Depression
A heavy weight seemed to hang over Sarah's head as she went through her day-to-day activities. She tried to push through, but everything felt like a burden. The things that once brought her joy now felt empty. She struggled to find the motivation to do anything, even the simplest of tasks seemed insurmountable. The dark cloud of depression followed her everywhere she went, and she couldn't shake the feeling of hopelessness and despair.
As the days turned into weeks, Sarah found herself withdrawing from friends and family. She didn't want to burden them with her problems, and besides, she didn't think anyone could understand what she was going through. She felt completely alone, as if she was trapped in a deep, dark hole with no way out. As much as she tried to push the feelings of depression away, they only seemed to intensify. The weight on her shoulders felt unbearable, and she often found herself in tears for no apparent reason. It was as if she had lost all sense of purpose and direction in life.
Despite the seemingly endless cycle of hopelessness, Sarah knew she needed to seek help. She confided in a close friend who encouraged her to take that step and seek help. With the help of a biblical counselor and the support of her loved ones, Sarah slowly began to emerge from the darkness of depression.
Although the journey was long and challenging, Sarah learned that there was hope even in the midst of despair. She learned that reaching out for help was a sign of strength, not weakness, and that it was possible to overcome the overwhelming feelings of hopelessness and despair that had once consumed her life.
Though this is just one of many possible scenarios, the reality is that many people in our society are experiencing similar feelings of despair and hopelessness. We have an enemy who wants to destroy us but a God who loves us, gives us new life through the Good News of Jesus Christ, and provides hope and healing.
Questions to answer with our counselee
When did you start feeling discouraged?
What was the progression that lead to how you are feeling today?
How does your depression affect your day-to-day?
Who around you knows you are feeling this way?
What made you decide to reach out to me for help?
Have you been to your doctor for a diagnosis.
If yes, what did you learn? How is your doctor treating the diagnosis?
If no, would you be willing to see your doctor for an evaluation. (Mention, if appropriate, your willingness to go along with them as a friend.)
Have you ever or are you currently taking medication for your mood? If yes, are you experiencing any side effects? (It is not up to us biblical counselors to ever suggest a counselee should or should not take medication. This is a decision a doctor must make. If they start feeling better after meeting with you, you can then suggest they talk to their doctor about decreasing or eliminating their medications. If their doctor is unwilling to consider anything other than medication, you may want to consider referring them to a Christian doctor who has a different philosophy, if you know of one.)
When is the last time you felt joy at all? How about for an extended period of time?
Do you see light at the end of the tunnel?
Are you willing to let me walk through this journey with you?
Is it ever okay to be angry with God or to blame God? (Though you likely won’t bring this up in the first session, as you continue counseling, you will want to help your counselee understand an accurate theology of God and of Satan).
Stories to consider
The Bible contains stories of people who experienced depression. Here are a few to choose from:
King David: In the book of Psalms, David expresses deep sadness, despair, and hopelessness, such as in Psalm 22, where he cries out, "My God, my God, why have you forsaken me? Why are you so far from saving me, so far from my cries of anguish?"
Job: In the book of Job, Job suffers a great deal of loss, including his children, his wealth, and his health. He expresses his despair and hopelessness, saying, "I loathe my very life; therefore, I will give free rein to my complaint and speak out in the bitterness of my soul" (Job 10:1).
Elijah: In the book of 1 Kings, Elijah becomes overwhelmed by his circumstances and prays for God to take his life. He says, "I have had enough, Lord. Take my life; I am no better than my ancestors" (1 Kings 19:4).
Jonah: In the book of Jonah, Jonah becomes so despondent that he asks God to take his life. He says, "Now, Lord, take away my life, for it is better for me to die than to live" (Jonah 4:3).
Jeremiah: In the book of Lamentations, Jeremiah expresses deep sorrow and despair over the destruction of Jerusalem. He says, "I am the man who has seen affliction... He has made me dwell in darkness like those long dead" (Lamentations 3:1-2).
Naomi: In the book of Ruth, Naomi experienced depression after losing her husband and two sons. She expressed her deep sorrow, saying, "Don't call me Naomi... Call me Mara, because the Almighty has made my life very bitter. I went away full, but the Lord has brought me back empty" (Ruth 1:20-21).
Paul: In his letter to the Corinthians, Paul described feeling depressed and overwhelmed to the point of despair. He said, "We were under great pressure, far beyond our ability to endure, so that we despaired of life itself" (2 Corinthians 1:8).
Hagar: In the book of Genesis, Hagar was a slave who became pregnant with Abraham's child. When she was mistreated by Abraham's wife Sarah, Hagar fled into the wilderness and became so despairing that she wished to die. But God spoke to her and comforted her, saying, "Do not be afraid; God has heard the boy crying as he lies there" (Genesis 21:17).
Asaph: In the book of Psalms, Asaph expressed his feelings of depression and despair. He said, "My soul is downcast within me; therefore I will remember you from the land of the Jordan, the heights of Hermon—from Mount Mizar" (Psalm 42:6).
These stories illustrate that depression is a common experience that many people throughout history have faced. Even the most faithful and devoted people can experience depression and despair. They also demonstrate that it is okay to express our emotions honestly and directly to God, who understands our pain and is always there to comfort and heal us. Even in the midst of despair, God is present and offers hope.
Verses for study
Depression; sadness; distress; exhaustion; suicide
Proverbs 15:13: “A joyful heart makes a cheerful face, but when the heart is sad, the spirit is broken.”
Proverbs 14:13: “Even in laughter the heart may be in pain, And the end of joy may be grief.”
Proverbs 17:22: “A joyful heart is good medicine, but a broken spirit dries up the bones.”
Isaiah 33:2: “Lord, be gracious to us; we have waited for You. Be their strength every morning, Our salvation also in the time of distress.”
Isaiah 35:3-4: “Strengthen the exhausted and make the feeble strong. Say to those with anxious heart, ‘Take courage, fear not.’”
Proverbs 18:14: “The spirit of a person can endure his sickness, but as for a broken spirit, who can endure it?”
Ecclesiastes 2:1-11: “So I considered all my activities which my hands had done and the labor which I had exerted, and behold, all was futility and striving after wind, and there was no benefit under the sun.”
Ecclesiastes 4:8: “his eyes were not satisfied with riches, and he never asked, ‘And for whom do I labor and deprive myself of pleasure?’ This too is futility, and it is an unhappy task.”
Jonah 4:3: So now, Lord, please take my life from me, for death is better to me than life.”
2 Samuel 17:23: Ahithophel hanged himself after Absalom rejected his advice
Matthew 27:5; Acts 1:18: Judas hanged himself after betraying Jesus
Put off | Put on
"to put off your old self, which belongs to your former manner of life and is corrupt through deceitful desires, and to be renewed in the spirit of your minds, and to put on the new self, created after the likeness of God in true righteousness and holiness" (Eph. 4:22-24 ESV)
Put off: Satan; temptation; sin; slavery; false teachers; idols; selfishness; blaming God; guilt and shame
Put on: God; repentance of my sin or forgiveness of another’s sin; Jesus; repentance unto salvation; Holy Spirit; sanctification; fruit; spiritual disciplines; identity in Christ; healthy emotions
Article: Depression from a Biblical Perspective by Bryan Carlson
Depression is a complex emotional and mental state that can manifest in various ways. The Bible does not provide a specific definition of depression, but it acknowledges the reality of feelings of sadness, despair, hopelessness, and discouragement. Cain and Elijah are two significant figures in the Bible who experienced depression in different ways. While Cain struggled with feelings of rejection and worthlessness, Elijah struggled with overwhelming feelings of hopelessness and despair. Cain's depression is depicted in the book of Genesis, chapter 4. Elijah's depression is recounted in 1 Kings chapter 19. Cain's rejection by God could have been avoided if he had only listened to God's warning and corrected his behavior. Elijah's despair was lifted by his encounter with God and His provision (Faith notes 35-37).
Manifestations of depression in the inner man can include feelings of hopelessness, sadness, despair, guilt, shame, and worthlessness (Psalm 42:5-6; 1 Kings 19:4). These feelings can lead to a lack of motivation, difficulty concentrating, and a loss of interest in activities that were once enjoyed (Ecclesiastes 1:2; 2:17). Outwardly, depression can manifest as social withdrawal, isolation, lack of energy or motivation, difficulty sleeping or concentrating, irritability and a lack of communication with others (Proverbs 18:1). Inner man and outer man influence each other – prolonged sickness can lead to depression; prolonged depression can lead to illness (Roy 7-8). From a biblical perspective, depression has two elements: the first is feeling; the second is allowing the feeling to determine action (Faith notes 35-37).
One of the biblical factors that drive depression is sin and guilt. In Psalm 32, King David describes how he felt when he was struggling with the weight of his sin. He says that his strength was sapped as if it was in the heat of summer. He describes how he felt that God's hand was heavy upon him, and he couldn't find peace until he confessed his sins to God. Another is overwhelming circumstances. In Psalm 42, the psalmist describes how he feels like he is drowning in his circumstances. He feels like his troubles are like waves that are crashing over him, and he can't catch his breath. He longs for God to intervene and rescue him from his circumstances. Injustice is another factor that can lead to depression. In Psalm 73, the psalmist describes how he struggled with feelings of envy towards the wicked. He saw how the wicked prospered and seemed to be immune from the consequences of their actions, and he felt like his commitment to God was in vain. He struggled with these feelings until he realized that the wicked would ultimately be held accountable for their actions. Relationships can also drive depression. In Jeremiah 17:5-6, the prophet describes the person who puts their trust in people and turns away from God. He says that such a person is like a shrub in the desert that doesn't know when relief is coming. He implies that relationships can be fickle and untrustworthy, and if we rely on them too much, we can end up feeling isolated and alone (Roy 8).
The Bible provides several strategies for responding to depression:
Seek to understand the root cause of your depression and address it in a biblical manner (Psalm 139:23-24; Proverbs 3:5-6).
Seek wisdom from God and submit to His guidance in how to respond to your depression (James 1:5; Psalm 25:4-5).
Seek the support of a community of believers who can offer encouragement and practical help (Hebrews 10:24-25; Galatians 6:2).
Pray and meditate on God's Word, seeking comfort and strength in His promises (Psalm 119:50; Isaiah 41:10).
Remember that God is present in your pain and will never leave or forsake you (Psalm 23:4; Hebrews 13:5).
Trust in God's sovereignty and His ability to bring good out of even the most difficult circumstances (Romans 8:28; 2 Corinthians 1:3-4).
Acknowledge and express your emotions honestly before God, knowing that He cares for you (Psalm 62:8; 1 Peter 5:7).
Confess and repent of any known sin in your life, and seek forgiveness from those you have wronged (1 John 1:9).
Practice gratitude and thankfulness, and to “rejoice always,” focusing on the blessings and gifts God has given you (1 Thessalonians 5:16-18).
Don Roy, IBCD, ACBC Theology Exam Study Guide, 7-8.
Faith Biblical Counseling, ACBC Exam Track 5, 35-37.
Article: Letter in Response to whether a Young Woman Should Take Anti-Depressants for Her Depression by Bryan Carlson
“Thank you reaching out to me. I'm sorry to hear that you've been feeling terribly sad for the last six months and that it's been difficult to keep up with life. Depression can be a challenging and overwhelming experience, and it's essential to seek help when you're struggling. First and foremost, I want to commend you for seeking help and asking for my opinion as a biblical counselor. It's a wise decision to turn to God's Word for guidance and wisdom, and our team is here to help you in any way we can. In the Bible, we see many examples of people who experienced depression. King David wrote many Psalms that express his feelings of despair. I will provide you a list of Psalms you can meditate on this week. The prophet Elijah, in 1 Kings 19, struggled with depression after he faced opposition from Queen Jezebel. Jonah experienced depression after the people of Nineveh repented.
However, we also see in the Bible that there are solutions to depression. King David often turned to prayer and worship as a way to lift his spirit and find comfort in God's presence. In Psalm 42:5, he writes, “Why, my soul, are you downcast? Why so disturbed within me? Put your hope in God, for I will yet praise him, my Savior and my God.” Additionally, the Apostle Paul encourages us to focus on positive and uplifting thoughts in Philippians 4:8, where he writes, ‘Finally, brothers and sisters, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable—if anything is excellent or praiseworthy—think about such things.’
Now, to answer your question about anti-depressants, I believe that it's essential to take care of our physical health, and sometimes medication can be a helpful tool in treating biological conditions. However, I also want to acknowledge your concerns about the side effects of medication. It's important to remember that medication is not a magic solution, and it's not the only way to treat depression. In addition to prayer, worship, and fellowship with other Believers, biblical counseling can be a helpful tool in addressing the underlying causes of depression. You can also consider other natural remedies such as exercise, a healthy diet, and getting enough rest. Ultimately, the decision to take medication is a personal one that you should make in consultation with your doctor. I encourage you to continue seeking guidance from the Lord and to consider all your options carefully.
Remember, God loves you and cares for you deeply. He is with you in this struggle and can provide the strength and comfort you need to overcome depression. I would be glad to connect you with one of the women in our counseling ministry to meet with you and help you walk through this difficult time. She will be willing to walk this journey with you, pray with and for you, and encourage you through the Word of God. Does that sound like something you would like to try?
Once again, I appreciate you reaching out. I truly believe we can help you feel better and find hope and peace in the Lord. If you are up for it, try to spend some time this week reading the Psalms I’ve included and journaling what you learn. Let me know if you would like me to set up a time to meet with someone this coming week.”
Article: Next Steps with the Young Woman Struggling with Depression by Bryan Carlson
As biblical counselors, our primary goal is to provide a safe and supportive environment where individuals can share thoughts, feelings, and concerns and to provide real help through the Word of God, prayer, the Holy Spirit, and the fellowship of the Saints. To find out more information, our team would use a variety of means to gather more information, such as:
Assessment Tools: We will use our Personal Intake Form to gather more information about this young woman, her background, her stage of life, her symptoms and their severity, her medical history, her spiritual beliefs and practices, big things going on or big transitions that have taken place recently, and past abuse and trauma.
Medical History: We will ask her about her medical history, including any previous mental health conditions, medications, or treatments.
Personal History: We will ask her about her personal history, including any significant life events, past traumas, or family history of mental illness.
Active Listening: Our team will listen attentively to her and try to understand her concerns, feelings, and beliefs. This involves using active listening skills, such as reflecting back what she says, asking open-ended questions, and seeking clarification. Proverbs 20:5 says, "The purposes of a person's heart are deep waters, but one who has insight draws them out."
Spiritual Life: As biblical counselors, we will inquire about her spiritual life and how it relates to her depression. This involves asking about her faith, prayer life, involvement with other Believers, any serving she does in the Body of Christ, and any spiritual struggles she may be experiencing.
By gathering this information, we will better understand this young woman’s current problem and develop a personalized treatment plan that addresses her unique needs and concerns. It also helps us to identify any underlying issues that may be contributing to her depression and tailor the treatment approach accordingly, including appropriate homework to assign during our times together.
In ongoing meetings, it may be appropriate to bring in other people to the conversation to gain more insight, such as her husband, one or more of her children, or one of her friends to act as an advocate—someone that can provide support, prayer, and ongoing discipleship and accountability. We will discuss the importance of being in a growing, healthy Christian community (Hebrews 10:24-25) and the importance of serving others rather than being served (Matthew 20:26-28; Philippians 2:1-11). We will work to identify any potential sin issue in her life that may be causing the depression and help her understand the importance of confessing sin, putting off sin, and putting on righteousness, and the importance of the renewing of her mind (1 John 1:9; Ephesians 4:22-24; Romans 12:1-2; Philippians 4:8-9). Over time, if it proves that she is not a Believer, we will encourage her to repent of her sin and turn to Christ for forgiveness and salvation.
Article: When to Work with a Counselee’s Physician by Bryan Carlson
In cases like the young woman from above, it would be a good idea to suggest that she get a physical exam to rule out any physical issues that may be contributing to her depression. If necessary and appropriate, you may want to offer to accompany her to the doctor's office to provide support and help answer any questions. To work with a physician, I would obtain the counselee’s consent for the physician to share information about her condition and treatment plan and for you to share what you have learned about her and have been working through with her. This collaboration would involve regular communication and updates between the physician and yourself to ensure that she receives the best possible care.
As a biblical counselor, it's important to work collaboratively with other healthcare professionals when appropriate and necessary, including physicians, to provide the best possible care for our clients. The counselee would have to specifically request it because of HIPAA laws and the fact that we are not licensed healthcare providers. When working with physicians, it is important to recognize their expertise and not be adversarial. It is good to find out their view on anti-depressants and counseling at the very start of the relationship. While they may be quick to prescribe medication, it is important to inform them that we would like to try counseling first. It may be helpful to ask if the doctor has any other suggestions, such as lifestyle changes. If the doctor does recommend medication, we should respect their decision but also continue counseling and potentially encourage the client to get a second opinion if necessary. This would be an excellent time to refer to a doctor who is a Believer or who endorses biblical counseling. We should be open to collaborating with them in order to provide the best possible care for our clients.
Working with a counselee’s physician can be helpful to rule out any medical problems that could be contributing to her depression or if her condition has become severe enough that she requires stabilizing help. However, there are situations where it is not advisable to work with her doctor—for example, if either she or her doctor are resistant to moving toward change, think that biblical counseling is not a legitimate solution, or continue to call something biological that is actually sin. Additionally, if the doctor's care is actually making things worse for her and she won’t listen to you as her counselor, this would be a time to stop working with both her and her doctor.
Ultimately, the decision to work with the doctor should be based on what is best for the counselee and her overall well-being. As a biblical counselor, it is important to prioritize her needs and work collaboratively with other professionals when and if necessary, while also being mindful of any potential ethical or theological concerns. (Faith notes 63-65; Roy 28-29)
Faith Biblical Counseling, ACBC Exam Track 5, 63-65.
Don Roy, IBCD, ACBC Theology Exam Study Guide, 28-29.
Article: Secular Treatment Methods by Bryan Carlson
“Cognitive behavioral therapy (CBT) is a common type of talk therapy (psychotherapy). You work with a mental health counselor (psychotherapist or therapist) in a structured way, attending a limited number of sessions. CBT helps you become aware of inaccurate or negative thinking so you can view challenging situations more clearly and respond to them in a more effective way” (Roy 13).
The process of cognitive-behavioral therapy (CBT) typically involves a series of steps aimed at helping individuals address and overcome their problems. One of the initial steps involves identifying negative thoughts and beliefs that may be contributing to their difficulties. With the help of a therapist, individuals can recognize negative thought patterns and beliefs that may be harmful to their mental health. The next step involves challenging these negative thoughts and beliefs by examining the evidence for and against them and replacing them with more rational and realistic thinking. This helps individuals develop a more positive and accurate perspective on their problems. Finally, individuals are encouraged to practice new thinking and behaviors in their everyday lives. Through practice and repetition, they can reinforce positive changes and maintain progress.
When evaluating cognitive behavioral therapy (CBT) from a biblical perspective, the first area to consider is the focus on self, as CBT emphasizes changing one's own thoughts, feelings, and behaviors rather than seeking help and guidance from God (Proverbs 3:5-6). This can lead to self-reliance instead of relying on God's power and grace (Philippians 4:13). Secondly, CBT relies on the use of the natural mind and reasoning to challenge and change negative thoughts and beliefs (Romans 12:2). While we are given the ability to think and reason, it's important to recognize that the natural mind is limited and prone to error (Isaiah 55:8-9). It is through the Holy Spirit that we are able to discern the truth (1 Corinthians 2:14-15). Lastly, while CBT can be effective in changing negative thoughts and beliefs, it does not address deeper spiritual issues such as sin, guilt, and shame, or provide guidance for a life lived in obedience to God's will (Romans 3:23-24, John 14:15). Scripture teaches that we need a Savior to address the root cause of our struggles and to guide us in our daily lives (John 16:13). Therefore, a biblical evaluation of CBT should recognize its limitations and emphasize the need for a holistic approach that includes spiritual growth and transformation through a relationship with Christ.
Biogenic theory of mood disorders: “Biogenic amine hypothesis (BAH) is the theory that defects in the physiology and metabolism of biogenic amines, especially catecholamines (noradrenaline/ norepinephrine and dopamine) and an indoleamine (serotonin), are pathogenetically linked to certain psychiatric illnesses, especially depression. The BAH arose from the discovery that monoamine oxidase inhibitors and tricyclic drugs had mood elevating properties and had a dramatic effect on brain monoamine functions; that phenothiazines inhibit cerebral dopamine activity further support this theory and suggest a link between a disorder of dopamine metabolism and schizophrenia” (Roy 13).
The term "biogenic" refers to the chemical imbalance theory, which suggests that certain chemicals in the synaptic junctions between nerve cells are either too high or too low, resulting in mood disorders. This theory implies that these chemicals can be measured and their normal levels determined, with many attributing the imbalance to genetics. However, there is currently no scientific proof of any specific chemical imbalance in mood disorders, and studies have shown that medications targeting these chemicals are no more effective than placebos in many cases. Instead, specific physical imbalances in the body, such as low thyroid function or low potassium levels, can be proven and corrected through targeted treatment (Faith notes 42).
From a biblical perspective, addressing mood disorders should be focused on following God's principles and seeking His guidance, rather than solely relying on medication to correct chemical imbalances. The Word of God provides motivation and behavioral guidelines for needed changes (2 Timothy 3:16-17; Philippians 4:8), and the Holy Spirit provides the grace necessary for spiritual growth (Philippians 4:13). The goal is to please God, rather than simply reducing unpleasant feelings, by focusing on changing one's thinking and actions. By working on pleasing God through our thoughts and actions, our feelings will ultimately follow (Romans 12:2; Colossians 3:2). Therefore, a biblical approach emphasizes the importance of addressing the root cause of the problem, rather than solely treating the symptoms through medication (Faith notes 42).
“Electroconvulsive therapy (ECT) is a procedure, done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions. It is conducted for severe depression and severe mania” (Roy 13).
An evaluation of ECT from a biblical perspective must consider its alignment with the teachings of the Bible. Firstly, ECT involves the use of physical means to treat mental illness rather than addressing the root cause of the problem through spiritual disciplines and the Word of God. Secondly, ECT has limitations, including the potential for serious side effects such as memory loss and cognitive impairment, and may not be effective for all patients. Finally, the use of a physical procedure to treat mental illness raises ethical questions regarding the value of human life and the use of medical procedures that may cause harm. Therefore, a biblical evaluation of ECT must consider these factors and weigh them against the principles taught in the Bible. While ECT may provide some relief for certain patients with severe mental illnesses, it is important to recognize that it is a medical procedure with potential risks and limitations. A biblical perspective on mental health would emphasize the importance of seeking help from a community of Believers, guidance from Biblical counselors, and considering alternative forms of treatment that may address the root cause of the problem in a non-invasive manner.
Resources
“Good Mood Bad Mood: Help and Hope for Depression and Bipolar Disorder” by Charles Hodges
“The Christian Counselor’s Medical Desk Reference, 2nd Edition” by Charles D. Hodges Jr., MD
“Will Medicine Stop the Pain?” by Elyse Fitzpatrick and Laura Hendrickson
“Depression: The Way Up when You Are Down” by Edward Welch
“Depression: Looking Up from the Stubborn Darkness” by Edward Welch
“Blame it on the Brain” by Edward Welch
“Spiritual Depression” by Martin Lloyd-Jones
“Down but Not Out” by Wayne Mack
“What do You do When you Become Depressed? (booklet) by Jay Adams
“Suicide: Understanding and Intervening” (booklet) by Jeffrey Black
“The Loss of Sadness: How Psychiatry Transformed Normal Sadness into Depressive Disorder” by A. Wakefield Horwitz
“Working with a Physician” by Dan Wickert
