Medication, Biblical Counseling, & Depression: What’s New in Serotonin?

September 7, 2015

A Word from Your BCC Team: You’re reading Part One of a two-part BCC Grace & Truth blog miniseries on Biblical Counseling and Medication, by Charles Hodges, MD. Return tomorrow for Part Two: Medication, Biblical Counseling, & Depression: What’s New in Treatment?

New Research

A good deal of new research has been published this year that is really interesting to anyone involved in medicine and biblical counseling. Some of it takes commonly held ideas about the cause and treatment of depression and turns them upside down[i]. Other articles give some encouragement about the role of biblical counseling in helping those who struggle with sadness and depression. Let’s start with serotonin.

For the last 30 years, we have been told that depression is caused by a chemical imbalance that includes a low serotonin level in our brains and that medication is the solution. In an article published in the journal Neuroscience & Biobehavioral Reviews[ii] the authors challenge both ideas. In the article, “Is serotonin an upper or a downer?” the writers make three interesting observations.

Their first is that serotonin is not low in depression and in fact may be elevated in many forms of depression. Second, antidepressants that are supposed to help depression by raising serotonin[iii] may not help at all in the first two weeks of treatment and make many patients feel worse. Finally, the improvement that may come from taking antidepressants that are supposed to raise serotonin may not come from the increase at all.

The authors state that the human brain will automatically respond to the increase by working to regulate the serotonin level back to normal.[iv] They speculate that the process the brain goes through to bring the serotonin back to normal is the cause of the improvement. After 30 years of being stuck in an unprovable chemical imbalance world, it is exciting to see medical science doing research that aims at a better explanation for things we see clinically.

Anyone in medicine or counseling involved in the care of those labeled as depressed in the past three decades has been aware of the two-week delay phenomena. Most of us have seen patients who struggle with symptoms of anxiety, nausea, and other side effects of the SSRI antidepressants. This research does two things for us in medicine and counseling.

First, it turns medical researchers away from the fixation on low serotonin as the explanation for everything wrong with human emotions. Now, we are free to look elsewhere. In the words of the authors, “Understanding the true relationship between serotonin and depressed states will be important in understanding the etiology of those states and developing effective treatment.”[v]

I have written along with many others that depression in the United States is amazingly over-diagnosed. Perhaps 90% of those labeled depressed every year are simply normally sad over loss.[vi] That does leave 10% who have many medical problems including some who have disordered sadness for no apparent cause. The current crop of antidepressant medications do not work well even for those in that ten percent. It would be great if this research sends medical researchers looking for a better answer for the cause and cure for the struggles of those in the 10 percent who may have a medical reason for their sadness.

Second, this research reminds those of us in biblical counseling that we are not obligated to counsel people according to labels or theories that have no credible scientific evidence to support them. This is especially true when those theories conflict with Scripture. The good news has always been that the answer to prolonged normal sadness can be found in the pages of our Bible. And even those who struggle with disordered sadness or depression with a medical cause can find the same comfort and encouragement in the Scriptures that anyone with a chronic disease can find.

There is more interesting research news to share. In tomorrow’s blog we will look at some encouraging ideas for those who struggle with sadness and depression.

[i]McMaster University. “Science behind commonly used anti-depressants appears to be backwards, researchers say.” ScienceDaily. ScienceDaily, 17 February 2015. <>.

[ii]Paul W. Andrews, Aadil Bharwani, Kyuwon R. Lee, Molly Fox, J. Anderson Thomson. Is serotonin an upper or a downer? The evolution of the serotonergic system and its role in depression and the antidepressant responseNeuroscience & Biobehavioral Reviews, 2015; 51: 164 DOI: 10.1016/j.neubiorev.2015.01.018

[iii] SSRI antidepressants, Selective Serotonin Reuptake Inhibitors, are supposed to work by raising serotonin in the human brain.

[iv] Andrews et al. p. 166-167, 175.

[v] Andrews, et al. p. 181.

[vi] Good Mood Bad Mood, Charles Hodges. Shepherd Press. Wapwallopen, PA, p. 66-69.

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