There have been and maybe still are psychologists and psychiatrists who believe that the Reformed faith makes people especially vulnerable to depression. In particular, the constant emphasis on the need to take full responsibility for our sins (detesting oneself because of one's sins is the first part of self-examination in our Form for the Celebration of the Lord's Supper) and on our total inability to do any good and inclination to all evil (Heidelberg Catechism, Lord's Day 3) is said to contribute to more depression among Reformed people. Grace is proclaimed, of course, for those who repent of their sins. But there remains that constant dealing with sin and the obligation to repent and to humble oneself before God and bring forth fruits that befit repentance. This emphasis, it is suggested, makes many feel unworthy and susceptible to depression.

But there are no statistics to prove that Reformed people are more prone to depression than any other group due to any particular cause. Reformed doctrine, if believed rightly, does not in itself lead to depression. On the contrary, it is the teaching of the full grace of God for salvation. That does not take away the fact, though, that there is a very real possibility that Reformed people could have an unbalanced view of what the Bible says, and that this could make them susceptible to depression. Maybe because of a wrong emphasis in their instruction, or because of certain experiences in life, they end up with a warped view of what the Reformed faith is about. Then it is not the Reformed faith that causes depression, but a misinterpretation of that faith.

It should not be discounted that such misinterpretation may well come from the pulpit. A minister's task is to “declare the whole counsel of God to his congregation,” as stated in the Form for the Ordination of Ministers (Book of Praise, p. 619). Declaring “the whole counsel of God” means that he must be careful not to overemphasize one part of the doctrine at the cost of another. Christians need to humble themselves before God because of their sins, but there can be an overemphasis on this which is unhealthy. A minister should be sensitive to the fact that there may be people under his proclamation who are already vulnerable to depression already, and who need to have the full grace of God for the complete forgiveness of all sins laid out for them on a regular basis.

It is true that the slack and straying need to see their sins in order to repent from them. But the full grace of God has to be proclaimed first, otherwise there is no real incentive to repent either. A covenantal balance is required. God first comes to us with the promise of His full and glorious grace. Then comes the obligation to live out of that grace in humble repentance. The grace of God is the incentive as well as the means to humble repentance and obedience. Balanced, covenantal preaching is therefore needed, otherwise the hearers of the preaching may be confirmed in misconceptions that make them vulnerable to depression.

But even though the preaching may be balanced, some people may still hear it wrongly. Due to exaggerated guilt feelings, negative thinking or a poor knowledge of the doctrine of Scripture, certain people may only develop an ear for texts and instruction and proclamation that mention sins or condemnation.

This leads to a constant reaffirmation that they are sinners and that the wrath of God constantly hangs over their heads.

Some might also have the idea that one needs to be almost perfect before one can truly call oneself a believer without being a hypocrite. This is the tendency towards perfectionism. These people will dwell on passages such as Matthew 5:48,

You, therefore, must be perfect, as your heavenly Father is perfect.

This results in an unrealistic and unscriptural pursuit of perfection. God certainly calls us to pursue perfection (Philippians 3:12), but not as if it is all in our own power to make any progress. It is God who not only justifies, but also sanctifies. Along with the call to perfection there is also the promise of the sanctifying work of the Spirit, which has to be the important part of striving for perfection. It is no wonder that people who neglect this truth become discouraged and despondent and set themselves open to depression. We need to strive for perfection, surely, but then not at the cost, of the joy of knowing that as covenant people we also have the promise of the washing with the Holy Spirit.

Can unconfessed sins lead to depression? It would appear from passages of Scripture such as Psalm 32:3, 4 that this can be the case. David resisted confessing a sin to God, and as a result, he says, “My body wasted away through my groaning all day long.” Always having been taught that a certain act is sin, and falling into that sin and resisting the admission of guilt before the throne of grace may bring on depression. However, the usual problem is one of exaggerated guilt which makes one afraid to face that sin.

Persons who are prone to depression because they have a warped view of the doctrine of God's Word need to hear the glorious promise that God justifies completely out of grace, for Christ's sake, and that He will not forsake His own, even if they don't perceive that He is near them. As the Psalmist writes in Psalm 73:21-23,

When my soul was embittered, when I was pricked in heart, I was stupid and ignorant, I was like a beast toward Thee. Nevertheless I am continually with Thee; Thou dost hold my right hand.

Is depression in itself a sin? From what was said above, it should be obvious that we would not call it a sin to be depressed as such. No one chooses to be depressed, while sin is a conscious choice (1 John 3:4). Depression, we could say, is a result of the fall of man and the brokenness of life. It can be brought on by factors which are completely beyond one's control. It can be the effect of a sinful lifestyle, as certain physical illnesses can also be the result of a wrong lifestyle. It is the mind's way of dealing with emotional dysfunction. It is a signal that something is wrong with one's emotional or physical health, and that a change needs to be made. But it is not a sin in itself to suffer from depression.

Christians can struggle with this aspect of being depressed. They are assailed by doubts and fears and, feeling distant from God, they are often unable to pray. Thoughts pass through their minds which alarm them, because they are afraid that they have lost their faith and trust and hope in the God of salvation. But we need to remember that with an emotional sickness, the way things are perceived can become very distorted, and people are not themselves., Depression is not a sure sign of spiritual deficiency, but an illness that, like any other adversity, ought to lead Christians to work ever more intensely on their relationship with the God of grace.

Suicide by depressed Christians, whether attempted or successful, raises many questions. It should be remembered that suicide may be attempted for various reasons. There is a drug-related hard rock suicide culture which entices people to play with their lives and even to end them as the ultimate “high.” To put an end to one's life when one has come to the fully rational conclusion that there is no longer any “quality of life” is also unbiblical and totally unethical. But in cases of true depression, also among Christians, suicide is a last desperate attempt to deal with the horribly distorted world in which the person is living at the time. It does not then imply a final rejection of God.

Relatives who are left behind have to struggle with many unanswered questions and conflicting emotions. We need, however, to be sober and not try to sit in the judgement seat of God, but leave everything up to His judgement. He is faithful and just and also merciful. Even if believers through weaknesses fall into deep darkness, God will never let them go. As David wrote in that deeply comforting psalm, Psalm 139:7-12,

Whither shall I go from Thy Spirit? Or whither shall I flee from Thy presence? If I ascend to heaven, Thou art there! If I make my bed in Sheol (the realm of the dead), Thou art there! If I take the wings of the morning and dwell in the uttermost parts of the sea, even there Thy hand shall lead me, and Thy right hand shall hold me. If I say, 'Let only darkness cover me, and the light around me be night,' even the darkness is not dark to Thee, the night is bright as the day; for darkness is as light with Thee.

What Can be Done to Help Depressed Persons?⤒🔗

Depression may become so severe that it requires professional care. When it lasts for a considerable length of time and the depressed person is unable to do his or her work anymore, it is clinical depression, and special therapy and/or medication are necessary to help them through it. What follows is some general advice about how relatives and friends and fellow church members may be able to help a depressed person.

The suffering of depressed people is sometimes made more intense and lengthened by the misunderstandings of those around them. A careful approach is therefore required, and in that context, it may be good to consider what is believed not to help.

It doesn't help to tell depressed people that they may not or should not be depressed. The fact is that while we may see no reason for them to be depressed, they are just that. It does not help to be negative about their state in word or actions, and preach to them about how they should be feeling in their circumstances.

It doesn't help to take a simplistic approach, as if there are certain words or ways to “snap them out of it.” Expressing one's anger or frustration at someone because of their depression does not help them. There is no “swift kick in the pants” cure.

It also does not help to think that you can talk and advise someone out of a depressed condition. No number of “justs” will help. “Just trust in God.” “Just remember the good things.” Neither does it help to argue with statements such as “It could be worse.” The depressed person needs to go through a process, to “stick it out,” and no prodding or advising really helps.

What Does Help Then?←⤒🔗

Experts agree that one of the major things that helps depressed persons is letting them express their feelings and emotions, letting them formulate what is going on inside themselves. In other words, listening and asking, without telling them how they are supposed to feel. We may be quick to judge their feelings as unrealistic or distorted, but they don't need to be told how they are supposed to feel according to our judgement. The fact is that they feel the way they do, and that needs to be heard, also by themselves, from their own mouths.

Depressed people also need to be allowed to be depressed. They need to be given time to work out their emotional dysfunction. The point is to let them know that others care about them. They need to be visited, to be listened to sympathetically. And, while preaching to their state does not help, it does help to gently advise with Scripture and to pray with and for them on the basis of God's promises. As Reformed Christians we have resources here which others do not have, especially in calling on God on the basis of His promises to each of us in Jesus Christ.

Helping like this does bring considerable strain on those around a depressed person. The causes of a depression often remain unknown or vague, which can frustrate. Also, it isn't easy to see and empathize with such deep sadness in someone else's life. Neither is it always easy to know how one should react to what a depressed person says. But empathy, listening and prayer mean more to a depressed person than we usually realize.

What Can be Done to Prevent Depression?←⤒🔗

To a certain extent we can prevent depression or a recurrence of depression in ourselves. These are some preventative measures that have been suggested.

• Stay as active as possible. Regular physical activity is not only good for the body, but also for the soul and mind.
   
• Develop a regular pattern of eating and sleeping. Irregular eating and sleeping habits affect a proper perspective on life.
   
• Plan certain things, especially pleasant events, well ahead of time. It gives a sense of being responsible and having a certain amount of control over your life.
   
• Be socially involved. Good conversation with friends gives you a balanced view of what is going on and also a sense of acceptance by others.
   
• Resist negative thinking about others and yourself. Scripture calls us to think positively about others and to also rejoice in the fact that God so loved you, in spite of yourself, that He gave His Son for you.
   
• Don't be afraid to express your emotions. Of course there has to be Christian restraint when negative emotions towards other people are involved, but speaking about one's feelings and expressing grief at sorrowful times is required as catharsis. Keeping a personal diary can also be good for those prone to depression.
   
• Read your Bible regularly and completely. In other words, don't restrict yourself to reading only the parts of the Bible that speak to your psyche. Going through and meditating regularly on the Bible and on the Christian confessions as a whole prevents misconceptions and misinterpretations from being born. And listening to the whole counsel of God should also be accompanied by a regular prayer life. Developing and using these means of communication with the God of all mercies makes one less susceptible to depression.

Having said all this about the prevention of depression, I must again add that since it is such a complex illness, there is no way to actually make oneself “depression-proof.” The point is that there are things we as Christians can do to reduce its incidence and severity as much as possible. Depression may then not be completely prevented, but it can be dealt with in a positive way and to positive effect.

This sickness is something that does not come by chance but by God's fatherly hand, as confessed in Lord's Day 10 of the Heidelberg Catechism. That means that also this illness can be turned to one's good. Both sufferers and those associated with them have every motivation to seek more eagerly for the grace of God and the complete manifestation of Christ's redemption, when there will be no more crying nor mourning nor pain forever.