He lifted me out of the pit of despair, out of the mud and the mire.
He set my feet on solid ground and steadied me as I walked along. (Psalm 40:2)
If you have ever suffered from depression, it’s good to know that Scripture comes to life on this topic in many places. And you are not alone. Depression is one of the most common problems people face, one that motivates many people to seek therapy.
Researchers and clinicians have developed an array of effective treatment options for depression. But our eternal source of wisdom and hope also speaks in some way to all the problems we experience as human beings, including this one. God’s word and clinical knowledge flow together and can work together when helping sufferers overcome this type of severe emotional pain.
After many years of wearing my clinical hat, I readily recognize when a client meets the criteria for major depressive disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). If you are not familiar with this weighty tome, it is the guidebook used by clinicians to diagnose and treat psychological problems and bill insurance companies for the treatment.
According to the DSM-5, major depressive disorder, also called clinical depression, varies in prevalence according to age group, gender, ethnicity, and socioeconomic status. But over a lifetime, most of us will experience this distressing condition at some point.
According to the National Institutes of Health, an estimated 21 million adults in the United States had at least one major depressive episode in 2020, which is 8.4 percent of all US adults. (That may be a very conservative estimate—2020 was an especially tough year around the world.) And not every depressed person reports their symptoms or seeks treatment.
The prevalence of depression is significantly higher in women than in men and is especially concerning among teenagers. In 2020, an estimated 4.1 million adolescents aged 12 to 17 in the United States had at least one major depressive episode, and an estimated 41.6 percent of these teens had an issue severe enough to warrant professional treatment and/or medication.
The numbers speak the reality that at any given moment, a huge number of people are either depressed themselves, concerned about a depressed loved one, or both.
There are two cardinal symptoms of major depression, as defined by the DSM-5. The first is depressed mood most of the day, nearly every day over a period of two weeks or more. This may be experienced as a pervasive sense of sadness, emptiness, or hopelessness. The second is loss of interest or pleasure. Things that we normally are motivated to get up and do no longer matter and we lose motivation to engage in life. Everything becomes flat and empty.
After these two signs—one or both of which must be present to render the diagnosis—seven other symptoms might be observed in a depressed person. To summarize, they are marked increase or decrease of appetite, insomnia or hypersomnia, agitation or slowing of motion, fatigue, feelings of worthlessness or inappropriate guilt, impaired concentration, and recurrent thoughts of death or suicide.
Depression presents differently in different people because of our life experience, environment, and how we are each uniquely knit together. Genetics, medical problems, life stressors, and spiritual and sociocultural factors influence the onset or course of the disorder. With all of these variations, one thing we can say for sure is that deep depression has existed as long as humans have walked the earth.
Fortunately, given its prevalence, depression is one of the more treatable psychological problems. Much research over the last century supports the hypothesis that psychotherapy and antidepressant medication are often effective separately, and even more effective when used together. Clinicians can legitimately offer hope of recovery to all but those with the most resistant of cases.
Because depression can be caused by many different biological, environmental, and temperamental factors, treatment is most effective when it corresponds to the cause. For example, if there is a physiological depletion of serotonin in the brain, an antidepressant might be called for. Sometimes improved diet and exercise regimens are sufficient to bring relief, restoring the flow of naturally occurring endorphins. Where there are overwhelming environmental and relationship stressors, they must be recognized and reduced, often with the use of some form of counseling or psychotherapy.
This makes sense. As with any type of chronic physical pain, dulling or temporarily silencing the pain does not cure the underlying problem or cause. With depression, pills can pull us back from danger and mitigate the symptoms causing acute suffering. Sometimes I have had to proceed slowly with clients until medications or other medical treatment renders them capable of engaging in a deep counseling process. Mood needs to lift to the extent that we can begin to discuss the inner and outer conditions triggering the symptoms and what might be done to bring hope and renewal.
Unfortunately, some people self-medicate with street drugs or alcohol, and this compounds the problem. Long-term numbing of emotional pain with no attempt to understand its causes can be a recipe for disaster. Instead, the onset of major depression is a time to open ourselves to an outside influence—a minister, a therapist, a healing prayer partner, and God himself—so we don’t just mask our symptoms but work to eradicate the disease.
This is where Scripture is especially helpful. Did you know that the Bible frequently portrays people with depression? There are numerous stories depicting despair, hopelessness, and loss of the will to live. Consider Job, Naomi, David, Hannah, and Saul, for example. But depression is most vividly portrayed in the Psalms. Psalm 102 stands out in this regard.
Psalm 102 presents a particularly compelling portrait of depression. Penned many centuries ago, this lament by an unidentified psalmist lists an array of nearly life-threatening physical, emotional, relational, and spiritual complaints. Combined, they depict a person in the throes of a depressive episode.
Listen to his cries:
• For my days vanish like smoke; my bones burn like glowing embers. (v. 3)
• My heart is blighted and withered like grass; I forget to eat my food. (v. 4)
• In my distress I groan aloud and am reduced to skin and bones. (v. 5)
• I lie awake; I have become like a bird alone on a roof. (v. 7)
Notice the loss of appetite, fatigue, and insomnia. He is in acute pain; even his bones feel like they are burning. The DSM-5 doesn’t list it as a symptom, but after thirty years of talking with depressed people, I know that depression often causes real physical pain. As one antidepressant commercial claims, depression HURTS.
Then the psalmist names some relational and emotional effects:
• All day long my enemies taunt me; those who rail against me use my name as a curse. (v. 8)
• For I eat ashes as my food and mingle my drink with tears. (v. 9)
• Because of your great wrath, for you have taken me up and thrown me aside, my days are like the evening shadow; I wither away like grass. (v. 10)
Clearly this person feels alone and abandoned, forsaken by God and man, metaphorically thrown aside. He has become hopeless, a mere shadow of his former self. Do you see the loss of interest or pleasure in living? He awaits help and comfort.
One reason this psalm stands out is that we don’t just witness the problem, but also the cure. We observe a hurting person’s path from the darkness of depression into the light of hope. It is doubtful that mental health professionals were standing by when Psalm 102 was written. The psalmist probably had to find his way out of the darkness on his own.
The first thing this writer does is approach God with the problem. He prays:
Hear my prayer, Lord; let my cry for help come to you. Do not hide your face from me when I am in distress. Turn your ear to me; when I call, answer me quickly. (v. 1)
He acknowledges his need for help from the Master Therapist. He is ready to surrender his problem and is counting on an answer from the Lord. There’s something about confessing and admitting our need that gets us unstuck. It helps to talk it out with someone qualified to listen in a helpful way. We must come out of hiding when depressed and begin to share the burden with someone. Who better than God?
After telling his woes, the psalmist begins reminding God of who he is, and of what he has promised to his people. He praises:
But you, Lord, sit enthroned forever; your renown endures through all generations. You will arise and have compassion on Zion, for it is time to show favor to her; the appointed time has come. . . . The nations will fear the name of the Lord, all the kings of the earth will revere your glory. For the Lord will rebuild Zion and appear in his glory. (vv. 12–13, 15)
Do you feel this palpable shift from groaning to praising? As he releases his song of praise, he is delivered from obsession with his misery and remembers that God has always been his deliverer. Maybe you have experienced this phenomenon. When feeling bound by an inner cyclone of distress and despair, you raised your head, sang God’s praise, and found a sudden sense of freedom. The cage door was opened. The clouds parted and you could see the sun again.
The rest of Psalm 102 reads like a good therapy session. The psalmist tells his story. He gives background, reciting both the causes of his despair and his unfolding revelation of the path forward. He regains perspective. The psalmist talks it through (or sings it through) until he remembers that he is part of God’s story and not the other way around. He’s had mountaintop experiences with the Lord, and he’s been in deep, deep valleys where he felt forsaken, but in reality, never was.
He remembers that he and his generation will pass away, but while in the land of the living, they can look to the Lord their God and keep their trust in him. New generations will come and live in the presence of this same faithful God and join his never-ending story.
But you remain the same, and your years will never end. The children of your servants will live in your presence; their descendants will be established before you. (vv.27–28)
While the sinister lie of depression is that we will always feel this way and there is no way out, I’ve watched hundreds of clients climb out of the pit and regain hope and health. It can happen in a variety of ways. But the underlying process follows the same pattern found in this psalm and can be employed when we find ourselves in the grip of depression.
We pray and ask for help—from human helpers and God. We praise, give thanks, and in telling our stories, remember that there is still much worth living for. We regain the perspective that all things do pass. We trust that we will get better if we don’t give up.
