A Christian Perspective on Antidepressants
September 10, 2020
by Jennifer Huang Harris, MD
Downcast: Biblical and Medical Hope for Depression is meant to be a guide for the layperson and clinician considering how to approach the treatment of depression as a Christian. We encourage you to purchase a copy for yourself, for your church ministry leaders and for your Christian patients struggling with depression.
It discusses such practical subjects as considering medication, types of psychotherapy, spiritual practices that can help and misconceptions about depression, as well as an interview with Rick and Kay Warren (The Purpose Driven Life) on their personal experience with suicide. It is also a book which seeks to answer the question of how our Christian faith changes our fundamental stance toward depression, in considering the role of lament and crying out to God amidst the suffering of living in a fallen and broken world. And one way we experience that brokenness is in our bodies.
This excerpt from Downcast focuses on the role of the body and a Christian perspective on antidepressants.
“Or do you not know that your body is a temple of the Holy Spirit within you, whom you have from God? You are not your own, for you were bought with a price. So glorify God in your body.” — 1 Corinthians 6:19-20, ESV
Our bodies matter to God. Depression tends to deny that, and it tells people they don’t matter, their lives don’t matter and their bodies don’t matter. But that is depression’s lie. God certainly paid for lives and our salvation at great cost to Himself. And as a consequence, we are no longer our own. We belong to God. Moreover, He dwells within every believer. Our bodies are not simply our own to use and abuse. This means we are to be stewards of our bodies and care for them, even when we feel worthless and self-destructive.
And this is especially true when it comes to depression. To glorify God with our bodies means to care for our bodies, even as depression seems to drain the body of its vitality. Regardless of what the cause is for depression (see Chapter 3), depression is experienced in the body. People experience depression as physical symptoms, such as difficulty sleeping, change in appetite, lack of energy, moving slowly, difficulty thinking and a dulling of the senses, while food lacks taste and colors appear less bright. So, it makes sense that one way to fight against depression is also through physical strategies involving the body.
In most books about depression, the only two strategies discussed are medication or
psychotherapy. While we spend significant time discussing those two strategies, we also address other strategies like sleep, diet and exercise that can be helpful; although, for anything more than mild depression, they should probably be combined with therapy (Chapter 6) and/or medication.
Ruts in the Road and Neuroplasticity
The brain is one of the mysteries of creation that we are only just starting to understand through science and medicine. As more knowledge about the mechanisms of the brain is uncovered, researchers are also constantly revising their theories about how it works. As we discussed in Chapter 3, an early theory was that depression was caused by a neurotransmitter deficiency in the brain.
But science has moved ahead to understanding the brain as functioning primarily through connections between neurons, through how the brain gets wired and rewired, in a process called neuroplasticity. The brain is constantly changing and adapting, strengthening the pathways used to make them more efficient and removing the pathways we no longer use.
Why is this important? The way that I (JH) often explain it to patients is that the repeated thoughts of depression or anxiety function like ruts in a road. Repeated thoughts wear those ruts deeper and deeper as we use these particular pathways in the brain over and over. So, it becomes easier and easier to slide down these ruts into depression, and it becomes harder and harder to get out of them and create new pathways.
Fortunately, there are ways to break out of those ruts. One particular growth factor to remember is Brain Derived Neurotrophic Factor (BDNF), a protein in the brain that supports neuron survival, growth and development. One might think of it as fertilizer for the brain. Long-term stress decreases the amount of BDNF in the brain and causes shrinkage of the hippocampus, the area in the brain associated with learning and memory. People with chronic depression have atrophy of the hippocampus and the areas of the brain related to motivation and emotion. Fortunately, increasing BDNF in the brain can stimulate neuron re-growth and development. BDNF can be increased by several strategies, including sleep, exercise, diet, medication, ECT, learning and psychotherapy.
How Medications Work
We’ve named this book Downcast, and in a very real way those who are depressed are cast down. Those with depression find it very hard to break out of this—they lose their sense of motivation and meaning, they tend to interpret everything through black-tinted lenses and they find it very difficult to learn or try something new.
All these aspects of depression have corresponding findings in the brain. People with depression have reduced levels of BDNF, which results in decreased neuron growth and development. Within the brain, there is atrophy of the hippocampus and prefrontal cortex, which are associated with motivation and learning. In contrast, there is overgrowth of the amygdala and nucleus accumbens, which are associated with fear, emotion and sleep regulation.
Understanding how antidepressants work is important. Antidepressants do not work, as was once popularly thought, by fixing a chemical imbalance. In our experience, this misconception has led to many fears about taking antidepressants, such as that they will change a person’s personality or that a person will become dependent on the medication. Rather, recent research suggests antidepressants work by two mechanisms. The first is by increasing BDNF in the brain, which enhances neuroplasticity and can counter the atrophy that occurs with depression. This process takes weeks to occur.
Antidepressants work through a second more immediate mechanism by altering the black tinted lenses by which depressed people experience the world and recall events. Depressed people have a negative bias—they tend to pay attention to and remember only negative information, and they disregard positive information. This bias can be addressed through therapy (which we describe in the next chapter) and can be helped by antidepressants. Several studies have shown that after just one dose of an antidepressant, people are more attentive to faces with positive facial expressions, not just to faces with negative expressions. Although the symptoms of depression do not lift so quickly, what is important is that over time, depressed individuals can learn a new way of perceiving the world and their interactions in it.
The practical takeaway from this is that antidepressants work by helping depressed people learn new ways of perceiving and interacting with the world. In order for antidepressants to be effective, individuals must engage in activities that allow learning to occur. They need to engage in activities such as psychotherapy, exercise and social interaction including attending church, serving others or meaningful work. Antidepressants are not a quick fix, so simply staying at home and taking antidepressants will be insufficient to break out of the cast of depression.
What does the Bible have to say about the use of medication for depression?
Some Christian counselors and pastors teach that Christians should only use the Bible, faith and the Holy Spirit’s power to overcome life’s difficulties, including depression. They usually come from one of two camps: (1) they believe depression is only a spiritual problem, or (2) they believe depression is a physical problem but individuals need to have enough faith for physical healing (and likewise do not seek medical help for other physical ailments as well.)
With regard to the first camp, we hope we have addressed this issue of causes of depression thoroughly in Chapter 3, by explaining that what affects us spiritually also affects us psychologically, sociologically and physically, and vice versa. The second camp might be addressed by challenging them to examine their beliefs about how it is that Jesus works in the world. Does Jesus only work through prayer and miracles?
Consider, for example, when Paul included in his letter to Timothy a brief practical
suggestion: “No longer drink only water, but use a little wine for the sake of your stomach and your frequent ailments” (1 Timothy 5:23, ESV). It sounds like Timothy struggled with gastrointestinal and other medical problems. Paul’s advice to Timothy was not to pray for healing, but to consider taking something medicinal for his health. While we strongly discourage using alcohol to treat medical or psychiatric problems, and Paul strongly discouraged addiction to alcohol (1 Timothy 3:3), few medications were available during that time, so wine was often used as medicine by the Jews and the Greeks. God can work miracles through practical ways. This is the “common grace” He grants to both believers and unbelievers: “…For he makes his sun rise on the evil and on the good, and sends rain on the just and on the unjust” (Matthew 5:45, ESV). We believe antidepressant medication is one of those means of common grace.
What is God trying to say to you through your depression?
This is the fundamental question to consider while taking antidepressants. We have used the fever metaphor repeatedly, and it is true again here. Depression is like a fever, and while for the minority it may be a purely biological cause, for most others depression is a symptom indicating that something deeper is going on in a person’s heart or a situation is making her or him feel deeply unhappy. Antidepressants can “reduce the fever” and give the person time to make the necessary changes in their life.
As C.S. Lewis puts it, “We can ignore even pleasure. But pain insists upon being attended to. God whispers to us in our pleasures, speaks in our conscience, but shouts in our pains: it is his megaphone to rouse a deaf world.”
The pain may be so loud that it is difficult to reflect and make changes. As Michael Emlet, a professor of biblical counseling at CCEF, put it, sometimes medication can “calm the waters of the mind to allow for deep-sea exploration. You can’t have a diving expedition if there is a gale on the surface of the water.”
Taking antidepressants or other medications is only one step toward healing from depression. The next step is much more difficult, since it requires examining your heart. What is God telling you? What have you been deaf to? What is He shouting at you in your pain?
Medications are hardware solutions and can solve hardware problems. Depression is likely mainly a software problem. It is not likely that a software problem can be solved by a hardware solution.
this was a refreshing take on what most christian counselors say about this, depression can be cured but you have to be willing to examine your heart, be an environment for fruitful learning and not solely relying medications to do all the work for you.
I had major depression and got over it. Years later I quit smoking and entered deep depression. I smoked again and gradually came out. Years later I quit again. Terrible depression. I never smoked again and the depression never went away. 30 years. Meds,therapists, exercise, prayer. I do fine on meds. My psyc agrees my brain never recovered from quiting. But how do I recover?
The Bible says, “We Overcome(in your case (smoking sensation) By The Word of Our Testimony and The Blood of The Lamb.” Speak this Powerful Word with Belief in your Heart boldly and simply Believe it to do what it says which is OVERCOME! HOPE THIS HELPS LIZ.
I agree. Medication does not exempt us from striving to walk in the Spirit or Overcoming the dictations of the flesh. Good word Chloe.
My husband started taking antidepressants and within 2 weeks had completely changed personality, walked out on me and went from a Christian loving husband who loved me to someone who walked out on his family, turned his back on God and started having an affair. Since this I’ve done a lot of research into SSRI’s and while I’m sure the vast majority of people are not affected like this there are still people who are- dangerous drugs and people need to know the risks
Yes…the meds have changed my brain too.
I don’t know if I’ll ever recover.
To me, it sounds like the meds gave him the courage to carry out what was in his heart already. I could be wrong. You know your husband better than I do. lol
Same happened to my family. It is well documented. The same woman who hated divorce and loved her kids left.
The second mechanism you say antidepressants work by is not clearly explained. “Altering the black tinted lenses” as you say, is a consequence of the first mechanism.
Dearest sister in Christ, I feel your pain. I’m just starting out on Ambien for sleep and Welbutrin for depression. After reading your post I’m thinking maybe its not such a good idea. Sorry for all your pain, I pray you find some relief through the help of the Holy Spirit. I pray also God put someone in your life that you can be comfortable with and confide in…….may God’s peace be yours soon.
I can feel your pain. So bad what u have gone through.
I am on low dose. I am better. It is hard not to think on the negative when that is all u have known and to be alone.
I do encourage u to pray for a special friend. God is Able.God Bless
I was 2nd of 8 children. I had just one older sister and was 5 months old when my mother came to Ireland and left me with her mother. I did not know that. She never enquired for me or showed any love. I am 70yrs of age and have 3 brothers and 3 sisters who don’t know me and don’t want me to. My mother when i found out that my grandmother was not my mother, has been appallingly abusive and cold toward me. I have had a hard life and found God some time ago.
I say, walk in my shoes. I believe a propensity to Depression and Anxiety can be DNA just as psoriasis is and other illnesses.
I don’t use Depression as an excuse and went off, weaned , with horrific results. I have been on tablets for ‘nerves’ since a small girl and a teenager as I had chronic Agoraphobia. I believe God knows my heart and knows how hard I have tried to kick Antidepressants, sleeping tablets [chronic insomnia] and anxiety medication. I suffer horrific panic attacks. I have no family and live alone. My social phobia and agroraphobia has left me that I am not able to socialise well. I don’t drink or smoke and I have alot of physical ailments. I am all too aware of the damage that SSRIs do and how they damage the brain and lead to Dementia. I can but pray but I take the medication and the alternative after years of trying hard and therapy , is not worth thinking about. I love God, I do keep his commandments and spend my time reading scripture online and found this page. I hope you realise we are all different. Clinical depression accompanied by constant pain and other health issues is hard . I have God. Blessings.
I believe yours is the most realistic commentary on the issues of depression and anxiety that I have ever read. I have struggled with anxiety and depression my whole life due to so much lack of love in my life. I say lack of love but more specifically I should say much violence, hate and anger have been all too prevelant in my life. Acceptance I believe is key and relief from taking meds and counteracting all the hate with acts of love accepting it and sharing it. I also love the Lord and follow Him . I have for most of my adult life. I am 61 years old now. I walk in fear but I know it is but an earthly thing and will be non existent when I am finally with Jesus.
Same here. I deal with the same health issues. Its so hard.
I feel so numb, but I love the Lord.