ACBC Counseling - Question 5

5. (Content) Provide a biblical definition of depression. Describe manifestations of depression in

both the inner and outer man. Explain the biblical factors that drive depression. Detail several
biblical strategies to respond to depression.
I. Overview
A. Define Depression Biblically
B. Explore Manifestations of Depression in both the Inner and Outer man.
C. Explain the Biblical Factors that Drive Depression.
D. Describe Biblical Strategies & Practical Steps for Responding to Anger.
II. Define Depression Biblically
A. Depression is a state of mind or attitude that affects the individual in such a way that they
are unable to adequately handle the responsibilities of their, or those they are responsible
for, everyday normal duties. Furthermore, it is characterized by sadness and
hopelessness, many times in a downward spiral without end.
B. Adams “Depression, narrowly speaking, is the attitude that one has that affects his ability
to function responsibly in life, to love God and love his neighbor as himself. His chores
and responsibilities are shirked. He lays aside things that he knows that he ought to be
doing because he doesn’t feel like doing them.” 1
C. Adams “A debilitating mood, feeling, or attitude of hopelessness which becomes a
person’s reason for not handling the most important issues of life.” 2
D. Adams “Almost anything can be the root of the counselee’s depression: a recent illness in
which he gets behind in his work, hormonal changes, a reversal of his fortunes, the
consequences of simple negligence, guilt over a particular sin, self-pity arising from
resentment, worry, etc. The important fact to remember is that a depression does not
result directly from any one of these factors, but rather comes from a cyclical process in
which the initial problem is mishandled in such a way that it is enlarged in downward
helixical spirals that eventually plunge one into despair.” 3
E. Adams “Sin leads to guilt and depression, sinful handling of sin further complicates
matters leading to greater guilt and deeper depression, ad infinitum. In the downward
cycling the depression certainly contributes to further failures as it often becomes the
excuse for a faulty handling of the sin itself.” 4
F. Welch “When you listen to people describe their depression, you will hear two extremes.
People will report that the pain is so intense that they want to die. Others will describe an
emotional numbness in which they are already dead. Sometimes you will hear one person
describe living with both extremes simultaneously.” 5

1 Jay Adams, Depression, as spoken in message from Mid-America Institute for Nouthetic Studies, as found at:

[Link]
2 Jay Adams, as quoted in Robert Smith, The Christian Counselor’s Medical Desk Reference, Timeless Texts: Stanley, NC, 2000,

p. 206.
3 Jay Adams, A Christians Counselor’s Manual, 375.
4 Jay Adams, A Christians Counselor’s Manual, 375.
5 Edward Welch, Blame It on the Brain: Distinguishing Chemical Imbalances, Brain Disorders, and Disobedience, 116.

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G. Gather more data when a counselee tells you that they are depressed.
1. Criteria used by the Diagnostic and Statistical Manual of Mental Disorders to
diagnose depression. Five or more must be present for two weeks and represent
a difference in the person’s behavior. 6
a. A depressed mood daily for most of the day, nearly every day, as
indicated by subjective report or the observation of others.
b. A loss of interest or pleasure in all activities for most of the day, nearly
every day.
c. Weight loss or gain of more than 5 percent of body weight due to an
increase or decrease in appetite.
d. Inability to sleep normally or excessive time spent sleeping daily.
e. Visible restlessness and agitation or sluggishness and slowing down as
seen by others.
f. Fatigue or loss of energy daily.
g. Feelings of worthlessness or guilt without a reason.
h. Decreased ability to think, concentrate, and make decisions.
i. Recurring thoughts of death, or suicide without a plan. Suicide attempts
or plan for suicide.
2. Welch “The truth is, not only are the criteria flawed but most of the time
physicians simply don’t use them when they diagnose depression. . . A full
quarter of psychiatrists admit that, more than half the time, they do not use the
DSM-IV criteria when they make a diagnosis of depression. It is even worse
among primary care physicians. . . two-thirds admit that they don’t use the
criteria half the time.” 7
H. Biblical examples of Depression
1. Depression caused by Guilt
a. David
1) Psalm 38:1-8 O LORD, rebuke me not in your anger, nor
discipline me in your wrath! For your arrows have sunk into me,
and your hand has come down on me. There is no soundness in
my flesh because of your indignation; there is no health in my
bones because of my sin. For my iniquities have gone over my
head; like a heavy burden, they are too heavy for me. My wounds
stink and fester because of my foolishness, I am utterly bowed
down and prostrate; all the day I go about mourning. For my
sides are filled with burning, and there is no soundness in my
flesh. I am feeble and crushed; I groan because of the tumult of
my heart.

6
Charles Hodges, Good Mood Bad Mood: Help and Hope for Depression and Bipolar Disorder, 25.
7
Charles Hodges, Good Mood Bad Mood: Help and Hope for Depression and Bipolar Disorder, 28-29.

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b. Cain
1) Genesis 4:6-7 The LORD said to Cain, “If you do well, will you
not be accepted? And if you do not do well, sin is crouching at
the door. Its desire is for you, but you must rule over it.”
2. Depression caused by circumstance
a. Job
1) Job 3:11 Why did I not die at birth, come out from the womb and
expire?
2) Job 3:26 I am not at ease, nor am I quiet; I have no rest, but
trouble comes.
3) Job 6:1-4 The Job answered and said: ‘Oh that my vexation
were weighed, and all my calamity laid in the balances! For then
it would be heavier than the sand of the sea; therefore my works
have been rash. For the arrows of the Almighty are in me; my
spirit drinks their poison; the terrors of God are arrayed against
me.’
4) Job 10:1 I loathe my life; I will give free utterance to my
complaint; I will speak in the bitterness of my soul.
i. Job 1:22 In all this Job did not sin or charge God with
wrong.
ii. Job 5:17 Behold, Blessed is the one whom God
reproves; therefore despise not the discipline of the
Almighty.
iii. Job 8:4 If your children have sinned against him, he had
delivered them into the head of their transgression.
iv. Job 8:6 if you are pure and upright, surely then he will
rouse himself for you and restore your rightful
habitation.
v. Job 11:13-14 If you prepare your heart, you will stretch
out your hands toward him. If iniquity is in your hand,
put it far away, and let not injustice dwell in your tents.
Surely then you will lift up your face without blemish;
you will be secure and will not fear.

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III. Explore Manifestations of Depression in both the Inner and Outer man.
A. Outer Man
1. Westerberg “Physical, or organic, conditions can cause depression. . . It is
important, as Biblical Counselors, to know and understand that there are
physical conditions that cause depression.” 8
a. Westerberg “There are some teachings that say Christians should never
get depressed, pointing to a lack of faith, or even questioning their
salvation . . . Teachings like this offer no help o Christians that are
suffering with (organically caused) depression.” 9
b. ACBC “The Bible is clear that God created human beings to consist of
both a body and soul. To be a human being is to exist in these two
constituent parts, which are separable only at death. Even after death,
Christians confess that the bodies and souls of human beings will be
restored at the Last Day. This biblical truth points to the high honor and
regard that God gives to both the physical and spiritual realities of
humanity. (Genesis 2:7; Matthew 10:28; 1 Corinthians 7:34; 2
Corinthians 5:1; 1 Timothy 4:8)
A theological reality like this one requires Christians to honor both body
and soul as crucial to human existence. Christians, therefore, should
respect medical interventions as a fully legitimate form of care for those
struggling in this fallen world. Examinations by medical professionals
are crucial adjuncts to a biblical counseling ministry as they discover and
treat, or rule out physical problems, which lead many to seek counseling
help.” 10
2. Hypothyroidism: “A condition in which the Thyroid gland, located in the front
of the neck, which controls and regulates hormones, metabolism, energy levels,
sleep, or even moods, is producing ineffective levels of hormones.” 11
3. Adrenal Exhaustion: “The Adrenal glands, located on top of each kidney,
secrete the hormone adrenaline when the hypothalamus activates the
sympathetic nervous system due to an external stressor . . . The problem is that
those living in our society today are under constant stress nearly every day, so
our adrenal glands are always producing adrenaline, becoming exhausted or
fatigued.” 12
4. Medication: “A study published in the Journal of the American Medical
Association found that 200 prescription drugs can cause depression.” 13

8 Randy Westerberg, Depression, from an outline at the 2021 Biblical Counseling Conference at Cross Pointe Church.
9 Randy Westerberg, Depression, from an outline at the 2021 Biblical Counseling Conference at Cross Pointe Church.
10 ACBC, Mental Illness and Medicine: I. Mental Disorders and Biblical Counseling, Statements from the Board, as found at:

[Link]
11 Randy Westerberg, Depression, from an outline at the 2021 Biblical Counseling Conference at Cross Pointe Church.
12 Randy Westerberg, Depression, from an outline at the 2021 Biblical Counseling Conference at Cross Pointe Church.
13 Qato DM, Ozenberger K, Olfson M. (2018) Prevalence of Prescription Medications With Depression as a Potential Adverse

Effect Among Adults in the United States. JAMA. 2018;319(22):2289–2298. doi:10.1001/jama.2018.6741. Retrieved from:
[Link]

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5. Westerberg “When you think depression . . . think, could there be a

physiological cause? And, after attempting to determine the cause, you can’t
find anything, there is a good chance that there is something physiological.” 14
B. Inner Man
1. Depression typically follows an individual’s response to a particular situation.
The situation itself does not need to be serious or dramatic, although it might
be, it may also be quite inconsequential and insignificant. The focus of our
attention should be on the response to the event. Were they overwhelmed? Did
they become discouraged? Did they begin to let their daily responsibilities
slide? Did they begin feeling guilty because of their response? The response
can bring on a negative feeling, which in turn, brings another negative
response. This is the downward spiral into depression.
2. Adams “Depressed persons whose symptoms fail to show any sign of a
biochemical root should be counseled on the assumption that they are
depressed by guilt.” 15
3. Welch “Feelings of worthlessness or excessive or inappropriate guilt is the
most obvious (symptoms of spiritual problems). Guilt is not a sin in itself, but
it is a signpost point to a spiritual problem. Guilt is clearly an expression of the
heart and conscience.” 16
IV. Explain the Biblical Factors that Drive Depression.
A. Life in a fallen world
1. The Enemy Within (Our sinful flesh)
a. Romans 5:12 Therefore, just as sin came into the world through one
man, and death through sin, and so death spread to all men because all
sinned—
b. The natural state and inclination of man is to sin. We all have an
inherited proclivity to sin.
1) Romans 3:10-12 as it is written: None is righteous, no, not one;
no one understands; no one seeks for God. All have turned
aside; together they have become worthless; no one does good,
not even one.
2) James 1:14-15 But each person is tempted when he is lured and
enticed by his own desire. Then desire when it has conceived
gives birth to sin, and sin when it is fully grown brings forth
death.
3) Genesis 6:5 The LORD saw that the wickedness of man was
great in the earth, and that every intention of the thoughts of his
heart was only evil continually.

14 Randy Westerberg, Depression, from stated at the 2021 Biblical Counseling Conference at Cross Pointe Church.
15 Jay Adams, Competent to Counsel: Introduction to Nouthetic Counseling, 126.
16 Edward Welch, Blame It on the Brain: Distinguishing Chemical Imbalances, Brain Disorders, and Disobedience, 120.

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4) Matthew 15:19 For out of the heart come evil thoughts, murder,
adultery, sexual immorality, theft, false witness, slander.
5) James 3:10 From the same mouth come blessing and cursing.
My brothers, these things ought not to be so.
B. Idols of the heart that fuel depression?
1. Pride
a. Proverbs 29:23 One’s pride will bring him low, but he who is lowly in
spirit will obtain honor.
b. Proverbs 16:18 Pride goes before destruction, and a haughty spirit
before a fall.
2. Fear
a. Proverbs 29:25 The fear of man lays a snare, but whoever trusts in the
LORD is safe.
V. Describe Biblical Strategies & Practical Steps for Responding to Depression.
A. “The basic steps of a biblical approach to helping them (individuals who are suffering
with depression) are similar to those you would follow to help people with physical
problems. First, you understand the experience of depression. Second, you make tentative
distinctions between physical and spiritual symptoms. Third, this distinction will allow
you to focus on heart issues. In doing this, you will point the person to Christ as her hope
in suffering, you will encourage her in her faith, and you will guide her in her battle with
sin. This focus on heart issues may actually relieve the depression. Fourth, if the pain of
depression is excessive, consider using medical treatment to possibly ease the pain.” 17
1. Welch “. . . the immediate response of God’s Word is compassion. The church
must move toward the depressed person and mourn with those who mourn
(Rom 12:15), pray for God’s deliverance (2 Cor 1:9-11), and search for
encouraging words that can bless and give hope.” 18
B. Share the Gospel.
1. The first thing you can do with someone who is suffering from depression is to
share the gospel. This is obviously true for an unbeliever but is also important
for a Christian if they don’t fully understand the gospel. Reviewing the
unmatched love, forgiveness, and grace that we receive from God can have a
great impact on someone who is depressed and doesn’t know the Lord or his
promises.
C. Address sin issues directly and conclusively, both their thinking and actions.
1. Welch “Too often, family and friends think the depressed person is very fragile
and cannot handle any frank discussion about sin or hard-heartedness. But to
ignore these issues when they are obvious in someone’s life is to treat that
person without love and compassion.” 19

17 Edward Welch, Blame It on the Brain: Distinguishing Chemical Imbalances, Brain Disorders, and Disobedience, 115-116.
18 Edward Welch, Blame It on the Brain: Distinguishing Chemical Imbalances, Brain Disorders, and Disobedience, 121.
19 Edward Welch, Blame It on the Brain: Distinguishing Chemical Imbalances, Brain Disorders, and Disobedience, 123.

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a. Proverbs 28:13 Whoever conceals his transgressions will not prosper,

but he who confesses and forsakes them will obtain mercy.
b. Westerberg “Sin and guilt are a major factor causing depression, but
forgiveness and repentance are major factors in getting over
depression.” 20
2. Welch “Of course, the knowledge of sin must be accompanied by the
knowledge of God’s great, forgiving love. . . When we grasp this forgiving
love, we understand why Scripture considers repentance a path to liberation,
not condemnation.” 21
D. Consider a depressed person’s feelings of guilt as serious and genuine.
1. Welch “The person may be involved in things for which he or she should feel
guilty. The person does not believe what God says about forgiveness. The
person wats to use guilt as a way to punish himself to pay back for his own
sins. This betrays a heart of pride that thinks I can deal, in some small way,
with its own sins.” 22
a. If you are able to determine that your counselee has committed some
sinful act and they are experiencing guilt, encourage them to repent,
confess their sinfulness, and seek reconciliation.
E. Physical Exercise and Nutrition
1. Physical exercise and proper nutrition have been known to directly affect an
individual’s moods. Getting regular exercise promotes healing, increases
circulation, and releases dopamine in the brain. It also provides a sense of
accomplishment. Celebrate the small victories when attempting to respond to
depression.
a. Ask your counselee to maintain an exercise and nutrition journal. If you
find out that your counselee isn’t physically active and surviving on a
regular diet of Mountain Dew and Honey Buns, you might have
identified some important information about a contributing factor of their
depression.
F. The importance of Sleep
1. Encourage your counselee to get enough sleep each night. Between 6-8 hours is
typical, but more may be required. Also, encourage your counselees to get up
at the same time each day, regardless of the time they fall asleep. This has been
shown to dramatically affect an individual’s moods as it directly impacts the
circadian rhythm.
a. You could ask your counselees to document, with as must accuracy as
possible, when they fell asleep and when they woke up. This may reveal
important information about their sleep patterns.

20 Randy Westerberg, Depression, Lecture from Cross Pointe Church: Biblical Counseling Conference 2021.
21 Edward Welch, Blame It on the Brain: Distinguishing Chemical Imbalances, Brain Disorders, and Disobedience, 123.
22 Edward Welch, Blame It on the Brain: Distinguishing Chemical Imbalances, Brain Disorders, and Disobedience, 124.

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VI. Suggested Reading

A. Charles Hodges, Good Mood Bad Mood: Help and Hope for Depression and Bipolar
Disorder.

B. Edward Welch, Blame It on the Brain? Distinguishing Chemical Imbalances, Brain

Disorders, and Disobedience, 115-130.

C. Jay Adams, Competent to Counsel, 126, 146.

D. Jay Adams, The Christian Counselor’s Manual, 350, 375-376.