Latest / Reformed Thinking / Depression (Part 2)

Transcript

Depression (Part 2) · Reformed Thinking

• 0:00
  Welcome to reformed thinking and to another deep dive.
• 0:03
  Today, our attention turns to a subject that touches countless
• 0:05
  lives, sadness, often described in modern terms as depression.
• 0:11
  It's a complex experience, frequently felt deep within
• 0:16
  one's soul, yet it has visible effects throughout a person.
• 0:20
  Our goal today is really to unpack a wealth of sources, from
• 0:23
  biblical counseling materials rooted in Reformed thought to
• 0:26
  current medical literature, to give you a clear, discerning
• 0:29
  perspective on this vital topic. That's right, We want to provide
• 0:32
  you with insights that come from both the enduring truths of
• 0:35
  Scripture and, well, the observations of modern medicine.
• 0:38
  Exactly. Our mission is to guide you
• 0:40
  through these insights, helping you understand both the inner,
• 0:43
  the spiritual dimensions, and the external considerations of
• 0:46
  sadness. We hope to equip you with the
• 0:48
  discernment necessary to approach the subject with wisdom
• 0:51
  and care. So let's begin our exploration.
• 0:54
  All right. Let's start by grounding
• 0:56
  ourselves in a core understanding of sadness, or
• 0:58
  what we often call depression as presented in our sources.
• 1:02
  It's concisely defined as a feeling of sadness in one soul
• 1:06
  due to sin or circumstances. This simple yet powerful
• 1:10
  definition truly sets the stage for our entire discussion,
• 1:14
  pointing directly to the origins of this deeply felt sadness.
• 1:17
  But what does that really unpack for us?
• 1:19
  Well, this definition holds a few components that are vital to
• 1:22
  consider, especially from a reformed perspective.
• 1:25
  First, it identifies an emotive aspect, the sadness itself.
• 1:28
  It's not just a thought, it's a real feeling, you know?
• 1:30
  A raw feeling. Yes, raw wrenching.
• 1:33
  Second, it locates the sadness within the inner man,
• 1:36
  specifically in one's soul. This is the core of who we are,
• 1:39
  where thoughts, desires, affections, our spiritual life
• 1:42
  really happens. And 3rd, it attributes the
• 1:44
  causes to either sin or circumstances, which you could
• 1:48
  also view circumstances as suffering.
• 1:50
  Right sin or suffering? Exactly.
• 1:52
  So we're looking at internal moral failings, our own sin, or
• 1:56
  external hardships and trials as the pathways that can lead to
• 2:01
  this profound sadness of the soul.
• 2:03
  That dual cause seems really important.
• 2:05
  It is. It prevents us from
• 2:06
  oversimplifying things. It tells us, look, not all
• 2:08
  sadness is a direct result of personal sin.
• 2:11
  There's grace for suffering, but it also points to areas where we
• 2:14
  might need to repent. It's a more whole view.
• 2:17
  That distinction between sin and circumstance is indeed so
• 2:20
  fraying and helpful. Now.
• 2:22
  The Bible uses various terms that help us grasp what we
• 2:24
  categorize as depression today. Scripture doesn't use the modern
• 2:28
  psychological term depression, obviously, but it certainly
• 2:31
  describes similar states of inner distress with vivid
• 2:34
  language. Things like despair, being
• 2:36
  downcast, you know, like the psalmist asks, why are you
• 2:39
  downcast? Oh my soul?
• 2:41
  Then there's sorrow, discouragement, feeling
• 2:43
  disquieted. Why are you disquieted within me
• 2:46
  and just feeling hopeless? Think of job.
• 2:49
  Oh, Job, yes, saying his soul loathes my life in his
• 2:52
  suffering. Or Jeremiah, the weeping prophet
• 2:54
  lamenting over Jerusalem. Exactly.
• 2:57
  These phrases paint a clear picture of people experiencing A
• 3:00
  weighty inner struggle, a heavy burden, a loss of joy.
• 3:04
  The language is rich. It pulls you in.
• 3:06
  It confirms these feelings aren't new.
• 3:08
  No, definitely not new. And it's also crucial to
• 3:11
  recognize that sadness exists on a wide spectrum.
• 3:14
  Our sources differentiate between means simply being down.
• 3:18
  You know, a little sad, maybe a bad day, a small set back.
• 3:21
  Very fleeting. Fleeting exactly, versus being
• 3:24
  down and out, which refers to a far more severe level of despair
• 3:29
  or hopelessness. That's a big difference.
• 3:31
  A huge difference and it's vital because when someone says they
• 3:34
  are depressed it can mean anything on that spectrum, from
• 3:37
  a mood that lifts in a few hours to a state where getting out of
• 3:40
  bed feels impossible. Like comparing a missed deadline
• 3:43
  feeling to yeah, not being able to function.
• 3:45
  Precisely. So this wide range means we need
• 3:48
  careful, compassionate listening.
• 3:50
  We can't just assume we know what they mean by depressed.
• 3:53
  We need to ask, you know, can you describe what that feels
• 3:55
  like for you right now? That's essential if you want to
• 3:57
  help. That makes perfect sense.
• 3:59
  Context is everything. Building on that, let's turn our
• 4:01
  attention to something really striking in our sources, the
• 4:04
  profound connection between our inner and outer selves.
• 4:08
  Our sources state clearly that the health of the soul, the
• 4:11
  inner man, is connected to the health of the body, the outer
• 4:14
  man. This isn't just like an abstract
• 4:17
  idea, it holds deep implications for how we view our whole
• 4:21
  well-being. Absolutely.
• 4:23
  In a world that often separates mental and physical health or
• 4:26
  ignores a spiritual side, our sources remind us the Bible
• 4:29
  gives a truly integrated view. What happens inside doesn't stay
• 4:34
  inside. Precisely this connection means
• 4:36
  the state of our spirit can directly manifest in tangible,
• 4:39
  physical ways. Consider the toll unconfessed
• 4:42
  sin can take. Proverbs 14.30 states that envy
• 4:46
  makes the bones rot. Wow, envy makes the bones rot.
• 4:49
  Yeah, it illustrates how an internal, unconfessed sin like
• 4:53
  envy can literally lead to physical decay or weakening.
• 4:56
  It's not just a metaphor, it suggests a real physical decline
• 4:59
  stemming from a spiritual root. So like holding onto that
• 5:02
  bitterness or envy actually harms you physically.
• 5:04
  That's the idea. The internal corruption, when
• 5:07
  it's harbored, can manifest systemically, impacting even
• 5:11
  your bone health over time. It's a psychosomatic effect.
• 5:15
  The soul's dis ease, impacting the body's health.
• 5:17
  And we see this played out so vividly in Scripture,
• 5:20
  particularly with the psalmist David.
• 5:22
  He really knew first hand what carrying unconfessed sin felt
• 5:25
  like. In Psalm 32, verse four, he
• 5:28
  describes his body wasted away through my groaning all day long
• 5:32
  because of it. His spiritual distress had a
• 5:34
  direct, debilitating impact on his physical strength.
• 5:38
  Groaning all day long. That's exhausting.
• 5:40
  Totally. He couldn't sleep, constantly
• 5:42
  groaning. It was draining him.
• 5:44
  He also notes in Psalm 38, verses 3 and four, that there's
• 5:47
  no soundness in my flesh and no health in my bones because of
• 5:50
  sin. Powerful verses.
• 5:52
  They really are. They show that when we're out of
• 5:53
  step with God, when sin isn't dealt with, it starts to
• 5:55
  physically weigh down and wear out the body.
• 5:58
  It's like the spiritual burden becomes physically heavy.
• 6:01
  David's experience really underscores this holistic truth.
• 6:04
  And beyond the specific impact of sin, even deep suffering or
• 6:08
  despair in the inner man, whether from sin or just hard
• 6:11
  circumstances, can produce striking physical
• 6:14
  manifestations. OK, Proverbs 17.22 gives us both
• 6:18
  sides of the coin. It says a crushed spirit dries
• 6:21
  up the bones. Dries up the bones.
• 6:24
  Yeah, another Stark image. It is.
• 6:26
  It paints a picture of the physical consequence of despair.
• 6:29
  A spirit overwhelmed by sorrow or hopelessness can literally
• 6:32
  lead to a weakening, a wasting away, like a plant without
• 6:36
  water. You see that sometimes when
• 6:37
  people going through deep grief, don't you?
• 6:39
  They seem physically diminished. Exactly.
• 6:41
  They might lose weight, look frail, just a general physical
• 6:44
  decline, but conversely, the same verse offers the positive.
• 6:49
  A joyful heart is good medicine. Good medicine I like.
• 6:52
  That it implies a positive healing impact on the body, so
• 6:55
  joy that spiritual and emotional state can actually contribute to
• 6:59
  physical well-being and recovery.
• 7:01
  It acts like a restorative agent.
• 7:03
  It just underscores how profoundly the health of our
• 7:06
  inner person effects our outer person, for better or worse.
• 7:09
  OK, so with that framework established the soul body
• 7:12
  connection. What does this all mean for our
• 7:15
  daily lives? While that spiritual link is
• 7:18
  central, our sources also mentioned practical physical
• 7:22
  factors that can directly affect our mood and contribute to
• 7:25
  sadness. Right.
• 7:26
  Things we often overlook. Yeah, common lifestyle things,
• 7:30
  not necessarily deep medical issues, but things that impact
• 7:33
  us daily. Absolutely.
• 7:34
  For instance, just a lack of adequate sleep that can quickly
• 7:38
  lead to feelings of sadness and irritability.
• 7:40
  Oh definitely. We all know how feeling tired
• 7:43
  just makes everything feel worse.
• 7:45
  Exactly. When you're sleep deprived, your
• 7:47
  mental clarity tanks, your emotions are harder to regulate,
• 7:50
  and coping with even small stressors feels overwhelming.
• 7:53
  Yeah, that small frustration suddenly feels like the end of
• 7:56
  the world. Right.
• 7:57
  That feeling of being unwell mentally and physically makes
• 8:00
  you more susceptible to low moods.
• 8:02
  It's foundational, yet often sacrificed.
• 8:04
  And diet plays a huge part too. Remember this one time in
• 8:06
  college, my roommate and I, we decided to just go crazy at the
• 8:10
  convenience store. Got every snack imaginable, you
• 8:13
  know? Yeah, seemed like a great idea
• 8:14
  for about 5 minutes, but the physical impact of all that junk
• 8:18
  food was immediate. You just don't feel good.
• 8:20
  No, your body protests. It really does.
• 8:22
  It was so clear what you put into your body effects how you
• 8:26
  feel physically, and that total influences your mood.
• 8:29
  Processed foods? Sugar crashes.
• 8:32
  It all contributes. It's basic stewardship, really.
• 8:35
  It is, and furthermore, a lack of regular exercise is also
• 8:38
  noted as a significant factor. Physical activity improves
• 8:42
  metabolic processes, helps regulate hormones, releases
• 8:45
  endorphins, the feel good chemicals, right?
• 8:48
  So its absence can contribute to feeling unwell.
• 8:51
  When you don't exercise, you might feel sluggish, lethargic
• 8:54
  physically and mentally. That makes sense.
• 8:56
  Physical sluggishness leading to mental sluggishness.
• 8:59
  Exactly. Even moderate activity like a
• 9:01
  brisk walk can have a noticeable positive impact on mood.
• 9:05
  It shows that tangible link between physical habits and
• 9:08
  emotional state, and often overlooked tool.
• 9:10
  OK. So building on these practical
• 9:12
  aspects, let's now consider the core siritual approach to
• 9:16
  addressing sadness and related struggles.
• 9:19
  Our sources point us to a heart level issue.
• 9:22
  The ultimate goal here isn't just, you know, getting rid of
• 9:25
  bad feelings, right? That's not the primary target.
• 9:28
  While alleviating distress is good, it's not the ultimate
• 9:31
  objective in a biblical approach.
• 9:33
  You've hit on a crucial point. Instead, the ultimate aim in all
• 9:36
  of life, including when we face sadness, is to resolve ourselves
• 9:40
  to please the Lord. To please the Lord.
• 9:42
  Yes, as Second Corinthians 5.9 suggests, we make it our life's
• 9:46
  goal to please Him. That's the guiding principle,
• 9:48
  whether dealing with sadness, anxiety, whatever struggle.
• 9:51
  It's about addressing the core of our being, redirecting our
• 9:54
  deep desires towards God's honor.
• 9:57
  That really shifts the perspective.
• 9:59
  It does. It puts God at the center, not
• 10:01
  our feelings or circumstances. Gives us a fixed star to guide
• 10:04
  us. That realigns everything now.
• 10:06
  This next insight really challenges conventional wisdom,
• 10:09
  especially in our self focused culture.
• 10:11
  A crucial step in working through sadness is to look away
• 10:14
  from self as the solution. Very countercultural.
• 10:18
  Our society constantly tells us look within, find answers in
• 10:22
  your own strength. But the biblical perspective
• 10:25
  points us completely differently, acknowledging our
• 10:27
  limits. You're right, that's a
• 10:28
  countercultural truth. Psalm 94, verses 17 to 19 remind
• 10:33
  us help comes from the Lord. The psalmist says If the Lord
• 10:37
  had not been my help, my soul would soon have dwelt in the
• 10:40
  abode of silence. Wow, help came from outside him.
• 10:44
  Exactly, not from within. The analogy of a drowning person
• 10:48
  is really fitting here. Just as someone drowning can't
• 10:50
  save themselves no matter how hard they try, they need a
• 10:53
  stronger rescuer, A lifeguard. Individuals struggling with deep
• 10:57
  sadness need Christ. Their own efforts are
• 10:59
  insufficient. They need a greater power to
• 11:02
  lift them out of those overwhelming waters.
• 11:04
  We aren't designed to be self-sufficient in our deepest
• 11:06
  struggles. That resonates so much.
• 11:08
  I recall a summer vacation in Cape May, NJ years ago.
• 11:12
  My teenage sisters got caught in a bad undertow.
• 11:14
  Oh wow, scary. It was terrifying.
• 11:17
  They were pulled out so far, struggling.
• 11:20
  It would have been foolish, cruel even, to shout just save
• 11:23
  yourselves. They clearly couldn't.
• 11:24
  The current was too strong. They needed rescuing.
• 11:27
  They needed those strong lifeguards to come out and get
• 11:29
  them. In the same way, we might try to
• 11:32
  pull ourselves out of deep sadness, but without Christ,
• 11:36
  without his intervention, we'll eventually just run out of
• 11:39
  strength. Our own efforts are inadequate.
• 11:42
  And this also involves understanding and actively
• 11:44
  receiving God's mercy and. Grace receiving, not earning.
• 11:48
  Exactly, they are gifts freely given, not something earned
• 11:51
  through self effort. It's so easy to try and earn our
• 11:54
  way out. Thinking if I just try harder.
• 11:56
  Yeah, the performance trap. Right, But God offers salvation,
• 12:00
  freedom, help as a sheer gift to be simply received through
• 12:03
  faith. It means letting go of that
• 12:05
  exhausting idea and embracing the liberating reality that God
• 12:09
  extends kindness freely to those who can't help themselves.
• 12:12
  Reception, not striving. So, given that posture of
• 12:15
  reception, what does this mean for expressing deep sadness?
• 12:19
  Our sources present lament as a distinctly Christian practice.
• 12:23
  Not a bad thing, not weakness. Right, it's not something to
• 12:26
  hide. It's about crying out to God
• 12:29
  from the depths, pouring out your heart with complete
• 12:31
  honesty, which is often counter to our instinct to, you know,
• 12:36
  put on a brave face, especially in church.
• 12:38
  Yes, but the Bible gives us permission, even encouragement,
• 12:43
  to be completely honest with God in our lowest moments.
• 12:45
  True faith includes crying out and suffering.
• 12:48
  So where do we see that? Well, Psalm 77 is a compelling
• 12:51
  example. The psalmist expresses profound
• 12:53
  distress, saying My soul refused to be comforted and I am so
• 12:56
  troubled I cannot speak. Refused to be comforted.
• 12:59
  That's deep anguish. It is a soul actively rejecting
• 13:02
  solace, consumed by turmoil, speechless with grief, and he
• 13:06
  even questions God's character, asking, Will the Lord reject
• 13:09
  forever? Has his loving kindness ceased
• 13:11
  forever? Asking the hard questions.
• 13:12
  Yes, it shows it's permissible, even necessary, to voice that
• 13:15
  raw anguish, those doubts and fears, to the Lord to lay it all
• 13:18
  bare. God invites that honesty.
• 13:21
  But there's a crucial turning point in this lament, isn't
• 13:23
  there? That's the powerful lesson.
• 13:25
  There is He doesn't stay stuck there.
• 13:28
  He intentionally shifts to remembering God's deeds and
• 13:30
  wonders of old. After pouring out his heart,
• 13:33
  even questioning, he deliberately recalls who God is
• 13:36
  and what he has done. So setting his mind on truth
• 13:40
  even when feelings cool him down.
• 13:41
  Exactly. It's not denying the sadness,
• 13:44
  but a deliberate spirit empowered act of redirecting
• 13:47
  focus, an act of exercise in faith recalling God's past
• 13:51
  faithfulness to give hope in the present struggle.
• 13:54
  That redirection is vital. Yes, and it's crucial to recall
• 13:57
  God as sovereign, wise, and good.
• 14:00
  Avoid the temptation to latch on to just one aspect, like
• 14:03
  sovereignty, and distort it to criticize Him.
• 14:05
  Like blaming an indifferent God. Right.
• 14:07
  If you only see sovereignty without wisdom and goodness, you
• 14:10
  might misinterpret suffering. This recall becomes a faith
• 14:13
  building exercise. Remember what God has done,
• 14:16
  especially His salvation. Recall His accurate promises.
• 14:20
  Accurate promises. It's like.
• 14:22
  Like his promise to guard and keep one's soul, not necessarily
• 14:26
  guarantee easy circumstances or protect all our stuff.
• 14:29
  That's a meaningful distinction. When things are hard, it leads
• 14:32
  to a deeper, more abiding hope. That framework for hope is so
• 14:36
  clarifying. Another key step in this
• 14:38
  biblical pathway is confessing sin.
• 14:42
  And this is more than just admitting A stake, right?
• 14:44
  It's identifying specific self focused areas in our hearts,
• 14:47
  acknowledging our offense against God.
• 14:49
  That's right, it calls for deep introspection, confronting
• 14:53
  pride, envy, self pity, failure to trust.
• 14:56
  Not about piling on guilt, but seeking reconciliation and
• 15:00
  freedom. And who do we confess to
• 15:01
  primarily? Primarily to God, as David did
• 15:04
  in Psalm 51, recognizing sin is ultimately against him, even
• 15:08
  when others are involved. The deepest offense against God,
• 15:11
  OK, but additionally, when we have offended others, James 5.16
• 15:15
  reminds us to confess sins one to another and do our best to
• 15:18
  make things right. So both vertical with God and
• 15:20
  horizontal with others. Right.
• 15:22
  And as we discussed earlier, unconfessed sin can have that
• 15:25
  physical toll too. It absolutely can.
• 15:28
  Dealing with sin often brings both spiritual and remarkably
• 15:32
  physical relief as that burden lifts.
• 15:34
  OK, so having understood these foundational principles, what
• 15:37
  about active steps, getting to work, as the sources put it, but
• 15:42
  but not your own strength, right?
• 15:43
  Definitely. Not this work is driven and
• 15:46
  sustained by the Holy Spirit leaning entirely on his infused
• 15:50
  ability. Without him, we'd just run out
• 15:51
  of steam, right? And this process has both duty
• 15:54
  components actions were called to and delight components, the
• 15:58
  joyful pursuit of God. Duty and delight.
• 16:01
  OK, let's start with duty. What does that look like?
• 16:03
  Well, there are clear actions to take even when you don't feel
• 16:06
  like it. During sadness, the natural pull
• 16:08
  is to isolate, become self-centered.
• 16:10
  Pull covers over your head. Exactly.
• 16:12
  So to counter this, serving one another, getting out and
• 16:15
  actively serving others even when you feel awful is a vital
• 16:18
  step. That outward focus pulls you
• 16:20
  away from constant introspection.
• 16:22
  Breaks the cycle. It really does.
• 16:23
  It often brings unexpected refreshment in perspective.
• 16:27
  Investing in others needs paradigms toxically ministers to
• 16:29
  your own soul. Practicing forgiveness towards
• 16:32
  one another, just as Christ has forgiven you.
• 16:34
  That's also a crucial duty, isn't it?
• 16:36
  Absolutely. Unforgiveness is like a heavy
• 16:38
  chain. Releasing it brings profound
• 16:41
  freedom. And prayer.
• 16:42
  Prayer is central. It's the engine, how we access
• 16:45
  God's grace and strength. Lament.
• 16:47
  Psalms like Psalm 77 give us practical guides, words when we
• 16:51
  have none. We can just pray through them.
• 16:52
  Yes, and reading the Word is likewise a necessity, a
• 16:56
  spiritual lifeline. God's Word is truth, the sword
• 17:00
  of the Spirit. It does the real work.
• 17:02
  It connects differently than human.
• 17:04
  Advice it does. It pierces the heart, dissects
• 17:07
  motives, provides direction in a unique way.
• 17:10
  Actively engaging with it is vital.
• 17:12
  And singing that can be hard when you're sad, but it's
• 17:15
  mentioned as a way to uplift the soul.
• 17:16
  It is. Music has that power, but you
• 17:19
  need caution. Some music can deepen sadness.
• 17:22
  Right. I recall those old country
• 17:23
  songs, tales of dogs dying, trucks breaking down.
• 17:27
  Yeah, they could really spiral you down.
• 17:28
  Exactly. Careful selection is key.
• 17:30
  Choose music that points to truth, hope, God's character,
• 17:34
  not despair or self pity. Hymns praise songs often do
• 17:37
  that. OK, what else under duty?
• 17:39
  Finally, we're called to train for godliness.
• 17:42
  That word train comes from the Greek gymnaso.
• 17:45
  Like gymnasium, it requires discipline, effort.
• 17:49
  Like a workout. Yes, disciplining your body and
• 17:52
  mind to work through hard emotions, to engage in spiritual
• 17:55
  practices, even when it's tough. It's active, effortful pursuit
• 17:59
  of spiritual strength. OK, now for the delight
• 18:01
  component. Actively pursuing joy.
• 18:05
  This sounds different from just waiting for happiness.
• 18:07
  It is you. Don't wait for positive feelings
• 18:10
  to just show up. Instead, actively seek joy.
• 18:12
  Ask God for it in prayer. It requires effort before you
• 18:16
  see results. Proactive faith.
• 18:17
  Exactly believing joy can be found even in hard seasons, not
• 18:21
  just when circumstances are good deciding to engage with the
• 18:24
  possibility of joy and. Where should that joy come from?
• 18:26
  It's vital to derive joy from the Lord, not from shifting
• 18:30
  circumstances. So many people's sadness is tied
• 18:33
  to their situation. Bad stuff happens.
• 18:35
  Basing happiness on externals. Which are unreliable.
• 18:39
  But ultimate lasting joy comes from God Himself.
• 18:42
  His unchanging character, His faithfulness, His promises.
• 18:47
  That's stable even when life is hard.
• 18:49
  A deeper joy the world can't offer.
• 18:52
  So practically, how do you pursue that?
• 18:53
  Making a Thanksgiving list can be incredibly helpful when
• 18:56
  you're struggling to see good force yourself to list things
• 18:59
  you're grateful. For some small things.
• 19:01
  Especially small things. It actively shifts your mind out
• 19:05
  of that negative spin cycle. Forces you to look beyond
• 19:07
  immediate feelings. And joy is infectious, isn't it?
• 19:10
  It really is. Just like negativity can spread,
• 19:13
  a truly joyful person rooted in God can uplift a whole group.
• 19:17
  Think of a congregation singing with enthusiasm.
• 19:20
  That personal joy, when expressed, can spread.
• 19:22
  OK, that covers the biblical pathways.
• 19:24
  Now let's shift gears a bit into a sensitive but vital area, the
• 19:28
  medical side. We need to distinguish secondary
• 19:31
  depression. Yes, this is critical.
• 19:33
  Where sadness is actually a symptom of an underlying medical
• 19:36
  illness, not just being sad about being I'll.
• 19:39
  Exactly. The sadness is real, but the
• 19:42
  route might be physiological, demanding medical attention.
• 19:46
  Overlooking this can lead to misdirected efforts and
• 19:48
  prolonged suffering. So for individuals, families,
• 19:52
  counselors, being aware of this is key to determine if a medical
• 19:56
  issue is causing or contributing to the sadness.
• 19:59
  Precisely. It's not always either, but
• 20:02
  requires careful discernment. And the physical symptoms of
• 20:05
  sadness itself, pain, sleep issues, appetite changes, low
• 20:10
  energy, those can show up in the body anyway.
• 20:12
  It can, which is why when they're present, it should
• 20:14
  prompt further questions about the root cause.
• 20:17
  Are these symptoms of sadness from the soul or signs of an
• 20:20
  underlying medical condition causing the sadness?
• 20:22
  Signal to dig deeper physically. Yes, and there are several red
• 20:26
  flags or warning signs that strongly suggest sadness might
• 20:28
  have a medical cause and needs immediate medical evaluation.
• 20:32
  OK, what are those red flags? First, new onset.
• 20:34
  The sadness is brand new, maybe even with a specific start date,
• 20:37
  not a lifelong pattern. That abrupt change is a big one.
• 20:41
  OK. New onset. 2nd severity symptoms
• 20:44
  are so severe the person struggles with basic
• 20:47
  functioning, moving, thinking clearly, getting out of bed,
• 20:51
  self-care. That level of impairment is
• 20:54
  significant. Extreme difficulty functioning.
• 20:57
  Third, older age, especially if sadness is new for an older
• 21:00
  person as they're more susceptible to conditions
• 21:03
  presenting this way. 4th, a significant medical history.
• 21:07
  Complex past issues might be interacting, right?
• 21:10
  5th, a significant family history of relevant medical
• 21:13
  issues like thyroid problems. 6th No clear circumstantial
• 21:18
  explanation, no obvious life event, explains the deep
• 21:22
  sadness. That lack of context is
• 21:24
  suspicious, makes sense. And finally, if it's accompanied
• 21:27
  by other significant impairments like psychosis, hallucinations,
• 21:30
  things beyond typical sadness, these all weren't a medical
• 21:33
  checkup promptly. OK, that's a helpful list.
• 21:35
  And what are some of the actual medical causes that can show up
• 21:38
  as sadness? Broad categories include
• 21:40
  metabolic issues like thyroid disease and under active thyroid
• 21:43
  can directly impact mood or diabetes.
• 21:46
  Infectious diseases, especially affecting the brain, neurologic
• 21:49
  conditions like early Alzheimer's, Parkinson's, even a
• 21:52
  silent stroke, certain cancers, and certain medications
• 21:56
  prescribed for other things can have sadness as a side effect.
• 21:59
  Wow, medications too. Yes, and substance abuse can
• 22:03
  cause it, though if sadness lasts more than a month after
• 22:06
  stopping, it's likely something else.
• 22:08
  Even electrolyte imbalances like low sodium can do it.
• 22:11
  Low sodium. Really.
• 22:12
  Absolutely. We've seen real life cases.
• 22:15
  For instance, a 38 year old woman, usually joyful, suddenly
• 22:19
  became severely sad, exhausted, couldn't get out of bed.
• 22:22
  No clear reason why. Turned out she had
• 22:25
  hypothyroidism. And treatment helped.
• 22:26
  Dramatically, the sadness lifted once her thyroid was treated.
• 22:30
  It was a symptom. Amazing.
• 22:31
  Any other examples? Yes, a 73 year old man with a
• 22:34
  history of stroke, diabetes, high blood pressure.
• 22:37
  His wife brought him in constantly crying, not eating
• 22:39
  well, but drinking tons of water.
• 22:41
  The excessive water, that was the clue.
• 22:43
  It was significant. He had critically low sodium
• 22:46
  from over hydration causing the emotional changes and confusion.
• 22:50
  Correct the sodium and his mood return to normal.
• 22:53
  It shows how physical imbalances can directly cause sadness.
• 22:56
  Those cases really drive home the need for medical evaluation.
• 23:01
  So thinking about that doctor's visit often the first stop,
• 23:05
  right? Family doctor, internal
• 23:07
  medicine. Yes, typically they see a lot of
• 23:09
  this. But you mentioned time
• 23:11
  constraints, like maybe 15 minutes.
• 23:13
  Often yes, which makes a full history, life circumstances,
• 23:17
  spiritual state very difficult. Together this can sometimes lead
• 23:21
  to a quick prescription being the main action.
• 23:23
  Understandable, but potentially missing things.
• 23:25
  Potentially during the visit expect a physical exam test to
• 23:29
  rule out the secondary causes anemia, infection, chemistry
• 23:32
  panels like sodium, thyroid function, CT scans usually only
• 23:35
  if there are specific red flags. So the primary purpose of that
• 23:38
  doctor visit from our framework isn't automatically medication
• 23:42
  therapy referral, but what. It's to ensure that there aren't
• 23:45
  any secondary medical causes of sadness to check for a
• 23:48
  physiological issue causing the manifestations.
• 23:51
  That's the main initial goal. Rule out a physical problem.
• 23:54
  Got it. Rule out the physical first.
• 23:56
  Now regarding medication antidepressants, there are
• 24:00
  different types. Yes, older ones, the first
• 24:03
  generation TCA's like amitriptyline had more heart
• 24:05
  side effects though used sometimes now for pain OK.
• 24:09
  But the second generation ones are most common now.
• 24:11
  SSRI's, selective serotonin reuptake inhibitors like Zoloft,
• 24:16
  Lexapro, Paxil. Generally the lowest side effect
• 24:19
  profile, so often the starting point.
• 24:21
  SSRI's OK. Any others?
• 24:23
  There are SNRI's like Effexor and atypicals like Wellbutrin
• 24:27
  with slightly different mechanisms.
• 24:28
  Also serotonin modulators like Trazodone often used for sleep.
• 24:31
  So ideally the choice is personalized based on side
• 24:34
  effects, interactions, history. Ideally yes, but in practice
• 24:38
  SSRI's are often the go to start because of that general safety
• 24:41
  profile. And critically, even secular
• 24:43
  medicine sees medication as working with therapy, right?
• 24:47
  Not replacing it. That's the standard
• 24:49
  understanding, yes. Medication is often seen as a
• 24:52
  support, a tool to alleviate severe symptoms, provide a
• 24:56
  bridge, but not the sole solution for deeper issues.
• 24:59
  OK, so when might antidepressants be considered
• 25:03
  helpful according to our sources?
• 25:05
  They may be indicated when the symptoms are truly severe.
• 25:08
  Profound despair. Significant struggle with daily
• 25:11
  functioning. Unable to engage with God's
• 25:14
  Word. Fellowship.
• 25:15
  Basic self-care. So severe prevents engagement.
• 25:18
  Yes, Also if sadness has psychotic features,
• 25:21
  hallucinations, denusions, medication is often needed for
• 25:24
  stabilization, right? It might also be considered if
• 25:27
  intensive counseling and diligent spiritual efforts have
• 25:29
  been pursued consistently, but debilitating sadness persists,
• 25:33
  suggests an additional layer, or if someone had a clear positive
• 25:36
  response to a specific antidepressant before.
• 25:39
  The goal being enough relief to engage in the necessary
• 25:42
  spiritual and practical work. Exactly, that's the idea.
• 25:45
  OK, that clarifies the potential role.
• 25:47
  Now what about effectiveness? How well do they actually work?
• 25:50
  Improvement, if it happens, is usually seen in 1-2 weeks.
• 25:53
  Generally yes, though full effects take longer.
• 25:57
  Large meta analysis show little major difference in response
• 26:00
  between different second Gen. drugs, suggesting one SSRI isn't
• 26:04
  vastly better than another for most.
• 26:06
  But is the effectiveness clear cut?
• 26:08
  Well, it's not as clear cut as often perceived.
• 26:11
  That 2012 meta analysis of 8400 patients, it found one in seven
• 26:16
  people did better getting an antidepressant than just getting
• 26:18
  placebo. One in seven better than
• 26:20
  placebo, right? But notice the placebo effect
• 26:23
  itself was significant. 29% improved on placebo over 6
• 26:27
  weeks. So many improve just believing
• 26:29
  they're getting treatment. That's a strong placebo effect.
• 26:32
  It is. It doesn't negate the drug's
• 26:34
  effect for that one in seven, but it means we need discernment
• 26:37
  about the impact solely from the medication itself.
• 26:40
  And how is success measured in these studies?
• 26:42
  You mentioned the Hamilton rating scale.
• 26:44
  Yes, a 17 item scale, 53 points total.
• 26:48
  Higher score means more severe sadness.
• 26:50
  What's eye opening is how successful treatment is often
• 26:53
  defined. How so?
• 26:54
  Sometimes success is just an improvement of only three points
• 26:57
  on that scale. Three points out of 53, it
• 26:59
  doesn't sound like much. It isn't.
• 27:01
  It could be minor daily mood variations.
• 27:03
  It makes you question the real clinical significance.
• 27:06
  Does a three-point shift truly represent a life altering change
• 27:09
  or just look good statistically? A point to consider.
• 27:14
  And furthermore, even initial improvements often fade.
• 27:17
  Significant relapse rates are seen in studies following
• 27:20
  patients longer than six weeks up to a year.
• 27:23
  Short term benefits often don't last long term for many.
• 27:26
  Relapse is common. Plus, there are concerns about
• 27:29
  funding bias studies funded by drug companies and publication
• 27:33
  bias, where negative trials are less likely to get published.
• 27:36
  Right, the skewed perception. That 2008 FDA analysis, 74
• 27:40
  trials registered only 51% positive, but 94% of published
• 27:45
  trials reported positive outcomes.
• 27:47
  A 2022 update showed similar 5050 results overall, maybe
• 27:51
  slightly more transparency, but still a consistent pattern,
• 27:53
  casting doubt on claims of high effectiveness for many.
• 27:56
  That's certainly something to consider carefully.
• 27:58
  Now let's talk about that chemical imbalance theory.
• 28:01
  Low serotonin causing sadness that was everywhere for years.
• 28:05
  It was the dominant narrative used to explain why meds were
• 28:08
  needed. But that term has really faded
• 28:10
  among researchers. Why?
• 28:12
  Because the theory has been debunked.
• 28:15
  A thorough 2022 review in the journal Molecular Psychiatry
• 28:19
  found no evidence of such connection between low serotonin
• 28:23
  levels or related genes and sadness.
• 28:25
  No evidence, so the whole basis was shaky.
• 28:28
  Essentially, yes. The scientific support for how
• 28:30
  these drugs were supposed to work correcting that imbalance
• 28:33
  has been seriously questioned, which raises questions about how
• 28:36
  they do work, as the precise mechanism often isn't fully
• 28:39
  known. And highlights that medication
• 28:41
  doesn't fix the underlying soul issues or life circumstances.
• 28:44
  Exactly. Even if it offers some symptom
• 28:47
  relief for some, it doesn't address the root causes.
• 28:50
  OK. Beyond effectiveness, side
• 28:52
  effects are real too, aren't they?
• 28:54
  Absolutely, and they aren't minor inconveniences for many
• 28:56
  things like diarrhea, sexual dysfunction, somnolence, that
• 29:00
  persistent sleepiness and weight gain.
• 29:01
  Things that impact daily life significantly.
• 29:03
  Sometimes so much that people stop the medication despite any
• 29:07
  mood benefits. Understanding those trade-offs
• 29:09
  is part of wisdom. And there's a particularly
• 29:12
  serious concern, especially for younger people.
• 29:15
  Yes, a very significant concern, especially in children and
• 29:18
  adolescents up to age 25, is an increased risk of suicide
• 29:22
  attempts. Increased risk.
• 29:23
  Yes, particularly during the first one to two months of
• 29:27
  treatment. It's a statistically significant
• 29:29
  finding. Every patient and caregiver
• 29:32
  needs full awareness of this. Why might that happen?
• 29:35
  The theory, though unproven, is that as energy levels lift
• 29:38
  slightly from deep sadness, they might gain enough energy to act
• 29:42
  on previous suicidal thoughts. This increased risk isn't
• 29:45
  generally seen in older adults. So close monitoring is crucial
• 29:49
  in that initial phase for young people.
• 29:51
  Absolutely crucial. Open dialogue with doctors.
• 29:54
  Vigilant observation. OK, so if someone is taking
• 29:57
  medication and thinks about stopping, what's the key
• 30:00
  message? It is vital that it be done in
• 30:02
  conjunction with a medical professional.
• 30:04
  Don't just stop on your own. Why not?
• 30:06
  Because tapering off slowly is almost always necessary.
• 30:10
  Stopping cold Turkey can cause unpleasant withdrawal effects.
• 30:13
  What's called continuation syndrome, Flu like symptoms,
• 30:16
  dizziness, nausea, emotional distress.
• 30:19
  So never cold Turkey. Never.
• 30:22
  Gradual reduction monitored by a Doctor Who can adjust the plan.
• 30:26
  Patients and professional guidance are key.
• 30:28
  OK. Now let's touch on a very
• 30:30
  serious aspect. Suicidal thoughts.
• 30:34
  This represents such a low point needing extreme care.
• 30:37
  Yes, immediate attention and support are critical.
• 30:40
  What are the warning signs, the red flags to watch for?
• 30:43
  Key ones include a past suicide attempt, a strong predictor, a
• 30:48
  specific detailed plan for self harm, shows intent and access to
• 30:53
  means, drugs, alcohol, weapons. History plan means those
• 30:58
  increase risk significantly. Dramatically, they demand urgent
• 31:01
  action, seeking professional help immediately.
• 31:03
  You mentioned something striking that many people communicate
• 31:06
  these thoughts beforehand. Yes, studies suggest 70% of
• 31:09
  those who have committed suicide communicated thoughts of suicide
• 31:11
  to someone else before they took their own life. 70%.
• 31:14
  It highlights the life saving value of recognizing those flags
• 31:17
  and taking any mention of self harm seriously.
• 31:19
  People often reach out. And resources for those
• 31:22
  struggling or grieving. For those struggling, David
• 31:24
  Powellison's book I Just Want to Die offers biblical perspective.
• 31:28
  For those Grieving a Suicide, Palicine's Grieving a Suicide
• 31:31
  and Nancy Guthrie's Finding Hope Together have helpful insights.
• 31:36
  OK, looking at the bigger picture now, our current
• 31:39
  generation, there's been a noticeable rise in anxiety and
• 31:43
  sadness, particularly among younger people.
• 31:45
  Yes, a concerning trend. Many have noted significant
• 31:48
  shifts in mental health challenges among youth.
• 31:50
  And factors contributing. It's strongly connected to
• 31:53
  things like ubiquitous smartphone use and pervasive
• 31:56
  social media. Jonathan hates book The Anxious
• 31:59
  Generation documents this well. How so?
• 32:01
  Constant comparison, sleep disruption from phones, loss of
• 32:05
  unsupervised play, it's all contributed to this crisis.
• 32:08
  It's heartbreaking seeing more kids in ERS with debilitating
• 32:11
  anxiety and suicidal thoughts. A stark change.
• 32:14
  Highlights the need for discernment about digital
• 32:16
  habits. Definitely ultimately discerning
• 32:19
  when sadness has a medical component, when to seek medical
• 32:22
  advice. It requires wisdom, prayer,
• 32:25
  careful observation. Understanding those red flags is
• 32:27
  crucial. And biblical counseling remains
• 32:30
  vital even for those on medication.
• 32:32
  Highly impactful, It focuses on spiritual truth, heart issues,
• 32:36
  the core of the person. It aims to equip people to
• 32:39
  counsel themselves from God's Word, not be a perpetual
• 32:42
  process. And any new developments in
• 32:44
  medicine, Pharmacogenomics. Yes, that's an emerging field,
• 32:48
  using DNA testing to understand how your body processes meds,
• 32:52
  potentially helping doctors choose the right antidepressant
• 32:54
  from the start rather than trial and error.
• 32:56
  Personalized medicine for mental health.
• 32:58
  That's the hope. Large studies specifically for
• 33:00
  antidepressant selection are still developing, but it's a
• 33:03
  fascinating future direction. OK, so wrapping up today's deep
• 33:08
  dive, we've explored sadness from its biblical definition in
• 33:11
  the soul due to sin or circumstances, to its physical
• 33:15
  lengths and the biblical pathways through it.
• 33:19
  Looking to Christ, Spirit empowered actions like lament,
• 33:22
  confessions, seeking the Word, pursuing joy.
• 33:25
  We also took a discerning look at the medical side.
• 33:27
  Secondary sadness. The purpose of doctor visits.
• 33:31
  A critical look at antidepressants.
• 33:33
  Debunking the chemical imbalance theory and noting concerns like
• 33:37
  side effects and suicidality risk in youth.
• 33:40
  And touched on modern challenges like technology's impact.
• 33:43
  The interconnectedness of our inner and outer selves really
• 33:46
  stands out, doesn't it? True well-being involves both
• 33:49
  the spiritual and the physical. It does.
• 33:51
  It's a holistic reality God designed.
• 33:53
  So as you, our listeners consider these insights, perhaps
• 33:56
  a final thought to reflect on. Ask yourself, what does it truly
• 33:59
  signify to derive joy from the Lord irrespective of shifting
• 34:02
  circumstances, especially when life feels hardest?
• 34:05
  Right. How might actively seeking that
• 34:07
  joy influence not only your spirit, but also echo out
• 34:10
  influencing those around you in your community?
• 34:12
  Something to really Mull over. We trust this deep dive is
• 34:16
  giving you valuable perspectives and tools for discernment.
• 34:19
  Thank you for joining us on Reform Thinking.