Depression: Getting Up When Life Has You Down
Dr. Pearson L. Johnson, M.Div, ThM., D.Min.
Inter-City Baptist Church
I. What is Depression?
A. Personal Descriptions,
a. “A melancholy heart” (Robert Burton)
b. “The dark night of the soul” (John Chrysostom)
c. “My heart is empty. All the fountains that should run with longing, are in
me dried up.” (C.S. Lewis)
d. Depression bends inward. It is like being trapped in a mirrored shell.
e. These reflections were from people telling a larger story of hope and
change as they sought God in His Word in the midst of their depression.
B. Department of Mental Health Description
http://www.nimh.nih.gov/publicat/depression.cfm (read with biblical discernment).
a. “A depressive disorder is an illness that involves the body, mood, and
thoughts. It affects the way a person eats and sleeps, the way one feels
about oneself, and the way one thinks about things”
b. Diagnosis: A physical examination by a physician in order to make a
connection between a physical illness such as a viral infection or certain
medications. Depression in these cases can be linked through examination,
interviews and lab tests. If no link is found, referral is made to a
psychiatrist or psychologist who does a diagnostic evaluation based on
C. American Psychiatric Association (DSM-IV Manual)
a. Situational Depression or Dysthymic Disorder
b. Clinical Depression or Major Depressive Disorder.
c. Bipolar Disorder (up and down swings)
D. It is a state of being that is symptom diagnosed and symptom described, and as such it
is very subjective and complex.
APA Descriptions and Diagnoses of Depression
Clinical Depression: More Severe Situational Depression: Less Severe
Major Depressive Disorder Dysthymic Disorder
American Psychiatric Association Description: American Psychiatric Association
From the DSM-IV (Diagnostic and Statistical Description from the DSM-IV (p. 349)
Manual of Mental Disorders, fourth edition): last longer—at least two years—but is
sometimes called Depressive disorder or bipolar less intense.
disorder (more up and down swings): Presence, while depressed, of two (or
Five or more of the following symptoms have more) of the following:
been present during the same two-week o Poor appetite or overeating
period and represent a change from previous o Insomnia or hypersomnia
functioning; at least one of the symptoms is o Low energy or fatigue
either (1) depressed mood or (2) loss of o Low self-esteem
interest or pleasure. o Poor concentration or
Depressed mood most of the day, nearly every day, difficulty making decisions
as indicated by either subjective report (feels sad or o Feelings of hopelessness
empty, for example) or observation made by others
Markedly diminished interest or pleasure in all, or Bipolar Disorder, formerly called manic-
almost all, activities most of the day, nearly every
day depressive illness, is becoming more and
more popular. It is marked by variation
Significant weight loss when not dieting or weight
gain (e.g. a change of more than 5% of body between severe highs (mania), or outbursts
weight in a month), or decrease or increase in of anger or emotion and low times of
appetite nearly every day depression. Sometimes the swings are
Insomnia or hypersomnia nearly every day sudden. Sometimes they are gradual.
psychomotor agitation or retardation nearly every (National Institute of Mental Health)
day (observation by others…)
fatigue or loss of energy nearly every day
feelings of worthlessness or excessive or
inappropriate guilt . . . nearly every day…
diminished ability to think or concentrate, or
indecisiveness, nearly every day
recurrent thoughts of death . . ., recurrent suicidal
ideation without a specific plan, or a suicide
attempt or a specific plan for committing suicide, , ,
The symptoms are not due to the direct
physiological effects of a substance (drug abuse,
medication) or a general medical condition
Chemical Imbalance Relationship problems
Other causes Difficult circumstances
II. What Causes Depression?
A. Depression is a form of suffering that can‟t be reduced easily to one universal cause.
Don‟t commit yourself too quickly to any one explanation
B. Genetic Theories (see NIMH Pamphlet, page 4-5)
C. Physical Symptoms of Medical Problems
NIMH, 5 “In recent years, researchers have shown that physical changes in
the body can be accompanied by mental changes as well. Medical illnesses
such as stroke, heart attack, cancer, Parkinson‟s disease, and hormonal
disorders can cause depressive illness.”
Illegal Drug or alcohol abuse and addiction will almost always contribute to
some kind of depression.
Women experience depressive symptoms twice as often as men, often due to
hormonal factors as can be seen in post-partum depression and menopause.
D. Biomedical Theories: A Chemical Imbalance.
1. This is seen in the treatments given
A chemical imbalance was said to be caused by the cells “uptaking” too much
of the neurotransmitters serotonin, norepinephrine, or dopamine.
SSRIs, Prozac, Paxil and Zoloft, for example- Selective serotonin reuptake
inhibitors are said to cause the nerve cells in the brain to be inhibited from
taking up the serotonin in the synapses between cells.
I.e. Bruce Stutz says in his NY Times Magazine online column, “Self-
Nonmedication” on May 6, 2007 the following:
“This was the purpose of taking the drug—to increase the amount of serotonin my
cells had to work with and therefore, in theory, enable me to cope with my stress
and depression. I say „in theory‟ because even 20 years since the introduction of
drugs like these [Effexor in his case], every researcher with whom I spoke was
cautious about presuming a direct relationship between increased serotonin levels
in neural synapses and a decrease in depression. [Why?]
o First, no one has ever measured the amount of serotonin in the
synapses between anyone‟s brain cells. No one knows what constitutes
a low, high or even standard level.
o Second, for reasons unknown, only a little better than half the people
treated with antidepressants respond to them.
o Third, studies have shown that placebos have only a slightly lesser rate
of effectiveness than the drugs.
o Fourth, serotonin levels are affected by many things—exercise, light,
sleep, diet, and even time of day.
o And finally, serotonin has so much influence on chemistry and
functions in so many places in the body and brain relating to mood,
sleep, sexual desire, appetite and body temperature that to say that it
acts in any one particular way is impossible.” (5)
E. Other Psychological Causes
o History of problems—abuse, mistreatment, etc.
o Low self-esteem
o Pessimistic outlook
o Overwhelmed by stress
o Serious loss
o Difficult relationships
o Financial problems
o Stressful changes in life patterns
o Combination of genetic, psychological and environmental factors.
E. Biblical Causes and Examples: A Biblical approach to Depression causes us to
implement the following principles
(1) Limiting yourself to a physical or biomedical explanation may cause you to
miss God‟s help in other areas of your life (See Welch, chapter one).
(2) Be careful about assuming that depression is a spiritual issue as well,
thinking if you can identify the one sin causing it, everything will be ok.
(3) We have to use depression as a time to search our hearts and revisit our
expectations for our emotional life
(4) We all want relief from our pain, but we must not seek relief at the expense
of growth in Christlikeness. If we get relief, it may cover important matters
that will only need to be dealt with later.
(5) Consider the following Scriptural examples and what caused the depression
in each situation:
Psalm 32:3,4- Unconfessed sin
Psalm 73:1-14- Envy of those who prosper without God
Genesis 4:6,7- Cain- disobedience, anger and jealousy
Deut 1:28,29- A failure to trust God or have faith in God- the spies
going to Canaan and fearing rather than having faith
Psalm 55:2-8- Because of opposers or enemies, he lost focus on God
Luke 24:17-21- The loss of Jesus (of a friend and leader)
2 Samuel 18:33- David after his son was killed.
1 Samuel 1:7,8- Hannah when she could not have children wept
1 Samuel 18- Saul- became jealous of the victories of David and so the
Lord left him and he was distressed.
Jonah 4:1-3- A failure to submit your will to God‟s will when Ninevah
(2) The causes for depression in the life of a believer can be categorized as
Other People—half of the Psalms are cries to God because of the
oppression and mistreatment by others.
Ourselves—Many of our personal sins have ensuing consequences for
us and others.
Our Bodies—Since sin entered the world and death by sin, Rom 5:8,
we will have physical, mental and emotional problems.
Seeing suffering, death and loss- Unbelievers come to a point of
ultimate hopelessness in times of death. They should be depressing
times for unbelievers.
Satan—the Book of Job is an account of the spiritual attacks Job is
uknowingly enduring. He was never aware of what happened in the
God Himself—The biblical authors are convinced that God is the one,
true, absolute sovereign creator God.
(i) 1 Sam 2:6-7
(ii) Isa 45:7
(iii) “God is over all things and nothing happens apart from His
knowledge and will. By the time suffering or depression
comes to our doorstep, God did it. To believe anything else is
to opt for a universe that is random and out of control.,
without a guiding hand bringing all things to a purposeful and
awe-inspiring conclusion” (Ed Welch, 41).
(3) Often there are multiple and even sometimes paradoxical causes
Joseph: sibling jealousy, personal naiveté, a lying woman, forgetful
friend. He said “You meant it for evil, but God meant it for good.”
Paul described his thorn in the flesh in 2 Cor 12:7 as something
(i) Caused by his pride
(ii) A messenger of Satan
(iii) Given and allowed by God so Paul would know God‟s grace,
strength in weakness, and the power of Christ.
III. How Do Find Hope in Depression?
1. Commit yourself to having a biblical, God-centered and eternal perspective on
depression and suffering.
Jay Adams gives the following three points of advice in this regard:
You must know God personally before you can expect Him to give you
the help that you need.
You must not put the alleviation of depression first as your goal, but rather
the desire to please God by doing what He says.
You must do exactly as He says regardless of how you feel.
Submit to God, His purposes, plans and promises, even if you do not know why
things are happening.
Remember the following main points (from Ken Collier of the Wilds)
God’s Love for me is unchanging
I John 4:10
God’s Purpose for me is Christlikeness
2 Cor 3:18
God’s Word for me is the final, right answer
2 Tim 3:15-17
1 Jn 5:3
2 Pet 1:3-4
Dt 6:6-9; Dt. 30:11-20; Jn 16:13-15
God’s Grace for me is sufficient
2 Cor 12:9,10
2 Tim 2:1
2. Pray regularly, crying out to God for help, using the Psalms.
Psalm 13, 22, 55, 69, 88 for example
3. Become an active part of a loving and truthful community (church) of believers.
Heb 10:24,25, “And let us consider how to stimulate one another to love and good
deeds, not forsaking our own assembling together, as is the habit of some, but
encouraging one another; and all the more as you see the day drawing near.”
David Powlison, (Seeing with New Eyes, 5) says this, “The most magnificent
institutional structure imaginable is a community living up to how Ephesians 4 weds
pastoral leadership with every-member mutuality. Both the special gifts from God
and the general call to all God‟s people traffic in the cure of souls, as each part does
its part. “
4. Seek counsel from spiritual leaders who can effectively use God’s Word to encourage
Hebrews 13:7-9, 17, “Remember those who led you, who spoke the word of God to
you; and considering the result of their conduct, imitate their faith. Jesus Christ is the
same yesterday and today and forever. Do not be carried away by varied and strange
teachings; for it is good for the heart to be strengthened by grace, not by foods,
through which those who were so occupied were not benefited. . . Obey your leaders
and submit to them, for they keep watch over your souls as those who will give an
account. Let them do this with joy and not with grief, for this would be unprofitable
Listening to people familiar with the scriptures can help determine some of the
causes, should they be fixable or changeable.
Dietrich Bonhoeffer (who stood up to the Nazis in Germany and died for it) said this
(in Powlison, 12). “The most experienced psychologist or observer of human nature
knows infinitely less of the human heart than the simplest Christian who lives beneath
the Cross of Jesus. The greatest psychological insight, ability, and experience cannot
grasp this one thing: what sin is. Worldly wisdom knows what distress and weakness
and failure are, but it does not know the godlessness of man. And so it also does not
know that man is destroyed only by his sin and can be healed only by forgiveness.
Only the Christian knows this. In the presence of a psychiatrist I can only be a sick
man; in the presence of a Christian brother I can dare to be a sinner. The psychiatrist
must first search my heart and yet he never plumbs its ultimate depth. The Christian
brother knows when I come to him: here is a sinner like myself, a godless man who
wants to confess and yearns for God‟s forgiveness. The psychiatrist views me as if
there were no God. The brother views me as I am before the judging and merciful
God in the Cross of Jesus Christ.”
5. Make wise, informed choices about medication usage. If you choose to use medication for
relief, do not place your hope in it. Rather, determine to learn from your experience and
grow through it.
“Is this ability to keep us going altogether good? . . . people under stress can do great
harm not only to themselves but also to those around them—parents to their children,
couples to each other. But when does reliance on a drug keep us from seeking ways to
resolve the causes of stress? General practitioners, not mental-health specialists, write
most of the prescriptions for antidepressants. For most doctors and psychiatrists,
drugs, not therapy, have become the first line of defense. Only some 20 percent of
people prescribed an antidepressant ever have even a single follow-up
appointment”(Stutz, “Self-Nonmedication,” 9).
Gardiner Harris, Benedict Carey and Janet Roberts write in a May 10, 2007 article in
the New York Times titled, “Psychiatrists, Children and Drug Industry‟s Role” about
the prescription growth of atypical antpsychotic prescriptions given to children says
“best-selling drugs, including Risperdal, Seroquel, Zyprexa, Abilify and Geodon, are
now being prescribed to half a million children in the United States to help parents
deal with behavior problems despite profound risks and almost no approved uses for
Medication has been helpful to many people. If you are taking it, do not stop taking it
on your own. There is a careful process one must undergo to wean themselves off of
6. Make a small list of people you respect and ask them to pray for you and to encourage
you in biblical obedience. Stay away from people who give you the wrong kind of sympathy
and encourage self-pity, excuse making, brooding, or the neglect of your responsibilities. Avoid
the type of people Scripture speaks of:
1 Cor 15:33,34a, “Do not be deceived: „Bad company corrupts good morals‟. Become
sober minded as you ought, and stop sinning; for some have no knowledge of God.”
Prov 22:24,25, “Do not associate with a man given to anger; or go with a hot-
tempered man, Or you will learn his ways and find a snare for yourself.”
Prov 14:7, “Leave the presence of a fool, or you will not discern words of
Gal 6:1, “Brethren, even if anyone is caught in any trespass, you who are spiritual,
restore such a one in a spirit of gentleness; each one looking to yourself, so that you
too will not be tempted.”
Heb 3:12,13, “Take care, brethren, that there not be in any one of you and evil,
unbelieving heart that falls away from the living God. But encourage one another day
after day, as long as it is still called „Today,‟ so that none of you will be hardened by
the deceitfulness of sin.”
7. Make a “think and do” list of profitable things you can think about and do when you are
tempted to be discouraged or despondent.
Phil. 4:8,9 says “Finally brethren, whatever is true, whatever is honorable, whatever
is right, whatever is pure, whatever is lovely, whatever is of good repute, if there is
any excellence and if anything worthy of praise, dwell on these things. The things you
have learned and received and heard and seen in me, practice these things, and the
God of peace will be with you.”
8. Make a list of your responsibilities. Wayne Mack gives this advice: Note which ones you are
fulfilling well and regularly. Also note those that you have been or are prone to neglect
because you do not feel like doing them. Ask God to help you do what you should do
regardless of how you feel; plan a schedule which gives you time to do all that you really
must do, and then get busy fulfilling your responsibilities. Don‟t focus on how bad you
feel or how you dislike the task. Focus rather on God, His will for you, His promises and
provisions for you, and the help He will give you to do anything He wants you to do. In
all you do in obedience to God, count on His presence and help and blessing. (Mack)
Phil 2:12,13, “So then, my beloved, just as you have always obeyed, not as in my
presence only, but also in my absence, work out your salvation with fear and
trembling; for it is God who is at work in you, both to will and to work for His good
9. Make a list of at least 50-75 blessings that God has bestowed on you. As you make a list,
thank God for each blessing and make this a daily practice. Look at every area of
your life: spiritual, physical, family, financial, social, work, possessions,
environment, community, abilities, housing, opportunities, etc. Continue to add to
the list daily. Psalm 68:19 says that God “daily bears our burden.” (Mack)
Phil 4:6, “Be anxious for nothing, but in everything by prayer and supplication with
thanksgiving let your requests be made known to God. And the peace of God, which
surpasses all comprehension, will guard your hearts and your minds in Christ Jesus.”
Psalm 34:1, “I will bless the Lord at all times. His praise shall continually be in my
Ephesians 5:20, “Always giving thanks for all things.”
10. Maintain a regular practice of daily Bible reading and study, prayer and meditation.
Plan it out: schedule a regular time and do it. Make it an appointment. Write down in a
journal your thoughts and what you learn from your Bible reading. Ask a friend to check
in with you daily about what you have learned from your Bible reading.
2 Tim 3:14-16
2 Peter 1:3-4
11. Practically turn your focus outward to serving God and helping other people. Get
involved in a ministry or in helping those less fortunate than you or with similar struggles
using God’s Word. Make a list of your gifts and abilities and use them in serving in the
2 Cor 1:3, “Blessed be the God and Father of mercies and God of all comfort, who
comforts us in all our affliction so that we will be able to comfort those who are in
any affliction with the comfort with which we ourselves are comforted by God.”
Romans 12:4-6, “For just as we have many members in one body and all the members
do not have the same function, so we, who are many, are one body in Christ, and
individually members one of another. Since we have gifts that differ according to the
grace given to us, each of us is to exercise them accordingly.”
12. Take care of yourself physically
Exercise regularly, Watch your diet, Get plenty of sleep, Plan regular outdoor
activities which you enjoy
“Sleep, Efrain C. Azmitia of the biology department and the Center for Neural
Science of New York University, told me, increases serotonin levels too. Azmitia,
who has conducted research on the serotonin system for four decades, said that light
and good nutrition can also increase serotonin. Anything, in fact, that relieves sever
stress, which, he has found, is disruptive to the serotonin system. It‟s why therapy
might work just as well as medication, why placebos may work. The stress is
relieved, and the system recovers.” (Stutz, 7).
Contributions from, A Homework Manual for Biblical Living, by Wayne Mack (Phillipsburg, NJ:
P&R, ), 57.
IV. How can you help others suffering from depression?
A. Be prepared to love and have your love stretched.
If the person decides to make an effort to work through the depression, they will need
people surrounding them who they know they can trust.
B. Be prepared to be disappointed and discouraged
It is probably the passivity that will discourage you the most (Welch, 222).
People are “not themselves” the “people we once knew”
Your love becomes motivated by the glory of God and love for Christ
more than by receiving love back. This is spiritual service.
C. Provide daily reminders of God, His Word, and Your prayers.
Share what God is teaching you, don‟t “tell them.”
Stick with scripture and not with opinions, internet information or pop
D. Provide a partnership relationship
You and the depressed person share a common humanity. The basic
struggles are more common to us all than different. Gal 6:1,2 bears this
Express shared goals you are working toward together.
E. Provide a structure and accountability
Sleep schedule- go to bed and rise the same time each day
Eat at appointed times and share diet plans
Make a simple goal for each day and talk about it.
Follow through on agreements and don‟t affirm a lack of responsibility.
Start slowly. Don‟t let them set unrealistic goals and then fail.
Make accountability regular and frequent.
F. Be willing to challenge unbiblical statements and interpretations of feelings. Do so
with questions that lead to the Bible.
Welch, 228, gives this example: “I‟m going to stop you for a second. Can
you hear what is happening? The more you talk, the more you despair. I
can see it in you. In fact, I can feel it in myself. Here is a plan. From now
on, when I see the wave of depressive and, actually, unbiblical
interpretations of life [and feelings or information] crashing down on you,
I am going to point it out and try to run from it with you.”
G. Tell them you are doing this for them now, and you hope they will do the same for
Unless otherwise noted, all Scripture Quotations are from the NASB, 2005 Update.
The following resources are available in the Inter-City Christian Bookstore.
Edward T. Welch. Depression: A Stubborn Darkness. Winston-Salem, NC: Punch Press, 2004.
Wayne Mack, A Homework Manual for Biblical Living, vol. 1. Phillipsburg, NJ: P&R, 1979.
David Powlison. Seeing with New Eyes: Counseling and the Human Condition Through the Lens
of Scripture. Phillipsburg, NJ: P&R, 2003.
D. Martyn Lloyd-Jones. Spiritual Depression: It’s Causes and Its Cure. Grand Rapids, MI:
Jay Adams. How to Handle Trouble. Philipsburg, NJ: P&R, 1982. Also, What Do You Do When
You Become Depressed. Pamphlet.
Jim Berg, Changed Into His Image. Greenville, SC: BJU Press.