I’ve written quite a few posts about psychological disorders on this blog but I have yet to talk about taking psychopharmaceuticals. Taking drugs like antidepressants seems to carry a stigma in general, anemia but especially in the Christian community. I think this is partly due to a lot of confusion about mental illness in general so in this post I want to try to demystify depression and anxiety and the medications that can be used to treat these disorders.
My first semester of my freshmen year in college I was struggling. I had just ended my way-too-rushed time at an eating disorder treatment program (just ended as in the day before I left for college), skincare I had been diagnosed with major depressive disorder, and was experiencing intense, almost constant anxiety. It was also the semester I took Abnormal Psychology, a class that was all about the causes, treatments, and methods to diagnose psychological disorders. At times, the class was really difficult for me, not just academically but also emotionally. The day the professor lectured about anxiety disorders was really triggering for me and I was sitting in my chair tensely thinking, “I’m not going to make it.” But you know what? I did make it through that class and all the others that semester and it’s still one of my favorite college courses I’ve taken (that’s how you know you’re in the right academic field). In Abnormal Psych I learned a lot about a ton of mental disorders but I found that learning specifically about the neurological underpinnings of depression and anxiety disorders and how medications that treat these disorders work gave me a lot of clarity when it came to my own struggles. I’m going to share my super simplistic understanding of the things I learned in my Abnormal Psych class with the hope that it will be helpful for you, too!
There are neurological, psychological, and social factors that contribute to all psychological disorders. These include things like stressful family situations or life events (social factor), a tendency to focus on negativity or a heightened vigilance to threats in the environment (psychological), or abnormal brain areas, genetic influence, and an imbalance of neurotransmitters (neurological). All three of these factors interact together to lead to these psychological disorders. I feel like the social and psychological factors are more self-explanatory and easy to understand so this post focuses on the neurological causes and treatments.
Forgive me, this is going to be so simplified but my goal is to give you a small sense of what’s happening in the brain of a depressed or anxious person, not to enable to you pass a neuroscience class!
Here is a synapse:
Let’s pretend this is a serotonin synapse, meaning that this synapse is in charge of releasing the chemical serotonin to the receptor. Serotonin is a chemical that does a large variety of things for our bodies, including regulating mood, appetite, and sleep. Can you see why serotonin irregularities might have something to do with depression which is marked by symptoms such as depressed mood, low or increased appetite, and insomnia/sleeping all day? There are multiple neurotransmitters that are implicated in depression, including dopamine, but regulating those chemicals has not proven to be very effective in the treatment of depression. Serotonin irregularities are also found in anxiety disorders, which is why the same or very similar medication is used in the treatment of both anxiety and depressive disorders.
The most common drugs that are now used for the treatment of depression and anxiety are called SSRIs (Selective Serotonin Reuptake Inhibitors). How these work is that they slow down the reuptake of serotonin released from the synapse. In the diagram, do you see the little black dots labeled “neurotransmitter?” The serotonin is released from the synapse into the synaptic gap (the space between the synapse and the receptor) and then the receptor takes up that serotonin. SSRIs stop/slow the reabsorption of serotonin by the receptor meaning that the serotonin is floating around your system for a longer time, changing the balance of serotonin in your body, which helps lessen depression and anxiety. As said above, the same drugs are often prescribed for both anxiety and depression, with smaller doses prescribed for anxiety.
There are a lot of different categories of drugs used to treat anxiety and depression including SNRIs, TCAs, and MAOIs for depression and SNRIs and benzodiazepines for anxiety (there are a wide variety of anxiety disorders such as generalized anxiety disorder, panic disorder, and OCD which may require different medications). But all of these medications target different biological irregularities that influence depression and anxiety.
Why is all of this information important? Because I think many of us have this view of antidepressants as mysterious and possibly dangerous drugs that will alter who we are. And while changing our brain chemistry is no insignificant thing, I would submit to you that taking an SSRI for depression is not so different from taking Advil for a headache or Claratin for allergies or chemo drugs for cancer.
“But shouldn’t we trust that God will heal us of depression? Why should we take medications? Aren’t psychological disorders sin that should be dealt with like all other sin?”
My response would be this: Psychological disorders are NOT sin. If you are struggling with a psychological disorder, it is NOT your fault, it is NOT your choice, and it is NOT your sin. It is partly caused by very real things happening in your body. Do I believe God can heal us of depression? YES! Because I’ve seen him do it in my life. But who are we to say that God doesn’t want to use SSRIs and therapists to help us heal?
My story: Let’s go back to my first semester in college. Two of my therapists felt that I would be an excellent candidate for SSRIs and recommended that I try them. I had been struggling with depression for a long time at this point and hadn’t gone on an antidepressant because the thought of gave me such anxiety. It was learning about the neurology of depression and SSRIs that convinced me that taking antidepressants wasn’t as scary as I thought and could be hugely helpful to me. So I prayed about it and asked God if I should go on antidepressants or not and I felt like the Lord told me that he would support me either way and that it was up to me. So I decided to go on them. But the trouble was, I couldn’t find anyone to prescribe them to me! I couldn’t find a psychiatrist to meet with, the university doctors wouldn’t prescribe it, my psychologist wasn’t a psychiatrist so she couldn’t prescribe it, the university health services wouldn’t let me meet with a psychiatrist, and it just went on. It felt like everyday I was at therapy or with the nutritionist or doing weight-checks at university health services and fighting with health insurance. I was fighting so hard for my recovery that I ended up not having the time and energy to actually recover! So I finally decided that I wasn’t going to go on the antidepressants and God supported me in that decision and gave me tools to overcome my depression which I talk about in this post. The Lord was faithful to me and helped me overcome my depression, but I think that my recovery might have been easier had I been on an SSRI. There were a lot of times I wished I were on an antidepressant and if I could do it over again, I might have kept trying to get one prescribed for me.
If you are struggling with depression, an anxiety disorder, or any other psychological disorder, I pray that you would first be released from anyone or anything that says that your struggle is caused by your sin or that it’s your fault because it’s not. I also pray that you find community that will help carry you and support you through this tough season. I also recommend that you regularly meet with a therapist and then maybe consider trying psychotropic medications (with the guidance of your therapist/psychiatrist).* A whole combination of things contribute to psychological disorders and there are a whole combination of things that lead to recovery. And finally, I pray full healing over you in the name of Jesus! He is faithful and will bring you through.
*People who receive therapy and medication are more likely to have sustained recovery than people who just take medication. I always always recommend therapy.