How can I know if my depression is primarily caused by a malfunctions in my body-brain or wrongs I’m committing in my beliefs-behaviors?
Another way to ask this question would be, “Is my depression something I am doing or something that is happening to me?” There is no universal answer to this question. The two leading treatments for depression tell a conflicting story: cognitive-behavioral therapy (CBT) and psychotropic medications. The effectiveness of CBT indicates that beliefs and behaviors play a large role in depression. The effectiveness of medication indicates that body malfunctions, particularly in the brain or glandular systems, also play a large role.
The reality is that depression is always both: (1) beliefs-behaviors and (2) body-brain. We are embodied souls. Every emotion we feel registers neuro-chemically in our brain; this is true of pleasant emotions (i.e., joy, excitement, and peace) and unpleasant emotions (i.e., depression, anger, and anxiety). Every change in our brain affects our thoughts and actions. Consider how you think-move in the morning before coffee.
There is a long list of things that can cause depression (i.e., a persistent down mood and/or the inability to enjoy normal pleasures): a significant loss, failure, lack of purpose, unrealistic expectations, temperament, glandular malfunctions, chemical imbalances, certain diseases, response to some medications, change in seasons, fatigue, isolation, sin or idolatry, unbelief, foolishness, legalism… (the list could continue).
The follow up question would be, “How can I tell if my experience of depression is rooted primarily in my beliefs-behaviors or my body-brain?” Here are a series of questions to guide you in this assessment. The order of these questions is intended to help you eliminate belief-behavior causes first. There are body-fluid tests for glandular causes of depression, but not for brain-chemical causes, so in most cases, it is recommended that you assess things in this order.
- Are you harboring any known sin that would affect your mood (i.e., bitterness, abusing a depressant like alcohol, lying-hiding to make your relationships feel fake, overworking to the point of exhaustion, etc…)?
- Are there any false beliefs about God or unrealistic expectations of yourself that you struggle to relinquish?
- Are there events, challenges, or changes in your life which would make your level and duration of depression an appropriate emotional response?
- If after addressing whatever changes are revealed as necessary in questions one to three, your depression persists then it would be probable that your depression is rooted in your brain-body more than your beliefs-behaviors. Consulting a physician or psychiatrist would be recommended.
You might ask, “But what if I have a family history of depression, does that mean I can/should skip to question four?” My response would be, “Not necessarily.” From our family we get both genes and habits; biology and culture. You are as likely to “inherit” things from your family that would be revealed in questions one to three as you are question four.
You might also ask, “What about suicidal thoughts? If I am feeling desperate, should I still go through all these steps?” My answer would be, “Not at all.” Going to a doctor to get medication for relief from depression is not a sign of weakness or spiritual immaturity; even if it means calling 911 because of your level of despair. Safety should always be the first concern. In intense cases of depression, the relief medication provides can help you think more clearly about the concerns raised in questions one to three.
If I am struggling with depression, what are some basic things I need to do to get some relief?
Begin by sharing your struggle with a trusted Christian friend. We read in I Kings 19:10 how believing that you are alone with this experience magnifies the emotions and false messages of depression. Isolation is a repeated theme in Scripture when it describes the experience of depression (Ps. 88:18). There is nothing like allowing someone to care for you to break the isolation and stigma that often comes with depression.
Regulate your diet, exercise, and sleep patterns. Depression will make its home in your lifestyle choices and stay until you kick it out. Diet, exercise, and sleep are not just “healthy choices;” they are the natural way our bodies regulate our brain-chemistry. Long before the availability of SSRI’s (Selective Serotonin Reuptake Inhibitors) people combatted chemical imbalance in these ways—even if they didn’t understand neurology, they knew a healthy diet, cardiovascular exercise, and regular sleep helped them feel better. Even with modern medicine, we should not force medication to sustain a neural-balance that our lifestyle is fighting against.
Read Depression: Looking Up from the Stubborn Darkness by Ed Welch. This is an excellent book that deals with the sin (beliefs-behaviors) and suffering (body-brain and hardships) sides of depression with a gospel-centered approach. This book should allow you to understand your experience of depression better so that you are more free to talk with Christian friends and feel more motivated to make lifestyle changes. In addition to Ed Welch’s book, here are three blogs I believe can be helpful.
- Medication and Despair – Contains brief Q&A videos from Ed Welch and David Powlison on medication and other resources to help you think through the possible wise use of psychotropic medication.
- 5 Part Series on Depression and Ministry – Contains to a series of posts on depression created by the Biblical Counseling Coalition for the Gospel Coalition. While it is written for pastors, it is helpful for any Christian who is struggling with depression.
- When We Believe Suffering’s Lies – Reflects on how the hardships of life introduce damaging messages into our lives. We are most prone to believe lies when the harshness of living in a broken world seems to validate them.
If I have a friend who struggles with depression, how can I be a more effective friend and encourager?
Listen well without assuming your “instinctual explanation” of depression is accurate. We all have a default explanation for emotional experiences. It may come from our own experience, our “common sense,” or a favorite book. But when you listen do not force your friend’s experience into your assumption. Allow whichever of the causes (likely plural; review the list in question one) that best-fit your friend’s experience to be the cause. Just because something “worked for you” doesn’t mean it will work for your friend. Just because something is “right” doesn’t mean it “fits” every experience.
Be content to “walk with” rather than “fix” your friend. It is likely the cause-solution will not be easy. To rush to a premature “answer” is both ineffective and insulting. As you get to know your friend’s experience better and narrow down the causes; you may or may not feel competent or comfortable addressing them. Legalism or performance-driven overworking are easier for most Christians to address than the side effects of a new medication or a hypoactive thyroid. Regardless, remain an actively listening friend even if you encourage your friend to see a counselor or doctor.
Your presence and care have a powerful impact on removing the isolation and stigma associated with depression even if you are not the “advice giver.” Good advice without authentic, personal relationships is limited in its effectiveness. Your role as friend will outlast whatever role a counselor or doctor may play.
It would also be good for you to read some of the resources listed above. Depression is a common experience we all need to be skilled in addressing and these resources will equip you to echo important truths into the life of your friend.
If my struggle with depression persists and I wanted to seek counseling, who would you recommend?
If you are in the RDU area, we have a couple of options to serve you.
- Summit Counseling Graduate Intern Program – This is free counseling with students completing their masters or doctoral degree in counseling.
- Bridgehaven Counseling Associates – Bridgehaven provides a context to receive counseling from a full-time, experienced counselor on a donation basis. Bridgehaven offers a high quality of care that is both clinically-informed and consistent with the teaching of The Summit Church.
If you are outside RDU or prefer to pursue other counseling options, here are some helpful guidelines from CCEF on how to find a good counselor.
This article was originally published here.