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Antidepressants and Pastoral Counseling

Do antidepressants help those who have been diagnosed as being clinically depressed? Most people, including doctors, would say yes. One can hardly watch TV without seeing an advertisement for an antidepressant promising help and hope to the defeated and depressed. In 2005, 27 million people took antidepressants.

But a recent Newsweek article, “The Depressing News About Antidepressants,” reports, based on numerous studies, that antidepressants are no better than placebos.

Yes, the drugs are effective, in that they lift depression in most patients. But that benefit is hardly more than what patients get when they, unknowingly and as part of a study, take a dummy pill—a placebo. As more and more scientists who study depression and the drugs that treat it are concluding, that suggests that antidepressants are basically expensive Tic Tacs.

So why do so many people feel better after taking antidepressants?

The lion’s share of the drugs’ effect comes from the fact that patients expect to be helped by them, and not from any direct chemical action on the brain, especially for anything short of very severe depression.

But what about the oft-repeated claim that certain antidepressants increase serotonin levels and correct a depressed person’s brain’s “chemical imbalance”?

Unfortunately, the serotonin-deficit theory of depression is built on a foundation of tissue paper. How that came to be is a story in itself, but the basics are that in the 1950s scientists discovered, serendipitously, that a drug called iproniazid seemed to help some people with depression. Iproniazid increases brain levels of serotonin and norepinephrine. Ergo, low levels of those neurotransmitters must cause depression. More than 50 years on, the presumed effectiveness of antidepressants that act this way remains the chief support for the chemical-imbalance theory of depression. Absent that effectiveness, the theory hasn’t a leg to stand on. Direct evidence doesn’t exist. Lowering people’s serotonin levels does not change their mood. And a new drug, tianeptine, which is sold in France and some other countries (but not the U.S.), turns out to be as effective as Prozac-like antidepressants that keep the synapses well supplied with serotonin. The mechanism of the new drug? It lowers brain levels of serotonin. “If depression can be equally affected by drugs that increase serotonin and by drugs that decrease it,” says Kirsch, “it’s hard to imagine how the benefits can be due to their chemical activity.”

Pastors, what’s your perspective on antidepressants? If a church member tells you his or her doctor has prescribed antidepressants for that person’s depression and asks you if he or she should take them, how would you respond? How do you counsel someone who is on antidepressants?

8 Comments

  • Corey Brookins says:

    Thanks for bringing this common issue to light!

    First of all, I am not a doctor (I don’t even play one on TV). If someone is currently taking any prescribed medication I will not advise them to go off of it against a doctor’s wishes.

    That being said, if a member of the flock seeks advise concerning whether or not to begin an antidepressant I will definitely ask them to wait until I (or a qualified biblical counselor) can talk with them further. My goal would be to help them see that there may be some spiritual issues that may merely be masked with the antidepressants; that biblical instruction may bring about the lasting change they desire to see in their life.

    The problem lies in people’s tendency to ask, “How can I get rid of this thorn?” rather than, “How can I most please the Lord?” I see my job as helping them to come to the latter.

  • Jeff Gates says:

    I am currently not a pastor, although I was on a pastoral staff for many years several years ago. Having dealt with depression since a teenager, I have done extensive reading on the subject and have been to several counselors throughout my life. Most of them have been pastors. In my studies opinion, doctors are too quick to prescribe antidepressants. However, I am not opposed to using them. I realize that is is a multimillion dollar industry, but that does not mean antidepressants should never be used. In my early 20s I reluctantly went to a psychiatrist to see if there was a test to show that my depression was biological. He assured me that there was no such test. Depression has so many factors that it is hard to distinguish biological causes from other factors. Because of this there is no way to prove whether or not depression has biological factors. For this reason, antidepressants should only be used as a last resort and it should never be used without good biblical counseling (I do not necessarily mean nouthetic counseling. I agree much more with Ed Welsh and Dave Powlison than with Jay Adams.) Those who do not suffer (and I mean suffer) from depression do not understand how debilitating it is. I know first hand the eagerness to discover an easy solution to depression and the tendency to put off dealing with other causes that are more difficult to deal with, but in my opinion ruling out antidepressants is not wise. Again in my studies opinion, taking antidepressants is no more a moral issue than taking aspirin is to relieve a headache. People can rely on both more than God, but need not do so. Many have testified to the help they have received from antidepressant. Those who have reported no positive effect or harmful effects should not use them. I am not advocating waste, but realize that depression is so debilitating that I would say that even if the positive effects of antidepressants are purely psychological, the expensive Tic Tacs are worth it!

  • Greg White says:

    Thanks for the post, Greg! First let me say that the Newsweek article was a refreshing change from the normal drug company induced promotions for antidepressant use. I have spoken with doctors (including my own) about the subject of anti-depressants. Most accept what is being told them by drug company research. However, Dr. Peter Breggin has been sounding the cry for years concerning what he calls a “pro-drug environment” in his book “Your Drug May Be Your Problem”. Having gone through nouthetic counseling training under three different physicians and hearing what they had said concerning the dangers of these drugs and how they mask the real problems, I am biased against their general use. The exception for using them would be in extreme situations (i.e. suicide threat or attempt, violence toward others, etc.) and the drugs should be cut back and discontinued as they respond favorably to biblical counseling.

    If a church member tells you his or her doctor has prescribed antidepressants for that person’s depression and asks you if he or she should take them, how would you respond? I am sympathetic to people like Jeff who have had or currently are having severe depression. I have witnessed the pain, confusion, and debilitating effects. When asked in advance I have told those who are considering the use of antidepressants that these drugs are not a solution to their depression but will only mask the natural warning system that God has placed within them that something is wrong and needs to be taken care of biblically. “So the Lord said to Cain, “Why are you angry? And why has your countenance fallen [depression]? If you do well [respond biblically], will you not be accepted? And if you do not do well, sin lies at the door. And its desire is for you, but you should rule over it.” Genesis 4:6-7 (NKJV) also cf. Psalm 32; 38. When people correct unbiblical thinking and behavior, the depression will alleviate. Depression won’t go away overnight but takes time. Some want a quick fix and or unwilling to put out the effort to change their thoughts and actions biblically. I realize this is a simplistic answer but I need to be brief.

    How do you counsel someone who is on antidepressants? I have counseled those on antidepressants just like I have any other person who is going through depression. When they make enough progress that I believe they can get off their meds, I ask them to speak with their doctor about it. I am not a doctor and cannot tell them to stop. Even if I was a medical doctor, I am not THEIR doctor – the one who prescribed the drugs. They need to speak with him about their progress and about getting off the antidepressants in the correct manner.

  • Greg Long says:

    Thank you, Corey, Greg and Jeff, for your wise and helpful comments.

  • Great point about the dangers of hiding symptoms. If there is a spiritual problem, we need to deal with it rather than hiding it, but we must also be sensative to the possibility of an actual physical problem. Blood sugar issues or thyroid problems can also be the cause of depression. What a shame if a doctor just prescribed Tic Tacs instead of helping someone with a real physical problem. A few years ago I took a counseling class and read an interesting book called “Blame It on the Brain” by Edward T. Welch. He was not advocating sending everyone to the doctor, but pointed out that there are times when we should.

  • Greg White says:

    Jerry, excellent point! I have sent severely depressed people to their doctors in the past to ask specifically about those two organic problems. I did caution them prior to their appointments about some doctors being quick to prescribe antidepressants. BTW – Ed Welch’s books are great resources.

  • Jamie Hart says:

    It’s certainly not uncommon to have a counselee on antidepressants. My position is…I don’t touch it. I’m not a physician. And I think the Bible has answers for the counselee regardless. A person may have a tendency toward depression and if that’s the case, I’ll be sure to be loving and understanding…but we’ll still be talking about biblical principles of growth and change. I agree with Jeff (on a number of levels)…in some ways it’s no different than any other physical illness…a sovereign, loving God has allowed this in their life for their good and His glory. Let’s learn how to honor Him through this. There are some practical things that may help, so data gathering will be very important. When do you get depressed, how often, are there different levels…etc. I’ll have them journal with date, time, situation, thinking log, etc. Often there will be patterns that we can see and triggers that we avoid. In some cases, it’s really hard to see any pattern at all…and there may be some organic cause.
    I guess I don’t spend a lot of time asking if it’s legitimate. It certainly is to the counselee! It becomes an opportunity to teach them how to live in a way that honors God through the difficulty. Sometimes (often) after applying biblical principles of thinking and acting, they come to the conclusion on their own that they no longer need the drug. In those cases, we’ll leave that between the counselee and their doctor. Some have felt they still needed the drug. As long as they are striving to honor God with the way they handle it, I don’t feel it’s big deal.

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