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Is it ethical for a Christian to treat depression with anti-depressants? A careful answer from Simon Jooste, Part 1

3 June, 2008

Our friend Simon looks at this serious question in detail, and concludes that in specific circumstances, it is appropriate to use anti-depressants as part of a holistic approach to treating depression — provided that the sacred means inform these secular means. He looks at four aspects of this question and his answer:

    • Depression in light of the Fall
    • The Christian life of suffering
    • The ‘therapeutic narcissism’ of our age
    • The godly wisdom which draws on both sacred and secular means

We’ve really enjoyed Simon’s previous contributions to C or C, and hope that this essay will provide food for thought and purposeful Christian reflection. Here’s part 1:

Introduction

Christians suffer in this life, not only because they live in a fallen world, but also because of their cross-bearing identity with Jesus Christ. Depression is one way that disciples of Christ suffer. With the advancement of medical technology, there is an ever-increasing range of psychotropic drugs available for treating the symptoms of depression. Arguably the most advanced are the selective serotonin reuptake inhibitors (SSRIs), of which Prozac is the most well known (and will be used as representative of this class of drug for the purposes of this essay). Since its release in 1986, Prozac has become the “most widely prescribed antidepressant in medical history.” (1) It has been known to elevate mood and even make some feel more than well. The medical community has been divided over biochemical changes in the brain relative to depression and Prozac. These facts have led many to raise concerns over whether laws, knowledge, and ethical practices are lagging behind in this new medical technology. (2)

Is it ethical for a Christian to take Prozac for depression? In this essay I argue that, in specific circumstances, it is appropriate to incorporate Prozac into a holistic approach to treating depression, provided that sacred means inform the secular. In navigating the ethical path that advocates a cautious use of antidepressants in treating depression, this essay is divided into four parts. In the first place, depression is contextualized in light of the Fall. Secondly, the Christian is called to and benefits from a life of suffering. Thirdly, the Christian must guard against the therapeutic narcissism of our age. Finally, it is argued that godly wisdom for restoration can draw upon both sacred and secular means.

For the purposes of this essay, “depression” excludes those with a history of significant mental illnesses such as Alzheimer’s and dementia. (3) Instead, drawing on the Diagnostic and Statistical Manual of American Association, 4th edition, the inner pain of depression can be described as, but not limited to, the experience of five or more of the following symptoms:

(i) Depressed mood most of the day; (ii) markedly diminished interest or pleasure in all, or almost all, activities of the day; (iii) significant weight loss when not dieting or weight gain; (iv) insomnia or hypersomnia nearly every day; (v) feeling physically restless or slowed to an extent that is observable to others; (vi) fatigue or loss of energy nearly every day; (vii) feelings of worthlessness or excessive or inappropriate guilt; (viii) diminished ability to think or concentrate; (ix) recurrent thoughts of death, recurrent suicidal thinking without a specific plan, or an actual suicide attempt. (4)

Thus, the term ‘depression’ used henceforth is of a more serious and crippling nature than normal sadness, and adjectives such as ‘major’ or ‘clinical’ are useful.

Sin, Suffering, and Bodily Flourishing

Had Adam passed his probation in the Garden he would have entered into a state of eternal embodied bliss (WCF VII.2). The story did not end that way. Instead, since Adam’s failure to keep the covenant of works, sin and death have ravaged body and soul ever since (WCF VI.2). Things are not the way they are supposed to be. (5) All of mankind now suffers to some degree.

By the grace of God, the story did not end east of Eden. Shortly after the Fall, God promised that he would once again restore a congregation of mankind to a state of eternal bliss and happiness (WSC 20; HC 57). Yet, while that process of recreation and restoration has been guaranteed and set in motion by the coming of Christ, God’s people still await its consummation (Mk. 1:15; Rom. 8:19-25; 2 Cor. 4:16; Rev. 21:1-4). In the tension of this already-and-not-yet age, God’s people wrestle to make sense of suffering (cf. Job; 2 Cor 12). In the case of depression, it is assumed to be a function of a mysterious combination of physical and spiritual causes, for we are body and soul creatures. (6) Physical causes stem from living in this fallen world and include fatigue, stress, disease, etc. (7) Spiritual causes arise from sinful responses to living in this fallen world as well as God’s loving chastisement. (8 ) In turn, it is assumed, though the medical community is divided, that depression can result from a chemical imbalance in the brain (brought on by physical and spiritual causes).

In this in-between age, God has provided medicine as a mercy by which some degree of bodily flourishing can be restored and can reasonably be extended to the treatment of depression. Prozac is a candidate for inclusion here. It is assumed that Prozac can both alleviate adverse physical symptoms resulting from depression as well as correct chemical (serotonin) imbalances in the brain. (9) Before an explicit consideration of Prozac for depression, wisdom is to be informed by the believer’s vocation of suffering, as well as guarded against the idolatrous pursuit of medicinally induced ‘happiness’.

  1. Quoted from: http://www.prozac.com, accessed 05-15-08.
  2. President’s Council on Bioethics (U.S.) and Leon Kass, Beyond Therapy : Biotechnology and the Pursuit of Happiness, 1st ed. (New York: ReganBooks, 2003), 214. I don’t pretend to be a medical expert and have written this essay as a theologian from a confessionally Reformed perspective. In addition, I assume as Biblical the ‘two kingdoms’ arguments used in this essay. In dealing with ethical questions surrounding medical advancement, there are few explicit biblical guidelines to which to appeal. There is not much to be found in the church fathers either.
  3. This category would also include bipolar disorder and schizophrenia and assumes a degree of brain damage. Excluding these illnesses does not imply ambivalence on my part, a lack of moral culpability for the sufferer, or the cause having no spiritual component.
  4. Depressed mood or loss of interest or pleasure being one of the symptoms to qualify (American Psychiatric Association. and American Psychiatric Association. Task Force on DSM-IV., Diagnostic and Statistical Manual of Mental Disorders : Dsm-Iv, 4th ed. (Washington, DC: American Psychiatric Association, 1994), 161-64.)
  5. Cornelius Plantinga, Not the Way It’s Supposed to Be : A Breviary of Sin (Grand Rapids, Mich.; Leicester, Eng.: Eerdmans ; Apollos, 1995).
  6. Eward T. Welch, Blame It on the Brain?, ed. Susan Lutz, Resources for Changing Lives (Phillipsburg: P & R Publishing, 1998), 44-48.; WLC 17; Louis Berkhof, Systematic Theology, 4th rev. and enl. ed. (Grand Rapids: Wm. B. Eerdmans, 1969), 191-201.
  7. Pastor and medical doctor Martyn Lloyd-Jones acknowledged the range of non-sinful physical problems that may induce depression. He also pointed out that certain melancholy personalities have a natural predisposition toward depression and that throughout history the best of Christians have been afflicted with this distemper (David Martyn Lloyd-Jones, Spiritual Depression: Its Causes and Its Cure (Grand Rapids: Eerdmans, 1965), 18-19.
  8. Persecution for one’s faith would include both physical and spiritual causality. Some theologians, like Jay Adams, have been less sympathetic to physical causes of depression and wants to locate much of blame and remedy in the spiritual realm (Jay Edward Adams, The Christian Counselor’s Manual (Grand Rapids, Mich.: Baker Book House, 1973), 375-83.)
  9. Furthermore, as a baseline starting point, it is assumed that Prozac does not adversely and irremediably remap the brain, and in most instances has manageable side-effects.
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25 Comments
  1. Benjamin P. Glaser permalink
    3 June, 2008 11:08 am

    I would recommend consulting Timothy Rogers, Trouble of Mind and the Disease of Melancholy: Written for the Use of Such As Are or Have Been Exercised by the Same. Even though it was written in the 17th Century it provides quite a good exegetical answer to Christianity and depression.

  2. Eric permalink
    3 June, 2008 4:51 pm

    As a long-time sufferer of manic-depression, I can state clearly that use of SSRI’s like Prozac can be very useful in restoring balance to the brain, provided that they are not seen as the ultimate solution to larger spiritual problems. I take Paxil, a drug similar to Prozac. Recently I tried to gradually go off of it, but a series of crises and stressors led me to return to its use.

    I think it’s unfortunate in the larger evangelical community that a form of gnosticism reigns. Everything is hyper-spiritual, not grounded in the earth and the body. Just as we obtain nutrition through eating various kinds of foods, so science has developed various medications that, if used properly, help restore the imbalances created through the fall. In this world we find balance by trial and error, testing one substance or another which affect our brains in different ways.

    In a very real way, our brains are the hardware of our souls. Though there is an important distinction between mind and brain, the truth is that one intimitely affects the other, and vice versa. We do not only have bodies; in a real sense we are bodies. In our glorified state we will have glorious resurrection bodies impervious to sin, disease, and death. Our glorified brains will still be affected by everything we take in and encounter–only there will be no more depression, mania, tears or suffering. In the meantime, drugs like the SSRI’s can indicate God’s merciful provision for those affected by the ravages of the Fall.

  3. 3 June, 2008 5:06 pm

    As a user of Effexor, I am glad to read this. My taking an “anti-depressant” drug, is because of a medical condition, Fibromyalgia. When I was told that my seritonin level was way too low, I was leery of taking this drug….but with prayers and a good pastor saying that I really need it, here I am years later.

    Unfortunatly some people think that Christians should NOT take this or any other “mind altering” drug but for me, I thank God that He has given men the wisdom to make these drugs.

    Thank you for explaining this is a very good way.

    Blessiings

  4. danielj permalink
    3 June, 2008 6:07 pm

    May Christians take a little bit of cocaine instead of using alcohol?

    Why not I say!

  5. 4 June, 2008 2:05 am

    Eric, I think your thoughts on the biblical teaching of the human person being a body-and-soul unity are spot on. There is a tendency to divorce ‘spirit’ from material reality when we approach these things, which I think is more Western philosophy than Bible.

    Danielj: Cocaine is extremely dangerous even in tiny quantities, and it’s thoroughly illegal (for starters). For certain things like cocaine — and unlike alcohol — there is really no line between use (proper enjoyment of God’s good gifts) and abuse (sinful indulgence or reckless abandon).

    ~B

  6. danielj permalink
    4 June, 2008 1:29 pm

    It isn’t illegal in every country and in really small amounts has around the same effect as the S.S.R.I’s. Additionally it isn’t any more addictive and, Scarface jokes aside, cocaine doesn’t cause homicidal or suicidal outbursts during withdrawal sessions like anti-depressants.

    Why is the legality even an issue? Should the state be able to regulate your medicating of your own body? What if the state outlaws vitamin C injections? Will you comply?

    What about Coca leaf? One can obtain a lot of vitamins and minerals from chewing the leaf without about as much buzz as provided by a cup of coffee sans the naturally diuretic effects of caffeine.

  7. danielj permalink
    4 June, 2008 1:31 pm

    Eric I agree with your thinking as well.

    We tend to overly spiritualize and ignore the fact that DNA is real and thus, the flesh is real and immediate. The material universe imposes restraints upon us, that is in fact, part of what sin is. Is not original sin the spiritual indwelling the material?

  8. creedorchaos permalink*
    4 June, 2008 2:40 pm

    danielj~

    Legality is an issue because of the Christian’s requirement to submit to the ruling authorities; and the church’s situation when Paul wrote, under Roman rule, was certainly no bed of roses. And I have no objection to your munching on coca leaves any time you want.

    How can you agree with Eric (against gnosticism!) and at the same time say that the spirit indwelling the material is original sin? Are you serious? Or are you just attempting to be provocative…

    ~B

  9. Eric permalink
    4 June, 2008 3:25 pm

    Thanks for the feedback on this. I think that the use of good, positive, constructive substances are of the essence of what makes us human beings. I’ve always been intrigued by 2 Timothy 2:20-21, the realization that we are all in a great house, and that there are many different kind of objects in that house, some more valuable than others. In a real sense, that commands the kind of discernment we need as Christians. In I Thessalonians 5:21-22 (NIV), Paul writes: “Test everything. Hold on to the good. Avoid every kind of evil.” I think it is incumbent upon us not to be lazy in testing all the various substances of this world, but to be very active in our discernment, not sinking into legalism, nor flying into antinomianism, but being active and cautious participants in the world around us.

  10. Heather permalink
    4 June, 2008 7:25 pm

    It’s not really a christian issue…. even a pagan or satanist would be foolish to use antidepressents. It’s the biggest hoax propogated on our society in modern times. Big Pharma has duped everyone – antidepressents don’t work, and are poisons to peoples’ minds and bodies. They’ve ruined my family, they’ve ruined many of my friends’ lives. Thank God Jesus is an answer even when antidepressents aren’t, but even if someone doesn’t know Jesus, they’d be much better off to try almost ANYTHING else than an antidepressant. (And that goes for all the other psych drugs as well.) I realize that mental illness is a REAL experience and that people legitimately need help…but big Pharma does not have the answer on this one.

  11. creedorchaos permalink*
    5 June, 2008 1:17 am

    Heather~

    I think we can all agree that antidepressants are often WAY over-prescribed, and I think one of the great things about what Simon is saying, is that Christians should avoid taking these things, if it’s for any of the many wrong reasons — esp. if it’s an alternative to looking to Christ alone for all our hope and joy and peace.

    On the other hand, a total blanket conspiracy theory is a little hard to swallow (pardon the pun). I’m genuinely sorry to hear about your family’s troubles. I’m sure there are many other cases where these things are ineffectual and misused, but that doesn’t mean that ALL are such cases. I think Simon addresses this really well (have you read the other parts of the essay yet?) There are lots of people who have benefited from a cautious and wise use of these things, as a medical means rather than an idolatrous savior (as they are often treated, I agree).

    Yes, Jesus is THE answer, and nothing can or should compete with him — but Jesus doesn’t ask us to pit his redemption of our bodies and souls against using secular means appropriately. Jesus is Lord of both salvation and providence.

    ~B

  12. Eric permalink
    5 June, 2008 1:27 pm

    Thanks, Creed, I think you summed it up well in that last paragraph. There is the danger of idolatry–but people misuse a lot of things. Gluttony, for instance, is unfortunately one of the most acceptable Christian sins.

  13. danielj permalink
    5 June, 2008 4:47 pm

    How can you agree with Eric (against gnosticism!) and at the same time say that the spirit indwelling the material is original sin? Are you serious? Or are you just attempting to be provocative…

    I’m not sure. Perhaps a bit of both.

    What is original sin? Material indwelling material?

    Regardless, we are supposed to submit to ethical and Godly government aren’t we, not just any ol’ run o’ the mill tyrants?

    What if the government tells you pork is illegal to consume? (Coca leaves are illegal too as well in this country, even though it takes around a ton of leaves to make a kilo of cocaine.)

  14. creedorchaos permalink*
    6 June, 2008 12:14 am

    Danielj~

    Original sin is humanity’s loss of our native uprightness and communion with God because of our rebellion from God, and our being under the curse of sin and its consequences (leading ultimately to everlasting death), which all the natural sons and daughters of Adam suffer because of the just judgment of God pronounced upon his disobedience as our head: ‘in the day that you eat of it you will surely die’.

    In other words, I think the best way for us to understand original sin is to think in terms of Romans 5:12ff., where Paul specifically compares and contrasts condemnation through Adam leading to corruption and everlasting death for everyone he represents (all humanity in rebelliion against God), with justification through Christ leading to restoration and everlasting life for everyone he represents (all humanity who look only to him through faith). Paul says that the condemnation and justification both flow from the representative acts of either Adam or Christ, because of either their disobedience or obedience, unrighteousness or righteousness.

    All that to say, it’s not a spirit vs. matter issue, it’s a sin and rebellion issue, an issue of our rejection of our God-given identity and commission — our spirit-AND-matter humanity’s rejection of THE Spirit, the Son and the Father. See what I mean?

    I’m not saying we shouldn’t disagree with things the government does, or even try to work to change those things we feel are unethical — I’m saying that even while disagreeing and working for change we must submit to the authority that God has given the government for rule. The big exception is that we DON’T submit if the government’s laws explicitly conflict with the revealed will of God. We don’t support abortion clinics just because they’re legal, and we don’t stop doing missions in North Korea just because it’s illegal.

    And I didn’t know coca leaves themselves were illegal; I’d suggest you switch to coffee. 😉

    ~B

  15. Eric permalink
    6 June, 2008 1:59 pm

    Isn’t it great, though, how much God loved his people whom he elected and predestined for glory before the beginning of time? No cost was too great for Jesus to overcome man’s rebellion and bring many sons to glory through his suffering.

    It’s great that not only will there be a new heavens, but also a new earth, a paradise where the Fall will be overturned and men will live in peace and contentment.

    Even depression can work for the good if it lifts man away from himself and toward the God whom he can cry out to in his moment of despair.

    And the dead shall be raised, to take part in that glorious day.

    John Owen spoke of the “death of death” in the death of Christ. We saints can look forward to an infinite eternity in the place of our fallenness and rebellion.

  16. danielj permalink
    8 June, 2008 7:35 am

    Isn’t alcohol God’s prescription for depression alcohol?

    Prov 31:5-6 Give fermented drink to one perishing, and wine to the bitter of soul, let him drink and forget his poverty, and remember his misery no more.

    All that to say, it’s not a spirit vs. matter issue, it’s a sin and rebellion issue, an issue of our rejection of our God-given identity and commission — our spirit-AND-matter humanity’s rejection of THE Spirit, the Son and the Father. See what I mean?

    Are you saying the spiritual rebellion of Adam did not have an effect on our DNA or the material universe? Original sin scarred the physical, in some way, in my opinion and I don’t think I’ve read anyone that has explained it in a way that was sufficient and clear enough for me to understand.

    The big exception is that we DON’T submit if the government’s laws explicitly conflict with the revealed will of God.

    God has not outlawed intravenous vitamin C injections, eating pork, opium or coca leaf and if any government did such I would not submit and see no Biblical injunction to do so.

    I’m saying that even while disagreeing and working for change we must submit to the authority that God has given the government for rule.

    Is it okay for a slave to run away?

    The big exception is that we DON’T submit if the government’s laws explicitly conflict with the revealed will of God.

    God explicitly prescribes alcohol for the miser and the poor. Should they have not drank during the era of prohibition?

    We don’t support abortion clinics just because they’re legal, and we don’t stop doing missions in North Korea just because it’s illegal.

    God explicitly prescribes the death penalty for murderers.

    And I didn’t know coca leaves themselves were illegal; I’d suggest you switch to coffee. 😉

    Coffee contains caffeine, a natural diuretic and robber of precious nutrients so I prefer to abstain. 🙂

  17. creedorchaos permalink*
    9 June, 2008 1:15 am

    Eric: Very well said, and I hope something we can all say ‘Amen’ to.

    Danielj: I’m not sure what you’re trying to get at; honestly, I’m having trouble deciding whether you’re trying to figure things out and have a conversation or whether you’re just hair-splitting (or maybe, as you say, a bit of both). I don’t think the hair-splitting is helpful.

    If you are trying to have an honest dialog, then I think you need to listen more carefully to what the others of us in the conversation are saying and have already said, which often involves not bringing up a whole host of other issues which have little to do with what was originally said. Especially with the original sin issue, it seems you’ve come back around to saying something like Eric said at the very first and I agreed with — why would you then now say those very things as if in disagreement with me? As I said, I’m not sure what you’re trying to accomplish. Of course original sin ‘scarred the physical’, but that’s a far cry from ‘original sin is the spiritual indwelling the material’!

    Your appeal to the Bible is problematic — not because you’re appealing to the Bible, but because you’re being so selective. You appeal to certain passages concerning alcohol and the death penalty (neither of which I’m against in principle, but I don’t want to get into that now). Why don’t you do the same regarding your other questions? Paul addresses the issues of submission to government authority (esp. in Rom 13), and he also explicitly deals with slaves and masters (esp. in Eph 6).

    In fact, the whole epistle of Philemon is explicitly written on the occasion of a runaway slave (Onesimus) that has become a Christian, who Paul is sending back to Philemon his rightful owner! But here’s the kicker: Paul exhorts Philemon to receive Onesimus as a brother in the Lord rather than property. So no, it’s not right for slaves to run away, but neither is slavery right and it’s not right for Christians to have slaves.

    I want to stress, though, that these are biblical issues; it’s not an issue of spouting off my opinion or your opinion, or whatever comes into our heads at the time. Some things aren’t necessarily biblical issues, and some things are really complicated and really difficult to address, requiring wisdom. I’m not trying to be a wet blanket, or to say we should always take ourselves seriously — but we should always take these things seriously and our understanding and application of the Bible (all of the Bible) seriously.

    ~B

  18. 10 October, 2008 2:24 am

    I’m sorry. I couldn’t read beyond your first paragraph where you state:

    “(1) It has been known to elevate mood and even make some feel more than well.”

    Could you please cite your source(s)where you state some people “feel more than well.” It has been my first-hand knowledge, and through my education and training, that when one is administered too large a dose of SSRI’s one does not feel “too well.” On the contrary, one may feel worse, in fact, one may have to be hospitalized. Thank you for your article.

  19. 10 October, 2008 4:57 am

    Anonymous~

    I’ll have Simon get back to you, but I’m pretty sure he’s not talking here about any result of overdose. He’s saying that sometimes people who take prescribed levels of SSRIs not only feel emotionally ‘normal’, but ‘better’ or ‘happier’ or ‘more content’ than normal — as if in a perpetually good mood.

    I’m glad you found the article helpful,
    ~B

  20. 10 October, 2008 3:16 pm

    Because anti-depressants work on various brain chemicals (most work on the serotonin) some also work in tandem with other chemicals: norepinephrin, for instance. If one was given more than what one needed, the brain would actually start to form new receptor sites to “take up the difference”. An excess of norepinephrine in the brain, instead of giving one more energy, could make one feel more agitated. Our body is living miracle and is designed to keep itself in balance. I, for one, never heard of anyone being in a perpetually good mood, again, I would like the scientific resources where you are getting your information from. It doesn’t sound like science to me, more like, superstition and legend. Your blog is very well written however. Thank you.

  21. 11 October, 2008 12:00 pm

    Would a nay-sayer to Christians using antidepressants for major depression please explain the difference between such use and the use of an antibiotic for infection, a potassium supplement for a potassium depleting illness, an antihypertensive for hypertension or any of the plethora of medications God has blessed us to have developed for indicated and judicious use?

    I was an advanced practice psychiatric nurse prior to developing a disabling illness – vertigo. (I wish that I could find a medication that would assist me to feel and function better during vertiginous attacks!)I can not tell you how many patients have made nothing less than remarkable recoveries from major depressive episodes with the assistance of antidepressants. Many of them had tried other therapeutic modalities including Christian counseling prior to their having begun antidepressant therapy, and made great time getting nowhere, or even more deep in to their depression.

    I have found this discussion most enlightening and frustrating simultaneously.

    His shalom to all.

  22. Simon Jooste permalink
    16 October, 2008 7:59 pm

    Greetings anonymous ~

    Thank you for your stimulating feedback. If you have not already done so, I would encourage you to read the entire essay. Please note that I wrote the essay as a theologian and not as a medical expert (see footnote 1). Based on my research, the general consensus is that the medical field has not reached definitive conclusions regarding the effect of antidepressants, such as Prozac, upon the body. Thus an element of mystery must be allowed in this discussion.

    As to particular sources: I leaned heavily on ‘Beyond Therapy: Biotechnology and the Pursuit of Happiness’ by the President’s Council for Bioethics (Chairman, Dr. Leon Kass). Among other places, chapter 5, especially, advocates the thesis that SSRIs can be used in a ‘performance enhancing’ capacity (akin to steroid use in the athletic arena). They argue that to ‘feel more than well’ is, for example, to be sanguine when grief is appropriate or be indifferent when fear is fitting. Please see my section titled: ‘Looking for heaven on earth: navigating a culture of therapeutic narcissism’.

    The same ethical question is raised on a more theological level. To ‘feel more than well’ is to have SSRIs blunt one’s sensitivity to sin and its effects. This is also a risk for someone who has a real mental illness and feels less than well in other ways.

    As to the brain chemistry behind what effects such change in people, as far as I can tell the jury is still out. This field of biotechnology is young and powerful, thus my interest in posing some ethical questions.

    I hope this helps.

  23. 22 August, 2011 12:01 pm

    There is no such thing as chemical imbalance. Please read America Fooled by Timothy Scott. America is fooled by so called psuedo-scientific research. As christians we are called to build our life on truth and not a lie. The whole chemical imabalance theory is a myth. As Christians we can never subscribe to it.

    The reason why these psychotropic drugs work is still a mystery. We still do not know the kind of damage these drugs. Peter Briggin, Irvin, Josephn Gnenmeullen and others have all written on this topic. But the most convincing one is America Fooled.

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  1. May Christians Take Prozac? « Heidelblog
  2. Is it Ethical for a Christian to Use Anti-Depressants? « Docendo Discimus

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