April 24, 2014

What About Antidepressant Medication?

antidepressant.jpgI’ve been asked to give my view on the use of antidepressant medication, and I assume especially as it relates to the Christian community.

I’ve written about growing up with my dad’s severe depression, and I’ve written an entire series on “The Christian and Mental Illness.” I’m currently reading “Darkness is My Only Companion” and I hope to review it soon along with John Piper’s “When The Darkness Will Not Lift.”

Here in my ministry with students, I am surrounded by students who take psychiatric medications. Reviewing medications and their effectiveness with a student is part of the contribution I make to our admissions process. I often read letters from parents stating that they want their child in a school where there will be no place given to medications. While many of our students no longer take medications, we support the use of some medications with some students. We occasionally request a student be reviewed for possible diagnosis and prescriptions.

I have known many adult Christians who are on antidepressants, and I have current family members on antidepressants. I’ve thought a lot about this subject and I live with it every day.

My own community of Southern Baptists is rapidly rejecting any kind of traditional psychotherapy or psychiatric treatment as “unbiblical.” When I attended Southern Seminary – with my undergraduate minor in psychology- it was the era of Dr. Wayne Oates and the pastoral counseling movement. I had excellent classroom guidance from compassionate teachers like Dr. Andrew Lester and Dr. Wade Rowatt. We often discussed these issues.

I find the idea that the Oates’ pastoral counseling movement was busy compromising the truth of the Gospel and Holy Scripture to be absurd to a high degree. In those classes, scripture and Christian experience were deeply honored and respected. In fact, the teaching of Dr. Oates was far more rooted in Biblical approaches to human being than in secular psychology.

I am not impressed with what I have experienced in the Nouthetic counseling movement. I do not reject, out of hand, the value of some form of Biblical counseling for some kinds of problems. For example, relational problems based on learned behaviors or issues of forgiveness are appropriate for a Biblical counselor. In many cases, however, there is a medical and psychiatric component of treating relational issues.

I share the frustration that many feel with the amorphous nature of psychological theory. I have always had a very reluctant approach to the medication of children and teenagers in order to make their behavior “acceptable” to the someone’s standard of “normal” classroom behavior. Both the ethics and the worldview of psychology raise issues for me, but I have a generally low view of the immediate promise of “better living through science.”

A certain amount of reluctance and disagreement, however, does not change my conviction that we cannot use the Bible in a way it was not intended to be used. The Bible was written in a pre-scientific culture, and the increasing knowledge of the complexity of human beings does not mean we assume that the Bible speaks authoritatively on brain chemistry or genetics. The Bible is not a medical textbook, and it is a perversion to make it into such.

I consider it dangerous to ignore reasonable, prudent scientific discoveries that can treat the biochemical aspect of depression. I have seen depression be overcome through many different methods that did not involve medication, but I have seen many people greatly helped by prudent use of medication combined with other kinds of depressing-fighting activities. While I am cautious and moderate in my advocacy of antidepressants, I am insistent that depression like my father’s is a biochemical/physical problem most appropriately treated with psychiatric medications.

Many of the Christians I have met who disagree with the use of anti-depressants tend to see many human behaviors in terms of spiritual warfare and believe that Satan or sin is the cause of depression. For them, all disease is turned into a spiritual battleground only. While I believe that there is a spiritual component to all human life, I do not believe the demonic is normally deeply involved in typical human ailments such as depression. I also believe sin plays a part, even a large part, in some depressions, but I do not believe forgiveness and repentance affect all the factors that make up depression.

In other words, I believe depression is, in the main, a medical issue that should be treated with an array of treatments that often can include a monitored, prudent use of antidepressants. Prayer, scripture, diet, exercise, community, conversation, behavior change, rest, education….all of these factors play a role as well.

My own observation of depression convinces me that it is very simple for some Christians to say that a person is under a demonic spiritual influence, but this pre-scientific conclusion is often made by well meaning Christians who have no way to actually diagnose what is going on. They are hopeful for a dramatic cure, and they put a suffering person in the position of believing they are afflicted by demonic power. This, even when well meaning, is wrong. It can be abusive and it is often premised on a kind of knowledge that no human has.

I support anyone whose medical doctor believes that anti-depressants can be helpful. I believe counseling, physical activity and community are also part of the response. Monitoring how medication is affecting the whole life of a person is necessary and ethical. Knowing the limitations of medication is, of course, wise as well.

I believe in the sovereign freedom of God to intervene, but I have little time for those who insist that God will intervene, move beyond regular medical treatment and heal mental and emotional illness on command. It is inappropriate and often abusive to condemn sick persons as sinful or resistant to God’s power to overthrow spiritual strongholds. Recognizing the reality of depression is a compassionate response that honors what it means to be truly human.

Many Christians are grateful for the help that has come through antidepressant medication, as well as the help that has come through other medications and insights into the complexities of human weakness. The church shouldn’t be a shill for psychology, but we ought to be a compassionate advocate of helping people with medicine, as well as praying for divine intervention.

Comments

  1. The dilemma of psychotropic medications for Christ-followers is genuine, albeit at times made artificially more difficult than it need be in ways you have identified. I have had to wrestle with this issue professionally for 20 years and personally for much longer. There are no easy, one-size-fits-all answers.

    Depression in particular (as well as anxiety) is sometimes caused by sin: immoral choices and behaviors, whether our own or others; always, however, it is caused by Sin: the fallen state in which we find ourselves spiritually and physically. Our brains – the physical organ, not the mind – were not spared from the ravages of Sin as it coursed its way through our race following Adam’s fall. There are not only noetic effects from the fall but neurological effects as well.

    That antidepressants and other similar medications are abused and over-prescribed is very likely. But this does not mean that everyone who takes medications is failing to trust Christ or walk in the spirit: there are many (what percentage, I do not know) for whom depression is organic and no amount of prayer or Bible memorization is going to change it. I don’t believe God ever promised to refurbish our sinful, soulish bodies as a matter of course; in fact, he means to do away with this model and replace it with a spiritual body one day.

    Until then, some people will need medication for depression, bipolar disorders, anxiety, schizophrenia, and other difficulties. Perhaps medication should not be the first thing we think of or turn to, but it shouldn’t be the last, either.

  2. After spending seven years (and counting) wrestling with my own severe depression and helping others with their own, I have come to the realization that depression is an illness that is very poorly understood even by the experts. This is not a condemnation of these experts, but a recognition that scientific knowledge of the intricacies of the brain is still quite limited. Depression remains a catch-all designation for a grouping of similar symptoms with a myriad of possible causes and solutions. I have seen many suggestions for a single cure for all depression, but those who suggest such one-size-fits-all solutions rarely have robust knowledge or experience regarding depression. I haven’t encountered too many who suggest just repentance and prayer, but I have encountered many people whose doctors blindly write out a prescription and call it done. I have full confidence that God can heal those He will through either prayer, medicine, or both. But more so, I believe that God can display His glory and grace even in depression that will not lift.

  3. Thank you for the kind approach to psychological treatments. Having recently been diagnosed with ADHD as an adult, I find the stigma for this syndrome in Christian circles to be similar to that for depression. I have not taken the medication route but have embarked on a cognitive-behavioral regime, along with diet changes. The diagnosis was a relief; I do not rest in it as an excuse for my behavior/thought patterns but it does offer a way out to better living.

  4. “I haven’t encountered too many who suggest just repentance and prayer,….”

    Gammell, consider yourself very lucky. It’s hard to say if they or the doctors you reference do more damage to individuals.

  5. I’ve been reading your blog for a while, and it impresses me more with each reading how very “un-Baptist” you are, in spite of your employer.

    God endowed humans with intelligence. To me, it goes against God’s provision to ignore what we can objectively see about how human physiology works, and replace it with much “hootin’ and hollerin’” about God’s healing ways. If a man catches on fire and happens to be standing next to a river, should the man jump in the river, or just stand there praying that God should put the fire out? Is his faith weak because he jumps?

    A man like you needs a larger forum.

    Pax.

  6. Thank you, Michael, for your balanced view. Shame on the SBs and others for gnostifying the faith by ignoring the complex interactions of body/brain and personality/spirit. They seem to think creation was a good thing except for all the messy biology God chose. I would not be alive today except for the loving caring of a Christian counselor, a psychiratrist, and nine-month stint of anti-depressants. Anyone looking for a balanced treatment of the subject may want to check out “Broken Minds” by Steve Bloem (Kregel). Steve is a Baptist, seminary grad, former pastor, bi-polar sufferer, and full-time counselor. In the interests of full disclosure, the book is published by the company I work for.

  7. I have had winter depressions for 20 years, getting more severe for every year. I started medicating last fall, and a whole new world opened up. As far as I understand the level of seratonin in my system is too low, and my medicine adds what is lacking. In my opinion, this is just like when a person who has lost a leg uses an artificial leg. Not even a baptist would refer to an artificial leg as sinful, or say that the one legged person should just “walk in faith”…

    The southern batist just seems to get stranger by the day.

  8. It’s so good to see others in the Christian community addressing this issue. I’m in a conservative presbyterian denomination and the Nouthetic counseling movement as you call it has quite a stronghold here as well.

    While I do agree that a lot of medications are over prescribed for too many things can tell you from personal and experience with other family members that they are issues that Nouthetic counseling doesn’t address and doesn’t understand. About three years ago I experienced the first of some severe panic attacks. I did not want to take medicine. I prayed and prayed for relief but ironically I was brought to a time of humility in which I had to go to the doctor. When I took anti-anxiety medication for the first time I finally felt sober. The nouthetic counselors will not like hearing this but only after taking this medication did I become “sober” enough to deal with some other issues. it was getting so bad that I didn’t want to drive to work. I didn’t mind it when I got there but the short 5 mile drive was like a “living hell”. At home I could not sleep as I thought I was having heart attacks.

    Later my experience allowed me to see a problem in someone close to me and I was able to encourage them likewise.

    I have been off medication for the most part for quite some time but if I need it again I won’t hesitate to take better care of myself.

    I do see a lot of wisdom in nouthetic counseling but often it is taken too far and it concerns me that many are becoming “counselors” and counseling others irresponsibly.

    Regretfully I have had to go against pastors and teachers in my church to do what was best for me and my family. It scares me however that many are too scared to resist their “elders” in the faith to do what is right.

  9. Before doing ministry I was working on a Ph.D. in clinical and health psychology. I think there is much good that can be done through therapy and through psychopharmacology. I wholeheartedly agree with what you said about treating children in an attempt to make them “normal.” I think we have medicated out some of our future geniuses. What is normal? The best thinkers the world has ever seen weren’t normal.

    My experience is mostly with ADD/ADHD but also with depression, etc. There was one multimillion dollar NIMH grant that came out of our lab that found that a certain form of parent-training actually “cured” ADHD in 70% of the cases. This was very unexpected as the treatment for ADD/ADHD is medication. What was concluded – misdiagnosis. I say all that to say this, there is a place for medications but there is a HUGE problem with misdiagnosis today as MDs are not spending enough time with their patients to make an accurate diagnosis and to rule out other things. I would certainly recommend therapy first before medication (depending on the disorder). Cognitive behavior therapy has been extremely successful in treating depression. Depending on which doctor you get, you may never hear that and get right on a pill. But I see no theological problem with medication. Medications usually just increase or decrease chemicals that God designed to help our brains function. We don’t tell people not to have a blood transfusion but people in the church tell them not to take these medications. It just doesn’t make sense to me. It is just from ignorance more than anything else.

  10. I am much obliged for this important post. This subject has been heavy on my heart this week as my friend and neighbor hanged himself Tuesday morning, leaving twin sons and a loving wife in the most painful kind of grief.

    As someone who has struggled throughout my 45 years with depresssion, I agree completely with your observations. The same thing applies with alcoholism and seeking treatment in Alcoholics Anonymous.

    I’ve been sober 12 years, and have seen dozens of men and women get sober in AA, get saved, get drunk again, go to jail, or die.

    Most evangelicals (pastors included) simply have no clue about addiction and do great damage by counseling addicts that because they are now in Christ, they are no longer alcoholics or drug addicts.

    They might be interested to learn that AA was founded solidly on biblical principles. Indeed, it was the success of the Oxford group that gave AA founders its vision to apply those Christian principles to helping the alcoholic.

    I don’t know if I would be around to share the gospel today if it weren’t for AA and anti-depressants.

  11. My husband, a mental health worker at a psychiatric hospital, showed this blog post to his coworkers (psychiatrists and psychologists) who enjoyed it and said they identified with it.

  12. As a person who left pastoral ministry due to issues related to a bipolar disorder – now well managed – I appreciate your repeated focus on this important issue. Ever since I wrote a story about my experiences for my denomination’s magazine several years ago, I have continued to have people say how much they appreciate knowing someone in the church understands.

    I am writing a review of “Darkness is My Only Companion” for the magazine of the Evangelical Covenant Church, the denomination to which I belong. Overall, it is an excellent book and is wonderful at conveying what it feels like when a person is sick. I believe this is a “must read” for the church and one of the best on the topic that I have read in some time.

    A frustrating weakness comes in the middle of the book, when the author repeatedly breaks up the flow of her discussion on theology and mental illness by inserting lengthy quotes from various sources.

    I have made sure, however, to encourage friends and family to read this book. I look forward to reading your thoughts.

    Grace and peace,
    Stan

  13. You can read John Piper’s book When the Darkness Will Not Lift for free on his website. He has several books available for online reading.

    I have always been amazed at how John Piper can teach so strongly and uncompromisingly and still communicate so much compassion. I read where his Dad used to say about their family, “We Pipers are fundamentalists without the attitude.” When I read that it put into words exactly what I had felt while reading this book on Depression.

  14. I am a believer from an evangelical church who listens to preaching from the pulpit against psychiatric medication. Apparently if you are born again you do not need psychiatricl medication. If you submit to God’s plan of forgiveness for your life you don’t need it. When preached, psychiatric medication is classified to be in the same category as using alcohol. I don’t know what to believe. I am diagnosed bipolar. I have also had the pleasure of the pastor’s wife praying for the demon inside of me. I am currently trying to ween myself of psychiatric medication.

  15. c.caughey

    I certainly feel for you and your position.

    To mitigate with medication any of the numerous chemical problems to which the brain is susceptible is not escapism, and is not the same as using alcohol, any more than is treating hypothyroidism with medication. And frankly, I question the intelligence of anyone who makes that claim.

    After 9 years on meds (seratonin re-uptake inhibitors), I am intimately familiar with the difficulty of getting off them. I’ve tried unsuccessfully 3 times, not liking the dependence or some side effects. My doctor (a Christian) has said that some people end up having to resign themselves to remaining dependent on them. But if not for them, I seriously doubt I’d be alive now.

    mattdabbs wass right:

    “I wholeheartedly agree with what you said about treating children in an attempt to make them “normal.” I think we have medicated out some of our future geniuses. What is normal? The best thinkers the world has ever seen weren’t normal.”

    But I think he was mostly talking about kids. I would have preferred to stay “real” and let the chips fall where they may, but having a wife and kids kind of complicates things. It’s one thing to be whoever you are and embrace your pain, it’s another to inflict it on the innocent.

    I wish I had an answer for you, other than to be wary of the simple-minded opposition you’ve encountered and attendant eagerness to see everything in terms of spiritual warfare. (It seems to me that actual cases of demon-possession are rare and involve very peculiar circumstances). Just be sure that your doctor is closely involved with your attempts to get off the meds. And may the peace of Jesus Christ be with you as you struggle.

  16. That is like telling a person with diabetes not to take insulin. Depression is caused by an imbalance in the body. Take your medication as prescribed. When things balance-out for you, THEN look at weening yourself off with a doctor’s help. Yes, God can and does heal. It’s not lack of faith or demonic to take an aspirin for a headache, just as taking medication for depression is not. Don’t let the comments of your pastor compound your depression and cause anxiety. You WILL recover and get back to normal.

  17. As someone in the nouthetic camp, I do want to say that this article has made me think a little bit. I certainly do not disagree that these meds can help people feel better. However, I also think that they need to be used very sparingly (if at all) because of the unknown effects they have. Diabetes is something that can be tested for and treated. We understand the chemistry of blood and how diabetes works. I am not a Christian Scientist.

    However, comparing diabetes to depression does not make scientific sense. Many of these drugs have unknown action mechanisms. How many people on antidepressants had the same kind of chemical analysis done on their brain that a diabetic would have done with his blood? As far as I know, none. However, anyone who has quit meds cold-turkey (which is stupid) can attest to the dependence one develops on them after they do alter the chemistry of the brain.

    Doctors prescribe meds and hope for the best. If you’re lucky they do what they are supposed to do. If not, you can end up homicidal or suicidal. Maybe it’s a chicken-and-egg problem, but has anyone noticed how often the people who go off the deep end (i.e. shooting up a college, a high school, or drowning their kids) are on these meds?

    My wife suffers from what Martin Luther would have called “melancholy”. Yet she is able to cope with it apart from taking antidepressants. I know someone who was diagnosed as bipolar and after he found freedom from sexual sin he was able to quit his meds. Sure, he still has ups and downs, but they aren’t as drastic as they were.

    Still, I can’t discount the experiences of those who have had success with these meds. I just think that we need to be very, very cautious with them. To compare depression with diabetes is a logical fallacy.

  18. Hi,
    I have spent time dealing with my depression and anxiety/panic with meds and without meds.

    I would like to be able to get by with out these meds, but time and experience have shown me that I can’t. I’ve been on psychotropic meds for almost 17 years, now.

    I used to think it was just a matter of “pulling myself up…”, a matter of “riding it out”, even using it to feed my creativity.

    But, during 1979 certain events sent me over the edge; wwaaayyy over the edge. The psychiatrist told my parents I was a very sick young woman and he didn’t know if I’d “come back from it.”

    Even then I wasn’t put on any meds as the hospital I went to didn’t believe in giving meds for anything but psychosis. I was there for seven weeks. During that time my Psychiatrist forbid my husband and parents to see me. I won’t go into what my husband and my mother put me through physically and verbally/emotionally when I got out of the hospital. It was physically and emotionally brutal. I was divorced in 1983. My mother died in 1986. Dad had died Nov.1980. I left Minnesota and moved to Phx. Labor Day 1987.

    Let’s skip to 1990 I’d been living in Phx for three years. One night I had the worst panic attack I’d ever had(uncontrollable shaking,crying,end of the world, all my fault I’m going to he** kind of thoughts). A friend took me to a crisis clinic . They put me on xanax and a tricyclic anti-depressant. They hooked me up with a social worker.

    Nov. 1998 I moved back to my home state. Some relatives invited me back. “Come on home you can live with me..sure we’ve got room for your cat and dog. It’ll be fun.” It took me Three weeks to find my own apartment. It took me a year or so to go to a Psychiatrist and start taking meds, again. I hate needing them, but I know how I’d be without them.

    I would like to say that all the replies in this forum are well written and well thought out. I think I am among very intelligent people here.I feel kind of out classed.

  19. Jason,

    I beg to disagree with you about the false comparison between diabetes and mental illness.

    Just because we don’t know the exact causes of depression and the other mental illness, doesn’t mean that they don’t have at least partly biochemical cause. It took over 3000 years from when diabetes was first recorded to when scientists started identifying the causes and then ways to help the body handle sugar.

    I hope and pray that our suffering brothers and sisters don’t have to wait that long.

    As far as having to try different medications to see what works, that is partly due to the lack of detailed knowledge about the biochemistry involved. Part of it is also that drugs work for a while in some people and then stop working. Again, lack of extremely detailed knowledge.

    We humans are a varied bunch, and just as I react very mildly to skunk odor, while others react very strongly, our brains and bodies are very different.

    Personally, I’m for whatever works for a person, and will not say that what works for one, Must work for all.