Depression and Meds: “It’s Complicated”

PillsMy good friend Dan Phillips hosts a provocative conversation at his place on depression, the legitimacy of diagnoses like bi-polar, manic depressive, and the like, and whether treating such issues with medications is wise. It’s a response to Mike Adams’ even more provocative post at Townhall.com, “You Aren’t Bi-Polar, You’re Just a Jerk.” (How’s that for saying what you mean?!)

Here’s my “on the one hand, on the other hand” comment, reposted from Dan’s site without permission:

I had this (and several other things) all figured out when I finished seminary. People with emotional issues needed to pray. Duh. It’s not chemical, it’s spiritual. Amen?!

However…

Life is rarely that clean-cut. We can’t excuse sin, obviously, but the fall affected humanity in so many ways, all of them inter-related. In other words, it’s complicated.

Does a guy with undiagnosed diabetes need to “get right” because he’s sluggish and depressed? Or does he need to watch his diet and get on insulin?

Does a guy (like me) with Celiac Disease need to repent of laziness, or does he need to get off gluten so he’s not malnourished?

How about thyroid issues? You can apply the same principles, I think, to cases of post-partum, menopause, even PMS. None of these biological/medical/chemical issues excuse sinful thinking and behavior, but ignoring them as at least partial explanations is foolish.

So God sometimes prescribes sleep or nourishment to a rebellious prophet before (but not instead of) addressing his spiritual need.

I’m not suggesting that we give out pills like candy or deny people’s spiritual needs. Many so-called ADHD children need affection, instruction, and discipline rather than Ritalin. No doubt. But, again, it’s complicated. More complicated than I initially wanted to admit.

(Disclaimer: I’m not a doctor, nor do I play one on TV. Nor are pastors and counselors who poo-poo these things, however.)

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61 Responses

  1. Chris, well said. Teachers and movements that demand blanket rejection of medication for mental or emotional disorders make me nervous. (Or maybe I just need to repent.)

    Sometimes medications mask symptoms and hide sin. But sometimes they bring spiraling symptoms under control so that pastors and other *biblical* counselors can help the person deal with the root issues.

    So you’re right. It’s complicated.

  2. Amen. I appreciate your balance here.

  3. Chris, I’m with you on the seminary thing. I remember one of our profs stating with near Gospel-truth dogmatism that meds in such cases were ineffective because the problems were spiritual (We might have been in the same class that day). I had to rethink my position when, a few years ago, I counseled a woman for depression. As it turned out, she merely had a pretty significant case of anemia. Once she started taking iron supplements, she changed dramatically.

    That being said, I do wonder about the symptoms of sin. Like Ben said, sometimes the meds just exacerbate the underlying problems, such as irritability, mood swings, etc.

  4. “Spiritual Depression” by D. Martyn Lloyd-Jones is a good resource, addressing the physiological as well as spiritual aspects of depression and how they can at times dovetail. I’ve lent this book out many times.

  5. I work at a inner city rescue mission and on a daily basis I deal with individuals who have been diagnosed with bi-polar disorder. Most of them are individuals who were raised without any outside positive influence on their lives. They were never given boundaries or discipline and therefore are extremely selfish individuals. Many of them are master conmen/con-women and are very subtle with their selfishness. When they do not get their way they become extremely hard to handle, just like a spoiled child, and act almost as if their personality has changed. In reality, it has. The cool, calm and collected personality was just a facade that they turn on and off at will. Their real personality is one of anger and impulsiveness. The medical “professionals” who deal with them would rather give them medicine to keep them sedated than deal with their real problems. Thus, they are diagnosed by those “professionals” as being bi-polar. The drugs and alcohol they are normally addicted to doesn’t help the matter. By the time they get to the mission, they really do need medication to allow them to function somewhat normally. Weaning them off of the medication is a long and tedious process. Very few ever make it out of the “system.”

  6. Great recommendation, Diane. I’ve profited from that classic by DMLJ myself. Thanks!

    Jon, that all makes sense. I’m not arguing for a simplistic pill-pushing system (which is obviously where we find ourselves). I’m just not as ready to dismiss all of it with an overly simplistic response, either. “It’s complicated.” :)

  7. I find it interesting that some of the same people who think that that it is wrong to treat some of these “disorders” with medications, are only too eager to treat their particular “disorder” with Aspirin, Tylenol, Ibuprofen or, perish-the-thought, Nyquil!

  8. Chris,

    This is a very interesting post for anyone involved in serious ministry. And, I appreciate the sensitivity you show in handling manic depressant and bi-polar disorders, or whatever label we want to use. I think these issues are complex and require a pastor’s godly wisdom.

    Let me raise a few questions. Is a chemical imbalance physical? Or, spiritual? Or, somewhere in between? How much of Adam, his wife and posterity were affected by the fall? Did God’s judgment only affect Adam spiritually? Or did it also affect him physically? Or, is it easier to say that it pervaded him both materially and immaterially?

    Because of various people I have been involved with in many years of ministry, I have often asked myself these questions.

    I like the title of Mike Adams’ post “You Aren’t Bi-Polar, You’re Just a Jerk.” Many times I have thought like this; however, I am glad that I have not put anything in print like this because I know a few medical doctors who would say I am “just a jerk.”

  9. I think I’m safe to say the guy who wrote the “you’re not bi-polar, you’re just a jerk” article has not suffered from endogenous depression himself.

  10. Seeing that Andrew hasn’t said it, Chris, in response to this:

    Does a guy (like me) with Celiac Disease need to repent of laziness, or does he need to get off gluten so he’s not malnourished?

    umm… doesn’t a guy like you always need to repent?

    And I guess we all do, don’t we.

    With respect to the topic, my problem with anti-depressants etc is that it is too easy to simply dismiss problems as depression and prescribe a pill. It is the first resort of many physicians. Better to search for a real physiological cause (like Celiac disease) and address that than just say, well, here’s a pill and assume the problem is solved.

    I do think that the notion of “chemical imbalance” is sort of like saying “we don’t know what the problem is”. According to articles I have read, no one measures your chemicals, they have no idea if you are imbalanced, but they prescribe the seratonin anyway.

    Seems a bit backwards to me.

    Maranatha!
    Don Johnson
    Jer 33.3

  11. I, too, have done quite a bit of research on this and agree with Don Johnson’s conclusion regarding “chemical imbalances.” Which chemicals are out of balance, and how do i get them back? The current common anti-depressants claim that the seratonin levels are out of whack, but that is purely a theory, rather than a proven fact. Check out the websites of common anti-depressants like Zoloft or others or medicinenet.com and that can easily be seen.

    Lloyd-Jones book is the best book on this that I have read. It is also true that a guy like Spurgeon fell into serious bouts with depression, stemming from both his physical issues, as well as his wife’s health problems, and other things.

    Our experiences need to be judged by the authority of the Scripture. How does God deal with depressed people? How did God deal with Cain, or Hannah, or Elijah, or Job, or Jonah, or David (Psalm 32), or the psalmist of Psalm 42 & 43?

    If any of those people were alive today, they would have been prescribed drugs for their depression and suicidal tendancies, according to the medical model. However, God deals with it differently.

    This issue is becoming a huge issue, even amongst Christianity, as medications seem to be the solution to everything. If there are physiological issues, then medicines are meant to help. But if there are no physiological issues, I question the logic of throwing medication to treat an emotional or even a spiritual issue. Proper emotions are meant to follow obedience, never to dictate our actions or responses.

    Call me a jerk if you wish, but I am not too keen on the idea of adhering more to the medical model than to the biblical model when it comes to depression.

  12. Very sad to see these last two comments.

    This stigma is causing incalculable damage in Fundamentalism and you will never be told about it until it hits your close friends or family. =(

  13. Jason, really?

    Please tell me exactly what anti-depressants do. Please tell me exactly what they fix. Please tell me exactly how you can tell they fix anything.

    Chris mentions three clear physical problems that can produce depression. Diabetes, ciliac disease, thyroid issues. I didn’t and don’t deny that the struggles with these diseases and many others can be very severe and depressing. I know that when I have the flu I feel down emotionally. I agree that there are physiological reasons for depression.

    What I am against is for someone to go into the medical doctors office, tell him you’ve just been feeling sluggish and down and walking out with a prescription for anti-depressants. That is the option of first resort in many many many cases. Suppose someone has celiac disease but doesn’t know it. Suppose he goes in and tells the doc his problems, but perhaps doesn’t describe the symptoms in such a way that the doctor fails to suspect something like celiac disease. So he just puts him on anti-depressants and sends him on his way. What good does that do?

    Anyway, I’ll wait for Chris to come back in and see what he says. I’d be surprised if his views are that far from mine.

    I am NOT saying that all depression is spiritual and the result of sin.

    I AM saying that the automatic kneejerk prescription of seratonin with zero physical tests and zero knowledge of any other possible physical cause is a foolish position to take.

    But that is exactly what is going on in many doctors offices today.

    Maranatha!
    Don Johnson
    Jer 33.3

  14. It definitely is complicated. Unchecked depression leads to real physical problems. Just read Psalm 32!

    To be able to give the right diagnosis in these situations takes personal involvement in the life of the stricken individual. Most of the time you will find that their depression does stem from a personal sin problem. But this is not always the case. That is why you have to take the time necessary to figure it all out. Many “Christian” counselors I know don’t want to take the time and really get down to the nitty gritty of the issue. On the one hand you have the crowd that all too easily wants to throw medicine at the problem, and on the other you have the crowd that just tells you that you have a sin problem and need to get right with God. Neither is speaking the truth in love. Love without truth is hypocrisy, and truth without love is cruelty.

  15. Thanks for putting me on the spot, Don. My take? “It’s complicated.” I essentially agree with what you said. There is a lot of pill prescribing that is done in a reckless way. A call for caution isn’t a denial of real needs. On the other hand, there have been plenty of “just get right” responses to people on meds, even telling them to stop taking them. That’s just as reckless. Doctors should realize that it’s complicated. And pastors should realize that it’s complicated.

    I know some very mature and godly people who are on …um…happy pills. I’m not ready to condemn them. On the other hand, I’m glad that my doc looked for a specific diagnosis—she was great!

    A lot of emotional needs are due to unrepentant sin. A lot are not. Neither docs nor revs should make a knee-jerk responses or sweeping generalities. Because, well, it’s…you know.

    Now quit fighting. You’re making me depressed. :)

  16. Yes, that’s essentially what I am saying, Chris.

    I personally counsel against taking pills if there is no provable physical cause. I am against seratonin because no one knows what it does and can’t prove that it does anything other than get you hooked. It seems to “mellow” some people out, but who knows if that is psychosomatic or not? There is no proof on this either way to my knowledge.

    I agree that some counselors are equally knee-jerk in their reactions. ‘Job’s friends’ would be a good name for them.

    In other words, yes, it is complicated and it does take time to figure things out. Counselor and counselee and docs need to be committed to figuring things out no matter how long it takes.

    Maranatha!
    Don Johnson
    Jer 33.3

  17. Don,

    The specific part of your post I disagreed with is that just because we can’t exactly measure and observe Serotonin levels means we don’t have significant evidence that they are indeed a significant factor. There are a lot of medical things we can’t measure as well as we like, but the theory seems to hold quite a bit of water at this stage in medical knowledge.

    I agree with most of the points you just made. However, I think most doctors ask enough questions to know if they need to do tests for other things.

    Also, I agree that the world tends to run to medication first. But Fundamentalists don’t. Fundamentalists generally wait until after their first suicide attempt to even consider it because of what they’ve heard their pastors say about it. I’ve dealt with such a situation this week.

    Grace to you.

  18. Jason, what we have here is partly dueling anecdotal evidence. You maintain that “most doctors ask enough questions” … that isn’t our experience here.

    And you claim Fundamentalists take a contrarian position based on your experience this week. Without comment on the situation you describe, let me suggest that it is more likely those who slavishly follow the teachings of Jay Adams on this point are more likely to adopt the position of “depression = sin” all the time. I like Jay Adams, but I think his views are too strong here. But please note that fundamentalists are not monolithic followers of Jay Adams on this point and that there are more evangelical followers of Jay Adams than there are fundamentalists.

    It seems that you have a burr in your saddle about fundamentalists and they are therefore the epitome of ignorance and error in your view.

    With respect to Serotonin, if you can’t measure it, you can’t say an individual has a chemical imbalance. You don’t know that, the doctor doesn’t know that, the patient doesn’t know that. They have no way of knowing.

    Again, with anecdotal evidence – every person we have dealt with who went on anti-depressants (presumably seratonin) had very evident problems with sinful behaviour and attitudes that was (in my opinion) a leading cause of their “depression”. Every one of them exhibited irrational and increasingly sinful behaviour after going on the drugs. Every one of them had NO other physical diseases going on that contributed to their state of mind. And every one of them proceeded to make foolish spiritual decisions after taking the drugs.

    But, since it is just my anecdotes vs. your anecdotes, I guess that proves nothing.

    Maranatha!
    Don Johnson
    Jer 33.3

  19. I think to adequately diagnose depression, a doctor needs to know more than test results. What are the stressors present in the life of the patient? Have his adrenals been wiped out by the typical American diet (simple carbs, sugars, and caffeine–our country is in love with Starbucks), is he dehydrated (did I mention Starbucks) =) ? Is he rested? Yes, it is complicated.

    And, to compound things is the absurd idea that life is not supposed to ever have “downs.” I am supposed to be happy, fulfilled, comfortable– all the time, and right away. So, if I feel down, or experience any pain, or can’t sleep, I need a prescription to try and maintain this unattainable idyllic existence. God sometimes uses voids and imperfections.

  20. Don,

    You’re right. The thing about doctors asking enough questions was just my opinion and on reflection, was too broad a generalisation to be of much value. My bad.

    I understand that Fundamentalism isn’t monolithic. That’s why I said that “Fundamentalists GENERALLY wait until after their first suicide attempt to even consider it because of what they’ve heard their pastors say about it.”

    As a generalisation, I think it’s completely accurate to say that. Note that I didn’t say they don’t ever take medication. I said they tend to wait until the situation is extreme.

    I don’t see how this can be contested as a generalisation. Even you are using the premise that “it is complicated” (which I agree with) to suggest that we use it far too often. If you’re going to argue against the generalisation, what camp regularly tends to tell counselees to consider medical treatment? Hyles, BJ, Northland, Westcoast, Crown? Can you name any major circles in Fundamentalism that don’t hold depression=illness in high suspicion?

    As far as having a burr under my saddle… well, I hope I don’t come across as hating Fundamentalism because I don’t. I love Fundamentalism. I am passionate about fundamentalism. That’s why I want to see us develop our thinking on this matter a little better.

    I think the underlying issue here is that what you and Diane and Taigen are describing comes across as shallow. Depression is not someone having a bad day or even a bad week. Endogenous Depression is a black hole that changes a person’s reality, generally on a fairly regular schedule (certain times of day) and in devastating ways.

    We’re probably all familiar with a major Fundamentalist pastor who recently passed away. A man I knew, loved, and respected. I do not know if it was depression related, but this type of thing is happening far too often…

  21. Jason, I don’t know what is taught currently at BJU et al, but I have heard BJU criticised as being too ‘integrationist’. One place where I heard the criticism was in a meeting at Jay Adams church some years ago. He was at the meeting, I don’t recall him saying anything one way or another. BJU regularly uses material by Ed Welch who is criticised for the same by the Adams camp. So… I think you may not have a clear picture of where fundamentalism is on this question.

    If you mean in your last paragraph a pastor from my country, I don’t think it had anything to do with depression. But then, I never did like or respect the guy. It was more and still is on the level of a cover-up.

    Maranatha!
    Don Johnson
    Jer 33.3

  22. I graduated from BJU in 2004 and lived close by in 2006. BJU may be integrationist-leaning by Adam’s standards, but there is still very much a we-don’t-do-meds-and-if-you-do-don’t-talk-about-it type culture there.

    Welch views meds with significant suspicion. And yes, I’ve read his books.

    Are there any major circles in Fundamentalism that don’t hold the depression=illness paradigm in high suspicion?

    Yes, I was referring to the pastor from your country. I don’t think any of us know for sure, but if it was depression, I don’t think it would have been kosher to treat it in his circles. Do you?

  23. Have you read Welch on depression? I don’t think I would use the term ‘significant suspicion’.

    I probably shouldn’t have said anything about the incident you mentioned. I don’t believe it was depression. All reports (some unconfirmed) indicate otherwise. But enough of that.

    Let’s get back to “depression = illness”. If that is the concept we are debating, then I don’t mind being classed with those who dispute it. I would say that illness (real illness) can cause depression. I don’t believe that depression itself is an illness. It is a symptom of something else. The ‘something else’ can be very elusive and difficult to detect. If no physical cause can be found, the problem has to be spiritual – there are no other alternatives.

    According to NetDoctor, ‘endogenous depression’ is no longer accepted as a classification in psychiatry. I have no idea, but that is what the site says (I got the link from Wikipedia, so it must be true!)

    Maranatha!
    Don Johnson
    Jer 33.3

  24. I should clarify: I said “If no physical cause can be found, the problem has to be spiritual – there are no other alternatives.”

    It would be better to say: If no physical cause exists, the problem has to be spiritual.

    It is possible for a physical cause to go long undetected. In such cases, probing for a spiritual cause is wise, but I suppose what Chris was getting at in his original post is that we shouldn’t be browbeating the individual (or ourselves) if no spiritual cause can be detected either.

    Maranatha!
    Don Johnson
    Jer 33.3

  25. Yes, I’ve read Welch on depression. While he certainly allows for the possibility of biological causes for depression, as do many, in reality it tends to be a rare case and a last resort.

    You said: “If no physical cause can be found, the problem has to be spiritual – there are no other alternatives.”

    What if a physical cause exists, but we just can’t quantify it exactly? Your statement presupposes that if we can’t find a physical cause, there must not be one.

  26. Bro Jason,
    Please let me clarify. I recognize that there are cases that are legitimately serious and can have terribly destructive results.

    Pardon my own anecdote: I had some very bad experiences myself…and I was ashamed to go for treatment. I was a faculty member at BJU…so, I wasn’t “supposed” to have this problem, I thought. My patient, perceptive husband sent me to get it checked. In my case, what ultimately required a tweak in hormones was initially treated with an anti-depressant (which I fought–frankly, my pride didn’t like using that stuff that “weak people” use…I guess God used this to point us to the real solution, because it forced the doctor to investigate some other physiological factors). This was a Christian M.D. In my husband’s words, “That’s why they call it [i]practicing [/i]medicine.”

    What I should have said in my second para is that the superficial quest for happiness to which I alluded (if I’m not happy, fulfilled, etc. I must need treatment for depression) badly clouds this issue. Serious depression is not merely disappointment or sadness. It is much darker. It radically skews perception. The cacophony that it causes in the mind can block out every stabilizing truth you know. I had a taste, and it is supremely frustrating.

    Just my penny’s worth.

  27. All,

    My lack of interaction isn’t lack of interest. I don’t really have a lot more to add to the discussion. I appreciate your thoughts, though. Just keep it civil when you disagree. :)

    As you were…

  28. Diane,

    Thanks for that comment. Interestingly, my uncle was Dr. Harris at University Medical Associates.

    I can appreciate two things about that post:

    1) The stigma you felt even in an “integrated” school such as BJU. That is very real and as you said, it is dangerous.

    2) The danger of getting it wrong. It’s a valid point. I know at least some doctors ask a lot of questions before prescribing and then have regular check ups to find out how your body is responding and to tweak things.

    That said, it is a valid point that we need to look at all the possibilities including spiritual factors.

    Even the most passionate supporters of the medical model will tell you straight up that it’s a matter of experimenting with different medications and doses to find what works for you. At least in my circle of experience, it is a generally accepted reality that it will be a process of working through the options until you get a plan that works.

  29. I realize that I am jumping into this again after several days, but I think something needs to be said. I fear being called “shallow” in ministry. Forgive me for coming across that way. By no means do I wish to even be thought of in those words in ministry. Christ showed great compassion on people with all kinds of maladies, and always taught them the truth.

    When we speak of this concept of depression, I think we would all agree that it is fought primarily in the mind. This should be very obvious since the medications that are normally given focus on seratonine levels in the brain, which can change the way a person thinks/responds to situations. I am in complete agreement that this is a very complicated issue, but not because of a lack of teaching in the scripture. It is complicated because of man’s fallen condition, and our culture’s infatuation with “feeling good” and medicine.

    What goes on in the mind is simply a reflection of the heart. Ultimately, those sinful thoughts are a result of the fall, but our minds can be renewed by God. When I have dealt with people who are on anti-depressants, I feed them the scriptures and address those situations, choices, circumstances, etc. which have led up to this point in their lives where they “feel” depressed. Hebrews 4:12 tells us that God’s Word can even discern the very thoughts and intentions of our hearts. God addressed different people who felt depressed (see my previous post), but He never justified their depressing, and even suicidal thoughts. He confronted them with truth.

    The situations surrounding depression are incredibly complicated and must be carefully and compassionately handled, but not at the expense of truth. God addresses depression in the Bible and that must be our road map in dealing with people who face it as well. Our experiences must be scrutinized and interpreted by scripture; not vice versa. God brought victory in depressed people (Hannah, David, etc) and can gloriously do the same for people today.

  30. Moderation: Thanks all for sharing your thoughts on this subject. It’s clear that there’s not agreement from all participants (or any) :), but those who have engaged in the discussion have shared their thoughts with clarity. If you have a fresh argument you’d like to express, please do so. Let’s not rehash what you’ve already said, however.

    And as Taigen noted, let’s avoid impugning others’ character or ministries even where there is disagreement.

    Finally, take a break from this depressing blog and go read Scripture. ;)

  31. Bro Chris,
    I told you I’d be driven to post again. =) Actually this thought has been rattling around in my head all day.

    I just want to interject that when I was experiencing this bout of depression, I was fairly inconsolable. My husband tried to offer comfort, he tried playing my favorite sacred music, to no avail. I was too distracted to read. What finally calmed my spirit (until everything could be dealt with as a “package”) was listening to scripture tapes. While lying in the dark, hearing the Word of God, it was as if I was in the eye of the storm, together with Him. “Peace, be still.”

  32. Taigen,

    Do you believe the mind is an exclusively spiritual thing? Do you believe the neurology of the brain has anything to do with how we think and feel?

    The reason I ask those questions is that you seem to approach this with the assumption that there is a “reason” why one feels bad and if you can find that reason and address it from Scripture, the bad feeling will go away.

    While there is an element of truth in that, when we talk about clinical depression, we’re generally dealing predominantly with depression that doesn’t have a reason as such. The feeling bad is almost always attributed to some current or past event, but all out of proportion to how that event would really affect a normal person.

  33. Dr. Greg Mazak has suggested “Will Medicine Stop the Pain?” by Elyse Fitzpatrick and Dr. Laura Hendrickson. Here is a link for the opening chapter, which makes for interesting reading for this discussion: http://www.christianbook.com/Christian/Books/product_slideshow?sku=458025&actual_sku=458025&slide=2

  34. Dianne,

    It seems apparent to me that the brain and the mind are not necessarily the same thing. Our brains can be damaged (swelling, cancer, etc.). While we have physical neurotransmitters, what is it that fuels the thoughts of our minds? Christ said that thoughts come from our heart. When a person has a wrong thought response to a situation or current or past event, those thought patterns can very easily produce wrong emotions. In fact, Christ makes a very interesting statement in John 13:17 which is instructive when dealing with thoughts, emotions, and actions. (I realize the general context is servanthood, but the principle is universal) “If you know these things, blessed (happy) are you if you do them.” If we know “these things” (Christ’s teachings), and do them, the proper emotions will naturally follow.

    Now there are events that take place in life that produce sad emotions which are natural and normal (death, illness, etc), but we can even have joy in the midst of those difficulties by responding to them in scriptural ways.

    You hit the nail on the head earlier when you made the assertion that people function under the assumption that they have to feel good all the time. Jesus even wept at the death of Lazarus. Our goal in life, as you asserted, is not to be “healthy, happy, and wise” but to respond to all of life’s situations, whether good or not, in a way that brings glory to God. Those times may be incredibly tumultuous, like Job’s. But notice how God dealt with him at the end of the book, reminding Job of his place and God’s ultimate sovereignty. God never told Job why he allowed Satan to put him through the trial.

    In this world we will face tribulations, but we can still be of good cheer because our victorious Savior has overcome the world! May we glory in that truth.

    Sorry, long winded answer to a short question. :)

  35. This is a capacity that is peculiar to believers, to “rejoice and be exceeding glad” in persecution (Mt. 5:12), and in tribulation. I thought this was worth thinking about on Rom 12:2, from JFB commentary:

    “Here it is more lively to retain the order and the verbs of the original: “In hope, rejoicing; in tribulation, enduring; in prayer, persevering.” Each of these exercises helps the other. If our “hope” of glory is so assured that it is a rejoicing hope, we shall find the spirit of “endurance in tribulation” natural and easy; but since it is “prayer” which strengthens the faith that begets hope and lifts it up into an assured and joyful expectancy, and since our patience in tribulation is fed by this, it will be seen that all depends on our “perseverance in prayer.”

  36. sorry…Rom 12:12. =)

  37. I promise I’m done after this. I find it interesting that when you look for books about this type of battle on CBD (biblically dealing with depression, anxiety, stress…), you come up with 100+ titles. This is something that requires some sweat and study in order to address it effectively and biblically. It is a growing concern.

    I’ll offer a snippet from my discussion with Dr. Mazak (the illustration may bring repercussions from some at SI in the recent fervor over fermentation) :) :

    “i personally would not take Zoloft. i would rather solve the problem (root) than mask the symptom (fruit). we should address the spiritual issue. however, does that mean taking the medication is a sin? i’m not sure i have a biblical foundation for coming to that absolute conclusion. i think it is typically unwise. yet there may be a physical condition. the burden of proof is on the physician to explain what illness i have, how he knows i have it, and how the meds will help to correct the physical illness (not merely make me feel better). i don’t do this, since i am not a doctor. i think its best not to take meds.

    in any case, its not going to be my main battle. quick illustration….

    if i knew of a Christian who worries a lot about his job, and drinks a glass of wine each night to unwind, i think that would be unwise. if i met with him, i would not focus on convincing him to stop drinking wine. it would be more profitable to focus on how in Christ he does not need to be anxious, that a sovereign God controls the economy, that a loving Father will provide for him and his family, etc. once he realizes this the problem is solved… and he will realize he does not need the wine to unwind.

    Again, i recommend the book “Will Medicine Stop the Pain?” (Fitzpatrick).

    On to my day…

  38. Taigen,

    It seems like you answered my question but addressed it to Diane. Am I missing anything?

    I’m interested to see where Scripture says thoughts come from the heart. Do you mean the heart as an organ? (I ask because Bill Gothard has recently come out making this argument)

    Personally, I don’t think it’s accurate to say mind=brain. However, I do think it’s accurate to say that the mind operates primarily within the physical organ of the brain.

    If your paradigm is accurate, several questions arise.
    * Why do most people who claim to have clinical depression claim to get depressed for no reason regularly?
    * Why do people who attribute their depression to a particular thing no longer get depressed by that particular thing once they go on meds?
    * Why, in the experience of many believers who have dealt with clinical depression, is it possible for a believer to weep in agony of heart while at the same time worshiping and rejoicing in God?

    These are sincere questions and questions that need to be answered.

  39. Jason,

    Forgive me for addressing the previous entry to Dianne. I was mixing up entries in my mind. I think I addressed things from both of your entries. Sorry for the confusion.

    You raise some good questions that ought to be addressed.

    First, the scripture is replete with references to thoughts coming from our hearts. Here are some from the OT and NT for you to consider. Gen 6:5; 1 Chron 28:9; 1 Chron 29:18; Job 17:11; Ps 139:23; Dan 2:30; Mt 9:4; Mt 15:19; Mk 7:21; Lk 2:35; Lk 5:22; Lk 24:38; Heb 4:12. Some are more explicit than others, but all of these scriptures make the connection between our thoughts (both good and evil) to our hearts.

    Second, I am not in agreement with Gothard on this point (though admittedly I have not researched that view, but it doesn’t sit right with me). Biblically, our hearts are the seat of our thoughts, will, and emotions, not the organ that pumps blood. And yes, we generally view our thoughts/mind with reference to our brain.

    To answer your thought provoking questions:
    Q1 – In every instance of depression in the scripture (that I can think of), there is always some kind of cause. If people say there is no reason, I do not know that I would be content with that answer and seek to ask more probing questions.
    Q2 – medications can definitely change mood regarding situations, but they cannot change the heart in relationship to that situation. A person may not “feel” as bad, but that doesn’t address the real problem – their response to that “particular thing” in the first place. All the medication does is mask, not fix.
    Q3 – I am not quite sure if I get the gist of this question, but I will try. A good biblical illustration I think is Paul while in prison. He wrote in Philippians 4:4, “rejoice in the Lord always; again I will say, rejoice.” While his situation and circumstances did not provide happiness, he could still rejoice in the Lord because of what was taking place in him and through him. Another illustration comes from James 1:2, “count it all joy, my brothers, when you meet trials of various kinds….” In both of these passages, rejoicing in the midst of difficulty is not only possible, but it is commanded. That can only happen with God’s help.

    Our Christian lives are filled with difficulties, trials, temptations, heartache, pain, and sorrow. While we cannot always help it when those situations come, we are responsible for how we respond to them. Even Christ prayed in the garden in great agony of heart (Mt 26:36ff), but he responded in submission to the will of His Father, even when facing inevitable torture and death.

    I hope these answers make sense. In my study of scripture (as well as other godly Christian counselors)with regards to depression , these scriptures and the examples of men and women have been an incredible help.

  40. Bro Taigen,
    You did in fact address some things I had mentioned. =)

    There is a book by Edward T. Welch titled “Blame it on the Brain? Distinguishing Between Chemical Imbalances, Brain Disorders, and Disobedience” that looks like interesting reading. Find it here: [url]http://www.christianbook.com/Christian/Books/product?event=AFF&p=1011693&item_no=26020#curr[/url]

    There are three categories he addresses–“The Brain Did It”, “Maybe the Brain Did It” and “The Brain Didn’t Do It”. He addresses everything from depression to ADD, Alzheimers and homosexuality. He places depression in the “maybe” category.

  41. Taigen,

    No worries on the mix up. Thanks for your careful responses.

    I recognise the truth you are referring to in Scripture. The question is, does this “heart” which we understand to be “the seat of our thoughts, will, and emotions” function in a biological context? You said “we generally view our thoughts/mind with reference to our brain.” I would go a step further and say that our minds/thoughts *actually* and literally function in the context of our brain. I don’t think our minds are merely the sum of our neurological impulses, but I do believe God has chosen to create us such that our minds function within the biological context of our brains.

    Regarding your answers to the three questions:

    Q1 — Perhaps Elijah after Mt. Carmel is a good illustration. Looking at the story, you could say Elijah was just discouraged because there weren’t many prophets, and I’d agree that he was. And God did address the core issue with him. But the *first* thing God addressed with him was biological. Sleep, rest, and nourishment were the most pressing needs and I would argue that the lack of these things is the very reason why Elijah was thinking completely out of proportion to reality. He should have been rejoicing in a victory for God, but instead he was suicidal. Yet some would argue that to focus on dealing with these biological/chemical matters would merely mask the heart problem.

    Q2 — You said “All the medication does is mask, not fix.” Your assumption here is that the problem must have been spiritual in the first place. I agree that it often is. But can you really argue that it *always* is? I think if the problem was primarily biological, then medication can indeed “fix” the problem. Of course in real life on a fallen planet, it’s usually a combination of the two.

    Q3 — That is my point exactly. If you speak to mature believers who have suffered depression, they will often tell you that there are times when they are in mental agony, and yet they are praying and rejoicing in God in the middle of the pain. To make it analogous to Paul in gaol, yes Paul was rejoicing and singing, but no doubt he was wincing from the physical pain. A depressed person can be rejoicing in God and yet wincing from the mental pain.

    Grace to you.

  42. Jason,

    A few thoughts to interject:

    1. With respect to the connection between ‘heart’ (immaterial) and brain (material), while I agree there is some direct connection in this life, it can’t be that the brain is absolutely the center of thought and emotion since when we are absent from the body, we are consciously with the Lord and longing (desiring) to be ‘clothed upon’ with resurrection bodies. See 2 Cor 5. Nevertheless, there is obviously a need for body for the ‘whole man’ to fully function. I don’t think we have enough revelation to know all there is to know about this.

    2. I would dispute that Elijah was suicidal.He made no attempt on his life, but prayed that the Lord would take his life. I wouldn’t call that suicidal.

    3. When medication truly fixes a depressive situation, it is medication that addresses a physical problem. Someone may have cancer that saps energy and of course brings images of impending doom. But with the right medication, the cancer can be put in remission and life continues as usual. The depression disappears. But the medications we are talking about address no known physical problem and seem to work because they alter some moods. But likely they problem (whatever it is) is still there and won’t go away just because the mood is better.

    FWIW

    Maranatha!
    Don Johnson
    Jer 33.3

  43. Don,

    1) I totally agree that the brain is not the sum total of the mind/heart. I tried to word that carefully in the post.

    2) Perhaps we could say Elijah did what Christians typically do when they get to the point of being suicidal (ask God to do what they know they cannot morally do themselves, but want to do).

    3) I think your premise that depression is caused by “no known physical problem” is indefensible. We certainly don’t know as much about it as we would like to, but the same could be said for cancer.

  44. On #3, I think we are talking past each other a bit. I would concede that it is possible that low seratonin levels contribute to depression. There are problems with this view, but I will admit the possibility.

    I think that you would agree that it is possible to be depressed for entirely spiritual reasons, wouldn’t you?

    It seems, however, that the view of the medical community in general tends towards materialism and assumes that there must be a physical cause, hence if it isn’t some identifiable disease (say cancer, diabetes, or anything like that), then it must be a chemical imbalance, so let’s prescribe seratonin. No tests, no way of knowing if that is truly the problem, just prescribe a pill. The medical community in general seems to assume there is no spiritual aspect at all. That is what I object to, in addition to the serious problems we have already mentioned about seratonin and “chemical imbalance”.

    Maranatha!
    Don Johnson
    Jer 33.3

  45. Don,

    Sure, I can agree that we can and often are depressed for entirely spiritual reasons (though I tend to think this fits more in the category of discouragement, a category the medical model technically allows for).

    That said, I personally think the way spiritual matters lead to depression is by influencing the levels of chemicals in the body. Of course that’s just my theory.

    If that’s true, there’s a kind of symbiosis where the two can feed each other and either one can be the original “cause” of the depressed feeling. If that’s the case, it would be very difficult to determine absolutely which is the primary cause in any particular case.

  46. I do not want to pick on anyone by name but there are some things being said here that are not true. For example, an antidepressant is not serotonin. Doctors are not prescribing serotonin as one person keeps saying. Antidepressants slow down the body’s use of serotonin.

    Jason is exactly right. The current stigma within fundamentalism against treating depression with drugs is dangerous. That kind of teaching has led to catastrophic consequences including suicide. I cannot really give details but I know this first hand.

    I really believe that pastors who strongly preach against treatment are simply inexperienced and do not really understand what is going on from a medical perspective. I have known more than one that preached that way but softened once they went through certain situations. And for the record, I used to feel that way too.

  47. Fair enough, Greg, but you couldn’t have chosen a more patronizing method of correction, now, could you?

    Surely a more charitable method could have been used.

    Regardless, happy to stand corrected.

    Maranatha!
    Don Johnson
    Jer 33.3

  48. Don, I didn’t mean to sound patronizing and I’m sorry. I rarely comment anywhere but could not resist here because I am passionate about this subject and really feel that much of fundamentalism needs to fix its thinking about it. Again, there are personal reasons why I feel strongly about it that I just can’t go in to.

  49. No problem, I sincerely appreciate the correction. We can leave it at that.

    I don’t believe in anti-depressants. I haven’t read any articles a about them that proves they actually address any real problems and my experience is that they create serious spiritual problems for those taking them. (Anecdotal, I know.) If you can point me to articles that can disprove my view, I’d be happy to consider them.

    Maranatha!
    Don Johnson
    Jer 33.3

  50. […] a discussion over at Bro Chris Anderson’s “My Two Cents”, entitled, “Depression and Meds:  It’s Complicated“.  He’s right.  It is.  Going to Dan Phillip’s post and discussion (click […]

  51. I think it’s fascinating the mind/brain/spirit connection and how we are created. For example, in the mental health field and in law enforcement you will be taught that a person’s reaction to alcohol will depend upon things like their weight and their ATTITUDE. I don’t get it, and I’m not sure anyone does. It’s as if it’s a mystery how our bodies and souls and brains are connected. How can an organic chemical, such as alcohol, be more or less powerful, depending upon our attitudet vis-a-vis our spirit?

  52. For those following this thread, this article might be of interest: “Antidepressant use doubles in US, study finds”

    Maranatha!
    Don Johnson
    Jer 33.3

  53. Here is a quote from a critic:

    Dr. Eric Caine of the University of Rochester in New York said he was concerned by the findings. “Antidepressants are only moderately effective on population level,” he said in a telephone interview.

    Caine, who was not involved in the research, noted that several studies show therapy is as effective as, if not more effective than, drug use alone.

    “There are no data to say that the population is healthier. Indeed, the suicide rate in the middle years of life has been climbing,” he said.

    FWIW – see article cited above for source

    Maranatha!
    Don Johnson
    Jer 33.3

  54. Don,

    I have never posted here but cannot stand on the sidelines watching this any more. I am perplexed about something. You attack Greg for being patronizing. I don’t know how you can avoid being a little patronizing when you are pointing out that someone really doesn’t know what they are talking about. I actually thought he was gracious.

    You obviously know little about antidepressants. You know little about the medical support for antidepressants. But that does not stop you from “not believing in them.”

    Your two last posts are irrelevant to your case by the way. There are probably a variety of reasons why antidepressant use is up. One of them could be because they work. Another could be that more people are willing to lay aside stigma and stereotypes about this kind of medicine and actually help themselves. And, of course, in some cases, it could be abuse. But just because some people abuse something that is good is not a reason to reject it outright.

    There is intense debate about antidepressants in the medical community. Quoting one doctor is insignificant. There are numerous doctors that believe in the benefits of that kind of medication.

    I assume you are a pastor. I can only hope that if you have someone in your church suffering from depression, you will try to help without trying to overrule their physician’s advice. It is not your place to do that.

  55. Hi Frank

    My offense at the earlier post was over the words “one person” and “not true”. As for the “one person” choice of words, my complaint is, why not be direct? It seemed very condescending to approach it that way. The words “not true” imply “deliberately false”. “Incorrect” or “mistaken” or even “mis-spoken” would be more accurate, don’t you think?

    Be that as it may, Greg and I settled the matter between us, so what does that make you for dredging it up again?

    With respect to the article I provided the link to, I don’t offer it to make a point so much as that it seemed to me germane to the theme of this thread and worth our attention. You are welcome to think otherwise.

    In offering the quotes of the doctor who seemed to agree with my position, I don’t offer it as proof, but as evidence that my basic contention is correct. There is sufficient reason to question the use of anti-depressants and the questioning is not merely the province of wild-eyed fundamentalist preachers (a characterization I am happy to embrace). We don’t have all the answers on this question and it is even possibly doubtful that suicide rates are affected in the least by the use of anti-depressants.

    Some of the argumentation in this thread has been to this effect: “I know a guy who wouldn’t take anti-depressants because his preacher said it was sin and he eventually committed suicide (or attempted suicide).” This is offered as proof when it is impossible to know that anti-depressants would have made any difference in the individual case or not. But such an argument proves nothing, even if you could prove that it would help the individual case. It’s anecdotal evidence. The article I link to at least has the advantage of reporting wider trends and surveys.

    Finally, we are having a discussion on a blog. I think we should be able to throw ideas back and forth (as long as we are courteous to one another) and even make mistakes in our statements as we think these things through, don’t you? Must we be experts in order to post on a blog?

    Maranatha!
    Don Johnson
    Jer 33.3

  56. Don,

    My point is this. You obviously know little if anything about the medical causes of depression. You do not know how antidepressants work. So, why be so dogmatic when this is such a serious issue?

    If a woman came to you that was possibly suicidal and her doctor had prescribed antidepressants, would you veto him or not? I would think if you would, you had better know what you are talking about. If you don’t, why would you ever advise against a doctor’s recommendation?

  57. Frank, you say “obviously”, but you can’t know all that I know based on a few comments on a blog. You say I don’t know how antidepressants work. Neither do you. Nobody does, including the doctors prescribing them.

    Nevertheless, I know better than to contradict a doctor’s advice. There are huge legal ramifications, and I won’t take that risk. I would advise the individual to search out the facts for themselves and try to help them sort out other data in their lives to seek out non-medical causes of their depression. Better to deal with the causes than the symptoms, in my opinion. My goal would be to eliminate the depression and get them off the drugs, but that would require doctor’s advice on that side of it.

    Maranatha!
    Don Johnson
    Jer 33.3

  58. Reluctant moderation:

    This is an interesting discussion, but I don’t know that it’s progressing at all. A large dose of humility from all parties is certainly in order since (a) we agree that it’s complicated, (b) most evidence presented has been merely anecdotal or testimonial, and (c) clearly inaccurate statements have been made (e.g. regarding serotonin), indicating that the knowledge of most of those commenting (certainly including myself) is cursory, if not embarrassingly inaccurate.

    Everybody needs to chill out, make sure their pride isn’t running the conversation, and admit that they possess an inadequate amount of objective information to make sweeping claims on either side of the argument.

    It’s depressing.

  59. Antidepressants are Selective Serotonin Reuptake Inhibitors (SSRIs). What they do is block the reuptake of the body’s own serotonin back into the nerve terminals after release. Reuptake is what normally happens at the end of a nerve cell transmission. Blocking reuptake results in an increased level of serotonin at the place where transmission of impulses between nerve cells occurs. Although antidepressants do not supply serotonin, they do increase the supply of the serotonin the brain has already made at the nerve terminal. So the effect of giving an antidepressant is the same as if the person were “taking serotonin.” Therefore, it’s not correct to say that antidepressants decrease the level of serotonin. When they decrease reuptake, the result is a functional increase in serotonin level.

    This discussion is the reason I wrote my book with Elyse Fitzpatrick, Will Medicine Stop the Pain?, which was recommended a number of entries ago by Diane. I believe it’s possible to acknowledge the contribution the body makes to depression, and recognize that there will be times when giving an antidepressant is necessary to help a counselee work on his/her heart issues without taking a position that depression is purely physical problem. Our book attempts to walk a middle path between a strict medical model and a response that sometimes fails to consider the real pain and desperation that depressed persons feel. It includes numerous testimonies, including my own experiences with very severe depression and antidepressant meds. As your title says, it’s complicated, and while we don’t claim to offer the last word on this difficult issue, Elyse and I have taken a book-length stab at it. Perhaps some may find it helpful in sharpening their thinking on this difficult issue.

    Life is messy and there are few simple answers. May God grant everyone wisdom as you struggle with the interface between two truths, and enable you to find the balance that most reflects His heart, character, and purposes.

    Blessings.

  60. Chris,

    You forgot to include ad hominem in your list describing the argumentation.

    FWIW, I am not particularly embarrassed by any inaccuracies on my part. From Dr. Laura’s post, my statements were not technically correct, but the net effect of taking anti-depressants is the same as “taking seratonin”. So… what’s the big deal about a technicality?

    I appreciate Dr. Laura’s post, I think that I would generally agree with some kind of middle road approach, but I am still leery of drugs, but I have ordered her book.

    Maranatha!
    Don Johnson
    Jer 33.3

  61. Not to dredge up old wounds, but I have finished the book Will Medicine Stop the Pain?. I highly recommend it as an introductory resource on this topic. I have posted a review at my place.

    Maranatha!
    Don Johnson
    Jer 33.3

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