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The Underlying Causes of Depression

Why, my soul, are you downcast?

Why so disturbed within me?

Put your hope in God,

for I will yet praise him,

my Savior and my God.

Psalm 42:5

But with the slow menace of a glacier, depression came on. No one had any measure of its progress; no one had any plan for stopping it. Everyone tried to get out of its way.

Frances Perkins

After a patient has been diagnosed with depression, the first question that patient usually asks is, “What caused it?”

Many things contribute to depression and much emphasis is put on answering the question, “What caused it?” or “Where did it come from?” I frequently answer patients by saying, “For any particular individual, we may never fully know.” Is that frustrating? Hear me out. Often by the time someone comes to my office or goes to their general practitioner, multiple contributors have impacted their current situation.

Much as we don’t see a clogged drain before it backs up, we often don’t recognize the initial signs of anxiety, depression, cancer, heart disease, and many other conditions for what they are. Until enough signs and symptoms add up to a situation warranting concern, we don’t recognize a problem exists. We don’t seek help, often for months or years. Then we often don’t recall the initial warning signs. We may not remember if or when our sleep, diet, or exercise patterns became irregular. Or we may have forgotten about the stress we previously endured for a time at work, home, or other places.

Sometimes knowing the exact answer to “Why?” may not be as important as answering “What do we do about it?” Still, it can be helpful to know potential causes of depression in order to lessen the chances of experiencing it again in the future.

It’s Chemical

The symptoms associated with depression, for many, can be traced back to the chemical makeup of the brain. The brain contains many chemicals, called neurotransmitters, that help transport information from one part of the brain to another. Monoamines, which are mood-related chemicals, include dopamine, norepinephrine, and serotonin. These particular neurotransmitters help regulate sleep, appetite, sexual interest, emotions, and reactions to stress. Many individuals who suffer from depression have lower levels of monoamines in their brains. Yet different symptoms of depression are experienced depending on the varying levels of chemicals and hormones. This helps explain why, for example, some individuals with depression experience insomnia or a loss of appetite while others sleep or eat excessively. This is also why one person may respond to a medication differently than someone else being prescribed the same medication.

Studies indicate that our thoughts affect our neurotransmitter production, which then directly influences our physical experience of a situation. Imagine you are home alone late at night watching a movie when you hear a rattle of the doorknob. When you hear the unexpected sound, you think, “I don’t know what that is—maybe it’s a thief.” The thought signals to your brain that there is an emergency, and as a result, your brain produces excess chemicals such as cortisol, which is used in an emergency to help with fight or flight. Your body then reacts to the increased chemical production. Your heart rate increases as your blood flows away from your digestive track and into your limbs so you can react quickly. So while our chemical makeup can impact our mood, our thoughts can impact our chemistry.

It’s Genetic

Genetics can play a large role in our experience of depression. Research suggests that approximately 40 percent of individuals with depression suffer as a result of a genetic link. An individual is three to five times more likely to experience depression if a relative has suffered from depression.1

Even if there is a genetic predisposition for certain medical and emotional conditions in your family history, that does not mean you will necessarily succumb. Think, for example, about alcoholism. Having an alcoholic parent or grandparent may increase your risk of being predisposed to alcoholism yourself, but not everyone with an alcoholic relative becomes an alcoholic.

It’s Secondary

Physiology and medical disorders such as thyroid disease, diabetes, or stroke can also contribute to depression. I encourage those who experience symptoms of depression for a prolonged period of time to see their physician and undergo a routine medical physical to rule out physiological contributors to their mood.

Sometimes vitamin deficiencies, such as low vitamin D, can contribute to depressed mood, fatigue, and lack of energy. Thyroid dysfunction is often associated with symptoms of depression, including lethargy, irritability, and indecisiveness. Low blood sugar and insulin resistance often lead to similar symptoms. Many individuals who suffer from cancer, a heart attack, a head injury, or a stroke may also develop symptoms of depression. It’s not within the scope of this book to list every possible medical condition that can contribute to symptoms of depression. It’s important, however, to be aware that such relationships exist so you can explore these potential factors with your physician.

It’s Reactionary

Environmental factors and stress are also frequent contributors to depression. When we are raised around family members who suffer from mental health conditions such as depression, we can be susceptible to their influence and mimic their negative or depressed responses to situations because of their modeled behavior.

Major life changes can contribute to depression, yet the depression may not start right at the time of change or crisis but rather be experienced weeks or months later as a delayed response.

Stress can also contribute to depression, whether good stress or bad stress. Our bodies react chemically in the same way whether we are going through the death of a loved one or the birth of a new baby, whether we are sitting in a traffic jam late for a very important meeting or being given a raise for a job well done.

Am I saying that chemical imbalance, genetics, medical conditions, and environmental factors cause our depression? Yes and no.

It’s Spiritual

While all of the above contribute to depression, there are also spiritual roots. The next several chapters focus on the spiritual aspect because unless we treat the underlying roots of depression, we cannot expect to rid ourselves of it permanently.

All people, Christian or not, have a spiritual nature. It’s the way God made us. We also have an enemy who is a spirit, and we are susceptible to his attacks. Peter warned, “Your enemy the devil prowls around like a roaring lion looking for someone to devour” (1 Peter 5:8). Paul said that we stand in the middle of a war between two opposing kingdoms. “For we are not fighting against flesh-and-blood armies, but against evil rulers and authorities of the unseen world, against mighty powers in this dark world, and against evil spirits in the heavenly places” (Eph. 6:12 NLT). The enemy isn’t only concerned with strong-arming Christians. He seeks to separate believers and nonbelievers alike from God (see Eph. 2:1–2). Both Christians and non-Christians often unknowingly open the door to the devil by the things they do, say, or believe, allowing the “roaring lion” to enter and wreak havoc in their lives.

This is where spiritual roots to depression start, but it’s not where they end. In Scripture, the enemy is referred to as the father of lies, incapable of telling the truth (John 8:44). When we succumb to the enemy’s influence, we often unconsciously agree with the lies he feeds us, lies that do not align with God’s truth. And he builds lie upon lie until our view of ourselves, the people around us, and the world we live in becomes as bent as a tree in a hurricane. God described this situation in Hosea. He said, “My people are destroyed for lack of knowledge” (Hosea 4:6 KJV).

Lest you become worried or concerned about information you lack or about the presence of a shadowy spiritual enemy, I encourage you not to take on that fear. Fear is just another tool of this enemy. “For God hath not given us the spirit of fear; but of power, and of love, and of a sound mind” (2 Tim. 1:7 KJV). Take courage and rejoice because God’s Word reminds us, “You, dear children, are from God and have overcome them, because the one who is in you is greater than the one who is in the world” (1 John 4:4).

The common outcome of depression is usually a lack of peace and joy. We have a very real enemy who seeks to steal our joy and kill our peace. John 10:10 says, “The thief comes only to steal and kill and destroy.” In his Word, however, God promises to make our joy full: “I have told you this so that my joy may be in you and that your joy may be complete” (John 15:11). God sent Jesus so that we could live an abundant life. The verse above about the thief has a second half to it. Jesus does not leave us with loss, death, and destruction but gives us a promise. The entire verse reads like this: “The thief comes only to steal and kill and destroy; I have come that they may have life, and have it to the full” (John 10:10).

Do you want some good news? You are not the primary cause of your depression. Neither are your genetics or your situations. The thoughts that lead to your depression are not your thoughts. They are thoughts offered to you by the enemy that you’ve come into agreement with. The enemy aims to keep us in a state of bondage and despair under a canopy of heaviness and oppression. Our enemy influences us primarily through our thoughts during situations in our lives. Unintentionally, we allow the enemy access to interfere with our thoughts. A direct correlation exists between our thoughts and our physical and emotional well-being. Proverbs 23:7 reminds us, “For as he thinketh in his heart, so is he” (KJV).

We often unknowingly give the enemy permission to influence our lives. But 1 John 4:4 reminds us that the one who is in us is greater than the one who is in the world. James 4:7 tells us to resist the devil and he will flee. We have the authority and the ability to close the door and eliminate the influence of the enemy.

My experience of depression had a spiritual root. Since coming to understand the impact of spiritual roots on depression, I cannot recall an instance of dealing with a depressed person, professionally or personally, when a spiritual root was not evident to me. This is an area, though, that is largely unaddressed by the medical profession, or even by many churches. Not many people are asking about spiritual roots. There is not much contemporary discussion of it. It’s also hard to discern these spiritual influences within ourselves. Unlike the onset of a physical ailment such as a stomachache or a toothache, which is acute and demands our attention, the lies of the enemy slide undetected into our thoughts, and then into our emotions and choices, and eventually into the core of who we are. Only later does their destructive power emerge as they bring on an illness like depression.

My Own Story

Let me share some of my own story to help you see what I mean. Looking back, I can see all of the above-mentioned contributors to my depression experience. My first known personal acquaintance with depression came when postpartum depression rapidly overwhelmed me following my first son’s birth. During the postpartum period, hormones are erratic, so a chemical imbalance was undoubtedly a contributor.

After the postpartum depression resolved and I settled into parenthood and lived through what could be thought of as the normal period of sleep deprivation, I remained fatigued and moody beyond what was reasonable. My physician wisely ran tests, which revealed a thyroid disorder. This physiological condition affected my mood, energy, motivation, and outlook.

My mother, aunt, and grandmother all suffered with depression, so a genetic component was a feasible factor. Although I did not suffer with depression as a child, my mother was depressed most of my childhood years. She modeled behavior and a mentality that colored my perception of the world. I thought her experience was normal. So while a genetic predisposition was likely a factor, modeling within the home was also at play.

Throughout my life, I endured difficult circumstances and many trying events that each could have impacted my thoughts, attitudes, beliefs, and mood. They included:

multiple childhood surgeries and rehabilitation
the premature death of my father when I was young
years of graduate school
multiple moves
caring for a parent and a spouse with cancer
a miscarriage
a life-threatening illness

Do I think my family’s history of depression, my parent’s modeling in the home, the birth of my children, or any of my difficult life circumstances caused my depression? No. But I did before I understood the spiritual contributors to depression. Now I look at those experiences and situations as the seeds of depression. How I responded would either provide fertile ground for those seeds to flourish or choke out the seeds before they took root.

Having a greater understanding of our enemy and how he operates, I now clearly recognize the roots of my depression. This is my hope for you as well. God said his people are destroyed because of lack of knowledge (Hosea 4:6). Each week in my office I see how true this is. We are destroyed when the enemy knows more about the roots of our depression than we do. We cannot fight effectively until we understand what we are fighting and have the weapons to engage in battle.

My depression had many spiritual roots. Hindsight gave me fresh revelations about these roots. Very early in my life, I experienced a life-threatening illness, which resulted in multiple surgeries and hospital stays (during a time when parents weren’t allowed to stay with their young children). The enemy took advantage of that time and offered up lies:

“You aren’t safe.”

“You are abandoned and alone.”

“No one cares about you.”

“You can’t trust others to be there for you.”

“You need to be prepared to fend for yourself.”

As a child, I didn’t know any better at the time, and I fell for his deception and responded in ways that aligned my perspective with his dishonest manipulation and opened the door to the spirits of rejection, abandonment, fear, doubt, unbelief, and even a poverty mind-set. This was a spiral staircase going down because the enemy used that wrong thinking to convince me of more lies that interfered with my health, my mind, and my heart.

After my illness, physical disfigurement remained. I was too young to realize I was different from others, but the enemy knew he could use the situation to his advantage. Children teased me about my physical deformity, called me names, and isolated me at recess and in gym class. Even a Girl Scout troop leader made me a mockery to my peers by emphasizing my physical limitations to motivate the rest of the troop. Each time I heard the enemy’s lying whisper. At the time, I did not know it was the enemy and his lies:

“No one likes you because you’re different.”

“You’ll never be as good as they are.”

“Nobody will love you the way you are.”

As a naïve child, I readily believed the enemy’s lies. In my heart, I watered the soil to let those seeds take root. An unloving spirit firmly planted itself in the core of my belief system and colored my perception of myself, others, and God. It was then difficult for me to fully appreciate the Father’s unconditional and complete love for me, making it impossible for me to love myself or others fully. We cannot give what we do not have.

Living with a depressed mother, feeling I wasn’t good enough, and subconsciously fearing rejection and abandonment, I spent decades of my life trying to compensate for my perceived flaws by trying to be perfect in other areas. Never considered good enough for athletic pursuits, I focused my efforts on academics. Unfortunately, even in that area I agreed with the enemy: “Anything short of perfection is failure and unacceptable.” And again peers took their jabs at me, this time because I excelled. Again the enemy taunted, “It doesn’t matter what you do. You’ll never measure up, and you’ll never be accepted or acceptable.”

I believed the lies of the spirit of self-hatred, causing me to hate anything that represented imperfection in myself and believing others and God did too. After allowing years of derogatory statements by others to pierce my heart, I listened to the taunts of the spirits of self-hatred, self-rejection, self-condemnation, self-pity, self-bitterness, self-resentment, and unforgiveness. I even began to punish myself.

God’s Word declares, “How beautiful on the mountains are the feet of those who bring good news, who proclaim peace, who bring good tidings, who proclaim salvation, who say to Zion, ‘Your God reigns!’” (Isa. 52:7). Unaware of what the Word said, rather than agreeing with God’s truth and seeing my feet as beautiful, I looked at my physical deformity and hated it. I rejected that imperfect part of myself and “punished” that foot by never letting it take the first step as a way of acknowledging that its imperfection made it and me inferior.

I also lived much of my life agreeing with the spirit of fear rather than believing God’s truth: God did not give me the spirit of fear, but instead he gave me power, love, and a sound mind (2 Tim. 1:7). When my father died suddenly and unexpectedly during my adolescent years, my first thought was wrapped up in fear: “What do I have to do to help support the family?” The enemy taunted me with, “If God would take your father, what makes you think he won’t take your home, your finances, and the rest of your family?” Believing that lie just further entrenched fear in my life. I reacted with the belief that I couldn’t trust God and could depend only on myself. That was a very lonely and depressing place to live.

After decades of agreeing with the enemy’s characterization of me rather than believing what God said, I lived under the weight of the spirit of heaviness. I frequently woke in the morning feeling covered by a blanket of oppression, followed by days lived in despair and feelings of hopelessness. Those days were often governed by my feelings instead of by God’s truth. But feelings are not reliable. Our feelings are the outward manifestation of the thoughts we believe.

When we feel fearful, worried, or anxious, those emotions are the outward representation of what we have believed (e.g., “Something bad is going to happen,” “I can’t trust God to take care of me,” “God’s Word is true for others but not for me,” etc.). When we feel angry, we behave in ways that are consistent with what we have believed to be true (i.e., “I’ve been wronged,” “Others have intentionally hurt me,” “I have to protect myself,” etc.). When we feel sad, blue, or depressed, our emotions are a representation of the conscious or subconscious thoughts we have believed (i.e., “I’m not good enough,” “I don’t deserve better than this,” “I’m always rejected,” etc.). For many years I accepted the lie that “I’ll probably always feel this way.” Do any of these sound familiar?

Stress, anger, and the belief that our situation will never change (hopelessness or helplessness) can all lead to varying degrees of depression. The Bible talks about oppression and a spirit of heaviness, which is depression. Typically, I find that many spirits work together to exacerbate the effects. In my own life, I know the spirit of heaviness was a propelling force in my spiral down to depression’s valley. I also agreed with the lies presented to me through guilt, self-hatred, and self-pity that contributed to bitterness, anger, and a rejection of myself. I was unaware of the invisible war waged against me, but I was also unaware of what God’s truth said about me, making me an easy, defenseless target. I find this to be true of many of my patients as well.

For decades I was unaware of the evil forces operating against me, attempting to separate me from God and his truth. I was physically and emotionally perishing because of this lack of knowledge. That is why I want to share this knowledge with you. I was compelled to write this book to share what I learned so that others can experience the abundant life Jesus promised. In the next few chapters, we will uncover what the enemy does to make us depressed and keep us there. Then we will explore what, by God’s grace, God won’t allow the enemy to do to us.

You wouldn’t be reading this book right now if you or a loved one didn’t struggle with at least shadows of a spirit of heaviness and depression. Breaking the emotional chains of depression that weigh us down under that spirit of heaviness is a process. God’s Word reveals to us in Isaiah 61:3 that one of the keys in that process is to offer God our praise. It’s hard to remain beaten down and oppressed when we are praising the Lord. If you continue to praise him as you read this book and do the recommended exercises at the end of each chapter, he will meet you where you are!

Are you ready to learn the enemy’s tactics to keep you under the blanket of heaviness?

Your Rx

Look up the following verses: Psalm 42:5; Jeremiah 29:11; John 15:11; 1 John 4:4. Write them on index cards and place them where you will see them frequently. Read each of these passages aloud three times daily, committing them to memory.
List the potential chemical, genetic, medical, and environmental conditions in your life that may have had a role in your depression.
Prayerfully ask the Lord, “Father, what lies of the enemy have I believed that contribute to my depression and detract from my ability to live life fully?” Write down his response to you. Then pray, “Father, show me your truth. Give me the faith to believe your truth rather than the lies that seem true.” Record what he reveals to you.

My Prayer for You

Father, your Word says in Isaiah 54:17 that no weapon formed against us will prevail. I thank you that you give us so much grace when we make mistakes and when we believe lies that are not in agreement with your truth. I thank you that you show us so much mercy and that you’ve led this dear child of yours to read these pages in an effort to exchange despair for gladness. Father, I pray that your Holy Spirit will minister to this person’s heart and bring a fresh revelation of your truth. I thank you, Lord, that no matter what exists in our genetic inheritance, no matter what difficult circumstances we encounter, and no matter what the enemy plots to harm us, you are bigger and greater than all of it and that it’s your desire for us to be in health and to live life to the full. Because of the hope we have in Jesus, amen.

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3 The Underlying Causes of Depression

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The Underlying Causes of Depression