Treatments of Depression

I want to give up. I can’t go back to school, to work, to relationships. I don’t want to admit that I’m at the end. I can’t fail. I can’t succeed. I can’t love. I hate only myself.³³

Most depressed individuals have a difficult time seeking help. In fact, although 90% of depression cases are treatable, only 20% of those suffering from depression seek treatment.³⁴ Admitting to personal weakness is difficult for anyone, especially for those who’ve spent a good deal of time trying to hide the problems. When people with depression do seek help, they are likely to receive different solutions depending on whether they see a doctor, a psychologist, or a Christian counselor. Below are some of the major treatments offered in each area.

Physiological and Biological Treatments of Depression

Antidepressants. Since it is reasonably conclusive that neurotransmitters such as norepinephrine, epinephrine, and serotonin are involved in depression and other mood disorders, drugs that have been shown to restore normal neurotransmitter levels are often prescribed for depressed patients. Like most prescription drugs, antidepressants often have side affects, but the modern generation of drugs have very few side effects and are not habit forming.³⁵

The first generation of antidepressants were monamine oxidase inhibitors (MAOIs).  MAIOs block monamine oxidase which destroys certain neurotransmitters. While effective, MAIOs often produced serious side affects including high blood pressure and lethal reactions with certain foods.³⁶ The next drug type developed were tricyclics such as Elavin, Togranin, imipramine, and amitriptyline.  These drugs work by stopping the reabsorption of serotonin and noreepinephrine thus increasing their levels in the brain. These drugs are more effective than MAIOs and do not produce lethal effects when combined with certain foods.

The modern (or second) generation of drugs are heterocyclics, also called selective serotonin reuptake inhibitors (SSRIs). They are regarded as better than older drugs because they selectively prevent reabsorption of one neurotransmitter, serotonin. But “it is important to note that they are not more effective than the older drugs. The beneficial results effects and advantages of the second generation of drugs are only that they work faster and have fewer side effects.”³⁷

The four most common SSRI antidepressants are Prozac, Zoloft, Paxil, and Luvox. Other effective non-SSRI drugs with antidepressant effects are Effexor, Serzone, Remeron, Wellbutrin, and Ritalin. Each drug works somewhat differently and has as different set of side effects. Some patients may have to try several different medications before finding one that is effective for them. Sometimes a patient may need to switch medications after a period, possibly if the drug has lost effectiveness overtime. These changes are often very difficult, because the patient must stop taking his or her old medication long enough to prevent an overlap in treatment and then wait for the new drug to take effect. This process may take several weeks and result in a severe depressive episode.

Other Physiological Treatments. An older treatment method that is still occasionally used in severe cases is electroconvulsive shock therapy (ECT). The film One Flew Over the Cuckoo’s Nest famously portrayed this therapy in an unpleasant light. ECT is used in cases where antidepressants have been ineffective or the patient cannot take antidepressants for other medical reasons. ETC works by inducing a temporary seizure and temporary unconsciousness which has been shown to lead to improvements in a patient’s mental health and increase neurotransmitter levels.³⁸ It was formerly used for other mental health problems such as schizophrenia, but is now used exclusively for depression.³⁹

Another major, but often overlooked, cause of depression is one’s diet. Sugar and caffeine in particular have been linked to depressive episodes. Poor eating habits often accompany depression and should always be evaluated in any comprehensive treatment plan. Well-educated physicians will consider a person’s diet and exercise routine in addition to prescribing antidepressants.

Psychological Treatments of Depression

Although medical research has made significant strides in demonstrating biological causes and treatments for depression, psychology or “talk therapy” is still not only popular, but apparently effective. Of course, psychological treatments for depression are only as effective as the underlying assumptions of the psychological causes for depression. The three major psychological treatments below correspond to the previously mentioned causes.

Psychoanalysis. The goal of psychoanalysis is to resurrect buried, unconscious memories and determine their effects how a patient responds to their present day situation. Classically, the patient lies on a couch while the analyst sits behind him or her and talks the patient through free associations of various events. The analyst makes notes of how a patient addresses certain events and if a patient is more or less likely to talk about a given subject. If a patient shows unconscious resistance toward a subject, such as if he or she tends to change the subject when talking about the a parent, the therapist will try to help the client gain insight into these unconscious disturbances.

Behavioral Therapies. Behavioral therapies avoid delving deep into a person’s mind and instead focus on changing maladaptive behavior patterns. The theory is that acting in healthier ways helps people feel better about themselves causing them to continue with better behavior. This is achieved through various methods of conditioning through positive reinforcement. Clients are encouraged to set small achievable goals and then to reward themselves for success. The most famous of behaviorists, B.F. Skinner, boasted that he could take any person from any culture or background and use reinforcement conditioning (also called operant conditioning) to completely change the way that person acted.

Cognitive Therapies. Cognitive therapies seek to help depressed patients examine and change the way they think. Cognitive therapists emphasize that it is not necessarily events that cause depression, but our interpretation of those events.⁴⁰ For example, after failing a test, a depressed person might conclude that he is stupid and will never be success in life. A cognitive therapist would ask a client to think about other possible causes for his poor performance and suggest alternatives such as poor study habits and having insufficient study time due to other pressures. In this way, the therapist helps the patient understand the true causes of his or her problems and encourages positive change in light of these discoveries.

Evaluating psychological treatments for depression is difficult for a number of reasons. Although some studies suggest that as many as 75% of clients are satisfied with the experiences in therapy, other studies suggest that counseling on its own is “useless.”⁴¹ There are many different forms of psychological treatment and it is difficult to experimentally measure their success. Depressive symptoms typically last for 3 to 9 months and may patients may recover for reasons other than their therapy.

Though Psychological treatments most likely do have positive effects on many people, psychology alone usually cannot successfully treat depression because it only considers one aspect of a human. For example, psychologists therapist often do not give patients thorough physical examinations as part of their treatment causing them to miss obvious physical causes. Also, in some cases the worldview of a nonChristian psychologist may be more harmful than helpful, especially for a Christian patient.

Spiritual Treatments of Depression

The previous information from the fields of biology and psychology present us with helpful understandings of the human body and mind and how we can help them function better. As helpful as the information is from these disciples, there is much more to gain when coupled with a Biblical and proper understanding of both God and human nature. The difficulty in much of Christian literature tends to be overemphasis on spiritual terminology, unfounded bias against secular research, and failure to understand the interrelatedness of the human body and soul. Thankfully, many newer Christian books have addressed depression in a more balanced way. For example, in many of Neil Anderson’s works, he appears to over-emphasize spiritual or demonic conflict when writing about sin,⁴² but in his newer book Finding Hope Again, he approaches depression in a more balanced and helpful manner.⁴³ Unfortunately, some Christians still approach such issues with a neuthetic bias (considering the Bible the one and only source of help in all situations)⁴⁴ and fail to consider that everything we have, including medicine and secular psychology, was given to us by God and may be to our benefit

The most helpful books tend to emphasize the importance of correct Biblical views of one’s self and God, good doctrinal understanding in key areas such as salvation, and the role of community and honesty in recovering from depression. Christian cognitive therapy often focuses on the many “in Christ” statements in the New Testament (see especially Eph. 1) and encourage depressed people to view themselves in terms of Christ’s finished work rather than their perceived failures. Secular psychologists may provide a person some encouragement that he or she does have value and worth, but that value and worth is ultimately baseless. Christians on the other hand have the opportunity to understand themselves as a vital part of God’s creation and as having intrinsic self worth being created in God’s image. Christians also have a true source of hope. Martyn Lloyd-Jones in his classic work, Spiritual Depression addresses the significance of Christian hope:

As we face the modern world with all its trouble and turmoil and with all is difficulties and sadness, nothing is more important than that we who call ourselves Christian, and who claim the Name of Christ, should be representing our faith in such as way before others, as to give them the impression that here is the solution, and here the answer. In a world where everything has gone so sadly astray, we should be standing out as men and women apart, people characterized by fundamental joy and certainty in spite of conditions, in spite of adversity.⁴⁵

Lloyd-Jones is right to point out that followers of Christ are the one group of people who, though they may not possess all the “answers” to life’s difficulties, do have an enduring source of life and joy.

A complete treatment of spiritual treatments of depression is beyond the scope of this article, but this author hopes that this article will help direct Christians to view depression as a problem that is both spiritual and physical rather than as limited to one or the other. God has given us an incredible amount of wisdom and resources for treating this disease and we would be in error to ignore certain treatments because we are biased in either direction.