Depression

You may be seated. I invite you to turn to Psalm 42. Turn to that Psalm. We were singing; so we had our day of prayer last Lord’s Day—pause on the series that we are dealing with in the evening—and we return tonight then to address another subject in the overall theme of Bible answers for inner battles. We are complex creatures, and there are challenges that we face, that we feel within ourselves, that may not always be immediately obvious to those watching. So we’ve been trying to address these. And again, for many, if not all, it is really just scratching the surface. There are many, many aspects to things like anxiety and doubt and self-pity and so on and so forth.

But I turn your attention tonight to Psalm 42, and I’m going to take time to read the entirety of the Psalm with you. The Psalms, as I have told you and as you are well aware, give to us a spectrum of human experience. They bring us into where the heart can feel at times, regardless of how we may be looking on the outside. And so we get a little insight into how a man who may be a king appears to have it all together—has his responsibilities and his business and all that pertains to the outward life—and yet when he gets alone, you see something different than what may appear on the outside. You see a warrior ready to lead troops into battle fearlessly, whose courage is in so many ways inspiring, and yet the same man before God is sobbing, weeping, broken, filled, it would appear at times with uncertainty and weighed down with distress.

So let’s read Psalm 42 and follow from verse 1:

As the heart panteth after the water brooks, so panteth my soul after thee, O God.
My soul thirsteth for God, for the living God.
When shall I come and appear before God?
My tears have been my meat day and night, while they continually say unto me, “Where is thy God?”
When I remember these things, I pour out my soul in me.
For I had gone with a multitude; I went with them to the house of God, with a voice of joy and praise, with a multitude that kept holy day.
Why art thou cast down, O my soul?
And why art thou disquieted in me?
Hope thou in God.
For I shall yet praise him for the help of his countenance.
O my God, my soul is cast down within me.
Therefore will I remember thee from the land of Jordan and of the Hermonites from the hill Mizar.
Deep calleth unto deep at the noise of thy waterspouts; all thy waves and thy billows are gone over me,
yet the Lord will command His lovingkindness in the daytime, and in the night His song shall be with me, and my prayer unto the God of my life.
I will say unto God, my rock, “Why hast thou forgotten me?
Why go I mourning because of the oppression of the enemy, as with a sword in my bones?”
Mine enemies reproach me, while they say dearly unto me, “Where is thy God?”
Why art thou cast down, O my soul?
And why art thou disquieted within me?
Hope thou in God.
For I shall yet praise Him who is the health of my countenance and my God.

Amen.

I trust God will bless the reading of His Word. What you have heard is the Word of the eternal God, which you are to hear, you are to receive, and you are to obey. And the people of God said, Amen.

Let’s pray.

Lord, help us. Help us in this moment to receive from Thy hand Thy truth. Even in this hour, work powerfully. Even in these moments, bestow abundantly Thy grace and give to the preacher and to each of us gathered a portion of Thy Spirit to hear from the Lord. Oh, may we have ears to hear. So should there be dullness caused by whatever reason, remove it and take us from the experience of the ordinary into the experience of the extraordinary, because God is at work. Magnify Thy Son and give help now. In Jesus’ name we pray, amen.

I turn you to Psalm 42 because it is often the psalm I think of when you consider the subject or the experience of depression. The well-known twentieth-century preacher Lloyd-Jones addressed, in a series of sermons, the subject of spiritual depression, and this was his primary text. And he notes in it—he notes one of the things, one of the pieces of advice that he gives that I have given many, many times from the pulpit and in person—how the psalmist learns to talk to himself instead of listen to himself. And so when he’s saying, “Why art thou cast down, O my soul?” he responds, “Hope thou in God.” He’s speaking. It’s almost like he, if someone comes to you for counsel or for advice, and you set yourself on the other side of the table, and you say, “What would I say to a friend who’s feeling as I am feeling right now? My best friend, someone I love dearly, came to me and said, ‘Please help. Give me a word, give me something. I’m going through this,’ and you’re wondering, ‘What would you say?’” You might do a whole lot better in trying to help them than you would help yourself—but that’s what David does. It’s like he puts himself on the other side of the table and says, “David, hope in God. I will yet praise him.” And so this subject, as we come to it tonight, I’m going to say from the outset, like many of them, it’s not easy.

Perhaps this one is particularly difficult because it is something that we—there’s a certain visceral response to it; there are a lot of delicate aspects to it. And I trust that even in an overview like tonight, you will give me some latitude. I may not address every question that arises, nor may I word everything exactly as it should, but I will try my best. And I hope at the end of the message tonight that you will be a little more informed, a little more prepared, and a little helped when it comes to whether you go through this or someone you love.

The Bible has examples for us of those who went through tremendous anguish. Job was crushed by his circumstances, wishing for death. Elijah does the same at a point in his own ministry. And others, I think we can see it in Jeremiah and certainly here in David and in other places, men who are brought to rock bottom; they see no way out, and death seems like it would be a relief.

Now, for some people that might not be a big deal, but for a Bible-thinking person who sees life as a gift and God’s sovereign in giving us our days, we do not wish to shorten our days against the will of God. Though we may have that tension—even as Paul did, a desire to depart to be with Christ, which is far better—but to get to the point where really it’s not in response to going to Christ, it’s a response to getting away from pain, is a different thing.

So when we open up God’s Word and we find even men like Paul who writes of being “pressed out of measure, above strength” (2 Corinthians 1:8), many of the strongest saints were brought to their knees through their circumstances. Brought to a place where they felt there was no way out, no relief, and perhaps felt there was nowhere to go. And you can align then the experience, though the words are different. When you read the Puritans in that era, they talk about melancholy, but a lot of it correlates, ties into what we commonly will refer to as depression. And there are many different expressions of it, all sorts of ways in which it is categorized, especially in the clinical realm. You have major depressive disorder, which is the classic form that comes and goes, but is often very severe. You have persistent depressive disorder. It’s not as acute, but it’s prolonged; usually, you have to wait two years before they will diagnose you as having this persistent depressive disorder. You have bipolar. You have premenstrual dysphoric disorder that comes in, of course, at times of life—it changes and so on—and it brings this feeling of depression. And all of a sudden, someone who never had this problem enters into it. And there are many others related to substance abuse affecting the mind and the brain. And on and on you could go. There’s depression brought on by thyroid disorders and chronic pain and neurological diseases. There are adjustments, that come from adjusting to a new phase or season of life, which bring in a sense of depression because of some disturbance or change.

And when you bring all this together, you say, does the Bible have anything to say about all of this? And obviously, I’m not here to diagnose or to reflect on the individual or full expression of each way in which we may categorize depression in our day. But just to see it as a broad subject of man’s feeling in a fallen world— that he does not always wake up in the morning rejoicing, full of energy, and delighting that the sun once again has arisen; that there’s a new day to enjoy, and there are blessings abundant bestowed, seen and unseen. Sometimes the mind is so weighed down it makes us blind to, or unable to truly appreciate or express gratitude for, the other times and seasons where it’s easy for us to give thanks.

We are complex, of that there’s no doubt. And many of you—I know, I know—even I can probably guess that many of you have had some season where you have gone through some form of a feeling, whether temporary and periodic or prolonged and deep, of depression. You may have come through it, not even realizing as you came through it, that that’s what was going on. Some of you have gotten to the point where you’ve had to go to your doctor and explain the symptoms and what you’re going through and take it from there.

Depression. We come to this subject and we want to find an easy way through it. But as I think you’ll see tonight, certainly as far as I’m concerned, there’s no easy answer. So let’s look at it. Let’s consider again in the outline that we’ve been using. First, its character. How do we see depression? How does it manifest? How might you detect it? Again, it can be difficult. And if you’ve not gone through it before, you may not notice or say that that’s what you’ve gone through.

I certainly stand here tonight. I’ve never been diagnosed; I’ve never been on medication for depression and so on. But I can point to at least one season of my life of a very intense feeling that went on for a number of weeks—perhaps even a couple of months or so—and yet I didn’t know at the time. I saw the issue; I knew what I was faced with; and all I could think about was the problem, but I wasn’t realizing how it was affecting me. And you may be the same.

So some of the characteristics: first, deep despondency and sadness. Depression is often marked by a pervasive low mood, and it’s more than sadness. It’s not just being sad—it’s a sense of being cast down, like the psalmist describes here, cast down. And it’s not fleeting; it doesn’t go away easily—it sustains, it’s like a fog over the soul, it doesn’t seem to lift. You might go and do things; you might spend time with your friends; but still you feel this fog over you. Again, the sun might be shining, many things might be going well in your life, and still you feel this heaviness cast down, deep within your soul.

Another thing we might see in depression is loss of interest. There’s no interest in things you used to be interested in. The vibrancy of natural passions and joys in life—things that once brought you delight—now diminish. Maybe you love food, you love enjoying food, trying new foods, and it goes away. That interest fades. You can’t be motivated or encouraged to participate as you once did. And this loss of motivation often is a self-perpetuating experience where we can’t move ourselves and then we fall into a pattern.

Physical fatigue and even disturbance of sleep—depression frequently attacks various aspects of how we experience our day-to-day living, and we feel fatigue. Often there’s a real tiredness that coincides with someone who then has said, “You’re depressed, you’re melancholy, you’re going through this experience.” And so they don’t understand why they feel so heavy and lethargic and they can’t move. But again, maybe—again, instead of just saying you’re feeling tired—there’s depression and other elements of depression that are feeding into that physical weariness.

There can be changes in appetite, fluctuations in weight; again, it might not all correlate, but it ties into some of the habits that create this. So you’re not thinking, you’re not looking after yourself, you start eating in a different way. And all of this has a knock-on effect and just compounds more and more upon you. And so you just find yourself different than you may have been six months or a year ago.

Feelings of worthlessness and guilt—you can’t see meaning in yourself. Someone says, “But you’ve so much going for you,” but that language or encouragement doesn’t seem to ring true. They tell you, “Look, you’ve got everything going for you, look at what’s going on in your life. You’ve got this job, you have this family,” and so on and so forth. They list all the things they can see and say, “You’re blessed,” and yet you can’t see it. You just feel worthless, overcome with guilt. The life of your soul is being strangled within you.

Social withdrawal and isolation—those who are depressed tend to withdraw from others. They don’t wish to be around others. They retreat. They avoid going to places that would put them in the midst of other people. Now again, there can be pressures that force them. And so there’s bills to be paid, there’s things to do—so they go to work—but even there, they’re not entering into, maybe, get-togethers and other aspects of social life that coincide with employment. And then again, maybe if they go to church, they don’t go there; and there are other aspects again where they just withdraw.

There’s impairments—cognitive impairments, things that affect the mind. You feel like, maybe someone is watching on. They’re struggling to make right decisions. They’re making poor decisions; they’re doing things that are out of character. You say, “Why are they doing this?” Again, they’re in a haze. There’s something going on that’s more than just that they’re feeling down—there’s something deeper than that.

And there can also be then an aspect of existential despair, hopelessness. It leads to the languishing like Elijah and Job—“Why am I even on this earth? Lord, kill me.” And to the healthy-thinking person, to the person who’s never gone through it, to someone who hasn’t studied it or lived with it or had any familiarity with it, they look on and say, “What have you got to complain about?” It is one of the oddities of the Western world that we tend to have prosperity that far exceeds many other parts of the world, and yet things like anxiety and depression are off the charts compared to places that are less well off. Again, there may be various reasons for that, and I could give some of those reasons if I desire to.

Let’s think about here. Think about ourselves. Do we understand? Can you relate to any of this? Can you say, “I’ve gone through that—despondency, loss of interest in aspects of life, fatigue, changes in appetite, and overall neglect of your health, feelings of worthlessness and guilt, withdrawing socially, not thinking right, and a sense of despair and hopelessness?” Some of those things—you’ve experienced. The chances are, even if you weren’t aware of it, you’ve gone through what we call depression today.

So that’s its character.

What are its causes? Why should man go through this? Well, obviously, we’re in a fallen world, right? Everywhere you turn, there’s pressure; there’s resistance; there’s friction; there’s difficulty; there’s hardship. The whole of creation groans, and we groan. Man groans with creation, feeling the weight and the struggle and the difficulty. But while there are many things we could point to, let me try and break this down in a number of ways. And I’ll leave first with categorizing some of the causes with regard to what we put under a broader theme of the biological and physiological causes.

Now, in some men, as they come to this subject, they’re not going to address this at all. And if it’s brought up, they’re going to dismiss it and say it has nothing to do with the problem. But I disagree strongly—and that has come through in some of my other messages, I trust you’ve noted—that we are complex beings. We are not just spirit; we are body. And we can’t ignore this part of us that belongs to God, I might add. Not to turn to a mentality and say it doesn’t matter and neglect what God has given. We belong to God. Your body is God’s. It is to be stewarded like it matters.

And at times we enter into seasons—and societies enter into seasons—in which there are complexities and difficulties that are undetected. People are suffering in ways physically, and they don’t know why. You don’t understand all that is going on.

For example, there was a, and I did not look this up, so I’m really going on probably 15 years ago when I read this. I remember Melanie wrote about it. She was writing about—oh, just discovering how slow our society can be to notice that there are problems in our diet and so on, and the effect of it. And she was dealing with scurvy and how there had been this sailor—and I hope I’m getting this right, Melanie, correct me when I go home—you got that totally wrong. You botched it entirely; might be. But there was some explorer or sailor or someone who had a ship who realized that when he had limes on the boat, his sailors—those with him, his crew—did not get scurvy, which was a widespread problem. It was a known problem. And of course, they would take meticulous details—they were taking down everything—and he sees the correlation. And he says to the British Navy, he tells them, “for some reason, you take limes and you don’t have a problem with scurvy.” It took 150 years for, at a governmental level, them to recognize, “Oh look, yes, there’s a real thing here.” And so, you think of all the people who suffered. If they’d just thrown some limes on the boat in their travels, they would have diminished so many of their problems.

We live in a fallen world. And part of taking dominion is recognizing how we respond within environments and what’s going on, how it affects us. And so I don’t dismiss those who talk about, you know, “there’s no proof of chemical imbalances.” Well, I’m not going to get into arguments about whether or not there’s such a thing as chemical imbalances. What do you mean by that? The mind is delicate; it’s a delicate machine. Twenty percent of all the energy you use in your body is used up by your brain—and it’s not even moving. You think that all your energy is being burned up by your limbs, but a fifth of the energy is burned up by your brain. It is constantly active, working, and if it is not fed right, it malfunctions. It’s very delicate.

The weight, balance of serotonin, dopamine, and so on—these things play a critical role in how we think and how we feel, and balances in this regard are real. There may be aspects of genetic disposition as well, though I’m inclined to imagine that some of the environmental factors are passed on. Like this is happening, not because there’s a genetic predisposition, but because you’re following the same pattern that your parents did, and so you succumb to similar things. But again, there are certainly aspects of that that we may not yet fully understand. But there are real aspects with regard to deficiencies in the body. And I won’t ignore this. I won’t go down the path of saying these things are irrelevant. Sometimes when I’m looking at someone, I’m asking myself, “How are you treating yourself?” Deficiencies are a problem—deficiencies related to exercise, deficiencies related to sleep—huge factors, massive. Those two things, before I say anything else—sleep and movement—if there’s not regulated sleep, consistent good sleep, you are asking for mental and cognitive issues such as depression. If you’re not moving, you’re not causing the brain to fire and the body to function and to regulate even the hormones that affect so much of how you feel.

There are also other nutritional deficiencies—the effects of not being in sunlight, and, of course, the deficiency in vitamin D; a lack of certain B vitamins. I’ve seen it, I’ve seen—let me just be blunt—some young women, and they go into a period where they don’t eat right for various reasons. Maybe because of how they look at themselves and how they perceive themselves, and they start to avoid certain foods. As they eliminate meat—remove it from the diet—don’t want anything with fat in it, they eliminate meat. And then they start—their brain, they’re not thinking, they’re not functioning in a healthy way. And you say, “Why? You need the B vitamins. You need the B vitamins.” And you’re not feeding your body, and you’re wondering why you can’t make healthy decisions. You’re trying to advise and counsel and say, “Here’s what you should do.” And they can’t respond with logic and coherence. Omega-3 fatty acids, magnesium— all of these things have been shown to help aspects that are related to depression—not to mention practices that help regulate healthy hormone function. And again, as you go into midlife, menopause, and even for men, midlife—the changes in hormones and so on can have an effect on how you feel. And some of it can be mitigated and helped if you just think about what’s going on and take care of yourself in a right way.

Now, again, these are dismissed. I know people that look on and say, “What’s he talking about? Pastor Tomasi has turned into Dr. Tomasi.” Well, not quite. Go and do your own research. Not medical advice, let me just say. But go and look at it yourself. I will not be persuaded otherwise. These things are massive—massive factors. It might help if I said to you, “What happens if you go and put diesel into a gas engine? Well, try it and see.” And that’s what’s happening with some people and how they’re treating themselves. I’d be on top of the world if I go day after day after day on three and a half hours of sleep, playing video games until 2:30 in the morning, and having to get up at 6 a.m. for work and repeating that day after day—I’ll be functioning optimally. No, you won’t. Get into a pattern of these things.

So there are biological and physiological causes that plunge you into a feeling of depression. I could say more there. I must move on.

They’re psychological and social causes: traumatic events, life stressors, loss, bereavement, breakdown in significant relationships, transitions in life—going from working all the time to being retired. You go into this awful feeling; it overwhelms you. We know these things. If you pay attention and look within and we wonder what’s wrong with us, then of course, as believers, we immediately begin to have this self-loathing—“God’s left me,” and so on. Well, we’ll get to whether or not that may be the case, but look at some of the practical factors: social isolation, cultural pressures. The environment in which we’re in—again, feeling like you have to measure up to something, some imaginary standard; feeling like you’re not getting there; feeling isolated by that—intensifies these feelings of low self-worth and, again, moving into depression. Not being around people, not spending time with people…

I mean, not to open up a can of worms, but five years ago, you will remember COVID. And I’ve thought about this stuff for years—I’ve seen this in my family. So you think about it—you think about why this loved one of yours has gone through this, that, and the other; and you think about it. And when COVID landed, they were isolating everybody. I’m like, “This is going to be catastrophic for mental health—catastrophic.” This is the equivalent, for mental health, of Mount St. Helens erupting. And nobody cares; just stay at home. And we control function, we control action, we control movement based on one parameter and ignore all these others. This is not good.

Some of you know it—even in the short time we’re in South Carolina, things weren’t too bad here. Some of you can look back and say, “My mind sometimes went to a very bad place in those few weeks that we were all isolating.” Chronic stress, prolonged exposure to stress, affects the body—it affects cortisol levels. Sustaining stress through your life—again, stress is not all bad; our bodies are built to deal with stress periodically. Sustained stress, constant, prolonged stress, begins to cause breakdowns in various ways. We struggle to properly regulate our moods, and again, we get plunged into a low frame of mind.

There is, of course, with regard to its causes, the spiritual dimension. We can’t ignore it—there’s a spiritual aspect. Unresolved guilt, patterns of sin. I received a phone call this week—not from anyone here, so I mention it and you will have no idea who it is, and I will say no more about what went on in that conversation except to say that the person on the other end, Jung, definitely was struggling with how they were thinking, their frame of mind. And certainly at least one factor was tied to sinful behavior. You can’t keep sinning over and over and over and over and over again, know its wrongness, and think it won’t affect you. Unconfessed sin, a guilty conscience, contribute over time—not checking sin, allowing bitterness to flourish in the soul, making excuses for it, imagining it’s justified. Pride—we dealt with self-pity. These things can precipitate a fall into a melancholy frame.

Of course, if you go to your doctor, he’s probably not going to mention that unless he’s a Christian. He’s going to look at the symptoms and he’s going to say, “Oh, this is,” he’ll just deal with it purely with a spirit of pragmatism. But it’s real. How can we expect to be in a healthy frame of mind? How can we expect our minds to be living in joy when we plunge our souls into the mire of sin? And we don’t soberly and seriously seek Christ and the cross for cleansing and the Spirit of God to transform our lives. We deceive ourselves.

Another spiritual dimension is spiritual desertion. It would seem that there are those—indeed, you see it in the Psalms on many occasions, as we see here: he’s panting after God, he’s thirsting for God; he wants to know. He remembers in his mind times, as in verse 4, when he went with people to the house of God with a voice of joy and praise—but not today, not when the Psalm is being written. There’s a sense of spiritual desertion, and that comes through in what even the enemies are saying: “Where is your God?” And oh, how that rubs salt in the wound. “Where’s your God?” Why does that bother the psalmist? Why does it bother? Why would he even think that way? When you’re living in victory—when things are going well and the world says, “Where’s your God?” You say, “Oh, He’s here. I’m enjoying Him. It’s evident, visible, tangible.” When the world says, “Where’s your God?” and you’re asking the same question, “Where art thou, Lord?” you go through this feeling of being deserted, of despair. There can also be the spiritual struggle that ties into faith and assurance where, again, with the challenge of sin and the reality of sin—maybe because we haven’t been properly taught or some other thought, maybe from the enemy or whatever direction it may come from—we struggle really to trust, struggling with a sense of assurance. And some of you know that. This is why the psalmist has to tell himself, “Hope thou in God.” That’s his hope, reassuring himself that God will not leave him or abandon him.

So we come then to his cure. What’s the cure? And let me just, before I get into this, say it can be very difficult to source the origin of depression. If you’re there tonight, or you have been there, or in the future you get there, you may not always know why. I’m a psalmist—“Why art thou cast down, O my soul?” Why am I feeling this way? I shouldn’t be.

There are two pitfalls when we come to the cure. One pitfall, one ditch, is being overly pietistic and the other being overly pragmatic. The hyper-pietist, if I can use that term, says everything’s spiritual. “Just repent. Just repent. Believe God’s Word. I’ll fix it.” Really? Really. And I know there are going to be good, very good men who will differ with me with regard to this. I’m not about to get into debate on it, but I hope I’ve already expressed the complexity of our biology and all the various factors that make a difference. And we know this. We know this. We’re living in a time where we can measure these things. I imagine they knew them back in the day. Years ago, they would say, “You know what? When winter casts its shadow over Northern Europe, everybody feels down.” Probably has always been the way, and certainly is today. We have a name for it today—SADS, Seasonal Affective Disorder. And it’s rife in Scotland, Northern Ireland, other parts of Northern Europe; some cultures are mitigated by, you know, some of the Scandinavians—red light therapy and going into the sauna and all that can help sort of mitigate some of the experience. And maybe that’s what they learn. Maybe that’s why they have those things in those cultures. I don’t know. But for the Scots, they don’t. They give up their Highland games and go into caves and just feel depressed.

The hyper-pietist says it’s spiritual. The pragmatist says this can be solved: medicine, good food, supplements, exercise—I’ll fix it. As I say, diagnosing the reason is not easy, and yet it’s important. Why am I going through this? It’s a fair question. Terrible men can have great health. And if that be true, it’s not a stretch to suggest that great men can have terrible health. And you feel like you’re trying to live for God, and yet you’re afflicted—not just in body, but in mind.

And of course, there are other factors. God is sovereign over everything. God afflicts Nebuchadnezzar with madness. He did that. He afflicted him with madness. And he afflicted the Corinthians with sickness. Someone died—He did that. That’s spiritual. And I don’t care what you try to do to mitigate that. Nebuchadnezzar has the best doctors, and they’re feeding him all the best; they’re trying to help him however they can. But God has afflicted that man. And only humility and repentance are going to bring him out. So we can’t ignore that. That’s a real aspect.

At the same time, when Timothy was frequently getting sick, Paul did not tell him to repent. “Timothy, I hear about thy oft infirmities. Repent, young brother. There must be sin in thy life.” No, no, no. “Drink no longer water, but use a little wine for thy stomach’s sake and thine oft infirmities.” That sounds like: go outside, get some sunshine and exercise. That sounds like it’s within that category, doesn’t it? You have these infirmities. I don’t know all that was going on there. I can’t say definitively. It may have been—I just suggest the possibility—it may have been that Timothy wasn’t interested in taking alcohol, avoided alcohol. He was a teetotaler, like a good, free Presbyterian. And maybe he had learned that from Paul, and Paul lived that way too—the kind of life of the Nazarite. Dedication to God. Reasons with regard to social perception and so on. But Paul had lived in Ephesus for three years, and Paul may have known that massive city—its water is horrific. And you can imagine, they didn’t have all the sanitation processes we have today. So Paul had lived there; he knew Ephesus; he was familiar; and there’s young Timothy, and the water’s affecting his health. Paul says, “Yeah, sounds like something I went through. Add wine.” Why wine, Paul? It has alcohol. What will the alcohol do? It’ll kill the germs. The germs are causing the infirmities related to thy stomach. So Paul had no problem having that pragmatic element—not saying, “Timothy, you’re getting sick all the time. It must be divine judgment.” I want you to take that to heart because there are people who are afflicted frequently with sickness, and I fear at times there can be an ease with which our minds just run into, “There must be sin in their life.” Timothy was being afflicted repeatedly with infirmity with regard to his health. It was maybe putting him out with regard to preaching, and he wasn’t able to preach and minister the way he ought, and people were talking and wishing Paul would come back. He was more robust. This Timothy is always sick. It was nothing to do with sin.

So there is that pragmatic aspect. There is that, “Look at the issues. Oh, look, Timothy’s in Ephesus. I know what Ephesus is like. Maybe I can solve that.” That’s the same as me looking at you coming to me and saying, “Pastor, I’m really—I’m struggling right now. My mind is not in a good place. How are you sleeping? How are you eating? Are you moving? Do you exercise at all?” You might look at me and say, “What’s that got to do with it?” It may have everything to do with it.

I know a question that will arise in your mind: What about pharmaceuticals? I would not put a blanket ban on them. I have discovered much over the years in reading and researching and listening and paying attention with regard to this. And I trust I have the humility to also recognize there’s still things we don’t yet get. I would be very careful with it, though, and I would explore every other avenue. I would encourage you to explore every other avenue.

When I went to Tasmania, the reason I was sent there was the pastor—who’s no longer in pulpit ministry—but he was dealing with mental health problems. And I went there trying to help, and I knew—I already knew—his pattern was very much isolated, socially isolated, in the house, not moving, not going anywhere. And whatever had triggered it—and I couldn’t tell you what that was—but whatever had triggered it was not being helped by his social isolation and his lack of movement. He wasn’t eating well, drinking too much coffee, not exercising, and so on and so forth. And I met with him, and I tried to encourage him, “Please join me for a walk. Let’s go walking together.” I failed; he wasn’t interested.

The reason I took that approach goes back many years. My grandfather, on my father’s side, told me—Armenians living in Iran, and living there leading up to the Iranian Revolution—and many, many could see the writing on the wall. And my father, or my grandfather, and many of his friends—like really the wider family—they all had the means to get out of there. They had the wealth, and many of them did. They saw it. Their friends and high places were telling them. “You can feel, you can feel a revolution happen. It doesn’t happen overnight. You can feel the energy.” And so many of them, they came here, came to the U.S., started a new life, sold everything. My grandfather did not. He stayed, hoping for the best, only to watch as the revolution unfolded. Every non-Muslim—especially those who had status and position in the society, who held high rank—were treated with suspicion. Some of them lost their lives.

What I tell you, I can only tell you based on the testimony of my own grandfather. Obviously, I was not there. He said that the only reason he was spared his life was because there was a Muslim of high rank whom he had worked with and knew, who said, “He’s okay, leave him.” But he left Iran with his wife and nothing else and got to Germany with nothing. And everything he had built up, everything he had owned—everything he had—and he’s now in his mid to late 50s; it’s all gone, overnight, gone. And I remember him telling the story. And he got to Germany, and the overwhelming sense of depression came over him. And we are not talking about someone—I can’t describe to you the kind of personality he was—when you talk about someone with grit and who, at least outwardly, looks like they’re impenetrable, that’s who I’m talking about. The drive—it’s probably unlike anyone I’ve known in the flesh. When he got there, he got to Germany; he had nothing. And depression hit him hard. And when he would tell the story later, he would say, “That German doctor—was my angel sent from God?” You’re talking about very early ‘80s by this point. And this doctor said to him, “You have two choices here. I can begin you on a course of medication, and it may be that you will never come off it ever in your life—That’s it; or you can follow my advice.” And he told him to do this: sleep well, have a good breakfast in the morning, and go and walk for two hours outside in the countryside. Come back, take a nap, eat well, and go for another two-hour walk, and then go and rest. Do that every day for a month and come back to see me.” And his own testimony was that when he came back after that month, he wasn’t out of it, but his whole mind was in a different place. He began to believe all was not lost. He packed up, relocated to America, got a job at 62 years of age, and tried to rebuild again—rebuilt in 13, 14 years; retired at 75. That doctor understood something that still some people don’t get.

So I am not completely rolling out pharmaceutical intervention. I think sometimes it can stabilize, but I would encourage exhausting every other avenue.

And in addition, very quickly, let me just suggest other things. First, you must hope in God amid despair. That’s the word of encouragement that the psalmist gives to himself: “Hope thou in God.” You have a right to hope in God. “God, thy God”—that’s what he says. “I shall yet praise him who is the health of my countenance and my God.” He is my God. He’s made Himself known to me. He’s condescended to me. He has saved me. I will hope in the God of my salvation. Hope is a powerful thing. Whatever despair comes into your mind, however bleak may be the outlook, hope in God.

And do the same as David does. Put yourself on the other side of the table. Talk to yourself. Take your own name. Just take it and start talking as if you were talking to a friend. Hope in God. Remember God’s sovereignty. Remember God’s sovereignty. You can’t get away from His sovereignty. Nothing is meaningless when God is sovereign. Nothing. And we can start looking at all the outcomes, and we can say, “Well, it’s because of, again, even the matters I’ve raised—things like exercise and diet and sleep and all those things,” we might look at that, for example. But even in that, God is sovereign. He’s teaching you something. He is in control. He is guiding. He is leading. And so, recognize, He is sovereign. Don’t forget He is in control. The Lord gives. The Lord takes away. Bless His name.

Maybe He’s detaching, or loosening rather, the hooks of your attachment to this life and all your hopes and dreams that are rested and settled and rooted in things that are not Him. He has a right in His sovereign purposes to keep you in a state of despair. He has that right. Maybe He doesn’t want you to entirely escape from this. Maybe He wants to make you a testimony of someone who perseveres in a condition of continual feelings of despair. Maybe. I think those circumstances are very few. But I don’t doubt that God may—He may have His purposes.

We sing William Cooper. We sing other writings. We rejoice in Spurgeon’s writings, so much of it birthed in an understanding of the sufferings, the feelings of depression, the horrors of being forlorn and downcast and melancholy. And they tap into something. These men, the grip of this world is taken from them, so they do have this aspiration. Their minds are more readily set upon things which are above. God—since God is sovereign—He may, He may so choose such suffering for you. And your response is to trust and to bless His holy name.

Repentance and confession—Luther had it right. He had many things that he got wrong, but he certainly had it right when he nailed his 95 theses. And he begins with repentance as an ongoing expression of the believer’s life. It’s not a one-and-done thing. We don’t just go and do penance. The priest says, “You’ve done something wrong, go and do penance.” No. The believer is in an ongoing frame of repentance. Oh, understand this—understand this. Repentance, true repentance, is a believing repentance. You can’t rightly repent without believing. The turning away from sin is a recognition of who God is, His hatred of it, and so faith undergirds your repentance. I want to please God. I want to respond as God wants me to respond. And so, faith rises up and turns away from the thing that God hates. Confess it. Make sure that sin isn’t the issue. Just leave it there. Make sure sin isn’t the issue. Unconfessed sin is not the issue because I have laid my soul bare before God, and I’m detached from everything that may be an idol or some act of disobedience in His presence.

And then assure yourself of God’s covenant presence with you. Assure yourself of God’s covenant presence with you. I said this before—He will never leave nor forsake His people, ever. And what faith does then is it says, “He is here. I am in such a darkness as to make it imperceptible to me. I can’t feel Him. I can’t see Him. But He said He would never leave me.” And it reaches out. Faith reaches out because He promised He would never leave Him. He says, “I know you’re there, Lord. Help. Help.” He will not despise the broken and the contrite. There’s a sense in which that— that happy-go-lucky, that, we’d say in the old days, that gay spirit—it isn’t always where God wants you to be.

Did our Lord go through His life in ministry without weariness? Do you think? That being a man of sorrows has nothing to do with what we describe as melancholy or depression? A man of sorrows— that has melancholy, depression, whatever you want to call it, written all over it. No, I am not suggesting that there was any sin. But a real battle—a real battle in the soul of our Redeemer—as He bears the weight of the curse and has a knowledge of the experiences and the hurts and the pains and the sins. Because of the purity of His nature, He has a knowledge. He sees things and feels things you nor I can. So without sin, He endures the very sufferings of this life. And you may be called to it as well.

Oh, I know, I know—that’s not what this world promised you. Everything’s always going to be swell. No, no, it won’t. What matters is that no matter what, do not lose hope, or deframe it, as the psalmist says to himself: “Hope thou in God, no matter what.” May the Lord bless His Word.

Let’s bow together in prayer.

Beloved, let me say to you: do not suffer in silence. Do not suffer alone. I do not claim to have all the answers, and I cannot say that I know an easy way through such an inner battle that we may describe as depression. But you’re not called to suffer alone. And there are all sorts of reasons that can trigger it—frustrations, challenges in the home, in the workplace, in the world. The Lord knows our frame, that we are but dust, and He has given us each other, that we might pray one for the other and bear one another’s burdens. I say again, do not suffer in silence. Don’t isolate yourself.

Lord, bless Thy Word. I pray that each one of Thy people would be strengthened by the Spirit in the inner man, and that whatever despair, whatever lament, whatever the hardship, whatever the feeling that brings that sense of overwhelm and immobilizes our souls, Thou wilt be very gracious and lead Thy people gently. Help us, Lord. Help us, though we may feel the burden, to rejoice in the Lord always. May our delight be in the knowledge that whatever is going on in our lives, our sins—which, praise God, are all washed away—grant us then peace and hope and joy. And may the grace of our Lord Jesus, the love of God our Father, and the fellowship of the Spirit be the abiding portion of all the people of God, now and evermore.

Amen.