If you have been a pastor for longer than one week, you have probably counseled someone who was taking medication for depression. This presents a consummate pastoral dilemma because pastors want to bring the Bible to bear on all of life, and at the same time, we didn’t go to medical school.
There is the reality that the help God gives us in the world comes in the form of special revelation (his Word has given us all things pertaining to life and godliness) and general revelation (medicine can really help you when you’re sick). Depression seems to have one foot in both worlds, and so it can offend secular psychologists when pastors take people to the gospel to bring joy, and it can rankle pastors when a person says that they are taking medication to find a way to cope with life.
And let me admit right away that the only medical knowledge I have comes from Wikipedia, I cheated in high school biology (I was caught and repented at conversion), and know nothing about the inner workings of the brain.
So I defer to the professionals when it comes to medical issues, and if a doctor says someone has a chemical imbalance that medicine can correct, I am certainly in no position to quibble.
This is why a report I heard this week on NPR (hardly a bastion for biblical counselors) astounded me so much I had to pull over to focus on it. Correspondent Alix Spiegel went on a quest to find the medical evidence that depression can be caused by a chemical imbalance. I’d encourage you to listen to the piece in all nine minutes of its radio glory, but here is a summary.
Spiegel begins by relating what happened to her when she was 17; she was so depressed she felt like she had a black hole in her chest. He parents took her to Johns Hopkins Hospital, and she was told:
“The problem with you,” she explained, “is that you have a chemical imbalance. It’s biological, just like diabetes, but it’s in your brain. This chemical in your brain called serotonin is too, too low. There’s not enough of it, and that’s what’s causing the chemical imbalance. We need to give you medication to correct that.”
Then she handed my mother a prescription for Prozac.
As a pastor, I have heard similar stories countless times. To be clear, I never have (and never would) counsel someone to stop taking medicine that a doctor gives. As I said earlier, I defer to the professionals. But the million dollar question Spiegel is asking is this: “is depression caused by a chemical imbalance?” After all, if pastors are expected to defer to the medical world on this issue, then obviously the medical world has evidence that links depression to biological issues, right? Dr. Joseph Coyle (a professor neuroscience at Harvard and the editor of Archives of General Psychiatry) tells Spiegel: ”Chemical imbalance is sort of last-century thinking. It’s much more complicated than that. It’s really an outmoded way of thinking.”
Spiegel then takes the listener on a tour through the history of Prozac. She explains why it is used to fight depression. Ostensibly, depression can be caused by low levels of a chemical called serotonin in the brain, and Prozac helps correct that. But Spiegel explains that this narrative—she calls it the “low serotonin story”—is propagated more for its simplicity than for its medical veracity.
Alan Frazer, chair of the pharmacology department at the University of Texas Health Science Center at San Antonio, candidly explains: “I don’t think there’s any convincing body of data that anybody has ever found that depression is associated to a significant extent with a loss of serotonin.”
Another researcher, Pedro Delgado (chair of the psychiatry department the University of Texas) adds that there have even been studies done that disprove the notion that depression is caused by low serotonin.
Spiegel’s piece concludes with some startling admissions. One after another, the experts grant that there is no real evidence linking depression to low serotonin. Amazingly, they justify the propagation of the “low serotonin story” simply because it is easy to understand. In other words, it doesn’t have to be true to be helpful. I’ll reprint a transcript of her conclusions:
So why are so many people still talking about low serotonin causing depression?
Frazer says it’s probably because it has had, and continues to have, important cultural uses. For one, he says, by initially framing the problem as a deficiency — something that needed to be returned to normal — patients felt more comfortable taking a drug.
“If there was this biological reason for them being depressed, some deficiency that the drug was correcting,” Frazer says, then taking a drug was OK. “They had a chemical imbalance and the drug was correcting that imbalance.” In fact, he says, the story enables many people to come out of the closet about being depressed, which he views as a good thing.
Still, there’s no question that the story also has downsides. Describing the problem exclusively in biological terms has convinced many people to take antidepressants when other therapies — like talk therapy — can work just as well.
One critic I talked to said the serotonin story distracted researchers from looking for other causes of depression. But Delgado agrees with Frazer and says the story has some benefits. He points out that years of research have demonstrated that uncertainty itself can be harmful to people — which is why, he says, clear, simple explanations are so very important.
“When you feel that you understand it, a lot of the stress levels dramatically are reduced,” he says. “So stress, hormones and a lot of biological factors change.”
Unfortunately, the real story is complicated and, in a way, not all that reassuring. Researchers don’t really know what causes depression. They’re making progress, but they don’t know. That’s the real story.