Do we need Xanax?

I woke up this morning and soon was feeling anxious.  I have struggled with my nerves at times in my life.  On a number of occasions, it has been debilitating.  Last night I had gone to our medicine box and dug out some Xanax I had been prescribed at a time when I had suffered a breakdown, and this morning I took one.  It is Saturday, and so I cannot talk to my doctor, but plan to do so on Monday.

I have been under a lot of stress.  There is a family situation that is quite demanding.  There is the fact that I had recently had a small operation, and was in agony for part of yesterday.  My siblings and I are currently trying to figure out how to care for our elderly parents.  I had just completed a couple of weeks of the busiest ministry I have ever experienced.  Then, last night, we took an antigen test and myself and my wife showed positive.  We are going to have to isolate for a week.

When my nerves struggle my thinking becomes unbalanced.  I get drawn to dark thoughts.  I began to think obsessively of the lostness of our world, and in particular the painful fact that people who refuse to give their lives to Jesus and embrace His forgiveness are going to be eternally lost.  It all became too much.  In the past, when I used to get into such a state, I feared that I was beyond God’s grace.  Such feelings are terrifying.  Such obsessing is related to the fact that I struggle with Obsessive Compulsive Disorder.

But should I have relied on a Xanax?  Afterall, shouldn’t it have been enough to cast my anxieties on the Lord who cares for me (1 Peter 5:7)?  Let me share a couple of thoughts.

Firstly, while we are told not to worry (Matthew 6:25) not all anxiety is sin.  We have been working through Second Corinthians in our Sunday evening service, and I am stuck by the anxieties that the apostle Paul and his colleagues felt under the crushing weight of their ministry.  Paul writes that ‘we were under a burden far beyond our ability to endure, so that we despaired even of life’ (2 Corinthians 1:8).  If our worries reflect a simple lack of trust in our heavenly Father to provide our daily needs then, yes, we need to exercise more faith.  But it may be that you are simply breaking under the weight of the pressures you are facing at this moment.  I also want to say, that even if our worries do reflect a lack of faith, our Saviour is gentle—a bruised reed He will not break, and a smoldering wick He will not snuff out (Matthew 12:20).  There can be a great gentleness in His command to stop worrying.

Secondly, in a fallen world our brains don’t function the way they should.  A failure to understand mental illness is a failure to understand the implications of the first three chapters of Genesis.  The fact that some people are more prone to anxiety than others may reflect such things as the make-up of their brain.  As I think of the current war in Ukraine I feel so weak that I can’t handle my current stresses, when there are so many people who are suffering the loss of home and the danger to life.  But we need to speak graciously to ourselves.  God is sovereign over the way we have been formed. 

So, do we need Xanax?  Issues like burnout, panic attacks and nervous breakdowns are more than simply not having trust in God.  They are like a wound or injury to the brain.  The brain is struggling to function well.  Like any wound it needs treatment.  I have never heard someone being accused of not trusting God because they practice deep breathing or figure out how to have a healthier work/life balance.  Often injuries or illnesses should be treated with medication, and these medications are received as a gift from God (1 Timothy 5:23

I want to finish with two insights made by doctor friends of mine.  One, a General Practitioner, expressed his frustration that in our overburdened health service it is too easy to simply write a prescription.  Mental health issues often have a variety of causes and resources need to be put into talking therapies as well as medicinal treatments.  The second, a neurologist, pointed out that one role of medicines, in regards to mental health, can be to restore a sense of equilibrium to the brain, and that this will help the Christian to be in a place where they can better trust in the goodness and promises of God.  That has been my case today! 

Is it unspiritual to be depressed? (Part 3)

During my recent struggle with depression I thought of the advice that I often give when talking on this topic.  I was struck by how inadequate it seemed to be.  So I am rethinking what to say to those who are depressed or anxious.  I am aware that what advice helps may differ from person to person, and may change with regards to what stages their depression-anxiety is at.  The following ten tips are very inadequate, and I would recommend that you read some good books on the topic.  One book I have really enjoyed by David Murray is called ‘Christians get depressed too.’  Another good book that I am working through is entitled ‘I am not supposed to feel like this’.

1.      Hope

My recent struggle seemed different than anything I had suffered before.  As a result I feared that it might not lift.  The psychiatrist did not share this worry.  She said that it would lift, and it did.  The fact is that the lowest part of depression does lift.  You need to remind yourself that this too will pass.  I was struck at how important a sense of hope is.  Do everything not to give up your hope and remind yourself that you have not always been in these depths and will not always be in these depths?

2.     Rest

Rest is a part of God’s design for his people.  I tend to be tempted to feel guilty for talking time off.  I remember when I was first married Caroline told me that I was working too hard.  I wanted to reply to this observation by saying, ‘thanks’.  I did not realise that it is actually disobedient to God not to refresh oneself through rest.  I am about to order another book by David Murray called ‘Refresh’. 

Meditate on the story of Martha and Mary, and hear Jesus inviting you to take some time aside.  Make as many changes in your lifestyle as you can to ensure that you can cope.  Learn to say ‘no’ without feeling guilty.  A friend pointed out that we are to work from a place of rest rather than rest from a place of work.  Make sure that you get enough sleep.  If you are struggling to sleep at night you will need a rest during the day (however, it can be unhelpful to stay in bed when you are not resting and just worrying).

The apostle Paul told his young disciple Timothy that bodily training is of some value (1 Tim. 4:8).  We must not ignore the connection between the body and the soul.  This can be a good form of rest and refreshment.  John Piper copes with his proneness towards a low mood through regular exercise.

3.    Talk

Talk to your loved ones and tell them how you feel.  Talk to your pastor and people in church.  Seek help and support.  It is really important that you feel free to talk to your doctor.

Sadly there are people who stigmatise mental illness.  Try not to let their ignorance hurt you.  I had one person tell me that he thought it was a mistake that I told the church that I had had a breakdown.  They thought that if I had simply explained that I was sick then people might have concluded that I was suffering from the flu!  Clearly this person sees mental illness as something to be ashamed of.  Don’t let such attitudes stop you from experiencing the support that comes through being open about the nature of your suffering.

4.     Pray

I used to tell people to pray the Psalms.  Yet when I was in the pits I could not pray with much focus.  I tended to go around and around in circles asking God to make me better.  I actually started typing out my prayers to give them more focus.  Journaling may also help you work through your thoughts. 

One of the important things to learn is not to feel guilty about how hard you are finding it to pray.  You heavenly Father understands.  He is kind and gracious to you.  Jesus taught us that he did not want to add heavy burdens to his beloved people.  Set realistic and helpful prayer goals.  Target just a few minutes of prayer a day.  Don’t beat yourself up over the fact that you can’t focus.  Don’t blame yourself for the fact that God seems absent.  He is not absent, even though your feelings tell you he is.  The fact that your feelings make him seem absent is not your fault.

I do think that the Psalms are a great resource for the depressed Christian.  Read them and you will be surprised at how honest the writers are with their complaints.  You may not have the energy to spend much time in them when you are in the pits, but see them as an invitation to get real with God.  I recommend Tim Keller’s meditations of the Psalms entitled, ‘My Rock and Refuge.’  

5.    Deal with feelings of guilt

I did say that there can be a relationship between guilt and sin.  However, I have found that many people who struggle with sin are too quick to assume that they are being punished by God.  God is our gracious heavenly Father.  He is slow to anger and abounding in love.  He does not treat us as our sins deserve, but according to his loving-kindness.  If there are things that you need to confess to God and repent of then do so.  Then thank God for the fact that there is no condemnation for those who are in Christ and that he delights to forgive.  God wants you to rejoice in his forgiveness.  It does not honour him to hold on to feelings of guilt over past sin.  I asked a depressed friend if he realised God sings over him (Zephaniah 3:17).  He replied by saying that seemed too good to be true.  But it is true!

Avoid sinful responses to depression and anxiety.  Your relationship with food will change.  I struggle to eat when I am anxious, but others are tempted to comfort eat (I am prone to do this when I am not ill).  You might be tempted to escape into a world of sexual fantasy.  When I am mildly depressed I am prone to enjoy self-pity (I try not to listen to soppy eights music at such times).  Such attempts to find comfort will only leaving you feeling worse.

6.    Grow in your confidence in the character of God

One of the cruel things about depression and anxiety are that when we are depressed we are vulnerable to believing lies.  We must combat these lies with the truth.  What many sensitive people need is to realise that God is a loving-Father who always seeks the good of his children.  Ed Welch writes, ‘Just think what it would be like to be certain that the God of this universe loved you.  That alone would probably change the contours of depression.’

One of the ways that God shows his love is through his people.  Look to Christians who reflect the gracious character of God.  If you focus on Christians who are harsh and unloving, especially Christian leaders who are not merciful, then your image of God may become distorted.  Look to people who know God and reflect God well to you.  Remember that it is God who makes them the way they are.

7.     Put your faith into practice

It is always important for us to put our faith into practice.  You may not be able to do this when you are very depressed however there is healing power in doing things for others for the glory of God.  Listen to the healing words of Isaiah (58:10):  ‘… and if you spend yourselves in behalf of the hungry and satisfy the needs of the oppressed, then your light will rise in the darkness, and your night will become like the noonday.’

8.     Guard your thoughts

The reformer, Martin Luther, said that you cannot stop a bird landing on your head, but you can stop it making a nest.  He was saying this regarding our thoughts.  I find that when I am struggling with anxiety my thoughts gravitate towards the worst possible scenario.  It can be very difficult to control your thoughts, and to stop catastrophic thinking making a nest in your mind, but it is important to try and guard your thoughts.

A friend of mine gave me the wise advice of writing down things that I am thankful to God for.  Thanksgiving is a good way to help your mood.

I have noticed that many depressed people struggle with an extreme and exaggerated sense of responsibility.  Allow God to be God and trust him to look after your life and the life of others.

9.     Self-worth

David Murray points out that deep rooted self-doubt and self-criticism will often emerge will often emerge and strengthen during a depression.  Depressed people often feel worthless and useless.  But some Christians are reluctant to give people any praise or encouragement because of the risk of making a person proud.  However Murray points out that pride is one of the least risky vices for the person who is depressed.  Pride results from having an over-inflated view of one-self.  Depression usually involves the opposite.  Without minimising the wickedness of the human heart and our inability to please God apart from Christ, ‘we should feel free to encourage depressed people to have a more view of themselves by highlighting their God-given gifts, their contribution to the lives of other, their usefulness to society, and, if they are Christians, their value to the church.’     

10.  Deal with issues in your past

One of the key things to understand about depression-anxiety is that it may be multi-faceted.  Medication may have its place.  There may be a need for rest and lifestyle changes.  There will also be wounds that we carry from the past.  We may have developed wrong ‘core beliefs’ about ourselves from our upbringing.  There may be hurtful things said to us, or traumatic incidents that need to be worked through.  Start by opening up to a trusted and wise friend.  But don’t be too proud to seek the help of someone who has more expert care. 

Is it unspiritual to be depressed? (Part 2)

Yesterday I posted on the causes of depression-anxiety.  Today I want to deal with some of the questions that Christians may be concerned about regarding depression-anxiety.

Is it unspiritual to be depressed? 

The first response to this question is to point out that there are many godly people who have passed through times of immense sorrow.  The great Baptist preacher, Charles Spurgeon, struggled with depression throughout his life.  One thing that appears to have ignited this was a specific tragedy. 

Spurgeon was preaching to a huge congregation—of over twelve thousand people, at the Exeter Hall in London—when some prankster yelled, “Fire!”  In the chaos that ensued seven people were killed, and Spurgeon was inconsolable.  Other factors contributed to his depressions, including his struggles with gout and his concern for those he pastored.  Spurgeon seems to have been good at caring for others but not so good at letting others care for him! 

He exclaimed that there are dungeons beneath the Castle of Despair, and that he had often been in them.  ‘I could weep by the hour like a child, and yet I knew not what I wept for,’ he recounted on one occasion.

In the book of Psalms, we often hear the psalmists crying out to God in despair.  Over fifty of the psalms can be categorised as psalms of individual lament—where the psalmist cries out in pain before God.  These psalms are given to us by God, in part, to help us express our pain.  They were also words that Jesus would have had on his lips expression his feelings (for example Psalm 22:1).

Most significantly we must remember that Jesus was a man of sorrows familiar with grief (Isaiah 53:3).  Spurgeon wrote, ‘No sin is necessarily connected with sorrow of the heart, for Jesus Christ our Lord once said, “My soul is exceedingly sorrowful, even to death.”  There was no sin in Him, and consequently none in his depression.’

However, John Piper warns us that depression does present us with particular temptations.  Most obviously, depression tempts us towards self-pity.  Also, there is a temptation to find comfort in wrong ways: like over-eating, overwork and substance abuse.

But what about the fact that the fruit of the Spirit includes joy?

But if the fruit of the Spirit includes joy, then am I less spiritual when I am depressed? 

I put this question to a friend of mine, who is a lecturer in a leading evangelical theological college.  He replied, ‘I guess joy is not simply an emotion.  And so someone with depression can still (though it would be harder) rejoice, [that is] have confidence in the Lord.’  He then says that Psalm 31:7-9 might be worth looking at.

Psalm 31:7-9 reads, ‘I will be glad and rejoice in your love, for you saw my affliction and knew the anguish of my soul …  Be merciful to me Lord, for I am in distress; my eyes grow week with sorrow, my soul and body with grief.’  Do you see that in these verses rejoicing and the sorrow seem to live side-by-side?  It seems that we have here an example of being sorrowful, yet always rejoicing (2 Cor. 6:10).  Ed Welch writes, ‘Joy is not the opposite of depression.  It is deeper than depression.  Therefore, you can experience both.’  However, I don’t want to be naïve.  In Psalm 88 there is no sign of the light coming.  It is the darkest of all the psalms and ends with the haunting words, ‘darkness is my closest friend.’  That has been the experience of some godly people.

Joan Singleton lectures in pastoral care in the Irish Bible Institute.   At one stage, when she was depressed, she wondered if her depression inhibited her witness as a Christian.  Then she realised the powerful testimony in the fact that she was still hanging on to God and believing his truth, even though her life was filled with pain.

What about anxiety, isn’t it wrong to worry?

I am not disputing that worry can be a real sin, but I think that anxiety can have many roots, some of which are not sinful.

In this I see a parallel between anxiety and doubt.  On certain occasions Jesus rebuked the disciples for their doubt, because it revealed a stubborn refusal to accept the truth (e.g. John 20:27).  Yet in the letter of Jude we read that we are to ‘be merciful to those who doubt’ (Jude 22).  Those to whom Jude was referring doubted, not because they stubbornly refused to believe, but because false-teachers had infiltrated the church and upset their faith.   So there is doubt that deserves a rebuke and doubt that needs gentle pastoral support.  Similarly, there is anxiety that deserves a rebuke and anxiety that needs gentle pastoral support.

Sinful anxiety is rooted in a failure to trust God, or in the fact that we have made peripheral things too important in our lives.  David Powlison observes that, ‘if what you most value can be taken away or destroyed, then you have set yourself up for anxiety.’  However, not all anxiety is condemned in Scripture.  For example, the apostle Paul experienced the anxiety related to caring for the health of Christian churches (2 Corinthians 11:28).  As we have seen in many of the psalms, God gives us words to put on our lips to express our anxiety. 

When our anxiety has roots in a distorted view of God, we need to be gently instructed in the truth of his gentleness and grace.  We are told to cast our anxieties on the Lord, because he cares for us (1 Peter 5:7), but some people need help in coming to understand that he really does care for them.  The person with an anxiety disorder may not even be fully aware as to why they are so anxious.  Their worries may have more to do with do with imbalances in brain chemistry than the actual issues they are focusing on.  It would simply be too harsh to simply tell them just to stop worrying.

Is it okay to take anti-depressants?

John Piper was asked the following question from a listener on his podcast:  ‘What do you think of Christians taking anti-depressants—I have been on them and have been accused on not relying on God?’

In his answer, Piper takes a drink from a bottle of water and then asks, ‘was that sip a failure to rely on God?’  After all, God could simply keep his throat miraculously moist!  He could have prayed for his throat to stop being dry.  But he took a physical solution for the problem (the water).  Piper’s point is that God has given certain means to provide for our physical well-being, and these are to be taken with thanksgiving.

iper then explains that he has reached the conclusion that there are profoundly physical dimensions to many mental conditions.  Since that is the case, physical means can be us to help people out of their depression—just as medications are gratefully received in the treatment of many other illnesses.  Indeed, in our depression or anxiety it may seem that we cannot focus our minds and hearts on the gracious promises of God and that these medications bring us to a place where the truth can better impact our hearts.

It is unspiritual to be depressed? (Part 1)

I have struggled with anxiety and depression on and off for years (depression and anxiety are so inter-related that doctors are increasingly using the term ‘depression-anxiety’ when referring to depression).  I have to say that I have many things in my life to be thankful for, and I can honestly say that I have seen God’s hand in my illness. 

Before Christmas I had a small breakdown, and at the start of the year I went through a number of weeks of dark depression.  This caused me to want to review what I had written on this topic.  I am thinking about the question ‘is it unspiritual to be depressed?’  But before I address that question I want to look at some of the causes of depression. 

The one thing that I want you to take away from this post is that depression and anxiety are multi-faceted, and therefore their treatment will involve a number of complimentary remedies. 

What causes depression-anxiety?

Ed Welch explains that, ‘Depression is a form of suffering that can’t be reduced to one universal cause.  Many factors may cause depression, and often more than one of these factors is at work in the depressed person’ (Ed Welch).  I will mention some of the causes of depression-anxiety.

Depression is the result of living in a fallen world.  The book of Genesis teaches that because of human rebellion, God has subject humankind to decay and death.  Our bodies ache and deteriorate, and we are prone to physical and mental illness.  David Murray points out that many people have a genetic predisposition to depression.  The physical root of much mental illness is part of the reason why it is appropriate to take physical treatments like medicines.  The fact that there are generally other factors contributing to depression is why medication alone will not be sufficient for its treatment in the long-term.

Depression can be the result of other people.  People hurt us in a variety of ways.  Many victims of abuse struggle with mental health issues in later life.  I know a number of victims of childhood abuse, and the scars they live with lie very deep.  Similarly, a friend of mine experienced terrible bullying when he was at school, and this has contributed to lasting mental pain.  Another friend of mine was regularly woken by her mother in the middle of the night, simply so that the mother could tell her how much she disliked her.  Many emotional problems can be traced to harsh, distant or unloving parents.  When someone tells me that they struggle to relate to God, I often begin by asking them how they got on with their father.

Sometimes we are the cause of our depression.  For example, anger is a notorious cause of depression.  We can’t expect a joyous life if we are critical, bitter and unforgiving.  However, it is not just sinful patterns of thought that contribute to depression.  Lifestyle issues can trigger depression.  You may be overworked and under-rested.  There may be issues of illness and grief that you can do nothing about.  I have noticed that many depressed friends have a tendency to feel an exaggerated sense of responsibility.  They blame themselves for everything and take the concerns of the world on their shoulders.  Some are prone to self-doubt and insecurity.  Another feature I have noticed in the depressed is a tendency to be overly harsh or critical of themselves.

Related to this is the role of false-beliefs.  If you think you are of no value, you will be prone to feeling depressed.  The reformer Martin Luther struggled with depression.  He claimed that his depression always focused on doubts about whether God is good or if he is good to me.  Another false-belief that the depressed can suffer is the fear that they will never emerge from the darkness.  That was something that terrified me in my recent bout of depression.  I thought, ‘maybe this is the way I will be for the rest of my life.’  You will get better! 

Satan is a factor in depression.  Not in a wacky way, but in the fact that he will remind you of your past guilt, tempt you towards bitterness and seek to implant in you doubts about the goodness of God.

In Psalm 32, David links a time of depression to God’s discipline.  He refused to face up to his sin, after his adultery with Bathsheba.  So God’s hand was heavy upon him until he acknowledged his guilt.  However never assume that someone’s depression is God’s discipline, but always examine your heart to see if God might be drawing attention to issues he wants to deal with you.  My experience is that many sensitive souls are far too quick to think that God might be disciplining them as they go through their depression.

Finally, there is a sense in which God stands behind all our depression.  After all God rules over all that takes place in the universe.  Enemies may wound us but God could shut their mouths.  Similarly, our brain chemistry is not beyond his control.  I have been greatly helped by words of the hymn-writer, John Newton, who said that ‘everything is needful that he sends; nothing can be needful that he withholds.’  The fact that God is in control may leave us with painful questions, but it is also one of the greatest sources of comfort.  He has a purpose in this, though we may never know what it is.  While God never does anything that he needs to apologise for, I do like the perspective of the person who said, ‘God does have an eternity to make it up to you.’