Chapter Eight: Depression

The pain of depression is difficult to describe. Depressed people simultaneously feel deep pain and emotional numbness. In a letter to J. T. Stewart, Abraham Lincoln said, “I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would not be one cheerful face on the earth. Whether I shall ever be better, I cannot tell; I awfully forebode I shall not. To remain as I am is impossible. I must die or be better, it appears to me.” A friend who was depressed wrote this: “I have no energy or reason to fight. I am numb and have tried all the things I know to try. I know that I will not be able to function like this much longer. There is no one to talk to. I’m suffocating. I can think the best thoughts all day and I still feel like this. No one knows how badly I want to die. My thoughts are obsessive and will not stop. They keep saying, ‘I want to die’.” Depression can be one of the most agonizing kinds of suffering. If we have the heart of Christ, we will show compassion to those who suffer in this way.
Given the 1300% increase in the use of SSRI antidepressants over the past two decades, one would expect a dramatic drop in the occurrences of depression. Studies have shown, however, no decrease at all in the occurrence of depression over the past ten years. In fact, doctor visits for depression have skyrocketed over the last twenty years. The world’s solutions are not working. 
Sometimes counselors feel unqualified to help a deeply depressed person because the counselor has never experienced such extreme joylessness and feels he could never relate to their suffering. Jeremiah, however, could relate. He lived through the horrors of the devastation of Jerusalem in 586 b.c. It was worse than what happened to Sodom (Lam.4:6). People were slaughtered; women and girls were raped; people lay languishing in the streets, wishing they had been killed by the sword. Jeremiah saw babies so thirsty they could not swallow, their mothers sitting by so despondent they did not even try to help them. Some women cooked their own children and ate them! To make matters worse, the Israelites brought all this suffering on themselves because of their rebellion against God. It was their own fault. It is helpful to read the first 20 verses of Lamentations 3 to the counselee to show him that Jeremiah’s was a case of the most extreme kind of depression. He suffered from all of the following:
Utter despair: “He has made me dwell in darkness like those long dead” (Lam.3:6)
Lethargy, fatigue, lack of energy: “he has weighed me down with chains” (Lam.3:7)
Hopelessness: “He has walled me in so I cannot escape” (Lam.3:7)
Isolation: “Even when I call out or cry for help, he shuts out my prayer” (Lam.3:8)
Frustration: “He has barred my way with blocks of stone” (Lam.3:9)
Feelings of worthlessness: “He pierced my heart with arrows from his quiver. I became the laughingstock of all my people; they mock me in song all day long. He has filled me with bitter herbs and sated me with gall. He has broken my teeth with gravel; he has trampled me in the dust. I have been deprived of peace; I have forgotten what prosperity is. So I say, ‘My splendor is gone and all that I had hoped from the Lord.’ I remember my affliction and my wandering, the bitterness and the gall. I well remember them, and my soul is downcast within me” (Lam.3:13-20)
A sense of helplessness and paralysis: “… he has made my paths crooked. Like a bear lying in wait, like a lion in hiding, he dragged me from the path and mangled me and left me without help. He drew his bow and made me the target for his arrows”(Lam.3:9-12)
How is it possible to comfort someone in such dire straits? Later in the chapter we will see how Jeremiah recovered from his depression. But first we must understand depression in biblical terms. 

What is Depression (In Biblical Terms)?
The biblical words for what we refer to as depression are despair, losing heart, being downcast, and weariness. Urge the counselee to use the biblical terms rather than the word “depression.” This will produce three benefits. First, the biblical terminology is more precise. The term “depression” lumps several different problems together under one heading. The biblical terms allow a person to deal with the various different issues individually. 
Second, when the problems are identified with biblical terms it is much easier for the person to discover what Scripture says about those problems. 
Third, in our culture depression is very often thought of as being a physical, medical problem, which obscures the real issue. The biblical terms make it easier to think in terms of spiritual issues. 
There are at least four biblical terms that describe the various elements of depression:
1)	Losing Heart (lack of motivation, feelings of wanting to give up, apathy)
2)	Despair (lacking hope – no feelings of pleasure in upcoming blessings)
3)	Joylessness (sadness, inability to enjoy present blessings) 
4)	Discouragement/weariness  (no energy for or delight in the tasks God has given)
1)	Losing Heart
The Greek word for losing heart (egkakeo) appears six times in the New Testament, and it refers to becoming so discouraged that almost all motivation drains away, apathy takes over the heart, and the person feels like giving up. 
God designed us to live with a tension of simultaneous joy and distress. The evils of our sin and this fallen world should distress us and the goodness of God and expressions of His love should delight us. The anxiety needs to be there to motivate us to action. For example, we won’t have the passion we should have to share the gospel until our hearts are compelled by compassion when we literally become emotionally upset thinking about them going to hell. We need to have a certain amount of distress in our hearts about evil and sin so we will be moved to take action and do something about it. In 2 Corinthians 11 Paul lists all his troubles and suffering, and then adds…
2 Corinthians 11:28 Besides everything else, I face daily the pressure of my concern for all the churches. 29 Who is weak, and I do not feel weak? Who is led into sin, and I do not inwardly burn?
That is anxiety. Inward burning. Daily pressure. Those are descriptions of decidedly unpleasant stresses. This is appropriate for the Christian and is not wrong. 
However, that anxiety should not run rampant and unrestrained in our hearts so that it causes us to lose heart. And the thing that should hold it in check and keep it from getting out of control is our joy (enjoyment of present circumstances) and hope (enjoyment of future blessing). In 2 Corinthians 6:9 Paul describes himself as “sorrowful, yet always rejoicing.” Sorrow and joy exist simultaneously in our hearts at all times, but it is crucial for the Christian that our joy always be greater than our sorrow.
2 Corinthians 4:8 We are hard pressed on every side, but not crushed; perplexed, but not in despair; 9 persecuted, but not abandoned; struck down, but not destroyed. 
When the sorrow becomes greater than joy, that’s when we lose heart.
 
2)	Joylessness 
Persistent, overwhelming feelings of deep sadness and a troubled, discouraged mood reflect an inability to enjoy the blessings of life. Even in the midst of suffering, life is full of potential joys, but the soul is not always able to enjoy them. 
Ecclesiastes 5:19 When God gives any man wealth and possessions, and enables him to enjoy them, to accept his lot and be happy in his work--this is a gift of God. 
There are people who are so wealthy they can have as much of almost any earthly pleasure as they want, and still, in some cases, they become so despondent and unhappy that they commit suicide. Unless God grants both the gift and the ability to enjoy the gift, no joy is possible. When this happens there is a loss of inertest in the pleasures of life. 
Psalm 102:4 My heart is blighted and withered like grass; I forget to eat my food.
3)	Despair
Despair is when sorrow eclipses hope. Hope is a feeling of happiness in the present because of some wonderful thing that is going to happen in the future. It is not merely believing something good is going to happen in the future, nor is it merely thinking about that good thing. Hope is a feeling of happiness and an elevated mood that results from being sure that good thing is coming. When a person feels there is nothing to look forward to, the soul becomes downcast. 
If something good is coming in the future, but it does not bring a feeling of happiness, it is because either the person does not fully believe the good thing will happen, or he does not fully believe that when it does happen it will be delightful and satisfying. 
Hope is essential for recovering from a downcast soul. The word translated “downcast” in Psalms 42 and 42 is SHACHACH, and it refers to feelings of deep sadness and a troubled, discouraged mood, and is connected with lack of hope. 

Psalm 42:5 Why are you downcast, O my soul? Why so disturbed within me? Put your hope in God
Psalm 42:11 Why are you downcast, O my soul? Why so disturbed within me? Put your hope in God
Psalm 43:5 Why are you downcast, O my soul? Why so disturbed within me? Put your hope in God
Lamentations 3:20 I well remember them, and my soul is downcast within me. 21 Yet this I call to mind and therefore I have hope
In each case the solution to being downcast is hope. 

4)	Discouragement/Weariness 
Fatigue is part of the human condition, and there is nothing necessarily sinful in it. Jesus Himself became weary (Jn.4:6). There is a kind of weariness, however, that is forbidden.
Galatians 6:9 Let us not lose heart in doing good, for in due time we will reap if we do not grow weary. 
Hebrews 12:3 Consider him who endured such opposition from sinful men, so that you will not grow weary and lose heart. 
Revelation 2:3 You have persevered and have endured hardships for my name, and have not grown weary.
God designed us to become weary, but we are not to become weary to the point of discouragement, so that we lose heart. When it does, so that we have no energy for or delight in the tasks God has given, that’s when we’ve crossed the line into discouragement (or weariness). 

Causes of Depression
The suggestion that depression is caused by serotonin imbalance or absorption in the brain is a theory that has not been proved (see chapter eight). No doctor could examine the body of a depressed person and discover depression. The only way he can possibly know if depression is a problem is if the patient tells him. As far as medical science can tell, the body of a depressed person is working fine. And in studies that artificially lowered serotonin levels in the subjects, depression did not result. However, there are physical problems that can contribute to depression. Low thyroid, for example, tends to make people much more prone to depression. Alcohol can also intensify depression. 
Whatever the connection between chemicals and depression, it should not be assumed that chemicals cause thoughts. A drug may hinder or enhance the ability of the brain to think, but chemicals do not create thoughts. Thoughts originate from an immaterial source (the heart - Mt.15:19). 
The most basic cause of depression is a blockage of the inflow of joy into one’s life. God designed our river of joy to be continually fed by three tributaries: His past goodness, His present goodness, and His future goodness. When any one of those three becomes blocked, the river of joy will drop to a level that is too low to flow over the dams of sorrow and hardship in life. So what it is that blocks the tributaries of joy?
1)	Ingratitude 
The tributary of joy from God’s past goodness is blocked by ingratitude. Failure to notice God’s past acts of kindness, or failure to appreciate them for what they are, or failure to remember them, or failure to spend adequate time thinking about them results in a lack of gratitude, and the flow of joy from past blessing is cut off. 
2)	Separation from the Presence of God
Since the only source of joy is the presence of God (Ps.16:2,11, 73:25), joylessness is a symptom of failing to experience the presence of God. This cuts off the flow of joy from present blessings. 
3)	Self-Pity (Grumbling)
Perhaps the most common cause of joylessness is self-pity, which is inward grumbling. When a person is distressed by circumstances and expresses his distress to others, that is complaining. When he expresses it to God, that is lament. But when he expresses it to himself, that is self-pity, and it is extremely destructive. Whenever the focus turns mostly inward, joy will always diminish. Suffering invades a person’s life, and rather than seeing the big picture of God’s sovereign purposes he turns his attention on himself and develops a “woe is me” perspective. This results in a tunnel vision that blocks out all cause for rejoicing and sees only those things that support his belief that he deserves pity. He becomes blind to all of God’s blessings, which cuts off the stream of joy from present blessings. 
It also cuts of the stream of joy from future blessings, which normally flow through hope, because hope is rejected by the soul that is consumed with self-pity. Self-pity always seeks to justify itself, by proving that “everything” is going wrong. This causes the person not only to notice only negative things while being blind to blessings, but it also causes an inner refusal to be comforted. Like Jacob, who wept and “refused to be comforted” (Gn.37:35), the self-pitying soul rejects thoughts about the kindness that God is showing, has shown in the past, and will show in the future (Ps.77:3). This unwillingness of the soul to be comforted is paradoxical, because for most people who suffer from extreme joylessness, their greatest desire is to recover. More than anything else in life they long to feel joy again. Yet at the same time something inside them refuses it. 
Self-pity is actually a form of self-exaltation. Thinking the most important object of my thoughts is me and my troubles – that exalts me to the place of highest importance. 

Steps to Recovery
Diagnose the Problem
After explaining the various components of depression in biblical terms, ask the counselee to diagnose himself. Give him the following list and ask him to check which apply to his situation, and what role he sees that aspect playing (Is it a cause or a symptom?).

Check Which Factors Apply in Your Situation				Role (cause or symptom)

Losing Heart (lack of motivation, feelings of wanting to give up, 
apathy about most anything other than feeling better) 		________________
Despair (lacking hope – no feelings of pleasure in 
upcoming blessings) 							________________
Being downcast (sadness, inability to enjoy present blessings) 	________________	
Weariness in well-doing (no energy for or delight in the 
tasks God has given) 							________________
Self-pity									________________
Grumbling (expressing your disapproval of circumstances) 		________________
Obsessive negative thoughts 						________________
The heart clinging to sorrow and refusing to be comforted		________________
Lack of appreciation for God’s expressions of love			________________

Help the counselee discern which aspects of his condition are sinful and which are not. It is not necessarily wrong to experience a measure of distress in suffering. Jesus was greatly distressed the night before the crucifixion. Paul, the psalmists, and other godly examples experienced tremendous anxiety. Anxiety becomes sinful when it eclipses joy in the long term (see the section “Fear of Pain” in chapter nine).
Anxiety and sorrow are also sinful when they arise out of sinful attitudes. Saul, for example, became depressed because of jealousy (1 Kings 19:34). Ahab was despondent when he coveted Naboth’s vineyard and couldn’t have it (1 Kings 21:24). Judas was so depressed after betraying Jesus that he killed himself (Matt. 27:5). Cain was rebuked for being downcast after God rejected his half-hearted, faithless worship (Gn.4:47).
Make sure the counselee understands that not all sorrow and sadness is sin. But it is important to discern which parts are sinful so repentance can lead to restored joy. Once the sinful aspects are determined, help the counselee discern where his thinking begins to leave a biblical path. It is at that point of departure that the remedy must come. The depressed man quoted above said he could think the best thoughts all day long and it would not help. But how does he know that? No one but Christ has ever thought the best thoughts all day long. No matter how good a person’s thought life has been in the past, it can always be better, and better thinking will most definitely help. 

Accept Suffering
Joylessness, despair, discouragement, and losing heart usually begin with an attitude of rejection toward suffering. God sends suffering into a person’s life, and rather than accepting and submitting to it as a gift from God, the person rejects it as an intolerable intrusion into his life. As long as suffering is thought of as an intolerable intrusion, the person will always be discouraged because there will always be suffering. 
Remind the counselee of God promises to only send suffering that will do us good (Ro.5:3, Jas.1:2-4, Ro.8:28, Jer.29:11, Heb.12:7-11, 1 Pe.4:1). When we experience the mighty hand of God in suffering, instead of arrogantly resisting, we must humbly submit (see chapter three under “Strengthening”).
The desire to feel better, when it becomes a person’s highest goal, can actually become one of the greatest hindrances to reaching that goal. When a person thinks, like Abraham Lincoln, “To remain as I am is impossible. I must die or be better,” that attitude actually increases feelings of despair. If the highest, most important goal is to feel better, and feeling better seems out of reach, then the most important goal of the person’s life is impossible to achieve and that will intensify the despair. 
It is fine to have joy as a goal, but it must never be the highest priority. Our highest goal must always be the glory of God, and that goal is never out of our reach regardless of how we are feeling. We must follow Jesus, who did pray “Let this cup pass from me” but also said, “Nevertheless your will, not mine, be done” (Mt.26:39). The will of God must always be more precious to us than relief from suffering. Urge the counselee to give up the priority of feeling better, and say to his soul, “It’s OK for me to suffer for now – for however long God decides to allow it to continue.” That can relieve the pressure of having to feel better, which will alleviate much of the despair. In my experience, both personally and in counseling others, once people come to a point of willingness to suffer, within days they are no longer depressed (or at least they feel significantly better). 
God requires suffering from some people. Immediately after the apostle Paul was converted, God appeared to Ananias and told him to go to Paul (then Saul) with these words:
ACTS 9:1516 “This man is my chosen instrument.… I will show him how much he must suffer for my name.”
 And did he suffer! Time after time he was whipped, imprisoned, beaten with rods. People stoned him, tortured him, persecuted him … that was how it was for Paul right up to his appointed time to enter the presence of the Lord. Paul’s life, all told, turned out well. He was possibly the most successful Christian who ever lived. Did he accomplish incredibly great things? Yes. Did he advance the kingdom of God around the world? Yes. Are there countless thousands in heaven because of God’s work through the apostle Paul? Yes. Is he enjoying paradise right now? Yes. So what does it matter that, for the relatively short time he was on this earth, he suffered?
If someone suffers from depression, maybe God, on the day of that person’s conversion, said to the angels, “I will show her how much she must suffer for My name. She will have to endure crippling emotions throughout her life.” This would not prevent her from having a life like Paul’s. There is hope outside of feeling better! 
Be Willing to be Comforted
Help the counselee discover thought patterns that show a refusal to accept comfort from God, such as focusing on hardships while ignoring blessings. Help the counselee become willing to let go of the blanket of sorrow with which they have wrapped themselves.  
Consider God’s Past Goodness
Unclog the tributary of joy from past blessings by considering carefully God’s past goodness. This was the solution for the depression of the writer of Psalm 77, whose soul was refusing to be comforted to the point of causing insomnia. 
Psalm 77:2 In the day of my trouble I sought the Lord; In the night my hand was stretched out without weariness; My soul refused to be comforted. … 4 You have held my eyelids open; I am so troubled that I cannot speak. ... 11 I shall remember the deeds of the Lord; Surely I will remember Your wonders of old. 12 I will meditate on all Your work And muse on Your deeds. 
Urge the counselee to describe to you a list of God’s past blessings – in the past days, then weeks, then months, then years, then past history all the way back to the creation. Help the person establish a routine of consideration of God’s past goodness. For instance, begin a routine of kneeling on the floor each night before bed and thanking God for each of His acts of kindness over the past 24 hours. 
Control Your Words
In Psalm 73 Asaph could feel himself slipping into despair. When he saw the prosperity of the wicked and then considered all his suffering and hardship, he started to stumble into thoughts of self-pity. Self-pity is always marked by exaggeration. 

Psalm 73:3 For I envied the arrogant when I saw the prosperity of the wicked. 4 They have no struggles … 13 Surely in vain have I kept my heart pure; in vain have I washed my hands in innocence. 14 All day long I have been plagued; I have been punished every morning. 
The wicked have NO struggles whatsoever, while poor Asaph has gained zero benefit from serving God. Both are ridiculous exaggerations, and Asaph knew it—so he kept mouth shut.
15 If I had said, "I will speak thus," I would have betrayed your children.
He resisted the temptation to verbalize these thoughts. He knew that to do so would be a betrayal of the people of God, because complaining harms all who hear it – even if the only one who hears it is you! 
Inner Grumbling
The verbs in v.21 are in a grammatical form that is reflexive (action acted upon oneself), so a literal translation would be, “My heart embittered itself and my insides pierced themselves.” Inner turmoil and anxiety is something the heart inflicts upon itself. Runaway thoughts of complaint, self-pity, and ingratitude are like the heart taking a knife and repeatedly stabbing itself. If a person repeatedly bludgeons his heart with a hammer, he should not be surprised when afterward his heart is in great pain.
When we grumble to ourselves we do spiritual damage. Reassure the counselee that it is appropriate to pour out his distress to God in prayer. But urge him, when he has finished praying, to be finished with his complaint. Suggest that he resolve to never dwell on his suffering or troubles unless he is speaking to God about it (unless it is something that requires him to think about it because he must take some action). This will help with the problem of exaggeration, as we are not as quick to overstate things when we are talking to the One who knows everything. 
This, of course, is easier said than done. The flesh, when it has a complaint, will insist on being heard. There are times when your flesh (the part of you that is prone to sin) talks to you, and there are other times when you talk to it. Scripture speaks of this inner dialogue.
Psalm 14:1 The fool says in his heart, "There is no God." 
Psalm 10:6 [the wicked man] says in his heart, “I shall not be moved; throughout all generations I shall not meet adversity.” 
Psalm 10:11 He says in his heart, "God has forgotten, he has hidden his face, he will never see it.”
The way to silence the flesh is by preaching to it. When the psalmist fell into despair, instead of listening to the grumblings of his soul, he preached to his soul.
Psalm 42:5 Why are you downcast, O my soul? Why so disturbed within me? Put your hope in God. For I shall yet praise Him, my Savior and my God. 
The first thing we have to learn is what the Psalmist learned—we must learn to take ourselves in hand.  This man was not content just to lie down and commiserate with himself.  … he talks to himself.  This man turns to himself and says:  ‘Why art thou cast down O my soul, why art thou disquieted within me?’  He is talking to himself, he is addressing himself.…
We must talk to ourselves instead of allowing ‘ourselves’ to talk to us!  Do you realize what that means?  I suggest that the main trouble in this whole matter of spiritual depression in a sense is this, that we allow our self to talk to us instead of talking to our self.  …  Have you realized that most of your unhappiness in life is due to the fact that you are listening to yourself instead of talking to yourself?  Take those thoughts that come to you the moment you wake up in the morning.  You have not originated them, but they start talking to you, they bring back the problems of yesterday, etc.  Somebody is talking.  Who is talking to you?  Your self is talking to you.  Now this man’s [solution] was this; instead of allowing this self to talk to him, he starts talking to himself.  ‘Why art thou cast down, O my soul?’  he asks.  His soul had been depressing him, crushing him.  So he stands up and says:  ‘Self, listen for a moment, I will speak to you’.  …  You have to take yourself in hand … preach to yourself, question yourself.  You must say to your soul:  ‘Why art thou cast down’ — what business have you to be disquieted?  …  And then you must go on to remind yourself of God, Who God is, and what God is and what God has done, and what God has pledged Himself to do.  Then having done that, end on this note:  defy yourself, and defy other people, and defy the devil and the whole world, and say with this man:  [“For I shall yet praise Him, my Savior and my God”].

Demand an accounting from your soul. Require an explanation for its grumbling. But don’t be content just to rebuke yourself. Just beating up on yourself will only perpetuate the problem of the self-focus. Preach to yourself not about self but about God. That’s what the psalmist did – he pointed his soul to God. The solution to self-pity is to turn attention from self to God. Teach the counselee the 5-to-1 principle: resolve to have five delightful thoughts about God for every one thought about self. So if a discouraging thought comes to mind, respond by thinking, “OK, what are five wonderful truths about God? 1) God is patient (followed by a few moments of thinking about God’s patience) 2) God is faithful (then a few moments pondering why His faithfulness is such a great thing) 3) God is kind, etc.” 

Enjoy God’s Presence 
Asaph recovered from his near-miss with despair first by backing up to consider the long-term, big picture of eternity (vv.16-20), then by focusing his attention on appreciating the incredible benefits of the presence of God (vv.23-28).
Psalm 73:23 Yet I am always with you; you hold me by my right hand. 24 You guide me with your counsel, and afterward you will take me into glory. 25 Whom have I in heaven but you? And earth has nothing I desire besides you. 26 My flesh and my heart may fail, but God is the strength of my heart and my portion forever. 27 Those who are far from you will perish; you destroy all who are unfaithful to you. 28 But as for me, it is good to be near God. I have made the Sovereign Lord my refuge; I will tell of all your deeds.
Joy is always available to the believer through enjoyment of the presence of God. On rare occasions God may withdraw His presence in temporary discipline, but most of the time when a believer is not gaining joy from the presence of God it is because of a failure to take advantage of the experience of God’s presence that is available. 
Here are some possible causes of inability to enjoy God’s presence:
Hanging on to a sin or some cherished idol in the heart  
Failure to interpret the countless blessings you experience each day as direct expressions of His love for you – ignoring His gestures of love
Failure to understand that all glimmers of joy and ability to enjoy life are experiences of His presence
Lack of wholeheartedness in seeking His presence 
Lack of willingness to believe what He says about forgiveness and His delight in His people
Distraction from God because of a focus on self (self-pity)
Listening to yourself instead of preaching to yourself – letting the flesh dictate all your thoughts
Dwelling on hardship
Preferring some other source of comfort rather than waiting for Him

Urge the counselee to have a planned statement to make to himself each time he begins to have feelings of despair. Here is what I tell myself: “It is not necessary for me to feel discouraged right now. God is right here! And I have His favor. And if I seek Him, there is a great enough experience of His presence available to me right now to satisfy my soul enough so that I will have more joy than sorrow.” This will unclog the flow of joy from present blessings. 
Anticipate Future Blessing
Help the counselee unclog the flow of joy from future blessing by teaching him how to hope in God. One of the most extreme examples of major depression in Scripture is Jeremiah in Lamentations (read Lam.3:1-20). But as depressed as Jeremiah was, he did recover. His despair gave way to hope in verse 21. 
Lamentations 3:20-21 My soul is downcast within me. 21 Yet this I call to mind and therefore I have hope …
Have you ever noticed that the effect trials have on you depends on your view of the future? If you are excited about what is coming tomorrow, the suffering of today has little impact. But if you have nothing to look forward to, even the smallest difficulty today can seem devastating. The day before getting married to the love of your life you can get a flat tire in the rain and laugh it off. But if tomorrow and next week and next year all seem to promise nothing but drudgery as far as the eye can see, something as small as stubbing your toe can make you want to give up.
Despair is not a chemical imbalance; it is a hope imbalance. It is not that your brain is leaking serotonin; it is that your spirit is leaking hope. 
But even in the depths of his depression, Jeremiah found hope. How? What specific good thing did he think of that God might do? What light did he see at the end of his long, dark tunnel? And what about you? How can you find hope like he did?
If you do see light at the end of the tunnel, of course you will come out of your depression—that’s easy. The problem is, what do you do when there is no light at the end of the tunnel? What do you do when even in your wildest dreams you cannot think of anything God might do to make the situation better? What do you do when all your hope is gone?
That is an important lesson we can learn from Jeremiah. For him there was no light at the end of the tunnel. There was no relief he could think of or could see on the horizon. What encouraged him and restored his hope was not something he could see coming, rather it was a specific piece of information: “Yet this I call to mind and therefore I have hope.…”
This is important, because there are many who would say that when people are hurting, that is not the time to try to teach biblical principles. They would say you need to just be there for people and offer them a shoulder to cry on. A shoulder to cry on is a wonderful thing, and offering it is a great act of love. But by itself it is incomplete. Jeremiah was brought from a state of clinical depression to being filled with real hope not through someone’s sympathy alone, but through a particular truth about God. 
What was that truth?
Lamentations 3:21-22 Yet this I call to mind and therefore I have hope: 22 Because of the Lord’s great love we are not consumed.
He called to mind something about the amazing character of God: His great love. Just thinking about God’s love made Jeremiah realize that blessing IS around the corner. You don’t have to see a light at the end of the tunnel. All you need is to consider the nature of the God who is at the end of the tunnel. 
Imagine a child who has two uncles that come visit every Christmas. One is great at picking out gifts and the other is terrible. That second uncle always gives some book the child will never read, or new tube sox, or some other thing that is no fun at all. But the first uncle is the opposite. Every year his gift ends up being the child’s favorite gift. And it’s never something the child asked for. This uncle is so creative, he always thinks of something that’s better than anything the child thought to put on his list. That first uncle is so good at picking out gifts – so generous and creative – that all that is required to fill the child’s heart with joy is just the sound of his car pulling up in front of the house. He doesn’t need to have a glimpse of what is inside the box to be excited about it. It is recalling the character of the giver, not getting a glimpse of the gift, that brings hope.
And the more specific and detailed the understanding of God’s character the greater the hope. “God is loving” is too general. Jeremiah was more specific than that. What turned Jeremiah’s despair into hope and joy was contemplating the fact that God is not only loving, but He is by nature creative in His love.
Lamentations 3:22,23 … for his compassions never fail. 23 They are new every morning; great is your faithfulness.
God’s nature is such that He will think of a way to show you kindness and tenderness—a new way every single morning. This is one reason God made mornings. When God created the solar system, He divided time into days. That gives us all a new beginning every twenty-four hours. God is a God of new beginnings and fresh starts, and He even built that into the creation.
Zephaniah 3:5 The Lord … is righteous; he does no wrong. Morning by morning he dispenses his justice, and every new day he does not fail.…
 Jeremiah called to mind the fact that God is creative in the ways He blesses His people. It suddenly occurred to him that God had something in mind right around the corner that will be delightful and satisfying. 
Jeremiah was not comforted by minimizing his suffering. He did not say, “Well, I have some hope because I realize things can’t be as bad as they seem. At least this or that didn’t happen.…” Rather, he was comforted in the midst of great anguish by turning his attention away from his circumstances and to the character of God, from Whom flows an inexhaustible fountain of creative kindness.
Notice his response in verse 24: “I say to myself, ‘The Lord is my portion; therefore I will wait for him.’” What does that mean? Portion of what?
The word portion, which means “amount, or share,” is a reference to Numbers 18:20. When God brought Israel into the promised-land, He divided it up eleven ways, but there were twelve tribes. When He got to the last tribe—Levi—nothing was left. 
Numbers 18:20 The Lord said to Aaron, “You will have no inheritance in their land, nor will you have any share among them; I am your share and your inheritance among the Israelites.”
So the priests were given no portion of the land. They owned nothing. Their list of assets was blank, yet they ended up being better off than everyone else. (Eleven tribes gave them a tenth, so they ended up with eleven tenths—one tenth more than any other tribe.)
That is what happens when the Lord is your portion. The only difference is, you can’t see it and you don’t know where it is coming from. God gave an inheritance to all twelve tribes. To eleven He gave an inheritance that could be seen; to the twelfth, the priests, He gave the same inheritance—in fact, bigger—but it could not be seen.
When God says, “I am your portion,” think of it this way: Suppose I took the youth group up into the mountains and gave them each a small survival kit. If my young son Josiah said, “Dad, where is my survival kit?” I would reply, “I am your survival kit—you stay with me.”
Or imagine that the billionaire CEO of the company you work for is your best friend, and when he is setting salaries, he says, “This is your salary, this is yours, this is yours,” etc. When he finally has gone through everyone but you, and you say, “What about me?” he says, “Don’t worry—I’ll take care of all your needs.”
Jeremiah had lost everything. He was depressed and at the end of his rope. He could not even imagine what God might do to make things better. But then the depression lifted and he was filled with hope because he began to think about the nature of God, who is like that second uncle—creative in His love. Jeremiah’s response was to say, “The Lord is my portion. I don’t need or want anything other than what He is pleased to provide.”
His attitude was, Lord, I look around and can’t see provision or blessing. I am like the tribe of Levi—all I have for a blessing is You. But I am confident I will end up with something wonderful—because I know what You are like.
Christians who struggle with depression should spend what little energy they have focusing on the goodness of God. Not only does God have infinite wisdom to guide them in life, infinite resources to provide for them, infinite knowledge to teach them, infinite mercy to care for them, infinite compassion to comfort them, infinite love to restore them, and infinite strength to protect them, He has also given future promises that are wonderful beyond imagination or comprehension.
It is not necessarily easy to hope in those things because they are invisible and intangible. It is much easier to look to the next vacation, that anticipated promotion, or other temporal pleasures, but those things will ultimately disappoint.
God knows this, so He tells us this: “[S]et your hope fully on the grace to be given you when Jesus Christ is revealed” (1 Pet. 1:13b). The solution to depression is to focus on the character of God, on “his very great and precious promises” (see 2 Pet. 1:4) and on the return of His Son, the Lord Jesus Christ.

“Put your ear to the ground of God’s word and listen to the rumble of His faithfulness coming” 
– John Piper

Enjoy Ministry
Twice in 2 Corinthians 4 Paul says that he does not get discouraged and lose heart, even though he was hard pressed on every side, perplexed, and struck down. How is that possible? Even in the midst of almost unbearable hardship Paul didn’t lose heart because of the joy he derived from his ministry.
Paul gives the answer in this chapter:
2 Corinthians 4:16 Therefore, (given the undiminished, untarnished glory of the New Covenant)1 since through God’s mercy we have this ministry (the ministry of the New Covenant, the Gospel) we do not lose heart.
The thing that kept Paul from losing heart was thinking about the nature of his ministry. If God called you to something that might turn out to be a failure, disgrace, or embarrassment, you would tend to lose heart when things started looking bad. But when your task is part of something that is guaranteed to be a glorious success, that is encouraging. Encouragement comes from ministry. 
We are all called to various aspects of the same ministry—the Gospel of the Lord Jesus Christ. Your calling in the church represents your role in this ministry – in something truly great. The less a person thinks about life in terms of ministry and calling, the less encouraged he will be by the fact that those things are guaranteed to be a glorious success. But since God has promised grand success to every Christian, the more a person focuses on that, the more strength he will have to persevere. That is exactly the point of Galatians 6:9.
Galatians 6:9 Let us not become weary in doing good, for at the proper time we will reap a harvest if we do not give up.
This is the same point Paul is making in 2 Corinthians 4. It is the hope of the great harvest—the fruit of our ministry, that gives us the stamina to persevere. No matter how things look, the Gospel (and its bearers) will prove to be glorious, therefore we do not lose heart.
Someone may argue, “That’s fine if you’re Paul. But my discouragement comes from the fact that I botch the task so much. I’m so weak and inept – my contribution probably does more harm than good.” Paul also lamented his inadequacy for the task (2 Cor.2:16). But it is actually our very inadequacy that makes us just right for the task.
2 Corinthians 4:7 we have this treasure in jars of clay to show that this all-surpassing power is from God and not from us.
The glorious treasure of the work of the gospel has been placed in weak, fragile, breakable pots like us so that no one is ever confused about where the real glory is.
Help the counselee think through all the various aspects of his calling – ministries at church, his role in his family, his role in the world – and how those things are of such breathtaking, eternal importance because of how God has promised to use them in His kingdom. 
Outward focus…….
Persevere
Won’t, not Can’t
Those who are losing heart are tempted to give up altogether (Gal.6:9). Giving up can mean turning away from the faith, or committing suicide, or just checking out of life staying in bed most of the time. The severely discouraged person feels he has no choice but to give up. But that is never the case. 
Philippians 4:13 I can do all things through him who strengthens me.
1 Corinthians 10:13 No temptation has seized you except what is common to man. And God is faithful; he will not let you be tempted beyond what you can bear. But when you are tempted, he will also provide a way out so that you can stand up under it.
God always provides us with the ability to do what is right. It is essential that the depressed person understand that he can do everything God calls him to do. He can get out of bed when he needs to; he can serve his family; he can carry out his responsibilities. Failure to do what he should do is never justified under the excuse “I just can’t.” If feels that way, but God’s Word tells us otherwise. 
The remedies suggested in this chapter may not provide immediate relief from the suffering of joylessness. And in the mean time the darkness will remain. While it does, urge the counselee to persevere. 
Restore Long-Term Thinking
Despair has a way of shortening one’s perspective. The distant future means nothing. All that can be seen is the moment. But since so much of the flow of joy comes to us from thinking about future blessing, it is crucial to expand one’s thinking into the long term. 
One of the reasons people fall into despair is they lose sight of the importance of everything they do, and they stop doing it. Then they are not productive, and being unproductive makes them feel worthless, which saps their joy even more.
The important things, the truly great things, generally cannot be accomplished in an afternoon. They are done by tiny increments over a long period of time, and none of those increments seems all that significant. Since a depressed person tends to lose his long-term perspective, it becomes especially hard for him to do anything that does not have short-term results.
Discouraged people are often like the teenager who wants to look like a bodybuilder, so he goes to the gym and works out for two hours. Then he stands in front of the mirror and flexes, but he looks the same as he did before. To get big muscles, he would have to get into a routine of lifting weights every day for years. And each one of those days would hardly make a noticeable difference. He could even skip working out any one of those days and it would not matter (as long as he didn’t skip all the other days).
Some take a similar approach to spiritual things: They read the Bible every day for a week, and then look in the mirror and do not see any spiritual muscles. They start a new ministry and are enthusiastic for a month or two, but when they do not see any fruit, they lose interest. 
Urge the counselee to establish an easy, doable routine. The homemaker who is discouraged because she can’t stay on top of the housework. Help her find a 5 minute segment of her day that is not currently used for housework that she can use to chip away at some large task. Over the period of weeks she would start to notice a marked improvement in her productivity and in her ability to manage her home and give her a sense of accomplishment.
The same principle can help the counselee who is discouraged because of debt. Help him set up a budget so he can pay more against the debt than they are incurring in interest, and over time the debt will be reduced. It may take years to pay it off, but the feeling of making progress instead of sinking further into the hole will be encouraging. If once a week he decides not to stop at McDonald’s, or to put the magazine at the grocery store back on the rack, and put that $5 in an envelope—not every time, just once a week—by the end of the month they could have $20 or $30 in the envelope. If they sent in a payment of only $10 a month on a credit card debt with 18 percent interest, after twenty years they would have $23,000 less debt. (That’s $10 a month; just $2.30 per week.)
Establishing a routine is crucial for a person who is losing heart, because it enables him to know what to do when it feels like nothing is worth doing. When a person loses heart, motivation disappears. He can’t find any reason to do anything. Having a routine helps keep the person moving even when he loses sight of the reason why those things are worth doing. 
Laziness has a way of feeding on itself. The lazier a person is, the harder everything becomes—until he can hardly lift a fork from the plate to his mouth (Pr. 15:19, 19:24). One of the best things for a depressed person, many times, is to sweat. 
Focus on heaven
Perseverance is the opposite of giving up. It is when we become more severe than our trial, and we press on even through suffering. Hebrews 12 teaches us how to persevere. The word “persevere” (hupomeno) appears three times in the first three verses (translated perseverance once and endured twice).
Hebrews 12:1 Let us run with perseverance the race marked out for us. 2 Let us fix our eyes on Jesus … who … endured the cross… 3 Consider him who endured such opposition from sinful men, so that you will not grow weary and lose heart.
The key to persevering is fixing our attention on Christ’s example. He endured. Does that mean He never got tired or never felt sad or never felt like giving up? No. He experienced all those things in degrees we cannot begin to fathom. But He absolutely could not be derailed from His purpose. The enemy would repeatedly throw his full weight against Him, and Jesus would take blow after blow, but He would not be knocked off course. He could be reduced to tears (Heb. 5:7), but He could not be diverted from the path of God’s purpose. 
But didn’t Jesus have an advantage? After all, He is God. It is true that Jesus is God, but it is not true that Jesus used His deity as an advantage in the fight against discouragement. In His human nature Jesus subjected Himself to the same weaknesses we are subject to (Heb. 4:15). This means it was no easier for Him than it is for us.
So how did He do it? The answer is in verse 2. He persevered by means of the joy that was set before Him. He looked ahead to the final outcome of persevering. This is exactly the same way the faithful saints in chapter 11 persevered through all kinds of horrible suffering. They were tortured and refused to be released, faced jeers and flogging, were chained and put in prison; they were stoned, sawed in two, they were put to death by the sword. They went about in sheepskins and goatskins, destitute, persecuted and mistreated. They wandered in deserts and mountains, and in caves and holes in the ground. And yet they persevered. They didn’t give up. Why? Because they wanted to obtain a better resurrection (Heb.11:35).  Moses chose to be mistreated along with the people of God rather than to enjoy the pleasures of sin for a short time because he regarded disgrace for the sake of Christ as of greater value than the treasures of Egypt, because he was looking ahead to his reward (Heb.11:25-26). The promise of heaven is our primary hope. 
Help the counselee develop a habit of thinking about the glories of our heavenly reward. This can be done by reading a good book about heaven, or by listening to sermons on heaven, or by memorizing Scripture that speaks of heaven. 
Put your suffering in perspective
Hebrews 12:4 In your struggle against sin, you have not yet resisted to the point of shedding your blood.
Keep suffering in perspective by remembering the suffering of the saints in Hebrews 11, and the suffering of Christ on the cross. Most people who are depressed have not shed any blood. It is as if the writer were saying, “Why are you becoming discouraged? You aren’t even bleeding. There is no crown of thorns on your head, no spear in your side. Are you being sawed in half, stoned, or flogged? I don’t see any drops of blood on your forehead. I don’t see any bodies lying around. You’ve hardly resisted anything yet.” Considering the suffering of Christ helps the counselee fight the tendency to exaggerate his suffering. 
Suicide 
Depressed people often think about dying. Their thoughts revolve around a desire to end the pain so they no longer have to suffer. Those are not necessarily sinful thoughts. Paul had thoughts like that. Philippians is a thank-you letter from Paul to a church that had sent him a gift. The letter is primarily about joy and encouragement, yet Paul devotes a significant portion of the first chapter to his desire to die! That may sound like a rather morbid topic to include in a thank-you note, but it is actually quite uplifting.
Philippians 1:23 … I desire to depart (die) and be with Christ, which is better by far;
It would be so much better to be with Christ than to be down here in prison, or on a sinking ship, or under a pile of rocks, or at the business end of a whip. All the suffering would be over, and the pain would end. It would be wonderful. There is nothing wrong with thinking like that. Paul wanted to die. But in the same verse he says, “I am torn.”
“Why, Paul? Why are you torn? If being with Christ would be so wonderful, what could be appealing enough in this life that you would be torn about whether you want to live or die?” He was torn because for him, “to live is Christ” (see Phil. 1:21). Paul realized that this life is our only opportunity to represent Christ and serve Him in this world. It is our only opportunity to bear on our bodies the marks of Christ and endure suffering for His name. Now is our opportunity to sacrificially serve God’s people in their time of need (Paul loved being the flesh and bone delivery system of God’s love to His people). This life is our only opportunity to fill up in our flesh what was lacking in Christ’s suffering. We desire to die and be with Christ, which would be so much better, but it is more necessary for God’s people that we remain in the body as long as God grants us breath.
From a selfish perspective the question of whether to live or die is the easiest choice in the world—go for the relief! But when the kingdom of God is taken into account, it’s not such an easy choice. Both options are extremely appealing—to go to be with Christ, or to stay on this earth to suffer on His behalf and bring Him great glory. Paul thinks it over, and then one of the two options emerges as being more appealing to him:
Philippians 1:25-26 Convinced of this, I know that I will remain, and I will continue with all of you for your progress and joy in the faith, so that through my being with you again your joy in Christ Jesus will overflow on account of me.
There is much joy to be found in bringing joy to others. Those who suffer from joylessness can become so focused on finding joy for themselves that they lose sight of the most effective method of finding joy, which is bringing joy to the hearts of others. When a person devotes himself to making others happy in Christ, it will take his focus off himself (eliminating self-pity), and it will open greater access to joy in Christ for himself. Note: this process  may be hindered if the person is taking antidepressants, as they can have the effect of reducing one’s ability to feel love (ch.7, “The Dark Side of Antidepressants”). 
Serving others is very difficult for people who are depressed. Everything is difficult. But urge them to avoid making decisions on the basis of how they feel. People who are depressed tend to be governed by their feelings. Help them realize that they do not have to be. They can decide to keep moving no matter how low they feel. Remind them that whether it helps them feel better or not, it is our responsibility to serve even while we are suffering. Jesus was involved in evangelism, a prayer ministry, teaching, prophecy, counseling, intercession and care for a widow—all while hanging on the cross! It is not a sin to feel down, but it is sin to use that as an excuse not to serve.
When a person becomes suicidal, remind him that it is not wrong to think about dying. Every Christian should long to be with Christ. But it is crucial to think about dying or living from a kingdom perspective, which can lead to a genuine desire to actually remain in painful circumstances.