When sin entered the world, a host of afflictions followed in its wake, including depression. Before Adam fell, he and Eve knew nothing of sin, shame, fear or grief. But when sin broke their perfect world, it doomed them to sickness, betrayal and loss (Gen 3:14-19; Rom 5:12; 8:20-22). The arrival of suffering made constant exhilaration no longer possible. Rather, many of their offspring would suffer depression at some point in life because of physical illness, sad circumstances, poor choices, broken relationships – or for no apparent reason at all. Depression traces back to sin, but often not the sufferer’s own sin. It strikes believers and unbelievers, the strong and the weak, the stoic and the sensitive, the spiritual and the carnal. It can drop down suddenly or creep up slowly. It might pass in a few weeks or become a lifelong struggle. And because of its stigma, many will hide their troubles and languish alone.
Depression differs from situational sadness. The Lord Jesus wept on sad occasions but was never depressed (Luk 19:41; Joh 11:35). Both normal grief and depression include intense sorrow often mixed with anxiety. With ordinary sadness following a loss, the painful emotion comes in diminishing waves interspersed with normal feelings and positive memories. In depression, however, the mood stays low for long stretches of time with little or no relief. Sorrow following a setback may include regrets, but depression commonly adds feelings of worthlessness and self-loathing. Bereavement may produce fleeting thoughts of dying to be reunited with a loved one, but depression often creates an obsession with death as an escape from pain that looks permanent.
Depression is neither exclusively physical nor spiritual; it is both. While depression affects sleep, energy, appetite and movement, it may also be an effect of some mix of illness, gender, genetics, personality, wintertime, stress and abuse (Lam 3:1-18; Psa 143:3-4). When people are depressed, they can’t concentrate or make decisions and lose interest in activities they once enjoyed. Some are highly anxious and agitated, lose weight and can’t sleep. Others note apathy, fatigue, sleepiness and weight gain. And their overly vigilant and sensitized nervous systems generate a range of noxious and medically unexplainable symptoms that add to their suffering. And no, they can’t simply switch these feelings off.
Scripture describes the raw emotions of men and women, faithful servants of God, who struggled with depression. In most cases, they suffered not because they were sinners under divine judgment but because they were humans under intense pressure. Job asked, “Why is light given to him who is in misery, and life to the bitter in soul, who long for death, but it comes not?” (Job 3:20-21). Moses honestly told the Lord, “The burden is too heavy for me. If you will treat me like this, kill me at once … that I may not see my wretchedness” (Num 11:14-15). Listen to David as he pled for God’s mercy: “I am worn out from my groaning. All night long I flood my bed with weeping and drench my couch with tears” (Psa 6:6 NIV). Later he wrote, “Record my misery; list my tears on your scroll – are they not in your record?” (Psa 56:8 NIV). Under a broom tree, Elijah dejectedly prayed, “It is enough; now, O LORD, take away my life, for I am no better than my fathers” (1Ki 19:4). And Paul, for a brief time, said he was “utterly burdened beyond [his] strength and despaired of life itself” (2Co 1:8).
Advice from James
Depression, when mainly a spiritual struggle, may resolve with conscientious reading of Scripture, dependent prayer and time. God can heal by direct intervention with no intermediary, and He sometimes does. Scripture, however, provides many examples of God’s use of means to bring help and healing. When depression does not resolve on its own, we need to take advantage of every means God provides to promote recovery. In protracted or difficult sickness (here a broad term for physical and spiritual problems), James advises calling elders, anointing with oil, praying with faith and confessing sin (Jas 5:13-20). These are means: accepting wise counsel, welcoming intercessory prayer, considering medical therapy and identifying potential sin.
“Is anyone among you sick? Let him call for the elders of the church, and let them pray over him” (v14). Shepherd care from other believers greatly helps people with depression. Their most effective work is intercessory prayer; James says it has “great power” (v16). But he also implies that as elders they will use their spiritual experience to provide wise counsel. They have learned the truth and can “bring back” those who wander from it (5:19-20). They realize, however, that platitudes and pep-talks won’t instantly cure depression; instead, they work with gentleness and sensitivity, first simply “weeping with those who weep” and sharing their burdens (Rom 12:15; Gal 6:1-2).
Any caring believer who listens, prays, and offers wisdom from the Bible is incredibly useful to depressed people. In difficult cases, however, professional counselors provide essential insights and tools that make recovery more likely. Since depression distorts thinking, skilled counselors help us identify false beliefs about ourselves and the world, modify those beliefs, and then test the new beliefs through planned changes in behavior. Christian counselors who base their recommendations on Scripture and help us see reality from God’s perspective are obviously more valuable than secular therapists. Positive problem-solving requires learning good coping skills and unlearning bad ones. Although depression may run in families for genetic reasons that can’t be helped, families may also perpetuate depression through learned behaviors that can be helped by therapy. These behaviors include thinking only emotionally, tolerating poor choices, focusing only on negatives, and escalating ordinary worries into catastrophes.
Some depressed believers who have a medical affective disorder suffer from untreated low mood for years, assuming that they are enduring this sentence because they have failed to overcome their spiritual weakness. James, however, teaches that the larger spiritual work of helping people to recover from distress may require medical therapy – even if sin is contributing to the illness. “Rubbing him with oil in the name of the Lord” (5:14) describes the use of current healthcare by lay practitioners serving as God’s agents. This passage, by implication, supports medical treatment for depression, including the use of prescription antidepressant drugs in some cases. Prescribing antidepressant medication is often unnecessary and never sufficient. These drugs should not substitute for reading, prayer, guidance and discipline. We help no one if we use them like narcotics to numb the guilt of unconfessed sin and the pain of unresolved problems. And they may have adverse effects. In severe depression, however, medication is not the last resort but the first. By the time they seek help, some people with depression and anxiety are too dysfunctional to participate in anything. By elevating mood, quieting agitation, focusing concentration, and regulating sleep, drug therapy sets up a stable platform to work from. As people gain momentum, many can stop these medications. Some, however, only remain stable with long-term support.
James continues, “If he has committed sins, he will be forgiven” (5:15). Although many godly Christians living holy lives have suffered depression, we should honestly explore whether unconfessed sin is contributing to our gloom (Psa 32:3-5). Often it isn’t. But David, who knew depression, still recommended this exercise: “Search me, O God, and know my heart! Try me and know my thoughts! And see if there be any grievous way in me, and lead me in the way everlasting!” (Psa 139:23-24). As believers, we are in Christ (2Co 5:17); we have new natures that long for God and His righteousness. Our sin creates cognitive and emotional conflict by violating our true selves (Rom 7:14-24). If we keep choosing to defile our spiritual values we will be depressed – and should be.
If sin is involved in depression, repentance is the first step to recovery. In 2 Corinthians 7:8-11, Paul distinguishes repentance from mere regret. In his earlier stern letter to the Corinthians, he confronted them with their sin and drove them to “godly sorrow” “as God intended.” Godly sorrow – the holy grief and wretchedness we feel when we face and forsake our sin – is the true repentance that “leads to salvation without regret.” Confession draws us closer to our heavenly Father, brings forgiveness and cleansing, and restores communion (1Jn 1:10; Jas 4:8-10). In contrast, worldly sorrow arises from hating the painful aftermath of sin, but not the sin itself. Worldly grief only drives people from God to deathbeds of resentment and regret. Sin’s bitterness pushed Peter to godly repentance, and the Lord forgave him (Mat 26:74-75); it drove Judas to worldly regret, and he hanged himself (Mat 27:5).
James began this section by writing, “Is anyone among you suffering? Let him pray” (5:13). Depression persuades us to think that we would be better off alone; its self-isolation, however, only makes our suffering worse. If instead we make a conscious effort to turn attention outward and revive our relationships with others, depression will start to lift. As believers, we are children of our heavenly Father and servants of our Lord Jesus Christ. He is our Rock, our Shepherd and our Helper (Psa 18:2; 23:1; 54:4). So we begin by baring our souls to this Counselor, because He cannot fail and will never forsake us (Isa 9:6; Heb 13:5). We start by praying to Him for strength, knowing that He draws near to the brokenhearted and heals them (Psa 34:18; 147:3).
Relationships strengthen through communication – a two-way street. We not only speak to God in prayer but also listen to Him speak to us in His powerful, life-changing, depression-defeating Word (2Co 3:18; Heb 4:12). The Holy Spirit has filled the Bible with guidance and solace for the distressed and downcast. Truthfully, we may not feel like reading the Bible at first. And if we are still wearing depression’s dark glasses, we may feel worse when we do start reading. In the murkiness, what we can see in God’s Word only seems to condemn us more. By faith, however, we read on, preferably aided by someone who can help us see the full light spectrum of Scripture. Then the therapeutic rays begin to shine on our hopelessness and despair. Emotions cannot lead us astray if we remain anchored to God’s firm and unchanging Word. As Scripture increases our faith, we begin to cling more tightly to God; as we focus on Christ, transforming worship begins to flow. Our struggles bring us closer to Him (Rom 5:3-5; 1Pe 1:6-7). The lowness and loneliness of depression make God’s promises more precious: “My flesh and my heart may fail, but God is the strength of my heart and my portion forever” (Psa 73:26). “Weeping may tarry for the night, but joy comes with the morning” (Psa 30:5).
 All Scripture quotations in this article are from the ESV unless otherwise noted.