Summary: The Bible is clear that the most often cause of depression and accompanying anxiety is sin that goes unconfessed and unrepented.


A Spiritual Malady

Sadly, an estimated 25 million Americans suffer with depression at any given time. These depressed Americans spend billions of dollars on anti-depressant drugs and billions more on psychological therapies and counseling. However, the vast majority of sufferers never come to a true understanding of the cause and true cure for chronic depression.

The Bible is clear that the most often cause of depression and accompanying anxiety is sin that goes unconfessed and unrepented. Throughout the Scriptures, God teaches that our feelings or emotions flow from our attitudes and actions. Simply put, people feel bad because of bad living. Good living produces good feelings. To have good days, one must have good attitudes and deeds.

In a culture, such as our own, that tries to preach that there are no absolutes of right and wrong and that we should never have to take personal responsibility for our problems (the fault always resides in somebody else), this message is considered insensitive, dangerous and unwelcome. However, the truth that sometimes hurts is the same truth that 'sets us free'.

I want us to see the connection between ungodly attitudes and/or actions and depression. To do this, I will begin by looking at the examples of two characters of the Old Testament – Cain and David.

The story of Cain is found in Genesis 4, where it is recorded (vs. 1) that he was the first son born to Adam and Eve. The record (vs. 2) also states that our 'first parents' had another son named Abel. Cain was a farmer and produced crops while Abel was a raiser/shepherd of sheep. We read, in verses 4-5, that both Cain and Abel worshiped God by offering to Him sacrifices, but the content of their sacrifices were quite different. Cain offered to God the fruit of his labors (a grain offering) while Abel offered to God the fruit of his labors (firstborn lambs). This all seems well and good.

However, the Scriptures teach that not only does God seek to be worshiped but, also, He always provides instruction on the way He seeks to be worshiped (John 4:23-24). We find that God did approve of Abel and his worship offering but God did not approve of Cain and his worship offering. We get further insight about this from Hebrews 11:4, where it says that “by faith Abel offered unto God a more excellent sacrifice than Cain.” Now, we are taught in Romans 10:17 that “faith comes by hearing, and hearing by the word of God.” Without hearing the Word of God, one cannot have true faith. Once God has spoken His will, only then do we have something to believe, accept and act upon. The fact that Abel offered his sacrifice “by faith” means that he heard God's will on worship and he obeyed God's instruction on what kind of sacrifice to offer to God in order to receive God's approval and reward. By inference, we can conclude that Cain's sacrifice was not offered “by faith” - that is, it was not in accordance with what God had taught about acceptable worship. Cain decided to worship God his own way and not in obedience to God. Therefore, God did not approve of Cain nor his offering. Cain may have been zealous to worship God but his worship was not based upon God's Word. This shows that Cain was guilty of human pride and this pride led him to disobey God's will.

Now, Cain's problem could have been quickly and joyfully resolved if he had been willing to acknowledge his ungodly pride and disobedience, ask for forgiveness and then repent (determine to henceforth submit to God and His will rather than do things his own way). God would have forgiven Cain and their relationship would have been fine and dandy. But, that is not what happened.

Cain compounded his problem by not only refusing to confess his sin and pursue repentance but the text says “he became very angry.” What did his great anger and unrepentant sin lead to? Depression! The text says that “his countenance fell” which is a metaphor indicating that Cain's inner happiness and peace had departed from him and he felt despondent or depressed.

Through decades of observation and providing some counseling, I have found that most cases of depression have as their root pent-up and unresolved anger. We are commanded, in Ephesians 4:26, to resolve an issue or problem causing our anger before the sun sets. We are not to carry it over to another day. Why?

There are three reasons:

First, to continue to harbor anger in our heart will likely lead to the rise of the sinful emotions of bitterness, resentment and eventually hate (Galatians 5:19-20; Colossians 3:8-10; Titus 3:2-3).

Secondly, harboring anger, bitterness, resentment and hate within us, according to Ephesians 4:26-27, 'gives the Devil an opportunity' to spur us to commit further sins, whether they be in our attitudes, speech or actions. As we shall see, this is exactly what happened in Cain's life.

Thirdly, allowing anger to abide within us over an extended period of time is dangerous because it actually begins to alter our brain chemistry. Prolonged anger, bitterness and resentment hinders the natural production and release in our brain of chemicals such as serotonin, norepinephrine and some endorphins all of which provide the individual with positive moods and a sense of well-being. A low level of these chemicals within our brain makes us feel depressed.

We find in Genesis 4:6-7, that God intervenes and tries to get Cain to think and talk about the roots of his anger and depression and then tells Cain how to overcome his depression - “The Lord said to Cain, 'Why are you angry? And why has your countenance fallen? If you do well, will not your countenance be lifted up?'”

Note that the Lord God tells Cain that if he 'does well' (obeys God in attitude and action) his countenance will be lifted (his depression will go away)! If Cain follows God's will, he and his worship will be acceptable and approved by God (thereby providing no reason for him to be angry) and his depression will be lifted from him.

It is vitally important for us to glean from this passage the connection between our conduct (attitudes, speech and actions) and our emotional/mental health. Submission to God and His Word greatly leads to healthy and positive mental health.

However, the Lord adds the warning that if Cain chooses to continue his rebellion of heart and action, sin and its effects will – like a hungry lion – consume and take control of his life - “if you do not do well, sin is crouching at the door; and its desire is for you, but you must master it.” Unconfessed sin and an unrepentant attitude will leave us vulnerable to the Devil (Ephesians 4:27; 1 Peter 5:8) and his clever temptations to get us to commit additional sins and suffer their terrible effects upon the mind and soul. In the case of Cain, he developed bitter jealousy of Abel and killed him.

When a person experiences the symptoms of depression, the first thing that the person should do is examine their spiritual life and ask themselves - “Do I know of a sin I have committed against another person or against God and I have yet to confess that sin and seek forgiveness? Are any of my attitudes, emotions, speech or conduct outside of what God requires? Have I been negligent in submitting all areas of my life to the Lord and His instructions?” If the person answers 'yes' to any of these questions, they need to understand that they may have uncovered the cause of their depression and they can take action to set things right.

A person suffering symptoms of depression might be surprised to find that confession of a past sin or pattern of sinfulness – whether of commission or omission - and a renewed commitment to obediently serve the Lord in all aspects of their life will have a huge positive impact upon their emotional/mental health. For the vast majority of people, sincerely serving the Lord and following His Example and instructions is the best prescription to overcome depression.

In the story of David, we have the most detailed presentation of depression (and it's frequent companion - anxiety) which often comes to a person who is guilty of unconfessed and unrepented sin. Through the openness and intimacy of his writings, we can easily see the typical toll depression and anxiety takes on the mind, body, and soul.

Let's quickly grasp David's situation by reading some passages in the Psalms. Psalm 32:3-4, “When I kept silent about my sin, my body wasted away through my groaning all day long. For, day and night Your hand was heavy upon me; my vitality was drained away.” Psalm 31:10, “For my life is spent with sorrow and my years with sighing; my strength has failed because of my iniquity, and my body has wasted away.”

Firstly, we glean from these two passages that David had sinned or committed iniquity. Secondly, David has kept silent about his sin, meaning that he had not confessed it to anyone including God. Thirdly, since he did not deal properly with his sin, David's guiltiness produced very negative effects upon his emotional, mental and physical health.

It seems to David, that God is 'pressing down' heavily upon him; that is, he feels depressed. Notice the symptoms of his depression: He is filled with unrelenting sadness or sorrow. Due to the pain of his continuing inward sadness and sorrow, He groans and sighs day and night....which might imply that he is also suffering sleep disturbances or insomnia. He is experiencing abnormal fatigue, his energy to do anything is “drained away” and he just feels like his physical body is “wasting away.” Performing the most basic tasks seems to require more strength than he has due to being depressed.

Let's further examine David's description of his depression and anxiety in Psalms 38.

Psalm 38:2, 4, 6, “For Your arrows have sunk deep into me, and Your hand has pressed down on me...For my iniquities are gone over my head; as a heavy burden they weigh too much for me...I am bent over and greatly bowed down; I go mourning all day long.”

These verses describe David's depression using the same descriptive terms we read in Psalms 31-32. In addition to his “mourning” (sadness and sorrow), he feels emotionally and mentally oppressed as if bearing burdens beyond what he is capable of bearing. His being “bent over and greatly bowed down” may be what he is feeling emotionally and mentally...but could also very well describe his literal physical condition.

Let's examine further David's descriptions of the agony he is suffering with his depression.

Vss. 3, 7, “There is no soundness in my flesh because of Your indignation; there is no health in my bones because of my sin... For my loins are filled with burning, and there is no soundness in my flesh.”

In these two verses, the Spirit of God gives David the insight that his physical discomforts are connected to his spiritual condition. He has been granted to understand that his mental and physical pain are a way that the Lord is trying to get his attention so that he might do some soul-searching about his spiritual condition and relationship with God.

For centuries, it has been taught that David's mentioning of his suffering in his flesh and bones was simply poetic hyperbole..not to be taken literally. However, those who suffer a prolonged period of depression will often develop physical ailments. In the last few decades, researchers have found a very real link between depression and physical ailments. Physical symptoms associated with depression include joint pain, limb pain, back pain, severe headaches, gastrointestinal problems, fatigue, sleep disturbances, psychomotor activity changes, and appetite changes. (Psychomotor activity simply refers to hand-eye coordination tasks like throwing a ball, driving a car, operating a machine, playing an instrument, typing, etc.)

The same chemicals in the brain that affect mood, which we highlighted earlier, also affect regulating pain responses and can disturb or disrupt the entire body's chemical balance. Therefore, when a person is suffering major depression and they claim to be experiencing physical pain, nausea, bowel troubles, severe headaches, fatigue (sometimes lasting all day and for a prolonged period), sleep disturbances, insomnia, etc. they are to be taken seriously.

Many times, depressed people will see their doctor to check-out the cause of their physical ailments and/or sleep difficulties and seek relief. Doctors many times cannot find an obvious medical cause and dismiss the patient's complaints as being more imaginary than physically real... “it's all in the patient's head.”

What many doctors yet fail to understand is that the patient is suffering depression and the depression is disrupting the body's chemical balance. Further, the doctors certainly do not understand the spiritual component of depression.

Vss. 8, 10, “I am benumbed and badly crushed; I groan because of the agitation of my heart...My heart throbs, my strength fails me; and the light of my eyes, even that has gone from me.”

Notice how that David continues to describe how a depressed person feels. He says that he is emotionally 'numb'; that is, the things in life that previously brought him an emotional response do not move him. What simple things that brought happiness and contentment do no longer bring those positive feelings and emotions. He is emotionally numbed to things going on about him. Realizing that he lacks those positive feelings, he is “badly crushed.” He feels helpless to restore the healthy emotional/mental person he once was.

Along with his depression, he develops anxiety problems. He feels his heart beating fast - “throbbing” - as it is full of “agitation.” This hyperactivity of his heart is due to the release of stress hormones (such as adrenaline) into the bloodstream. In normal situations, adrenaline will provide a boost of energy, power and strength to accomplish physical tasks. However, the periodic adrenaline rushes in the depressed and anxious individual acts just the opposite. David explains this when he says that even though his heart throbs, “my strength fails me.”

Tragically, David acknowledges what others around him surely had noted – 'the light or sparkle of his eyes has gone from him.' Often the depressed or anxiety-ridden person's eyes look blank, void, or empty.

Verse 11, “My loved ones and my friends stand aloof from my plague; And my kinsmen stand afar off.”

Here, David addresses a situation that often happens to people with depression. Family and friends do not understand the problem or 'plague' of depression. They do not know what is going-on with their depressed loved one. They see that their loved one has mysteriously changed but they cannot connect with the depressed and anxious person...especially with their negative mood and outlook. The family and friends are uncomfortable to spend time with their depressed and anxious family member or friend. What should they say or do to help the situation? Why will not the depressed/anxious person go out and do things with them as before? Eventually, family and friends, for their own sanity, will go about their normal lives and leave their hurting loved one behind. For the depressed person, this is very painful because it increases their already terrible feeling of isolation and lack of 'connectedness' with the world around them. They feel very much alone.

Verse 17, “For I am ready to fall, And my sorrow is continually before me.”

David feels like his situation is hopeless and feels he can no longer endure a life of continual sorrow. Sadly, David's case is not an unusual or unique case. Up to 15% of those who are clinically depressed end-up committing suicide.

David did not take the path of the 15%. Thankfully, God intervened by having the prophet Nathan confront David about his sin and compelled him to confess his sin and repent. Nathan basically taught David the truth found in Proverbs 28:13, “The one who conceals his sins will not prosper, but whoever confesses and renounces (repents) them will find mercy.” Let us read David's testimony found in Psalms 32 & 51:

First comes David's confession and repentance - Psalm 51: 1-3, 7-9, 12, 14-15, 17, “Be gracious to me, O God, according to Your loving-kindness; According to the greatness of Your compassion blot out my transgressions. Wash me thoroughly from my iniquity and cleanse me from my sin. For I know my transgressions, And my sin is ever before me. Purify me with hyssop, and I shall be clean; Wash me, and I shall be whiter than snow. Make me to hear joy and gladness, Let the bones which You have broken rejoice. Hide Your face from my sins and blot out all my iniquities. Restore to me the joy of Your salvation and sustain me with a willing spirit. Deliver me from blood-guiltiness, O God, the God of my salvation; Then my tongue will joyfully sing of Your righteousness. O Lord, open my lips, that my mouth may declare Your praise.”

Notice that David not only asks for forgiveness (restoration of spiritual health/well-being) but also the restoration of his emotional, mental and physical health/well-being which had been taken away while he had failed to confess and penitently seek forgiveness for his sins.

Second comes the Divine reward for David's having confessed and repented of his sins - Psalm 32 : 5-7, 1-2, 10-11, “I acknowledged my sin to You, and my iniquity I did not hide; I said, “I will confess my transgressions to the Lord” and You forgave the guilt of my sin. Selah. How blessed is he whose transgression is forgiven, whose sin is covered! How blessed is the man to whom the Lord does not impute iniquity, and in whose spirit there is no deceit! Many are the sorrows of the wicked, But he who trusts in the Lord, loving-kindness shall surround him.”

The word “blessed”, in this context, means happy and joyful...the opposite of being depressed. David acknowledges that his depression was taken away as a result of his trust in God's having forgiven and covered his sins. When he restored his spiritual health/well-being by confession and repentance, his emotional, mental and even physical health/well-being were restored.

I think that we have adequately proven that sin(s) which are not confessed and repented of can and will lead to depression; taking a toll on our spiritual, emotional, mental and physical well-being.

I want to close this study by addressing those who might say that their depression or despondency is not due to unconfessed and unrepentant sin but, rather, is due to adversity or tribulation that have come into their lives; such as, a death of a close loved-one, a natural disaster, a serious financial crisis, infertility, loneliness, a serious disease or life-changing physical impairment, losing one's job in tight employment environment, totally destroying one's vehicle in a collision, betrayal, unwanted divorce, prolonged abuse or bullying, etc..

It is only natural that the situations listed above and other similar troubles will cause us to react with sorrow, grief, and/or distress. It is humanly normal for us to experience a degree of emotional and mental anguish when such difficult events suddenly enter our lives. Even our Savior experienced much anguish, sorrow and distress as He faced the many incidents of adversity and hardship in His life (Isaiah 53:3; Matthew 26:37-38; John 11:33; 12:27; Hebrews 5:7-8). However, here is the key difference - our Lord never allowed the hardships, adversities and abuse to consume Him. He never succumbed to a state of despondency or depression.

There is a proverb that states 'life is 10% what happens to us and 90% how we react to life's events.' This wise saying is fully supported by the Word of God.

God has devoted a lot of space in the Scriptures discussing how He wants His people to react to the various adversities and trials that occur in their lives. He has provided a lot of instruction on how we are to react. If we do not react as He has instructed, it is sin. James 4:17, “To him therefore that knows to do good, and does it not, to him it is sin.”

To avoid allowing our natural short-term sorrow, grief, or distress to overwhelm us and slide into depression and/or debilitating anxiety, we are firmly instructed to exercise the spiritual virtues of (1) faith, (2) joy, (3) gratitude, and (4) obedience.

(1) Faith.

Psalm 84:12, “Happy is the person who trusts in You, Lord of Hosts!” The first virtue to exercise when agonizing situations or circumstances occur in our lives is a steadfast faith. We must believe with all of our being that God has complete control (sovereignty) over everything which happens and that there is nothing that is done that is not done by or allowed to be done according to His will. In Isaiah 46:10, God assures us, “saying, 'My purpose will be established, and I will accomplish all My good pleasure'.” Now, we find in Romans 8:28-29, a statement that boldly declares God's sovereignty and how that God exercises His complete sovereignty to orchestrate events in life to bring-about “good” for Christians; that is, “those who love God.” The specific “good” that God wills for individual Christians is for them “to become conformed to the image of His Son.” Which is to say that He wills that Christians learn and adopt the same character, the same moral and spiritual attributes, that Christ Jesus demonstrated through-out His Life. The passage reads: “We know that God causes all things to work together for good to those who love God, to those who are called according to His purpose. For those whom He foreknew, He also predestined to become conformed to the image of His Son.”

So, with respect to the situations that arise in our Christian lives, whatever they may be, we know that God made them happen or allowed them to happen so that they would provide the opportunity for we Christians to mature in the Faith; that is, develop the moral and spiritual traits and virtues of Christ Jesus. There is a Divine purpose in everything that happens in our Christian lives. Whether or not events actually fulfill their intended purpose or goal is greatly dependent upon how we respond to them.

It is crucial that we not become angry toward God when adversity comes; for, “God is for us” (Romans 8:31). We must not commit the damnable sins of complaining, grumbling and murmuring about our circumstances (Jude 15-16; 1 Corinthians 10:9-11); for, God is always seeking our highest good. There will definitely be situations that will come where it will be very hard to discern how any good could come forth from them. In such situations, we must heed the admonition found in Proverbs 3:5, “Trust in the Lord with all your heart and do not lean on your own understanding.” 1 Peter 5:6-7, “Humble yourselves, therefore, under the mighty hand of God, so that He may exalt you at the proper time, casting all your care on Him, because He cares bout you.”

Because He cares, we need not ever think that God will bring into our lives situations or circumstances that we cannot endure and overcome with the grace and power that God is willing and wanting to provide. God knows our strengths but He also knows and takes into account our frailties. Psalm 103:13-14, “Just as a father has compassion on his children, so the Lord has compassion on those who fear Him. For He Himself knows our frame; He is mindful that we are but dust.” And, with High Priest Christ Jesus, “we do not have a high priest who cannot sympathize with our weaknesses, but One who has been tempted in all things as we are, yet without sin. Therefore let us draw near with confidence to the throne of grace, so that we may receive mercy and find grace to help in time of need. (Hebrews 4:14-15)” Therefore, when we find ourselves in the midst of adversity, Jesus commands we “ought always to pray, and not to faint. (Luke 18:1)” Psalm 55:22, “Cast your burden on the Lord, and He will sustain you; He will never allow the righteous to be shaken.” Our testimony can be like that of the Apostle Paul, found in Philippians 4:13, “I can do all things through Christ who strengthens me.”

(2) Joy.

We are not only admonished to react to adversity with faith in God's sovereignty, goodness and sustaining power, but we are to respond to afflictions and trials with joy. It needs to be said that it is not wrong to briefly feel sorrow, grief and distress in response to the afflictions, trials and losses that occur in our life. However, a Christian can experience emotional sorrow, grief and distress while also experiencing inner spiritual joy. For example, in Philippi, the Apostle Paul and co-worker Silas were stripped, brutally beaten and afterwards thrown into a dark dungeon with their feet chained in stocks. They were very uncertain of their fate. However, while going through this crisis, they did not complain of their circumstances nor did they sink into despair. With conviction that the Lord would bring-about good in their situation, Acts 16:25 says that “at midnight, Paul and Silas prayed and sang praises unto God.” Even though they had been publicly humiliated, inflicted with painful stripes and tossed into a place of complete darkness, these two men found reason to rejoice about God's wisdom, power, goodness and mercy. Their faith-based joy gave them strength in a time of personal trial. Nehemiah said it right, in Nehemiah 8:10, declaring “the joy you have in the Lord is your strength.”

We rejoice in our trials knowing that such things are used by God to shape us according to His will. James 1:2-4, “Consider it a great joy, my brothers, whenever you experience various trials, knowing that the testing of your faith produces endurance. But endurance must do its complete work, so that you may be mature and complete, lacking nothing.” Thus, Christians who have an unwavering faith that there is an important purpose in the trials that befalls them, have a reason to rejoice in them. Romans 5:3-4, “We also rejoice in our afflictions, because we know that affliction produces endurance, endurance produces proven character, and proven character produces hope.” There are Christ-like character traits that can only be developed by enduring afflictions, trials and tribulations in this life with a proper attitude. It is crucial that we remind ourselves that we must develop Christ-like character traits in order to have any hope of receiving our eternal reward. James 1:12, “A man who endures trials is blessed, because when he passes the test he will receive the crown of life that God has promised to those who love Him.”

(3) Gratitude.

The third virtue which we are to exercise during the trials in our lives is gratitude. If trials are sent our way to help us mature in the Faith, we not only rejoice about them but we thank God for them. A heart of gratitude leaves no room for complaining. It is impossible to be truly thankful and be filled with negativity at the same time. Opposed to grumbling and murmuring about God's handling of us and our lives, we are told to express thanksgiving as we petition God for the help we need to endure our afflictions and trials. 1 Thessalonians 5:16-18, “Rejoice always; pray without ceasing; in everything give thanks: for this is the will of God in Christ Jesus concerning you.” Paul restates that command, in Philippians 4:6-7, “Be anxious for nothing; but in every thing by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which passes all understanding, will keep your hearts and minds through Christ Jesus.” And in Ephesians 5:20, “Giving thanks always for all things unto God and the Father in the name of our Lord Jesus Christ.” With a heart of thanksgiving, we realize that no matter what we face, God doesn’t just work to change our situations and help us through our problems. He does more. He changes our hearts. His power has the ability to work in hearts full of gratitude and in minds fondly focused upon Him. It releases the grip our struggles might have over us.

(4) Obedience.

Lastly, we are to react to our afflictions and trials with a renewed determination to obey the Lord. So often when we are going through difficult times, we grow weary or become distracted from fulfilling our obligations of serving and worshiping the Lord. If we use our problems as excuses to be less diligent in obeying the Lord and thereby sin, it will only cause us to spiral downward into depression and debilitating anxiety as we saw earlier in our study. Do you know what will rob your joy faster than anything else? When you know the right thing to do and you don’t do it. Our blessed Lord indicated that having inward joy is contingent upon obeying His commandments. John 15:10-11, “If you obey My commands, you will remain in My love, just as I have obeyed My Father’s commands and remain in His love. I have told you this so that my joy may be in you and that your joy may be complete.” The secret to continual, abundant, and overflowing joy is obedience. It’s doing what God tells you to do. Every time you do what God tells you to do, your life is going to be filled with joy.

Galatians 6:9, “Let us not be weary in well doing: for in due season we shall reap, if we faint not.” The Apostle Paul exhorted the Christians at Philippi, who were going through tough times, “The things which you both learned and received and heard and saw in me, these things do: and the God of peace shall be with you (Philippians 4:9).” Obedience brings inner peace, as we know that God is well-pleased with our sincere efforts to serve Him in times of trial. 1 Peter 3:10-12, “He that would love life, and see good days, let him refrain his tongue from evil, and his lips that they speak no guile: and let him turn away from evil, and do good; let him seek peace, and pursue it. For the eyes of the Lord are upon the righteous, and his ears are open unto their prayers: but the face of the Lord is against them that do evil.”

This has been a lengthy study but there is so much more that can be learned from the Scriptures on this subject. It is too bad that sermons about the root-causes of depression and anxiety are seldom heard from the pulpits. I hope that the points that I covered will save Christians from going through the pain of depression or will help the depressed and anxiety-ridden Christian to know what steps they can take to be freed from the clutches of the spiritual malady of depression.