Women, Depression and the Church (Part 1)

After the birth of our second child Caleb, my wife Julie became co-coordinator of a women’s outreach ministry at our local church. She was on a steering committee of 10women, all of whom were married and had young children. Julie knew all of the women well but quickly found out something she didn’t know, 7 out of the 10 women (70%) were taking antidepressant medication. This came as a shock to us, not because someone would be on an antidepressant medication but because of the sheer number of women in the group taking them.

All of the women in the group were very open about their antidepressant use and the struggles that had lead them to get the medication. Many said that they felt like they couldn’t handle life, that they were overwhelmed having to meet so many people’s needs. They felt like they were not good mothers and wives. They described feeling a lack of fulfillment in their lives, they were exhausted and it was taking a toll on their marriages. One woman said “I couldn’t stand to be around myself”. So they all sought out something from their family physician that would help them feel better about life and themselves.

We all know someone who is taking an antidepressant medication. And I certainly do not want to deny the potential benefits of these medications in individuals who truly need them. But while it is generally accepted that 5% of Americans suffer from clinical depression (women more than men) a far greater percentage of the population is being treated with antidepressants. This dramatic increase in the prescribing of psychiatric medications over the last two decades has caused some in the Christian community to question the legitimacy of depression as a psychiatric disorder and the use of antidepressant medications by those in the church.

In a recent study I conducted to investigate this problem I found that Texas pastors perceived biological causes as more important than psychosocial and spiritual causes for all mental disorders. There was however, significant variability in how much of a contribution the pastors believed spiritual factors influence various disorders. Spiritual factors were perceived to make a significant contribution in major depressive disorder but thought to have little influence in cases of schizophrenia and bipolar disorder. This may result from the fact that depression has a sub-clinical manifestation, as mentioned above, not seen with schizophrenia and bipolar disorder. A sub-clinical manifestation of depression could rightly be perceived by a pastor as resulting from spiritual factors (e.g., guilt over sinful behavior, poor marital relationship). Exposure to these types of sub-clinical problems might cause an over generalization of spiritual influences to all “depression” regardless of the severity. This same type of type of generalization would not be possible in disorders without sub-clinical manifestations like schizophrenia and bipolar disorder.

It is important to realize that being “depressed” or having the “blues” is different than meeting criteria for major depressive disorder. To limit confusion and facilitate appropriate treatment I recommend that an individual not begin taking antidepressant medication unless they have undergone a full psychological assessment (which takes several hours and is usually done by a clinical psychologist) to determine if they truly meet the criteria necessary for a diagnosis of major depression.