Psalm 139:13-14 (NASB): For You formed my inward parts; You wove me in my mother’s womb. I will give thanks to You, for I am fearfully and wonderfully made; wonderful are Your works, and my soul knows it very well.
Trouble in mind, I’m blue
But I won’t be blue always
‘Cause I know the sun’s gonna shine in my back door someday
(composed by Richard M. Jones and first recorded in 1924)
When I finished my post-doctoral research in biochemistry, my career took a turn that was both unexpected and a surprise to my graduate student and post-doc colleagues. I had gone out on faculty interviews at two different universities, expecting to pursue the “traditional” academic route for science Ph.Ds. I was reluctant to take this road because I had discovered that I did not enjoy the high-pressure academic research that I had engaged in for almost eight years. But a different door opened and I became director of a hospital chemistry lab, a position I held for thirteen years before God decided I needed to move to something else.
During those years, the hospital expanded and opened a short-term adult psychiatric unit, populated almost entirely by patients with unipolar depression. The idea of biological psychiatry was ascendant. The prevailing paradigm regarding depression dealt with supposed abnormalities in blood levels of cortisol, a steroid hormone produced by the adrenal cortex. The test for this was supposed to distinguish between “situational” depression (a response to life circumstances) and “endogenous” depression (due to a “chemical imbalance”). Unfortunately, the test was ordered on all admissions to the psych unit, regardless of the reason they sought treatment. When I reviewed the charts (mainly to look for medications that would alter the results), I found patients such as a woman who was undergoing divorce and living with dysfunctional children or a young Christian lady dealing with the guilt of having sex outside of marriage (definitely not OK with her home church). Both had the expensive lab tests ordered and both results were perfectly normal.
Did we really need a lab test (and a rather expensive one at that) to understand the cause of the depression for some of these patients? Lives were disordered, but the solution was not chemical in nature. During the two years we ran these tests before I left the hospital, there were well over a hundred tests requested, and all the results were normal. In fact, this test is no longer used to any extent. I began to question the underlying premise about the tests, and embarked on my present interest in what I call “biochemistry and behavior.”
There is still plenty of reason to pay attention to the balance between biochemistry and other parts of a person’s experience when treating depression. Depression is now widely thought to be due to a decrease of brain levels of serotonin. Treatment for depression often consists mainly of prescribing antidepressants, most of which are supposed to increase the amounts of serotonin in the brain, thus alleviating the psychological symptoms. However, the drugs are often not much more useful than a placebo. One recent study (reported in a January 18, 2012 issue of Time magazine suggests that, although many patients may benefit from antidepressants to some degree, about 25% are made worse by drug treatment. This suggests that it is important to consider other factors as well as brain chemistry (though antidepressants may be helpful for some patients).
Diagnosis of depression is not a simple matter. There are medical disorders in which a tumor will produce altered blood levels of certain hormones that result in depression. Removal of the tumor through surgery or radiation treatment is very successful in alleviating the depression. However, the major causes of depression for many people are not medical, but psychological. Abuse, loss of a loved one, conflict, major events, personal problems—these situations often produce depression.
A 2013 article in the New York Times highlights some of the critical issues associated with depression and its treatment. The report states that one in ten adults in the U.S now take antidepressants; for women in their 40s and 50s, the figure is one in four. The majority of prescriptions for antidepressants apparently are written by non-psychiatrists, mainly family medicine physicians. In my own experience as a university professor, most of the students that I knew who were taking antidepressants (and there was a surprisingly large number of them) were not receiving any form of psychiatric treatment.
In this context, it seems important to consider aspects of mental health beyond the chemical. As diagnostic tools improve, we are finding some intricate and complex relationships between the mind and the brain. Structural changes in the brain and alterations of brain neurochemistry are increasingly being seen as a result of depression, not as a cause. There is (again) growing interest in dealing with the emotional issues that are a part of our fragmented, often dysfunctional, often painful life experiences. Medications may help some people, but are definitely overprescribed and overused.
I can minister by using my scientific knowledge to help diagnose disease and monitor treatment. The trap comes in believing that this knowledge is all that is needed. We are much more than a collection of chemical processes. In my work, I have become increasingly aware of the complex interplay between the body and the mind, between emotions and biochemical processes, and I see once again that I am “fearfully and wonderfully made.”
Suggestions For Further Reading
- “New Research on the Antidepressant-vs.-Placebo Debate.” Maia Szalavitz, Time online edition, January 18, 2012. http://healthland.time.com/2012/01/18/new-research-on-the-antidepressant-versus-placebo-debate/
- “A Glut of Antidepressants.” Roni Caryn Rabin, New York Times online edition, August 12, 2013. http://well.blogs.nytimes.com/2013/08/12/a-glut-of-antidepressants/?_r=0
- “Neurobiology of Depression: An Integrated View Of Key Findings.” Maletic, M. Robinson, T. Oakes, S. Iyengar, S. G. Ball, J. Russell. International Journal of Clinical Practice. 2007 Dec;61(12):2030-2040. http://www.medscape.com/viewarticle/567400_6