in the towel. Depression usually comes from handling a "down" period wrongly. By slacking off when one feels down, he allows responsibilities to slide and pile up. That, in turn, makes him feel worse. But, if he continues to give in to his feelings even more will pile up, which leads to worse feelings, and so on ad infinitum. He follows his feelings rather than meets his responsibilities. To help him, call on him to act responsibly---regardless of how he feels. The more a depressed person acts in accordance with his feelings instead of assuming his responsibilities, the worse he feels. The sooner he begins to act responsibly, regardless of his feelings, the sooner his depression will lift.

In 2 Corinthians 4:1,8,9 Paul tells us that in spite of all his afflictions, disappointments and sufferings, he never became depressed. How come? He handled his down periods righteously. Though his own people failed to believe (a fact that broke his heart) he went on preaching the gospel out of gratitude for salvation and for his ministry (v. 1). He continued to act responsibly-in spite of feelings to the contrary---because he was thankful for God's mercy.

People with "nervous breakdowns," on the contrary, are anxious to do something, but perplexed about what to do. That is because they have run out of resources. They have painted themselves into a corner and don't know how to get out of it. If they ran from problems eventually there is no place to run. If they lied their way out of difficulties, and people stopped believing their lies, they found themselves up a creek without a paddle. In other words, their "tried and true" patterns have broken down (certainly not their nerves!)¹ Sinful patterns eventually let people down. But because they don't know what to do instead, they cease functioning.

People with "nervous breakdowns" are ready to listen to alternative ways of dealing with life's problems. There is great opportunity to help them make radical changes for good. However, you must be sure that you are not merely providing them alternatives. Rather, they must acknowledge the sin of their previous ways, repent of it and adopt God's ways out of a genuine desire to please Him. There is danger that they will grasp for what you offer as an expedient when faced with a difficult situation. Warn against this and take the time to instruct them thoroughly. They must make lifelong changes; not changes to meet some portending problem.

Counselor, you are able to greatly help people of this sort by the use of the helpful Word of God. Don't be cowed by the warnings of eclectic counselors. The dynamics involved are clearly within the purview of biblical teachings.