Depression: Did you know scientists and biblical counselors recognize at least three myths about this problem? In part 2 of this two-part series, learn the truth about a depression diagnosis and medication use as you seek help for you or a loved one. Read part 1. This post first appeared here on CareLeader.org, June 29, 2016, and is used with permisison.
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Myth #2: A Diagnosis Explains a Person’s Symptoms
According to the Diagnostic and Statistical Manual (used by medical professionals — Ed.), Major Depressive Disorder is characterized by nine symptoms:
a depressed mood, diminished interest or pleasure in anything at all, significant weight loss or weight gain, insomnia, psychomotor agitation, fatigue, inappropriate feelings of guilt, inability to concentrate, and recurrent thoughts of death.
For a person to be diagnosed with Major Depressive Disorder, he must experience at least five of these symptoms, at the same time, for a minimum of two weeks.
It lists numerous symptoms—but gives no explanations for why those symptoms occur. Unfortunately, many people view their diagnosis as an explanation for their behavior. Perhaps you’ve heard people say things like:
“I don’t have any energy because I’m depressed.”
“I don’t want to go out because I’m depressed.”
“I don’t feel like studying the Bible because I’m depressed.”
Dr. Michael Emlet explains why people tend to think of the diagnosis as an explanation for their behavior.
Giving a summary label to a set of symptoms gives the appearance of explanation, particularly in our medicalized culture. It suggests that each diagnosis is a discrete and largely brain-determined entity, and there is simply little evidence for that except in the major psychiatric categories of schizophrenia, bipolar disorder, and severe depression.
A Better Way to Think About a Diagnosis
In the article DSM-5: The New Normal? Dr. Emlet suggests a more helpful way to think about a diagnosis like major depression:
It’s important to remember that psychiatric diagnoses are descriptions of a struggling person’s thoughts, emotions, and behaviors; they are not explanations for them. They tell you what but not why. The [Diagnostic and Statistical Manual] admits that.
And even if the scientists were able to link symptoms of depression to particular biological markers, they still couldn’t say with certainty whether those biological abnormalities were caused by spiritual-relational-behavioral-cognitive dynamics or vice versa.
What Pastors Say About Depression
To be fair, pastors can’t say exactly why a person gets depressed either. But they can point to some of the reasons God says people can be depressed. Those reasons may not apply to everyone, but they should be considered. Here are a few examples:
- The Bible says that hope deferred makes the heart sick (Prov. 13:12). Experiencing the postponement or the loss of a dream or personal goal can result in sadness, discouragement, and lack of motivation. A person may tire of waiting for a desired result, or he may wonder why he should continue to try when his efforts seem fruitless. The sadness and discouragement are more potent when an individual’s dream was his primary driving force in life. Without that, he may feel empty and purposeless.
- In Psalm 43:5, the psalmist asks himself, “Why, my soul, are you downcast? Why so disturbed within me?” He proceeds to counsel himself to put his hope in God. Exploring what a person is hoping in, counting on to provide success, meaning, or happiness, can reveal areas in which he is not trusting God.
- Guilt is a common emotion associated with depression. The psalmist says that sin made him feel as if his bones were wasting away (Ps. 32:3). Dr. Linda Mintle has observed, “Unforgiveness is a cause of depression. Harboring anger, harboring resentment, allowing it to take root in one’s spirit and soul in a bitter way creates depression.”
- There are also biblical references to certain behaviors, thoughts, and values that can result in joy and zeal (Ps. 94:19; Ps. 122:1; Phil. 4:1, etc.). It is possible that the absence of such actions and thoughts would limit one’s experience of those emotions. Keep in mind, however, that it is possible for a person to obediently pursue God and still battle depression.
For more on how pastors can uniquely help those struggling with depression, see Jeff Forrey’s article How Pastors Can Help the Depressed.
Myth #3: Medication Doesn’t Help Treat Depression
Some people are under the impression that depression is purely a spiritual issue and that medication isn’t effective or needed in treating depression. Some who cite the ineffectiveness of antidepressants claim that they are slightly more effective than a placebo.
A fact sheet produced by MIT explains the origin of that idea:
Clinicians began hearing this question from patients after news articles reported on a 2002 analysis of published and unpublished studies submitted to the U.S. Food and Drug Administration (FDA) as part of the approval process for several new types of antidepressant medication. This analysis concluded that the newer types of antidepressants are only marginally more effective than placebo.
However, these analyses do not reflect how antidepressants are used in actual practice. Drug trials measure only how a person responds to a single medication taken at a specific dose for a limited time. In clinical practice, however, the patient and clinician work together to find the dose and the medication or combination of medications most effective for you. Most clinicians believe that this process results in much better results than these analyses imply.
Dr. Michael Emlet, in an interview for our DivorceCare and Single & Parenting projects, pointed out that the Bible doesn’t prohibit taking medications for psychiatric disorders. He said,
When Jesus came, He not only forgave sin but He also healed disease. He also relieved suffering. Medications may be one way that suffering is relieved…. I would say medication is a wisdom issue. It’s going to vary from individual to individual whether or not medications may be wise.
I think some people want to rush too quickly to medications. Other people refuse to even consider the possibility of medications. Both of those positions could be problematic because they reflect motives of the heart that may be off base.
Dr. Emlet reminds us of the importance of remembering the limitations of medicine:
Medication can help treat depression and shouldn’t be written off as one of the ways that God can bring healing and relief to a person’s life. For example, with stabilized emotions and higher energy, people can be enabled to make needed changes in their lives.
But people need more than drugs. Drugs, as helpful as they can be, do have limitations. They don’t treat any of the underlying spiritual or environmental issues that contribute to a depression.
Some people may not require medication to treat their depression at all. Less severe cases can be treated with nonmedicinal approaches and basic behavior changes. For example, one study reported by Reuters found that simply getting active three times a week reduces the risk of depression in adults by 16 percent, and additional exercise reduces the risk even more. You can also suggest that a person try a change in diet, since a lack of essential vitamins and minerals can result in depressive symptoms.
Conclusion
A strategy for effective care begins with an accurate understanding of the person’s problem. For more on how to understand depression from a biblical perspective, see Jeff Forrey’s article How pastors can help the depressed. It will help you understand the unique role pastors play in helping people deal with depression.
Also check out Kathy Leonard’s article 3 reasons depression is complicated, which features interviews with counselor Leslie Vernick and Dr. Robert Kellemen. It’s a great post to share with your deacons and care group leaders to help them understand why we shouldn’t use simplistic reasons to explain depression.
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