Most Americans do not feel comfortable speaking to their doctor about symptoms of depression.

Why?

That’s the question a team of psychologists at the University of California recently tried to answer via a phone survey of 1054 adults. Time reports the results:

  1. 23% were afraid that their doctor would try to prescribe them antidepressant drugs.
  2. 13% said they were worried they would be referred to a psychiatrist
  3. 12% said they didn’t want to be considered a psychiatric patient.
  4. 16% didn’t think psychological issues fell under the purview of a primary care doctor
  5. 15% were concerned about medical record confidentiality.

The first three certainly coincide with my own experience of counseling people with depression; and there is usually even greater resistance to seeking medical help among Christians. The majority of emails, letters, phone calls, cries for help, that I regularly receive contain extremely painful personal stories describing the impact of depression on people’s lives, and the lives of their loved ones. But they almost always conclude with some variation of, “But, I know that anti-depressants are not for me,” or “But, I want to beat this on my own.”

Why should this be?

depression

1. Over-prescription
Most of us have seen far too many people put on to anti-depressants far too soon and often with limited investigation as to causes. We’ve all known people who run for a pill as soon as they feel a bit down; there’s no willingness to bear any emotional pain; there’s no seeking of God’s help, grace and counsel; “Just give me something to make me feel better!”

Others want pills (and are usually given them) to deaden the guilt of living sinful lives. They will do anything to avoid taking responsibility and facing up to the spiritual causes of their pain; and if that means some emotion-killing meds, then pour them in. (Here’s a previous post on the pointlessness of medication-only approaches).

The abundant evidence of over-prescription in our society, even among Christians, is a huge impediment to the really needy going for appropriate help.

2. Confusion
The vast majority of people know very little about the role of the brain in our thinking and feeling processes. I’m afraid that even many Christian counselors and pastors lack vital understanding of brain science, and especially of the role the brain plays in our spiritual lives. It’s so embarrassing to see 20 and 30-year-old medical research, theories, and cliches still being quoted in modern Christian counseling books.

Yes, of course, some depressions can be caused by sinful actions, thoughts, and feelings. But depression can also be caused by the “machine” that processes our perceptions, thoughts, and feelings breaking down and malfunctioning. Like the factory with a broken conveyor belt, it doesn’t matter how many high-quality raw materials you put into it, the goods are going to come out damaged until the machinery is fixed. You can press the switch as often as you want, but if the cable is broken you will remain in the dark.

It’s actually amazing how much the church has gone backwards in its understanding of how the physical and the spiritual interact. I often hear the Puritans being promoted as models of men who used only Scripture to deal with depression. However, Puritans like William Perkins, Richard Baxter, Timothy Rogers, and Jonathan Edwards all understood and taught that there was often a physical or bodily element to many depressions, that needed to be treated with medicine, crude though their own solutions were at that time. For example, Richard Baxter wrote The Cure of Melancholy and Overmuch Sorrow by Faith and Physic (Medicine).

(UPDATE: I was just sent this fascinating Wall Street journal report on the impact of oxytocin on schizophrenics.)

3. Pride
We do not want to think of ourselves as weak (and we certainly don’t want others to think of us like that). Strange isn’t it that no one would view taking medication for any other malfunctioning bodily organ as a sign of weakness; rather, that’s wisdom!  Yet, taking meds for problems with the most complex organ in the body is somehow only for “losers!”

Pride can also be manifested among Christian pastors and counselors who think that they can “do it all.” Instead of viewing themselves as a vital and central part of a team of helpers from various disciplines working together to help a depressed person get better, some actively discourage the sufferer from working with anyone but themselves. This too deprives a person from benefitting from the gifts and talents God has distributed among different specialties.

4. Hyper-spirituality
Although Christians with heart disease, diabetes, blood disorders, cancer, etc. do not think that it is unspiritual to seek and use medicines to relieve their symptoms and even cure their illness, many seem to think that there is some special spiritual virtue in suffering depression for months and years without any medical intervention. Their family and friends don’t usually see much super-spirituality in this approach!

And the next time someone tells you that taking medication for depression shows a lack of faith, or a lack of trust in God’s Word, ask to see their usually overflowing medicine and vitamin cabinets!

5. Side-effects and mixed results
The side-effects of anti-depressants are often over-played by those who oppose any medical contribution to the treatment of depression. And it’s often used as an excuse by those who are resistant to taking them. However, we must accept that, as with all meds, there will usually be some side-effects to taking anti-depressants. Again, it’s strange to see the way that we will put up with some quite serious side-effects when it comes to the treatment of strokes, angina, cancer, etc; yet, with anti-depressants, we seem to demand perfect results with nil side-effects.

The question really is, “How desperate are we?” If we are truly desperate, then we will be prepared to put up with some lesser side-effects in order to start feeling and thinking normally again.

Brain scientists are increasingly referring to the brain as a “universe,” a universe that we’ve barely begun to explore. With new brain-imaging techniques, the previously slow pace of medical research is beginning to take some leaps forward. Let’s pray for God’s blessing on these researchers, that He would permit them to discover what He already knows about the role of the brain in our thinking and feeling processes, and that the relatively primitive medicines we presently have would be replaced by much more sophisticated and successful treatments.

And let’s pray for pastors, counselors, and Christian doctors that they will be given increasing skill to discern where each person’s depression lies on the spiritual/physical scale. God forbid that we help someone excuse and reason away their sin. But may God also forbid that we heap blame and responsibility on people for something that is not their fault.

Who is sufficient for these things?

  • Evelyn MacIntyre

    Thank you for your balanced perspective.

  • Tanya

    Amen, brother! Kidding aside, I fought through all those fears before I sought treatment. And although I may be unique (but I doubt it), I don’t find medication to be the cure-all for depression. It certainly helps me keep on top of things, but I must keep practicing the analysis I learned in therapy to lasso my emotions and sinful thought patterns. Pill-popping alone does not prevent descent into the pit. People fail to understand that today’s SSRIs are not happy pills or tranquilizers. Here’s to fully functioning machinery!

  • Rob

    The main problem with anti-depressants is that they don’t really work very well, have very nasty side-effect and lost whatever beneficial effect they might have over time. A lot of studies indicate that anti-depressants don’t work any better than placebos. Most people are better off doing pro-active things like committing to daily devotions, getting in a daily walk at a vigorous pace, eating whole foods only, supplementing with essential fatty acids, getting to bed on time and working on their social network- especially in the household of God. That’s my considered opinion after 25 years of pastoring Reformed churches.

    • http://headhearthand.org/blog/ David Murray

      Thanks for sharing your experience, Rob. I have to say, it’s quite different to mine. The placebo effect you quote is usually only found where there is no accompanying counseling or if the counseling given is wrong/poor/amateurish. “A lot of studies” have their own agendas too. But totally agree with you on the need for a holistic approach with all that you mention being absolutely vital parts of a healing/caring package.

    • Dave

      I realize that your comments are well-meaning, but as a medically trained family physician who has struggled with these issues, I can reassure you that while your suggestions are extremely good, I can also reassure you that you have not really had to deal with proper, diagnostic depression. And perhaps the reason you haven’t dealt with it is because the people in your congregation knew your particular views and therefore never sort your counsel in that regard, or if they did, very soon they would tell you that they were fine but actually weren’t fine but were too afraid to go back to you. I really am not meaning to be hyper-critical, but being a family physician with a number of year’s experience, my observations are quite different from yours. There certainly are many people who do not need anti-depressants, but I find it reprehensible that so many Christians are condemned to a life of misery because their well-meaning leaders are misguided. A family friend, who recently passed away, for many years took the views that you put forth, and basically told people that their depression was a result of their lack of faith and their lack of commitment to a Godly lifestyle…until one day he developed depression. Very quickly he changed his views and became a far more compassionate and loving leader.

      • http://headhearthand.org/blog/ David Murray

        Dave: Thanks for sharing your insights. I agree with every word you write. I’ve seen exactly what you describe as well.

      • Dave

        Sorry, my last comment was for Rob, not David.

        • Dave

          A very interesting article partially relating to this discussion, David, is an article by Tim Challies regarding “spiritual abuse”. Now I am certainly not accusing Rob of this at all. But I think that certain approaches to depression by certain pastors can become spiritual abuse – this is the link here http://www.challies.com/articles/spiritual-abuse. Rob, please understand this is NOT directed at you at all, this is a general comment about something I have seen happen.

    • Debbie E.

      Rob, that’s a pretty simplistic overview of people with depression. Have you been on antidepressants? I have for years and have had no “very nasty side-effect [sic]“. A good physician will work with a patient to find the right medicine for each person. It’s not a cut-and-dried formula. I’d like to see links to these “lots of studies” that say placebos are as effective as medication. It seems to me that you view depression through your Reformed lens and through your apparent devotion to “whole foods” and walking at a “vigorous pace.” Unless you have walked down the dark road of depression, you cannot understand it. You, my friend, are part of the problem in the church when dealing with depression. You have no idea what you are talking about and it saddens me that you pastor any church – I feel for your congregants who suffer from depression since they will get no real help from you. You are naive and misguided.

  • http://beggartobeggar.blogspot.com/ Eliza Huie

    David,
    Great article. You have done a great job reflecting the voice of those in Christian circles. There is a stigma still closely attached to depression. That makes it hard for those suffering to reach out especially to other Christians. We have done a poor job of caring for the hurting in this area for too long. I think this post is an excellent step in the right direction. May we seek to love well those who are suffering.

    CCEF’s upcoming conference will likely deal with the balance between the spiritual and physical. Hoping it is well attended, especially by pastors and lay counselors.

    Grace,
    Eliza

    • http://headhearthand.org/blog/ David Murray

      Thanks Eliza. Yes, I’m looking forward to hearing CCEF’s conference addresses. I was encouraged by the Lane/Powlison promo video.

  • http://www.housewifetheologian.com Aimee Byrd

    I appreciated your book, “Christians Get Depressed Too.” It helped me have a better understanding of some of my family members and friends. Also, I know the issue of anxiety is related (and you discuss briefly in your book), and I know at least a handful of people who suffered from panic attacks but were reluctant to take medication because they were counseled that anxiety is just a sin that they need to repent of. It was very hard watching them try to “repent better,” “read their Bible better and more often,” etc. I’m glad they ended up getting the help they needed.

    • http://headhearthand.org/blog/ David Murray

      Thank Aimee. Glad the book was a help.

  • Evie

    Thanks for the balanced article. I have quite the experience with anti-depressants, having been prescribed them in high doses for some 11 years before I tapered off. I was told that what was wrong in my brain was “permanent” and that I’d have to be on medication “for life” for my anxiety and panic attacks. I disagreed. The brain chemical imbalance theory cannot be tested with blood work, scans, xrays, anything. Seratonin is throughout the body, (stomach, etc) not just the brain, so it affects every thing. Doctors are not sure how or why the drugs seem to help, and that was a little scary to me. If you listen closely to commercials or advertisements for these meds, they say some theoretical statements such as “it is believed…” because scientists do not know or fully understand WHY these meds work which play with cellular chemistry. But I can’t tell someone to quit their meds or to not seek help in that way, because it does seem to bring people out of a mental rut or pit. It helped me for a time, with symptom relief, but now if I feel depressed I find it is what I’m saying to myself that’s dragging me down into the pit. I listen to myself instead of TALK to myself. They are usually un-renewed & un-biblical thoughts, me or not trusting God. That surely can’t be fixed by meds :) I agree with the wholistic approach but from my research, there isn’t a scientific basis for a ‘chemical imbalance’ which leads to depression, except what can be measured, such a thyroid problem, hormonal imbalance, and so forth. But I do agree that you can’t simply pull yourself up by your bootstraps and will yourself to feel better. That never worked for me! :)

    • http://headhearthand.org/blog/ David Murray

      Evie: Thanks for sharing your story. So thankful that the Lord has brought you out of the pit. I agree that so much of this is about patterns of thought, and I agree that the meds seem to give people an initial boost to get out of the rut and give them an opportunity/ability to start thinking again. That’s where counseling is so helpful, and once habits of prayer and talking to yourself have been re-established, you can make great progress and also learn how to stop falling into the pit again. There is actually increasing evidence for the “chemical imbalance theory.
      Here are a couple of helpful posts. See especially the Yale research (second article down on their webpage).
      http://yalemedicine.yale.edu/ym_sp01/findings.htm
      http://pn.psychiatryonline.org/content/38/17/24.full
      http://news.bbc.co.uk/2/hi/health/8304782.stm

      This more “popular” article also highlights why women have a biological predisposition to depression:
      http://anndunnewold.com/?p=104

      “However, serotonin synthesis is 48% lower in women versus men. Serotonin is one of the main neurotransmitters that affect mood. This fact, along with the stats about male vs. female rates across the life span, suggests that women are biochemically predisposed to depression and anxiety. Women can’t will themselves to make more serotonin any more than individuals with diabetes can will themselves to make more insulin.”

      Also the new brain-imaging techniques are finding similar chemical and electrical patterns in depressed people.

  • jim

    David,

    Thanks for the article and for your book. I downloaded it recently and have just started reading it.

    A question – in your article you refer to the brain as a machine and compare it to a conveyer belt. “…the goods are going to come out damaged until the machinery is fixed.” What part does an anti-depressant play in ‘fixing’ the machine?

    I realize that the best analogies fall short, but if there is an organic issue with the brain, how does the anti-depressant fix or help fix the problem? Or should we look at the anti-depressant as a ‘coping’ mechanism to help in the process of holistic soul care?

    I’m an aspiring biblical counselor wanting to understand these things more clearly. Thank you for your insight.

    Grace to you,

    jim

    • Ian

      Jim, the basics of how the most popular anti-depressants are thought to work can be found at Wikipedia (look at Mechanism of Action): http://en.wikipedia.org/wiki/SSRI

  • Reed Here

    David: following my first (short) pastorate, I had a few months of deflating from what was a very difficult and intense set of circumstances. On top the weaknesses of the circumstances were my own incredible weaknesses and sinfulness as a pastor, exposed by these circumstances.

    Moving, finding a temporary job, finding insufficient housing for my family, wondering whether or not I was ever going to find another church to serve again – all these things came crashing down on me in a short two months. One result was for 2-1/2 weeks I experienced a black as mid-night depression.

    As I was coming out of it (didn’t know it at the time), I went to my doctor thinking maybe I had a virus, or some other disorder in my blood or something. After the lab reports came back clean he gently led me through the basic questions. Before he was even finished, I looked up at him, with all the untried wisdom of my seminary training and said, “It was a depression, wasn’t it?”

    His gentle nod confirmed the diagnosis. Nothing in my training had prepared me for this. If my circumstances hadn’t lifted, he would have prescribed meds and I would have taken them. I would have done so with a faith humbled to point of a deep awareness of my own utter fallibility.

    Thank you for your blog post. May God prosper such thinking and speaking in His Church.

    • http://headhearthand.org/blog/ David Murray

      Thanks for your testimony to your own weakness and to God’s all-sufficient grace.

  • Tanya

    I think maybe I was unclear in my above comment, and I wouldn’t want anyone struggling with the medication issue to think that it wasn’t worth taking SSRIs. They are definitely necessary, for whatever time they work, but, as David keeps pointing out, only part of a complete therapy.
    In response to Rob’s comment, I’ve had to try a few drugs before finding one that works well with minimal side effects. I’m willing to live with the current ambiguity of the science to get these results. Let’s hope somebody is working away diligently in a lab, discovering news things about brain chemistry.

  • http://thenface2face.wordpress.com/ Karen Butler

    David,

    Have you read those depressing reports about the effects of anti-depressants recently published in the New York Review of Books? The author is Marcia Angell, a former editor with the New England Journal of Medicine, and who currently lectures on issues of Public Health at Harvard. The articles are “The Epidemic of Mental Illness” found here,

    http://www.nybooks.com/articles/archives/2011/jun/23/epidemic-mental-illness-why/

    and “The Illusions of Psychiatry” , here: http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/

    In her cogent and jargonless essays Ms. Angell reviews three books about the current state of psychiatric research and practice, and the new edition of the DSM. Clearly there is a crisis in that particular corner of the world–these books describe, in her words, “the baleful influence” of Big Pharma on the practice of psychiatry.

    She reports on research into the placebo effects of these meds, but also about their dangerous side effects, which are more deletrious than a little dry mouth or lack of libido. With long term use of psychoactives, the brain has been shown to shrink, creating a class permanently impaired and crippled by what previously might only have been a cyclical/seasonal attack of depression.

    In her response to letters printed in the NYRB here, http://www.nybooks.com/articles/archives/2011/aug/18/illusions-psychiatry-exchange/ ( many of these critics are drug company shills), she writes that they “simply assume that psychoactive drugs are highly beneficial, but none of them provides references that would substantiate that belief. Our differences stem from the fact that I make no such assumption. Any treatment should be regarded with skepticism until its benefits, both short-term and long-term, have been proven in well-designed clinical trials, and those benefits have been shown to outweigh its harms. I question whether that is so for many psychoactive drugs now in widespread use. I have spent most of my professional life evaluating the quality of clinical research, and I believe it is especially poor in psychiatry.”

    We have something greater than this bad “physic”. We have the Great Physician. We have the Gospel, and we have the ‘one anothers’ that this benighted industry completely lacks. Until there is better and proven outcomes from meds, I think we do better to stick to exercise and biblical counseling for depression.

    And I speak not only as one who struggles with anxiety and depression myself, but also witnessed my own mother’s renal failure from lithium and the soul deadening from the carbamazepine that followed –until she was healed by Jesus, shortly before her death, to the amazement of her social workers. Both of us learned how to take our thoughts captive to truth, and how to speak truth in love to others, which precipitated the physical healing of our symptoms. I walk in continuous peace, hope and rest now.

    • http://headhearthand.org/blog/ David Murray

      Yes, Karen, I’m familiar with these articles and with the career that Marcia Angell has built upon this view. As you probably know, her articles have been widely critiqued, and not just by Big Pharma. I’m afraid that like many Christians, she paints with a rather broad brush. Is there huge over-prescription of these meds? Yes. Have they caused damage? Yes. Conclusion: no one needs them or benefits from them. I’m not prepared to make that logical leap, especially when new brain-imaging techniques are proving more and more persuasive as to the chemical and electrical components of depression – though the meds are still lagging behind in their sophistication. Anyway, I base my belief in the chemical and electrical malfunctioning of the brain not on science, but on the doctrine of sin, the divine curse, and its impact on the whole body.
      I’m glad the Lord has granted you relief and pray that you will continue to know His peace. And may He continue to lead us all into greater understanding of these mysteries with open minds and hearts.

  • Brian

    I just don’t know what to do. I’ve taken numerous “depression checklists/tests” on different sites and every single one of them comes back that I’m definitely suffering from severe depression. This isn’t news to me from the way I feel.

    But I’m trapped. I know that the cause of my depression is obscene amounts of stress from my job. The depression won’t go away until my job changes but with the economy today, I’m lucky to have a well paying job. I can’t quit. I have a mortgage and young family to support. My industry keeps shrinking the number of workers and the pressure on each will continue to climb as more is demanded. It’s a vicious circle from which I don’t see any way out, I don’t see any way to change it and with the depression becoming severe, my motivation levels are next to zero from the exhaustion.

    The second source of stress is that my church is having a leadership upheaval currently and running headlong into the Emergent movement. I’ve been fighting to bring them back to Orthodoxy but the response has been one that half the leadership agreeing that things are off the rails but that they have just asked for patience while they work through it.

    So basically, the one area that I should be able to go to for support is just another source of stress.

    I don’t know what to do. I’m really lost.

    • http://headhearthand.org/blog/ David Murray

      Brian: I’m very very sorry to read about your suffering and your near-impossible situation. If you want to talk about this a bit with me, please use the email address on the envelope icon at the top of the page.

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  • Nina Ray

    When I take Prozac, I become apathetic toward God and spirituality, pretty much an atheist. When I don’t take Prozac, I pray regularly, participate in my church, and am generally a committed Christian, if a depressed one. It’s a little creepy.

    • http://headhearthand.org/blog/ David Murray

      Nina: Very sorry about your suffering. Difficult to say anything without knowing more, but have you considered asking to change meds? For some people it takes 2 or 3 trials until the right one is found. We are all so different.

  • http://thenface2face.wordpress.com/ Karen Butler

    Brian,

    I have been praying for you, and that the Lord would make His face shine upon you, and give you peace, that He would lead you and guide you towards a path of real healing in your life.

  • Susan in SF

    Karen, I am sorry to hear of your mom’s experiences. That said, I have to live on Carbamazepine for now at least, in my case it is used for Trigeminal Neuralgia. It is a hard drug to be on physically
    but it does work for my facial pain that was unbearable. As a child of King Jesus, I’d rather not hear other’s refer to it as “soul-deadening” thanks…(-: Exhausting, fatiguing etc it may be, but it has no power over my soul!

    • http://thenface2face.wordpress.com/ Karen Butler

      Susan,

      I am so sorry if I offended you by the use of ‘soul-deadening’. And I am so sorry for your suffering. When I reprinted these and other comments on my own blog, I edited it to read
      “life-sucking” –is that better? Because that’s sort of what happened to my Mother. She disappeared on the psychoactives, that brilliant, creative woman who graduated from Cal with a degree in Chemistry with such hopes for the future.

      And really, why I singled out Tegretol for special attention I have no idea. I think it was the last one she tried. I could have just as easily pointed out the same effects for Abillify, Seroquel, klonodine, Depakote –all of whose effects I have been an intimate witness for most of my adult life. And not just in my mother, but also in others dear to me.

      These drugs were not just lifesucking and exhausting, but disfiguring and crippling, like the tardive dyskinesia — charming Tourettes like involuntary tics. Which were treated with other drugs of course.

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