Moods, Medicine, Research, and Pathology 
 
This past Friday an article was published titled “Potential Cause of Depression Identified.”The writer described research that involved looking at the brains of mice and men. The question the researcher Dr Scott Russo sought to answer was whether or not chronic stress would change the way our brain circuitry functions and if that change might be responsible for major depressive disorder. The finding of his study identified a protein at the connection between nerve endings and cells in the brain “as a potential cause of depression.” 

It is hard to say whether this study will be replicated or if the findings on autopsy in the brains of individuals who
were known to be depressed are actually connected to the major depressive disorder they were known to have. But, the study is exciting for two reasons. First, it is exciting because it is being done. We need more research that looks
at the cause for the disordered sadness we now call depression. 

The second reason this research is exciting to me is that it is being done looking at actual human cell pathology. Any real  disease must have some sort of disorder of cell function. Until we understand that disordered function, we really do not understand the problem. And, it makes it very difficult to find a solution.

In the 1850’s, Dr. Paul Ehrlich used purple dye to stain cells from residents of an “insane” asylum in Berlin. All the
residents were assumed to be insane and beyond any help that medicine had to offer at the time. Ehrlich and his colleagues found that half of the residents had an infectious disease that was known to cause their behavior. They had an infectious disease not a mental disorder. And, on his 606thtry, Ehrlich invented the first treatment for that disease by chemically modifying arsenic.

That is the kind of research we need to be doing in medicine now. As Ehrlich said, “It should be possible to find
artificial substances which are really curative for certain diseases, and not merely palliatives acting favorably on one or another symptom.” Ehrlich was looking for cures for a disease that he understood. We should be doing the same
thing today. 

There are two things today that could help those labeled depressed while we wait on medical science to find a cause and cure like Ehrlich did. The first would be for all of us who want to help those who struggle with sadness to understand the difference between normal sadness over loss, and disordered sadness that comes without apparent cause. The 90% who sorrow for whatever reason can find comfort and direction in the Bible. The 10%  who may be struggling with undefined disease can find the same strength and comfort to deal with illness while they seek the best help available to them in  medicine.


More on this subject can be found in my
book “Good Mood Bad Mood.”

Moods, Medicine and the FDA      
 
The first thing I must say is that if you are taking medication of any kind for anything do not change your treatment plan or dose without consulting with your physician. Doing so can have serious problems. Reading this blog is not like an apple and is not intended to keep your doctor or his advice away! 

The second thing I need to tell you is that Bible has very little to say about taking medicine. Christ said “The sick need a physician,” even though He knew that most of what doctors did at the time was worthless and even harmful. I suppose He knew we would do better eventually. The silence of the Bible on the subject of taking medicine leaves it in the realm of  Christian Liberty. 

I think Paul defined Christian liberty best in Romans 14 when he told the readers that they were not better Christians if they ate meat offered to idols or refrained and only ate vegetables. The idols were nothing, so Christians had a choice that was limited by the rest of the bible and by not harming other believers with their freedom. I have always said that taking medication or not taking it is a Romans 14 issue. The thing that Paul blistered the believers at Rome for was judging one another. So taking medicine is matter of Christian Liberty.  

So, if we are free to choose, then how should we make that choice? I always liked what Ed Welch said in his Book “Blame it on the Brain.” Welch said that taking medicine was not a matter of right or  wrong, it was a choice between wise and unwise. And, that gets us to the point of this blog.  If taking medicine is a choice between wise
and unwise, then it really comes down to whether or not it works and if the side effects are worth it. I recently heard a speaker say that medicine approved by the FDA must be effective. The problem with the statement is that “effective”
covers a wide range from works every time, to works in one of 4 patients. It can also mean that the medication moves a Hamilton rating scale 2 points out of 50 when a good night’s sleep will move it six.

Dr. Alan Roses said the following about all the medication that we take in the UK Independent. "The vast majority of drugs - more than 90 per cent - only work in 30 or 50 per cent of the people," Dr. Roses said. "I wouldn't say that most drugs don't work. I would say that most drugs work in 30 to 50 per cent of people. Drugs out there  on the market work, but they don't work in everybody." A January 2010 article in  JAMA went further and said that most of the medications that we use for depression may only work better than placebo in 10% of the people who take them. 
 
When we think about medication for mood disorders, we need to realize that there is a significant potential for them to simply not work. This is particularly true if we are trying to “treat” normal sadness over loss with a pill. When I prescribe medication at a patients request for depression that has an obvious loss as the cause, I will always tell the
patient that the medicine will not change your life or how you look at it.  

And that is the heart of the matter. We can  choose to see our sadness over loss as something that God intends to use in our  lives like Hanna or Nehemiah in the Old Testament or Paul in the New Testament,  there is hope for a different result. And, hope is a very good thing. 
 
(http://www.independent.co.uk/news/science/glaxo-chief-our-drugs-do-not-work-on-most-patients-575942.html)
 

Yesterday I spent the day talking about  Biblical counseling to a great group of people at the Biblical Counseling
Training Conference at Faith Church in Lafayette, Indiana. The first hour was “The  Husband’s Role” in marriage. It was a really good topic considering that today  is Valentine’s Day. I had the privilege of reminding the men that it would be a really good idea if they at least went to Meijer’s and picked up a card or something for their sweeties! It is
hard to think of anything more important to the success of any family than a  husband who works daily at being the kind of husband described in the Bible. 

There are lots of things said in the Bible  that we husbands ought to be doing, but there were three that we talked about at  length. Husbands must be students of their wives. Peter told us (1Peter 3:7)  that we are supposed to live with our wives in an understanding way. In order to  that we must apply ourselves to studying our wives and then responding to their  needs in a way that enables them to grow more in their walk with Christ. 
 
Husbands are tasked with leading the home  and that leadership is expressed in service. In the same sense that Christ is  the head of the church and died for it, husbands have the task leading the home.  That means that we get to make decisions for the benefit of our wives &  children at our expense! Leadership is service as “Christ came to serve and give  his life as ransom for many.” 

The last aspect we discussed was the most  important. Husbands are commanded to “love their wives as Christ loved the  church and gave himself up for her.”(Ephesians 5:25) Husbands are supposed to  love their wives first, most, sacrificially, without bitterness, unmistakably,  and always! As I told the men, our example for loving our wives is Christ. If  you want to know how to be a good husband, then follow how Jesus provided for  the disciples and his followers in the gospels. Jesus loved the church which  Paul says is his bride. And, so should we. 
 
The last thing I told the men was that if  they wanted to really grow in being a biblical husband, they should journal
daily how they occupy those three roles. Journaling allows us to keep track of  how we are growing in our talk of being God’s best husband for our wives. 

When I think about the value of sadness in our lives as Christians, I think about Hannah and Grace. The following is an
excerpt from “Good Mood Bad Mood” and it discusses the role of grace and sadness in Hannah’s life. 

Not long ago, I was visiting my cousins in southern California and went to church with them. The sermon “happened” to be about Hannah and the problems we suffer. I left that morning with two things written in the margin of the bulletin. The pastor said, “Problems never come without purpose” and Hannah’s name in Hebrew means “grace.” I don’t believe it was an accident that the pastor preached about Hannah on a day when I had traveled 2000 miles to be there and when I needed to hear about problems, sadness, and grace. I also don’t believe it was an accident that Hannah’s name means “grace.” In truth, that  is what her story is all about. If you read the account quickly, you may think that this is a story about the evils of polygamy or the burden of infertility. And you would miss the point. It reflects the definition of womanhood in that era, when Rachel would tell Jacob to “give me children or I will die.” Rachel and Hannah shared the view that they could not be complete as women unless they  had sons. If you are not careful, you might think that the point of the story is that God miraculously opened Hannah’s womb to give her children. But the real point is how God worked in the heart of a woman whose sole desire was children.  Hannah’s situation truly was a burden and a heartache. But in the midst of it, Hannah was fixated on herself and her problem. It is there that we see God’s grace at work. From the time we see her in tears until she weans little Samuel and presents him at the temple for service to the Lord and Eli, Hannah changes. She changes from a sad woman who could only be fulfilled by having a child to a joyful woman who could give the person she valued most to the Lord. She did not go grudgingly to the temple with her son Samuel; she went with joy to leave behind part of her heart. Then Hannah prayed and said,
 “My heart exults in the LORD; My horn is  exalted in the LORD, My mouth speaks boldly against my enemies, Because I rejoice in Your salvation. There is no one holy like the LORD, Indeed, there is no one besides You, Nor is there any rock like our God.” —1 Samuel 2:1–2
 The rest of Hannah’s prayer is a testimony to God’s sovereign grace. The remarkable thing about it is that God could send a problem into Hannah’s life that brought her sadness, and then allow that sadness to drive her to himself, to grace, and to change. If we could do away with all suffering and sadness, we would indeed suffer a great loss. The real importance of sadness is that it drives us to the only place and power that bring about real change in our lives.

Last time we talked about normal sadness.  Jerome Wakefield and Alan Horwitz have recently helped revive this concept in  their book, “The Loss of Sadness.” In it they define normal sadness as a  “biologically designed” part of normal human existence. They also said that we  benefit from it because normal sadness will draw people to help us. Further normal sadness protects us from behavior that might harm us, and discourages us  from continuing things that are likely to fail. Paul illustrates how normal sadness  works in 2Corinthians 7. He says that the Corinthians were driven to sorrow by  the letter he wrote to them that reprimanded them for tolerating the immoral behavior of one member. Paul rejoiced that his letter caused them sorrow over their behavior that led them to repent and change. As Paul said, “When we sorrow  according to the will of God” it leads to repentance and change.  On the other hand, when we sorrow “like the world” it leads to deadly  living. Sorrow that does not draw us to God may drive us to anger, fear, worry,  and bitterness. When sorrow heads in the right direction it is very useful.    Chapter 6 & 7 of “Good Mood Bad  Mood” identifies the ways that sadness is a help to the Christian. Next time, we  will look at some of the ways it can help us.