Introduction

This world
This world is cold
But you don't
You don't have to go
...
Hold on if you feel like letting go
Hold on it gets better than you know¹

Depression Today

As I write this, the number one video on MTV’s Total Request Live (TRL) is Good’s Charlotte’s “Hold On” from their multi-platinum sophomore release The Young and the Hopeless.² The video depicts men and women of all ages who have lost friends, lovers, and almost themselves to depression induced suicide.

The subject of depression has moved from a taboo subject to being readily acknowledged as the “common cold” of metal illnesses.³ New stories of those suffering from depression, of companies creating the new drugs, and of counselors pushing new 10-step programs are continually found in popular media.

Unfortunately as the awareness and research on depression has increased, there has not been a corresponding level of understanding and clarity in regards to the causes and treatment of depression. Much noise has been generated through endless articles, books and opinions of our neighbors. For those seeking to help themselves or others suffering from depression, the overwhelming amount of material and opinions can be daunting and lead to further frustration. Many of the voices are either wholly incorrect or are one-sided in their approach.

Every Christian man, woman, or worker will undoubtedly encounter depression in their lives or careers. “It is very sad to contemplate the fact that there are Christian people who live the greater part of their lives in this world in such a condition.”⁴ Nevertheless, although Christians recognize depression as a problem, their approach often errs on one-sided “spiritual” explanations and treatments, without taking into account biological and psychological research.

Depression is a multifaceted problem that cannot be dealt with in a simple summary fashion. This paper will introduce some of the complexities in approaching the causes and treatments of depression. Hopefully, by presenting a variety of possible causes and treatments from both Christian and secular resources and by encouraging a holistic approach, the reader will be equipped with greater information about depression and grow more compassionate toward those suffering through depression. Dr. Martyn Lloyd-Jones has correctly said, “There is nothing more futile, when dealing with this condition, than to act on the assumption that all Christians are identical in every respect. They are not, and they are not even meant to be.”⁵

Defining Depression

He… a short tale to make,
Fell into sadness, then into a fast,
Thence to a watch, thence into a weakness,
Thence to a lightness, and by this declension,
Into madness wherein he now raves
And all we mourn for.⁶

Depression is a mental illness. Non-mental illnesses are typically classified according to their pathology or what causes them. Each disease is cataloged with a list of distinguishing symptoms to help the medical practitioner identify the disease. If enough symptoms are present, the doctor can perform a series of well-defined tests to concretely identify the illness.

Depression is not so easily categorized, defined, or identified. In 1992, the Royal College of Psychiatrists launched a campaign to increase the public’s understanding of depression and found that most people had great difficulty even defining the term.⁷ Depression is classified by the presence of a series of fairly well recognized symptoms, but it is often difficult to determine if those symptoms are in fact actually causes of depression. Depression also has a wide range of forms and severity. While the range of symptoms is generally agreed upon, there are no medical tests for identifying depression.⁸ There is also a heavy negative stigma around mental illnesses, especially in religious circles, causing many people to avoid treatment. These problems leave many cases of depression unidentified or improperly treated.

Clinical Depression and the Blues

One of the first difficulties in classifying depression is distinguishing clinical or major depression from the up and down moods of everyday life sometimes called “the blues.” When asked to explain the blues, Louis Armstrong is supposed to have said, “If you have to ask, you’ll never know.”⁹ Some of the symptoms of depression such as loss of appetite, depressed mood, and decreased energy are normal responses to stressful events such as performing poorly on an exam, caring for a dying parent, or a failed relationship. Most of the time individuals with a healthy outlook and strong relationships come out of these moods and “pull themselves together” within a few days.

The following is a list of symptoms associated with depression from the NIMH (National Institute of Mental Health). If the symptoms are present for more than two weeks, a person is likely to be suffering from clinical depression:

• Persistent sad, anxious, or "empty" mood
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
• Decreased energy, fatigue, being "slowed down"
• Difficulty concentrating, remembering, making decisions
• Insomnia, early-morning awakening, or oversleeping
• Appetite and/or weight loss or overeating and weight gain
• Thoughts of death or suicide; suicide attempts
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain¹⁰ 

Not everyone who is depressed experiences every symptom, and not everyone with any of these symptoms is suffering depression. In addition to the above list of psychological and physiological symptoms, the experiences of Christians are further compounded by more specific thoughts, such as:

• Wondering if one is truly saved
• Feelings of failure to live a worthy Christian life
• Irrational guilt over perceived sinfulness

A Broad Definition

A useful definition of depression must take into account the complex nature of the illness. Depression is both a distinct disease and a symptom of other illnesses. Regarding the nature of depression, on the one hand, “Scientists, researchers, and mental health practitioners erroneously insist on rigidly viewing depression as either a psychological illness or a biological one.”¹¹ On the other, “many well-meaning [Christian] writers have caused a lot of unnecessary emotional pain by condemning depression as sin.”¹² Depression cannot be seen in only spiritual terms, because humans are not only souls, but also have bodies which directly affect one another; and it cannot be seen in purely psychological or biological terms for the same reason. Kristina Downing-Orr, an academic and professional psychologist who is both familiar clinical research and active in treatment, proposed the following definition: “Depression is an illness, several illnesses, or symptomatic of another health problem that strikes both the mind and the body.”¹³

Her definition, while not necessarily accounting for any spiritual factors, is helpful because it considers the variety of causes and effects of depression.

Subtypes of Depression

There are three major medical classifications of depression. First, unipolar depression, where the patient’s mood swings in only in one direction, downward, is distinguished from bipolar or manic depression where patients experience both extreme highs and extreme lows. The second, and probably less helpful distinction, is endogenous (biological) versus reactive (environmental) depression. The third category is primary depression where depression is viewed as the major illness verses secondary depression which is caused by another illness such as an infection, endocrine disorder, or postpartum physiology.

Unipolar Depression. DSM-IV¹⁴ subdivides unipolar depression into three subtypes, Major Depressive Episode, Dysthymic Disorder, and Depressive Disorder NOS (Not Otherwise Specificed). A Major Depressive Episode occurs when the symptoms listed above are present for at least two weeks. The key word is episode, because “this type of depression is seen to be cyclical, episodic, and interspersed with periods of normal mental health.”¹⁵ If untreated, an episode will last an average 9 months and 50% of depressive episodes will reoccur. After three or more episodes, the odds of reoccurrence within three years increases to 70-80% if the patient has not received preventative treatment.¹⁶

Dysthymia is a relatively new classification of depression is alternatively called minor depression or chronic depression. It is distinguished by “a history of depressed mood more days than not for at least two years, but which did not originate with a major depressive episode.”¹⁷

Bipolar Disorder. Bipolar disorders are subdivided into a parallel set of three subtypes: Bipolar disorder, Cyclothymia, and Bipolar disorder NOS (Not Otherwise Specified).

Bipolar disorder, or manic depression as it used to be called, affects fewer people and is only diagnosed in 5-10% of people with depression. In addition to the melancholic symptoms of unipolar depression, those with bipolar depression also experience alternating episodes of mania which include psychological (euphoric mood, flights of ideas, heightened self-esteem, delusions and grandiose thoughts, and excessive, impulsive, or uninhibited behavior) and physical symptoms (rapid speech, reduced need for sleep, and excessive appetite).

Cyclothymia is similar to dysthymia in that it is a less severe form of bipolar disorder that occurs over a longer period of time. Patients have bouts of depression and hypomania with alternate or interspersed periods of normal moods.

Bipolar depression can be alternately understood as a more severe form of depression in a continuum from unipolar to bipolar depression rather than as a distinct disease.

Causes of Depression

I just didn’t care about anything any more.  If only I could’ve answered some of the many questions that tormented me, but I hadn’t found a single answer. Then I became indifferent to everything and the questions faded away.¹⁸

The current television ad campaign for Zoloft, one of the most popular new antidepressant medications, says of depression “although its cause is unknown, depression may be caused by an imbalance in the chemistry of the brain.”¹⁹ Downing-Orr says, “many scientist and health care professionals conceptualize depression as with biological or emotional and these conceptions then provide the framework for explaining the causes of depression.”²⁰ Neil Anderson says, “We can be depressed for biochemical reasons, but if there is no physical cause, then depression is often rooted in a sense of hopelessness or helplessness.”²¹ Dr. Lloyd-Jones begins his helpful book Spiritual Depression by emphasizing the role of individual temperament as a primary cause of depression.²²

As seen in the above discussion, the symptoms of depression are fairly well-defined and identifiable. But identifying the root cause of those symptoms is more difficult. This is due to several problems. First, many biases exist on toward depression at both the popular and clinical levels. Second, because depression is a mental illness, it tends to be much more complex than non-mental illnesses. Third, depression can sometimes be caused by other conditions and at other times should be considered a separate disease. Fourth, at this time there are no consistent testing methods to determine whether or not someone has a chemical imbalance.

Bias is also a problem in identifying the causes of depression. Depending on whether one is trained in medicine, psychiatry, or Christian counseling, one may have acquired biases that assume certain causes are more likely than others. Those that support a particular theory of the depression causes often support their theories with self-authenticating “case studies.” Many authors present their method as the method that worked when all the others failed. Biases may also be based upon stereotypes of patients based on their age or gender. For example, because women tend to be viewed as more emotional and weaker than men, it is more likely that a practitioner will assume the cause for their depression is emotional in nature.

Bias is also caused by what psychologists call “biases in attribution.” These biases occur when we attribute the causes of actions differently when judging ourselves verses when we judge others. “When we make a situational attribution, we identify the case in the environment (‘my depression is cased by a death in the family’); when we make a dispositional attribution, we identify the case in the person as an enduring trait (‘her depression is caused by a melancholy personality’).”²³ In other words, we may be more likely to classify depression as a personal weakness in others, while we assume external or biological causes in ourselves.

Below I have classified the major causes of depression into three categories: biological, psychological, and spiritual. These categories are not intended to be clean compartmentalized divisions nor are any of the causes mutually exclusive of one another. In fact, some of these causes of depression may in fact be effects of others and vice versa. This breakdown is meant to usefully categorize the various views and provide the reader with a broad range of options.

Physiological and Biological Causes of Depression

Because depression is clearly linked to physiological events menstruation and childbirth, continued research on other biological causes of depression is a vital field of study.

Neurochemical Causes of Depression. As in the above quote from a Zoloft ad, depression is often described as a chemical imbalance in the brain caused by neurotransmitters. Neurotransmitters are chemicals that transmit signals between nerve fibers running throughout the body. Neurotransmitters also regulate mood based on how much or how little of a given neurotransmitter is present. For example, when high amounts of adrenaline (epinephrine) are present, a person becomes highly energetic and enters what is called Fight-or-Flight mode. If other neurotransmitters are at abnormally low levels, a person may become lethargic and unresponsive because there is not enough neurotransmitter to pass messages to the brain.

Norepinephrine and serotonin are the two neurotransmitters most commonly associated with mood disorders. Unfortunately, there is currently no way to measure the levels of these two chemicals in the brain. Instead, doctors look for metabolites, which are the by-products left behind after the neurotransmitters are broken down.²⁴ Those with low levels of 2-methoxy-4-hydroxyphenylglycol (MHPG) or 5-hydroxyindoleacetic acid (5-HIAA) tend to have respectively low levels of norepinephrine or serotonin.

Sleep Mechanism and Depression. A common problem for those suffering from depression is sleeping either too much or too little. Depressed people often experience less rest from sleep because their sleep patterns are disrupted. Normally, people progress through several sleep stages over 90 minute periods and then experience rapid eye movement (REM) sleep for as little as 10 minutes at the end of the cycle. REM sleep normally increases in length throughout the night. But people with depression progress quickly to REM and experience REM for shorter amounts of time.

Interestingly, selective and total sleep deprivation works as an antidepressant. When depressed people are prevented from sleeping, although their mood is initially lowered, it gradually improves throughout the day and continues into the next sleepless day. It is thought that during sleep the body produces a substance with depressive effects. This substance is metabolized throughout the waking hours of the day and functions as a neuromodulator.

Researches do not yet fully understand why we sleep at all and its affects on mood are just beginning to be researched.  In the future, it may prove to be a valuable diagnostic tool.

Other Physiological Factors.  Other physiological explanations of depression involve the neuroendocrine system and circadian rhythms. Studies have also begun focusing on specific foods such as sugar and caffeine which appear to cause depression in some patients. A final factor for consideration is other diseases which may cause secondary depression.

The biological causes of depression can also be understood as symptoms of depression. It is difficult if not impossible to know which come first, the chemical imbalance or the change in mood.

Psychological Causes of Depression

Purely physiological explanations for mental illnesses tend toward assuming that what happens in the chemistry of the brain should replace what is sometimes called the “mind.” But psychological explanations of depression emphasize that the mind and body are distinct. Though psychologists usually recognize the affect of the brain on the mind, they tend to emphasize personal experiences, ways of thinking and learned behavior.

Many of the proposed psychological causes for depression could also be explained or understood in terms of underlying spiritual issues. We will consider this below, but in this section the terms are laid out as they are explained by secular psychologists.

Psychoanalytical Explanations. Sigmund Freud, perhaps more than anyone else, popularized psychological causes of mental illnesses and developed the idea of a mind-body split. Though many of his methods are no longer followed, his affect on psychological studies was profound.

Psychoanalysis is the study of previous experiences, typically childhood traumas, that affect a person’s present psychology. Major losses, whether perceived or actual, such as the loss of a parent through death, separation, or rejection are thought to make one more likely to develop depression later in life. If a person does not discover effective ways to deal with such loss early on, he or she is more likely to fall into depression when confronted with another major loss.

Freud emphasized the individual’s loss of self-esteem in depression. The psychoanalytic view suggests that low self esteem is often the result of anger inward when experiencing loss. The individual does not learn to express his or her anger or believes that it is wrong to do so and thus internalize it, destroying themselves.

Cognitive Theories of Depression. The cognitive view of depression emphasizes the way that people think about themselves, others around them, and their circumstances. A person is more or less likely to be depressed based on the way he or thinks about these things. “People with depression view themselves more negatively than their nondepressed counterparts.”²⁵ Dr. Aaron Beck, an influential cognitive psychologist, argues that depressed people think irrationally in three areas he called the cognitive triad: These individuals possess negative views of themselves, of their current position, and of their future possibilities.²⁶

Cognitive theory builds off of some of the ideas of psychoanalysis. During childhood and adolescence, people acquire a schemata, a way of thinking and viewing the world, based on their response to events. Through events like the loss of a parent, social rejection or criticism from parents and teachers, individuals may develop a negative schemata. This negative view of the world can continue to reinforce itself as each new event is interpreted through a negative bias.

Cognitive problems are further compounded by the tendency of depressed individuals to overgeneralize their experiences. For example a depressed individual might think, “Jessica did not compliment my new shirt, I must be the ugliest person in the world.” They also tend to explain good events negatively, attributing the event’s cause to luck rather than their own merit. They also have a tendency toward magnification or exaggeration. A scratch on a car might “destroy” it, making the individual “worthless.” As an individual’s thoughts become more negative, he or she may become more negative in their actions toward others, causing friends and family to reject them, which in turn reinforces negative thinking.

Behavioral Theories of Depression. Behavioral theory proposes that depression is not caused from by internal thought patterns, but by environmental factors that cause maladaptive behavioral and social behaviors.

There are many variations in behavioral theory, but they all stress the role of positive and negative feedback on an individual’s mood. A person may become depressed if he or she does not receive enough positive feedback or experiences too much negative feedback. This negative feedback may be due to the individual’s lack of sufficient social skills to elicit positive response. It may also be caused by major environmental changes, such as moving to a new city and starting a new job with different environment. A person’s daily activities or behavior such as waking up in the morning and visiting friends may be centered around his or her job schedule. If the individual losses their job, which functions as the core of that person’s behavioral reinforcement, this disruption may trigger depression.

Other potential factors that cause negative may be deficient social skills, the loss of a significant social relationship, or increases in an individual’s sensitivity to negative events or reduction in ability to enjoy positive events. As seen with cognitive causes of depression, behavioral causes tend to form a feedback loop in an individual’s thoughts and resulting behavior. This is compounded when a depressed person begins to feel a sense of helplessness and an inability to change his or her circumstances. Depressed individuals that have limited social networks or those that push away social support often continue further into depression.

As is the case with the proposed biological causes of depression, both negative thoughts and maladaptive behavior are also classic symptoms of depression and not necessarily the causes of a mood disorder.

Spiritual Causes of Depression

“Spiritual” causes of depression are in some ways as speculative as psychological or even physiological explanations. Just as there are currently no way to exactly measure brain chemistry, there are no ways for us to “see” all of what is happening spiritually within a person. Many of the spiritual causes of depression are essentially refined or redefined versions of psychological causes. For example, instead of talking about behavior, Christians talk about sin. In the area of cognition Christians emphasize not only one’s faulty view of oneself, but also a faulty view of God and his character. Finally, while secular psychology recognizes a distinction between body and mind, Christians should have a proper understanding of both the distinctions and interrelations between the human body and soul.

There are numerous examples of Biblical characters struggling with depression. Some are clearly identified as depressed, while others are more inferred based on their responses to situations. Jeremiah, in the book of Lamentations, expresses deep pain and agony of the soul: “Is it nothing to you, all you who pass by? Look and see if there is any sorrow like my sorrow, which was brought upon me” (Lam. 1:12). One of the most familiar passages is Psalm 42-43.  Psalm 42 begins with, “As the deer pants for the water brooks, so my soul pants for You, O God” (42:1), and continues with:

“Why are you in despair, O my soul?
And why have you become disturbed within me?
…
O my God, my soul is in despair within me” (Psalm 42:5-6)

The phrase “Why are you in despair, O my soul?” is repeated at the end of Psalm 42 and again in Psalm 43. Some authors have also suggested that Job, Saul, Elijah and even Jesus in the desert showed signs of depression.²⁷

Depression can be more difficult to deal with in Christian circles because the expectations for “life and life abundant” is much higher and because of emotional ties particular theological positions. Just as scientists have biases toward exclusively physiological explanations of depression and psychologists towards exclusively psychological explanations, Christians often gravitate toward interpreting all events in spiritual terms. While it is true that “our battle is not against flesh and blood,” Christians should also keep in mind that the physical world is real and that simple explanations are often incomplete. The following discussion will consider three major spiritual areas: thoughts, sin and the demonic realm.

Christian Thinking. Admitted many theological and biblical discussions have little or no bearing on one’s life. But in the area of depression, the Christian’s thought life plays a major role. The cognitive theory of depression in psychology has done much to help explain the significance of many of Paul’s charges such as “taking every thought captive” (2 Cor. 10:5), “if there is anything excellent or praiseworthy – think about such things” (Phil. 4:9), and to have the mind of Christ (1 Cor. 2:16).

The two most common areas of faulty Christian thinking are one’s view of oneself and one’s view of God. The earlier comments about overgeneralizing events are often applied to specifically Christian ideas such as, “I sinned in area X, therefore I must be an evil person, unworthy of God.” False doctrine, especially in the area of salvation, may also play a critical role. If one incorrectly believes that is possible to lose one’s salvation, he or she may experience depression from anxiety.

Many Christians also develop faulty views of God which can result in depression. Often Christian’s project onto God their own false expectations of themselves or false expectations placed upon them by parents or teachers. In his discussion of Psalm 13:1-6, Neil Anderson says, “Even though he believes in God, David is depressed because what he believes about God is not true. How can an omnipotent and omniscient God forget about David for even one minute, much less forever?”²⁸ Depressed people also tend to feel abandoned by God, characterized by David’s words, “My God, my God, why have you forsaken me?” (Ps. 22:1). “Does God abandon God’s people? No. Do people with depression feel that God has abandoned them? Yes?”²⁹

Sin and Depression. No other cause of depression should be as carefully discussed as that of sin. Unfortunately, the stigma in society at large surrounding mental illnesses is heightened rather than lessened in the Christian discussion. But at the same time, sin is very real and very harmful. Often depressed people are characterized by irrational guilt and shame, yet those that fail to deal with habitual sin often fall further and further into depression.

Consider the following statement, “Compassion cannot ignore unbelief or son. Too often, family and friends think the depressed person is very fragile and cannot handle any frank discussion about sin or hard-heartedness. But to ignore these issues when they are obvious in someone’s life is to treat that person without love or compassion.”³⁰ Some might consider this approach too harsh, while others might consider it too soft. Either way, assuming that sin alone is the cause and cure of depression is probably no more helpful than assuming that medical treatments alone can cure depression. But ignoring sin is equally unhelpful.

Spiritual Warfare. In C.S. Lewis’s The Screwtape Letters, an elder demon Screwtape writes lessons to his nephew Wormwood on how to cause the most damage to his human “student.” Screwtape suggests to Wormwood that his most successful course of action is either to cause his student to think about demons and the spiritual realm so much that it causes him to obsess and fear it or to ensure that his student never thinks about spiritual things and remains woefully ignorant on the matter.³¹ While it is true that those who do emphasize demonic activity often go to extremes, others tend to react too strongly against such overemphasis and ignore or downplay the reality of spiritual realm and its affects on our lives. As is true elsewhere, a balanced approach is vital.

Biblically, there is a good deal of support for the idea that demons can cause mental and spiritual depression. Job experienced severe ailments, both physical and spiritual, and it is very clear that God allowed Satan to directly cause the problems. Saul was tormented by “a demon sent from God” (1 Sam. 19:19). Jesus cast demons out of many people during his ministry on earth. Even Paul was sent a “messenger from Satan”³² (2 Cor. 12:7).

Similar to any of the other causes of depression, spiritual warfare may or may not play a role in a particular individual’s depression. And if it does play a role, it is probably one of several factors that should be considered.

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.

Conclusion

The purpose of this article was to provide an overview of the many different views on the causes and treatments for depression and to point out that no one approach can successfully treat the entire person. Humans are complex creatures that cannot be compartmentalized into bodies, souls and spirits.  Depression cannot be understood as a solely physical or spiritual problem, but should be gently approached with all the tools God has given us to for understanding ourselves and Himself.