I remember the onset of my clinical depression. I had just preached at the ordination service of a good friend. I was then to a join a young adults evangelistic camp. As I was driving away from the ordination service, it happened. It was as though someone turned off all the switches in me. I suddenly had no will and no strength to do anything.
I went to see a psychiatrist who started me on a regime of talk therapy and antidepressants. The doctor said that he wasn’t surprised that I was suffering from depression. I had gone through one major blow in life after another. (I had lost a wife to cancer, a second marriage broke down, and I had lost much of my public ministry.) He said that these major blows, one after another, had resulted in my going beyond reactive depression to clinical depression because it had affected my brain chemistry. He said that with medication and with counselling I should be over the worst of it in about 6 months. He was right, but those were some of the worst months of my life.
He made it clear that the antidepressants were not addictive because consuming them would not cause any immediate reaction. They were meant to correct the chemical imbalance in my brain. It was a long journey of trial and error to see what type of drug and what dosage would help. The key to the treatment was the face-to-face conversations we had where he helped me to make sense of my life and all I had gone through.
Two recent articles, however, have questioned if antidepressants are of any use at all.
“In the dark: 30 years after Prozac arrived, we still buy the lie that chemical imbalances cause depression,”
(Olivia Goldhill, Quartz, December 29, 2017)
“Is everything you think you know about depression wrong?”
(Johann Hari, The Guardian, 7 January, 2018)
The common drugs used to treat depression are SSRIs (selective serotonin reuptake inhibitors). The idea here is that if we inhibit the reuptake of serotonin, a neurotransmitter, there will be more serotonin available to the brain, and this helps because it is low levels of serotonin that is a key cause of depression.
However, studies are beginning to question this model of understanding and treating depression. Olivia Goldhill quotes the work of Irving Kirsch:
The work of Irving Kirsch, associate director of the Program in Placebo Studies at Harvard Medical School, including several meta-analyses of the trials of all approved antidepressants, makes a compelling case that there’s very little difference between antidepressants and placebos. “They’re slightly more effective than placebos. The difference is so small, it’s not of any clinical importance,” he says.
Of course it is simpler to just prescribe a drug. That takes much less time than the talk therapy needed for counselling. I have to say that I personally know a number of psychiatrists who function with compassion and skill and give whatever time needed to counsel their patients. I was a beneficiary of the care of one such psychiatrist. What we are questioning is the paradigm of reducing depression to a biochemical problem detached from the other elements of human experience. Researchers have discovered, for example, that the symptoms of depression are the same as those of grieving the loss of a loved one, something that is not pathological. Johann Hari writes:
Then, as the years and decades passed, doctors on the frontline started to come back with another question. All over the world, they were being encouraged to tell patients that depression is, in fact, just the result of a spontaneous chemical imbalance in your brain – it is produced by low serotonin, or a natural lack of some other chemical. It’s not caused by your life – it’s caused by your broken brain. Some of the doctors began to ask how this fitted with the grief exception. If you agree that the symptoms of depression are a logical and understandable response to one set of life circumstances – losing a loved one – might they not be an understandable response to other situations? What about if you lose your job? What if you are stuck in a job that you hate for the next 40 years? What about if you are alone and friendless?
What are we to make of these new challenges to the efficacy of antidepressant medication? I like the challenge to the reductionism that reduces depression to just a biochemical problem that is to be treated biochemically. My fear of reductionism also makes me wary of throwing out the baby with the bath water. Antidepressants have helped in some cases, though more honest ongoing research is called for.
But I like the reminder that we are not just brains. We are thinking, feeling, relational, vocational beings and we must treat the whole person in any attempt to help the depressed.
. . . all humans have certain basic psychological needs. We need to feel we belong. We need to feel valued. We need to feel we’re good at something. We need to feel we have a secure future. And there is growing evidence that our culture isn’t meeting those psychological needs for many – perhaps most – people. I kept learning that, in very different ways, we have become disconnected from things we really need, and this deep disconnection is driving this epidemic of depression and anxiety all around us. (Johann Hari)
I would add to Hari’s list to say that we are also spiritual beings and any definition of wellness must include the human need to connect with transcendence, to connect with God. A Christian approach to medicine and care must view people holistically. We must resist reductionism and short cuts.
Depression is more prevalent than many of us realise. It is painful and complex. I know. In reaching out to folks struggling with depression, we want to use all the knowledge that God gives us, and that means we must continue to do research in our journey to clarify the causes and cures of depression while helping folks with the light we now have. But the one thing we can and should do, and perhaps this may be most important of all – we must love them. In a fallen world, we are all bruised reeds needing the healing touch of God. May we be channels of God’s love to each other.