How Do Biblical Counselors View Psychotropic Drugs

Thank you for having us back. Our topic this afternoon will be about psychotropic drugs, counseling, psychotropic counseling, people on psychotropic drugs. How a, as biblical counselors, how should we think about psychotropic drugs? And let's, uh, we wanna talk a little bit about that. First of all, definition, psyche, we heard already talks about really the soul is the study of the soul.

But in modern vernacular, perhaps we would say it's the study of the mind. Tropism is to form, so it is a mind forming or mind altering drug. Some people call them psychoactive drugs, and uh, it is the area of antidepressants, antipsychotics, anti-anxiety medications and mood stabilizers. This is a hot topic because many people have strong feelings for and against the use of psychotropic drugs.

So how should we address them? Many counselors are taking them already. Pam, do you have Yeah, we probably, uh, most of the people that I see, maybe 60% of the ladies that I counsel are already on them by the time they come to see me. So we want to be sensitive. We wanna approach this topic with compassion and humility.

And there are four, uh, passages of scripture that are labeled in your notes there, listed in your notes. Um, two Timothy 2 24. The Lord's servants must not be quarrelsome, but must be kind, able to teach patient gentle, and then those who are opposing him. God may grant them repentance and lead them to the knowledge of truth.

It's not necessarily, it's not our job. God does it, but God can use us. Another, uh, scripture, Matthew 10 16. We need to be wise, but gentle wise as serpents and gentle as doves. Acts 17. We want to be noble bes. We want to study the scripture first. Ians 5 21. We want to examine everything carefully and hold onto that, which is good.

And these scriptures are pertinent to this topic this morning. We already talked a little bit about medical versus psychological diagnosis. Uh, diagnosis. By the way, that word, uh, dia is like diagrams a straight line, and Osis is knowledge. So we want straight knowledge about a topic. Uh, in contrast, prognosis is knowledge about something.

Projected in the future. So future knowledge about a disease. So that's prognosis, but what about a diagnosis? Uh, how is it made medically versus psychologically? Medically? We talked already this morning about a disease or an illness, has an identifiable pathology that can be measured. Uh, you can, uh, get a blood test such as a SED rate or a C R P for inflammation.

You can do a, a cbc, a complete blood count to look for anemia. You can get, there are some specific lab tests such as ANA or, uh, that might look for a specific, uh, disease and, uh, Rheumatoid factors can be done. And uh, so blood tests can be used to measure and to make a diagnosis medically. And of course X-rays.

And we talked about bone scans, CAT scans, MRIs, and this morning we talked quite a bit about the functional MRIs and P E T scans. And there will be many other variations on neurodiagnostic studies that, you know, they might look at altered blood flow, they might label a particular glucose or other molecule and then inject it into a person and then, Uh, scan it and see where does the brain change with various activities and to various stimulations.

And remember that important study we, we talked about this morning about, uh, O C D and they have, uh, altered pa uh, functional MRI scans, but then when they counseled them over a period of time, the brain changed back towards normal without any particular drugs. So just because, uh, neuro radiographic study shows an altered.

Pattern or, or even signature, they might call it. Just because that is present, it doesn't mean that that's the cause. Perhaps it's the result of the behavior. And this is gonna be hitting us in the decades to come. And of course, biopsies can be used to, uh, look at tissues to see, do you ha, is this tissue cancerous?

So forth. So that's a medical diagnosis or excuse me, that's a psych, yeah, that's a medical diagnosis. So a psychological diagnosis is made in a different way in a psychological diagnosis, people have been labeled with a condition from the dsm, the Diagnostic and Statistical Manual of Mental Disorders. So, And the currently accepted diagnoses are listed in there, and they, they talk about features, they talk about patterns of thoughts, typical course, familial patterns.

It gives lots of information about each label, age limits, and so forth. So psychological diagnoses are made on the basis of the symptoms of a person. The symptoms of a person in feelings, thoughts, behaviors, not the reason for the symptoms. That point is actually acknowledged In the DSM itself, it says A psychiatric diagnosis does not carry any necessary implications regarding the cause of an individual's mental disorder or its associated impairments nor treatment.

It doesn't talk about treatment either, so the point of that is that psychological diagnosis are basis. On a person's thinking, a person's feelings and a person's behavior, that's how they're diagnosed, not on a known pathology. Now, many people who had come to biblical counseling as, as Dan mentioned earlier, and that asked me about.

Many of them who come to me in counseling have already been put on psychotropic drugs. They already have a psychological diagnosis. Um, they could be given this diagnosis from another doctor, from a counselor from the internet. Do you know that you can type in your symptoms and come up with a possible label on the internet?

Uh, so some of them are self-diagnosed and generally people who have a label of, of some kind of psychiatric diagnoses. Are on one or more medications. So let's look at what a diagnosis actually says. I'm just gonna run with, run through with you the diagnostic criteria for adhd, and I'm gonna summarize it.

It's kind of long, but I'll just give the high points here. First of all, you have to have a person with inattention. So often fails to give close attention to detail. Trouble holding attention on tasks. Does not seem to listen. Does not follow through on instructions. Often has trouble organizing tasks and activities.

Often avoids dislikes or is reluctant to do tasks that require mental effort over a long period of time, often loses things necessary for tasks, easily distracted, often forgetful. And then there's hyperactivity also kind of symptoms. Fidgets with hands taps. The hands and feet squirms in the seat leaves the seat in situations when remaining seat is as expected.

Often runs about or climbs on things, unable to play or take part in things quietly on the go. Talks excessively blurts out an answer before the question is done. Often has trouble waiting. His or her turn often interrupts and intrudes on others. Now what does that sound like? A lot of people say that sounds like a boy.

I've heard that a few times. It sounds like a child. It really does, but the main point that I have given you those symptoms is because the point is they're descriptive. They're describing something. They're not diagnostic, and they're not prescriptive. They're not telling you why it's happening, and they're not telling you what to do about it.

It's. Descriptive, it describes things. So we've got these descriptions in the DSM with all the lists of behaviors and things, and then they make theories up to account for the behavior. There's lots of different theories out there. There's social theories and, and uh, there's biological theories. The one that we're gonna talk about today is called the medical model.

The medical model of psychiatric problems presumes a biological cause for disordered emotions, thoughts, and behavior. And with that assumption, there must be a biological treatment i e drugs prescribed by a specialist. So thoughts and behaviors and emotions are thought to be due to brain physiology or genetic inheritance, or perhaps a combination of the two.

There's no inner person. Do you notice this? There's no inner person to bother with. Here we're just a physical body, so brain chemicals are thought to determine our choices and our feelings. If we're feeling badly, we're given a disease label. Our mood problems are seen as due to brain malfunction. In this way, we are subject to our emotions and thoughts and not responsible for them.

They happen to us physically or chemically or genetically, we're a victim of them rather than an active player. So belief in this theory promotes research to seek a chemical fix so that that's the only way to deal with these emotions that are just uh, uh, not normal. So this has led to a generation of people who believe that the only answer to troubling motions.

And behavior is found in medicine Now. Having said all that, just as we spoke about this morning, there are some physical causes. For disruptive behavior. There are organic causes of altered behavior. Certain disease states and medications we talked about can have behavioral effects such as fatigue and sleeping and insomnia and racing mind and jitters, all of that.

You can have anemia, you can have hyperthyroid, diabetes, electrolyte imbalances. You can have infections. You can have brain disease, actually brain tumors or injury, Parkinson's, dementia, multiple sclerosis, epilepsy. Um, also some medications, and we talked about that. But whenever something is actually physically wrong with the body, it is not given a psychiatric label.

It's given a medical diagnosis. So if I'm acting fatigued and the lab work shows, I have a low thyroid, I'm not called depressed, I'm called hypothyroid, and they treat it with th uh, thyroid hormones. And again, the point I wanna make is even if there is an organic disease associated with any of our behavior, that disease cannot cause sin.

It doesn't cause sin in our thoughts, in our feelings, in our behavior. It may tempt us towards sin, but it doesn't cause the sin. It may expose our sin, but it's not the cause. Okay, I wanna talk about the chemical imbalance theory. And by the way, I don't want to minimize. How severe and profound that mental disorders can affect people.

It can destroy their lives. It can destroy the lives of the families taking care of them. So these can be profoundly destructive and people suffer tremendously. Um, chemical imbalance theory is the theory that abnormal neurotransmitters. Are the cause of emotional or mental disorders. Now we're not talking about electrolytes.

Electrolytes are salts in our bodies. That can be measured such as sodium, potassium, calciums, et cetera, and low, uh, abnormal levels of electrolytes can cause, uh, problems and changes in our behavior. Those can be measured and those can be corrected. We're not talking about hormone imbalance. Hormones can be measured in our bloodstream.

They are substances secreted by the glands in our bodies, such as pituitary gland, adrenal gland. When we have abnormal AL levels, they are a medical illness and that can be identified as an as a specific pathology. But the chemical imbalance theory is that the neurotransmitters. Are problematic now, neuro is nerve and obviously we want to transmit a signal from one nerve to another.

So how does a nerve talk? It is somewhat electrical down its axon or length of, uh, Body, and then it forms a junction or a synapse with another nerve, and it talks to that other nerve, and it sends a signal, and it does this by a chemical means a neurotransmitter, and there are probably 200 different neurotransmitters, serotonin, dopamine, and nore.

Norepinephrine are a few of them, but it is the theory that an abnormal level is the cause of the problem. Now it's kind of like I. Boats like say hundreds of years ago, how did you send a signal to the town across the river from you? You didn't have cell phones, so you maybe somebody would get in a rowboat and they would go to the other side and yell out the signals the British were coming or something.

And if there was a really important signal that had to be sent, the nerve cell might send all kinds of boats across blue boats, red boats, yellow boats. And they're all trying to get this really important message across the other side. Well then they want the boats to come back after they send their signals.

Now what if they blocked the pier and say, okay, all you boats, you have to keep sending your signals. We're not gonna take you back up. We're not gonna re-uptake your, but you keep staying out there. Well, there's gonna be a lot of complications cuz the boats are gonna run into one another. So the earlier drugs were non-selective.

They kept, they blocked the neurotransmitters from being taken back up from the sending cell. So there's a lot of complications. So the pharmacological industry pharmacy tried to, uh, address that and they say, we need fewer side effects of our psychotropic drugs. So they say, let's just be selective on a few of the boats.

Let's just block the yellow boats. So all the other boats that were out there, they're gonna come back in. We're gonna re-uptake them. But we're gonna be selective on a particular kind. So the pharmaceutical companies, they made these selective in re-uptake inhibitors. In other words, they were selective against serotonin, for example.

So they formed a class of drugs called the selective serotonin re-uptake inhibitors. That's a mouthful. But as I explained it, they just were selective against the yellow boats coming back in. So only the yellow boats, there's plenty of space for them. So there's fewer side effects. That's kind of in a nutshell now what we are getting now, you could be selective against norepinephrine reuptake.

You can be selective against do dopamine, and uh, a whole classes of drugs then came about because of this pharmaceutical gymnastics that came about. But anyway, I'm gonna show a video here that talks about the drugs. Now this is a pharmaceutically made video, and you can tell that they kind of hedge a little bit.

They say it may cause this. It may cause that. The problem is we cannot measure neurotransmitters at the synapse. We cannot measure them at the synapse. Now, serotonin can be measured perhaps in other ways in platelets, maybe in the csf, uh, maybe in the urine, but we don't know how that correlates to true, uh, emotional disorders at the synapse because we cannot measure them.

The human brain has about 10 billion brain cells. Each brain cell can have as many as 25,000 connections with other cells. Messages, which direct many functions throughout your body, travel through your brain from cell to cell. Through these connections, for these signals to move from a sending cell to a receiving cell, they must cross a small gap called the synapse chemicals called neurotransmitters, located at the ends of the sending cells.

Help the signal cross this gap. Serotonin is one such neurotransmitter, a very important one that helps regulate mood, emotions, and other body functions. After the serotonin has done its job, it's reabsorbed by the sending cell and is soon back in position to help with the next nerve signal. If you have depression, you may have a serotonin imbalance.

Your overall level of serotonin may be low, and some of it may be reabsorbed too soon. As a result, communication between the brain cells is impaired and SS R I or selective serotonin reuptake inhibitor is a medication designed to help increase the amount of serotonin in the synapse by blocking its reabsorption.

As serotonin builds up, normal communication between cells can resume and your symptoms of depression may improve. So you notice they have a lot of hedging words there, but the pharmaceutical industry put out a lot of these sort of direct to patient advertising and they made sense to people. Say, I have low serotonin.

Uh, but is that really the case? And we want to address that a little bit. Of course, the pharmaceutical companies could make a lot of money on this, and, and it was many different companies were involved and, uh, they made all different sorts of psychotropic drugs and it's difficult to classify them. But we'll just call, we'll have these six categories that we'll deal with today.

Uh, T c A, the tricyclic antidepressants, the mono immune antidepressants. Excuse me. The monoamine oxidase inhibitors, the SSRIs, the SNRIs, and the S DRIs selected dopamine up, uh, which are considered atypical. And then miscellaneous. So first of all, this tca and you can, if you remember organic chemistry, if any of you have taken that there are three carbon rings up there and hence the name tricyclic or a three ring as its base formula.

And these are very old from the 1950s Amitriptyline, uh, used to be called ville. That was, its generic, or excuse me, trade name. And now generically it's called Amitriptyline, uh, Pamela and some of those others, and they are used for a wide variety of. Of, uh, uh, emotional problems, but there are tremendous amount of side effects.

Remember, that's, they're not selective. So all those boats that are out in the river, were out there sending their signals at the same time, and there was, it was chaos at the nerve cell level. And the same thing with Maos monoamine oxidase inhibitors. They're an older class of drugs from the fifties. Um, an amine comes from the word ammonia, and that's a nitrogen with two hydrogens attached to a six carbon ring.

Uh, so that is an amine, and serotonin is an amine, but, so if you have that one amine monoamine, uh, normally it's digested by an oxidase, but if you wanna stop that digestion oxidase inhibitor, then you have more of the amine. Uh, remaining. So that's what the class of drug M AO stands for is monoamine oxidase inhibitor.

So it leaves more serotonin, re re, uh, behind. There is gonna be a quiz after this. That's right. All right. But again, these first two classes of drugs, many side effects because they are non-selective. So out of that came the, uh, pharmaceutical effort to do selective re-uptake inhibitors. And here are the most common ones that are today.

We see. The SSRIs, exa Lexapro. Paxil, Prozac is probably the, the biggest and one to me, the biggest splash. Zoloft Luvox, they're all SSRIs. There are some complications. They were very costly at first when, when they're, uh, under a patent. The SNRIs are different class. They're selectively, uh, norepinephrine uptake inhibitors, Cymbalta, Effexor, Alteram, Pristiq.

As dri selective against dopamine. Wellbutrin used for smoking cessation, uh, Ritalin even is in that category. Now, these categories, they are selective only to a variable degree, and the exact mechanism, how that translates into the synapse is still unknown. So when you, uh, look at the drugs, Uh, and they have this little long white, uh, piece of paper that, uh, tells about, you know, all the complications and what is their mechanism of action.

They always say it, the mechanism of action is unknown, but it might do this. And so that, that's, they're being honest in that regard. Uh, the miscellaneous category of psychotropic drugs could include mood stabilizers like lithium, which is commonly used for bipolar tegratal de Depakote. Adderall, uh, even.

And, uh, Dexedrine, uh, busbar, the anti-anxiety, the middle column there is, uh, Valium. We all know the benzodiazepines for anxiety. Valium, Librium, Xanax, transgene, erox, uh, Abilify Antipsychotic Drugs, uh, Haldol and Thorazine. We've heard of those. They are around for a long time, from the forties and fifties, and they are still being used, uh, newer versions of the.

Uh, antipsychotic drugs would be, uh, listed there. Psychosis, let me just define that, is it's really a thinking that is out of touch with reality. Uh, schizophrenia has altered thinking and altered perceptions, hence hallucinations, and they have, uh, behavior or actions that are not appropriate. And so that would be a psychosis and that can be, uh, very debilitating.

Okay, let's go back to the SSRS for RIS for just a second. Let's look at this list up here. This is not in your notes, so you have to look up on this on the screen. These are the potential side effects of SSRIs. Now remember that category of drugs is designed to have fewer side effects, right, than the meos.

Uh, look at the on the left column. I'm not gonna read 'em all. Uh, GI bone fractures, uh, depression. Oh, wait a minute. Depression, that's a potential side effect of an antidepressant. Isn't that interesting? So what if somebody that a physician started on an antidepressant, came back a month or two later and said, I feel I'm worse.

The physician will say, well, I think you need to double your dose. Right? Or is it a side effect? Yeah, of the antidepressant. So that's a conundrum and there's really no easy way for the physician to determine that. Uh, perhaps they'll say, well, I think I'm gonna add another drug, another category. So I'm gonna give you this and I'm gonna add a second one now.

Well now you're on two drugs. And, uh, so it's difficult for the physician to know what the right thing to do is weight gain of, uh, Uh, of course on the bottom right it would be sexual dysfunction and the loss of libido is a common, uh, potential side effect for SSRIs. But you can see that there are many, uh, potential problems, uh, that would take in these medications.

And what about the cost? Uh, you just talked to a, a person that I was counseling last week. And he is diagnosed with bipolar one and I would say yes, he has fit that criteria. He has had a manic episode to the point of psychosis that required him to be hospitalized for, uh, 10 days, and that would be one of the hallmark descriptors of bipolar one.

Well, he's been on Lithium and Depakote and other ones that he was spending a thousand dollars a month on his medications. Um, He quit on his own. Uh, but I did not tell him to do that. But, um, uh, so the cost of these medications are significant. What about the spectrum of usage? Is there a set? Perfect. Uh, you know, the psychiatrist, they got it down.

They know exactly how much to do and what dose. The answer is no. Uh, some psychiatrists or psychologists, actually, psychologists cannot prescribe medications, at least not in the state of Montana. Most states, a psychiatrist is an, is a medical doctor or a do that has prescriptive rights. A psychologist is typically a PhD, uh, that does not have prescriptive rights.

But anyway, as far as prescribing some, uh, some psychiatrist will always use x. Uh, a psychotropic drug and on the far end of the other spectrum would be they never use it. Well, that most commonly it's some, or in the middle where a psychiatrist, they'll say, well, I'll usually use it, or I'll sometimes use it.

But then the duration, the, do they believe that you need this medication for a lifetime or is it a temporary utilization of the psychotropic drugs? Some that believe this is a biological problem. It is. I always prescribe it and you need it for a lifetime. That's actually a minority of psychiatrists would do, would, but there are a few, but some would say never.

So anyway, the point is that there's not a consensus exactly of how to use these medications. Now the question is, do they work? Do they work? Journal of American Medical Association, January, 2010. The true drug effects were non-existent to negligible amongst depressed patients with mild, moderate, uh, and even some severe baseline symptoms.

So even the medical literature is, is starting to question it. Here's an article from 2002. Journal of American Medical Association. Uh, does it eliminate depression? And they con, they compared an ssri, Zoloft, which cured, that's an unusual parameter, but they considered cured depression, 25%. St. John's Ward, which is a natural herbal supplement, cured at 24% of the time.

But then look at placebo. Placebo. In other words, people given a false drug, a sugar pill, they actually had a higher rate of so-called cure. So does it really work? Uh, Irving Kirsch, PhD from Harvard, uh, psychologist said, uh, the biochemical theory of depression is in a state of crisis. The data just do not fit the theory.

And Irving Kirsch specialized in studying the placebo effect and in particular placebo effect of drugs. And he found it to be extremely high, as high as 75% of the effect of the drug was placebo. Uh, Tom Insole, uh, uh, Jim talked about Tom Insole a medical doctor at the National Institute of Mental Health as chief psychiatrist, if you will, of the United States.

The theory that is foundational for our current view of the cause of, and treatment for depression has never been established as fact. There's no biochemical imbalance that we've been able to demonstrate. N I M H is moving from investigating into medications. Towards research in other therapies. CBT is what was listed in this quote.

So even the psychiatrists in certain groups do not think that it is, that the antipsych, that the psychotropic drugs are all that helpful. In truth, the chemical imbalance notion was always a kind of an urban legend. Never a theory seriously propounded by a well-informed psychiatrist. Well, that's interesting because we that we are still hearing that today about the chemical imbalance theory.

Uh, what about, uh, psychosis in the long term? Many diagnoses with psychosis may do better without anti-psychotic drugs. Sometimes they do well with anti-psychotic drug, but sometimes they do better without them, and you're better off probably with low dose or cessation of the drug. They had a higher recovery than those with a regular dose of the antipsychotic, uh, use of medications.

So we're going to show a video by Dr. Kelly Brogan, who is a psychiatrist. She's not a Christian, but she's gonna be talking about, uh, depression is not a serotonin deficiency. Uh, she talks about the placebo effect and she talks about drugs may actually cause a change in our nervous system even when the drug is stopped.

That's an interesting concept that's been rarely teased out in the literature, uh, medical literature. In other words, we stop these drugs, is our brain, does it recover or go back towards normal? Um, and there is a better way to identify the, uh, root cause. So we'll listen to this video if it plays. So, Hi, I'm Dr.

Kelly Brogan, and I'd like to spend a few minutes speaking to you about my perspectives on psychiatric medications, which I began to investigate based on my perceptions of the severe limitations of this treatment model. So I'll tore you through four tenets that I appreciate in my daily practice. So the first is that depression is not a serotonin deficiency, and it surprises me to learn how much of the population believes that serotonin deficiency causes depression.

And this notion first came into existence through observations of medication, side effects in tuberculosis patients, but in six decades, Since we have yet to confirm in human studies the role of the monoamines, serotonin, dopamine, and norepinephrine, or the 100 other neurochemicals in depression, and this has LED leaders in the field to begin to admit that we need to abandon the monoamine hypothesis, which makes sense.

Because high levels of serotonin and low metabolite have been associated with very undesirable outcomes, such as suicide and bulimia. So you might wonder, well, how is it that antidepressants work so well? And that brings me to the second tenet, which is that the active placebo effect is responsible for antidepressant benefit.

And this is an idea that was pioneered through the research of Dr. Irving Kirsch, which demonstrated that up to. 73% of the perceived benefit of antidepressants is attributed to the active placebo effect, and the passage of time and the active placebo effect is when in a clinical trial, a patient becomes aware that they are not receiving placebo, that they are receiving the treatment, and they become aware of that through the side effects.

That they're experiencing. And when he uncovered unpublished data, more than half of which was negative in nature and included that this even this benefit disappeared. And even in the most severe depression, one point on a 52 point scale was all that distinguished treatment from placebo. And this one point could easily be attributed to side effects rather than the actual me.

Mechanism of the medication. So you can see how we have a scientific vacuum here and in psychiatry there are no objective tests. To diagnose. We use a manual that's a, a, you know, list of descriptors. And we have created an opportunity for pharmaceutical companies to infect a vulnerable host. And what I mean by that is that we have patients who are suffering, they're looking for answers, and they're looking for a cure.

And they are led to believe by direct to consumer advertising that all of these things are known and available. So what are the problems with this? With the placebo effect. Well, that leads me to the third te, which is that these medications cause significant and lasting perturbations to the nervous system.

And this happens because when you're chronically exposed to a pharmaceutical product, your body makes adaptations to accommodate that. It creates a new normal state rather than actually resolving a pathology And. When you discontinue a medication, the adaptation back to previous baseline can be very difficult, and this has been termed relapse and data suggests that those who are treated with medications relative to those who are not, are much, much more likely to relapse.

And in fact, moreover, they're more likely to experience decline in functioning and a compromised quality of life long term. And there has never been a study that has demonstrated that medication treatment, long-term provides better outcomes. So this brings me to my fourth and final te, which is that there is a better way.

Through personalized diagnostics and lifestyle medicine, you can identify the actual root cause of a depression. So Dr. Brogan was, uh, going on to another theory about, uh, what's the actual root cause but biblical counselors would want to go after what's the actual root cause of our depression? We remember we talked about heart issues and, uh, Pam talked about Sue and that you, she didn't seem to have normal sadness.

She seemed to have disorder sadness cuz there was no identifiable circumstances. But as Pam teased it out, there were heart issues there involved. There was a cause to Sue's depression, and that's where the biblical counseling can come into play. And what is the problem with, so what if the placebo, it's affect, you know, as long as they get better.

I don't care if it's placebo. What's wrong with that thinking?

Yeah, I see a few people, Dr. Brogan talked about perhaps long-term effects on our nervous system, but also we're exposing them to cost. So, $500 a month, a thousand dollars a month that the, if their health plan does not cover that, that's a huge effect on their family. Uh, what about the side effects? But most importantly, either they're, they have a false hope, their hope is in the drug rug.

They don't have a realization that there's a heart issue that needs to be addressed and can be addressed, and then that they can have true hope. So do antidepressants work from a biblical perspective, Dan talked about the secular perspective of whether they work or not. Let's talk about a biblical perspective.

And I think that in order to begin answering this question, we have to be sure that we're defining things carefully. So what do you mean by the word work? Do they work? What do you mean by work? What's the goal of our life? Honor God, right? Glorify God, become like Christ, grow in Christ likeness. So the question is then if they work biblically, has this person developed a closer walk with Christ through the suppression of their difficult emotions?

Chemically, are they growing in progressive sanctification and showing more of the fruit of the spirit? Galatians 5 22. Are they dealing with their heart issues or are they just suppressing the outward manifestation of those heart issues? John 1717 says, we are sanctified by the truth of the word, so we would ask, do psychotropic medications work?

In the way that God desires people to change in the heart by progressive sanctification, by remembering the gospel, by identifying sin, confessing, repenting, put off, put on, renew your mind. Persevere in gle teaching reproof correction, training, and righteousness by the word of God. I like to, uh, use the tack analogy when it comes to, um, Antidepressant medications.

If you sit on attack, it hurts. That's depression. Tylenol may help the symptoms. Ibuprofen may help. Oxycodone may help if you sit on that attack long enough and get cellulitis. Keflex may help with the infection, but what's the real answer?

Yes. Stand up, identify the tack, pull it out, and now other words address the heart issue. Mm-hmm. Mike Emmett's book, there is a very good book, uh, about descriptions and prescriptions that's in the available. He is a medical doctor and he has an excellent address of drugs also. He tends to have a little bit warmer embracing of the drugs than I would have, and I'll explain it in this nuance he uses.

He doesn't use the tack analogy. He uses a crutch analogy. Now listen to the slight difference. He says, if you have an injured ankle, perhaps you want to use crutches for a while. And I would say as an orthopedist, if you have a broken ankle, you must use crutches. Okay for a while. So that analogy is a subtle difference of an identifiable physical injury of a broken ankle.

And temporarily use crutches. Well, perhaps you need crutches for six weeks. You must use it. If you don't use crutches, there will be cru problems. Your ankle will get worse. That's how he uses that analogy to, uh, towards psychotropic drugs and antidepressants in particular. But I would use the, the TAC analogy as a slight nuanced difference.

I dunno if you can see that difference. If attack. Yes, the medications may help, but they're not essential. Crutches might be essential, but when you have TAC the medications are not essential. You must address the tac. So how do we counsel someone who's on psychotropic medications? First of all, you do need to encourage appropriate medical care.

If somebody's coming into you with new symptoms of any kind that are physical symptoms, it's always right to send them to the doctor. They may come back on psychotropic drugs if they find nothing wrong with them physically, but that's okay. We can, we can deal with that in counseling. So do encourage appropriate medical care for any new symptoms.

Uh, we are free to use legitimate medical means, uh, but don't be distracted by the fact that somebody comes in and they are on psychotropic medications. Heart issues are the target. It's important to remember that your primary goal in counseling a person with any really issue is to help them to become more like Christ.

That's our goal. I want to help, you know, Jesus better follow Jesus better become more like him. Two Corinthians five talks about us being ambassadors for Christ, so that we're pleading with people to be reconciled to God. That's our job. So what are some potential heart issues with, uh, people in, with a psychiatric diagnosis?

There's a bunch of them. Fear, worry, unrighteous, anger, unbelief, idols of the heart, unresolved guilt, uh, could be. But since those heart issues that we wanna go after are the target, we want to use biblical terminology instead of the psychological terms. And, and you guys have heard a little bit about this, but we're gonna get a little more specific about it.

We want to substitute biblical terminology for the secular words and categories. So we talked about a medical model, we wanna talk about a biblical model now. And, uh, this, this verse was quoted to you one Corinthians two 13. It's talking about using spiritual words for spiritual things rather than man's words for, for spiritual things.

So one Corinthians two 13. So, addiction becomes enslavement to sin and o d D becomes rebellion against authority and panic attacks become episodes of fear. Now Counselees people that we are trying to help might be hesitant to kind of change their label to what the Bible says about it, because the label does two things.

It takes away responsibility because I'm sick, I have a disease, but it also takes away hope because I can't cure that right? Without some kind of cocktail of medication. So we want to help them. We want to be sympathetic while we're trying to change this. I know some people are very, um, very, uh, loyal to their label.

They really believe it. And so we need to be sympathetic, but we do need to lead them to the truth, patience, sympathy, lead them to the truth. So how are we gonna do this? We have some slides from Garrett Higby, who was a clinical psychologist who kind of saw the light and had a radical change of heart and became a biblical counselor.

He now works up at Harvest, uh, in Chicago. But he, um, shows us from these slides. This is kind of an example of what the DSM descriptors are alike, so they kind of. Categorize behaviors into four different types of disorders. There's disruptive, that's the conduct disorders, oppositional defiant, um, disruptive nos just means not otherwise specified.

So if nothing fits you just put 'em in that category. Sexual disorders, impulsive disorders, ADHD would be under their intermittent explosive disorder, eating disorders. O C D is there. Addictions are there. You have the depressive disorders, which could be major depression. They might call it bipolar dysthymia.

Now dysthymia is kind of like, um, are there any Winnie, the Poo fans in here? Dysthymia is kind of like I, in Winnie the poo. He's just sort of sad but not, you know, not terribly depressed, sort of functioning, but he is just kind of sad all the time. That's dysthymia. And then the anxious disorders, the panic disorders.

PTSD would be there. Generalized anxiety. So that's, that's kind of how the DSM categorizes the different disorders. Now let's take a biblical look at what those things are actually saying. The disruptive disorders actually become anger, rebellion, foolishness. Stiff stiffness. Bitterness. Okay. The impulsive disorders become simple-minded, perverse, faithless, ignorant, divisive.

That's foolishness. The Bible would call the impulsive disorders acting foolishly the despair disorders. The Bible does have a lot of words for our despair, hopelessness, grief, sadness, downcast, soul, the fear. The Bible talks a lot about fear, actually worry, anxiety, double-minded, faint-hearted. So we wanna talk about the issues of the heart that produced or contributed to their struggles, and we yet to use a biblical terminology.

And this morning we talked about Garrett Higby, how he linked these heart topics and he says, uh, like a bipolar one may live in despair, visit foolishness, and, uh, driven by fear of man resulting in anger. So he, he talks about that dynamics of the various heart issues, and that's an interesting way of looking at, uh, our mental disorders.

Sanctification is a process in your notes. You may not have your chart labeled, but the the one that is goes from left to right in a downward manner is man's way. So label that in your notes. And the one that goes in upward is God's way. And as we go from left to right, that is our sanctification, uh, journey.

And we, on the far left would be an atheist would always use 100 percent's man's way. And in heaven, we're gonna be using 100% God's. Uh, wisdom, and that's where we want to get to. The integrationist wants to add the two together, and at first it seems logical. Well, let's do man's wisdom and God's wisdom.

It's A plus B, but I would say to you that we have only a certain amount of energy. Towards problem solving and we can do one or the other or a little bit of both. A plus B does not equal 200%. A plus B is still limited to 100% of the of our efforts. So I would say as Christians, let's use God's wisdom and that would be far superior to, uh, to man's wisdom.

And we talked a little bit about, uh, Chuck Charles Hodge's book, which I really like. Normal. It's a good mood, bad mood that's in available in the back. Normal sadness versus disordered sadness. We talked, uh, about that this morning. 90% of people now that are used in antidepressant drugs could be categorized as normal sadness or bereavement.

Now can there be benefit? To states of despair. We talked a little bit about that earlier. Yes, it, the states of despair or depression can be a tool that God can use to speak to us if we are willing to listen. It can drive us to see God and depend on his grace, and it opened the door for change and repentance.

It can drive us to become more like Christ in our response and it can equip us to help others perhaps, uh, if we go through that journey, we will then be able to, uh, understand others perhaps a bit more. So there, um, So that's something to consider. So we've talked a lot about the general counseling of people with a psychiatric diagnosis, but let's talk specifics here for a moment because if you are gonna get into counseling and you are gonna interact with people, you are gonna be interacting with people who are on medications.

How do we talk to them about their medications? Uh, so first of all, I would say respond carefully to any questions about medications. You need to just be prepared to wisely respond. So what if somebody says, should I start right? I'm having the struggle and I, I just don't know what to do and I've tried everything and I should I just start on medications?

What do you think? Here's exactly what I would say to them. Okay? Feel free to see your doctor who can rule out any physical cause for your problem. The decision whether to take a medication is between you and your doctor, but I believe the Bible has a lot to say about your struggles. Medications aren't gonna solve any heart problems.

And then I would probably use the tac anology. And then if somebody is with you in counseling and they say to you, you know, I'm kind of tired of these medications and the side effects and they're too costly, and all of those things, And I wanna get off of 'em. Well, you wanna know why exactly they want to get off of them if it is just side effects, and if it is just cost, but they haven't really understood that the Bible is sufficient for their issue.

Um, that's not quite the time yet. You wanna work a little bit longer with them. So you might say something like, you know, I, I, I appreciate the question. I think let's do a little bit more work and, and we'll get back to it a little bit later. Um, if they say, if you ask them a question, Uh, okay. Let's say you go off your medications and then the feelings return.

What are you gonna do? And if they say something like, well, I saved a bottle, just in case, you know, it's, it goes bad. That's not the answer you want. You want the answer that sounds something like this. You know what? I wanna get off of these things because I understand that the Bible has principles that can help me with all of the struggles that I have.

And I understand that Christ's grace is sufficient for me to handle my life. And I understand that I've been given everything for life and godliness through the true knowledge of Jesus Christ. That's the kind of answer you want before you're gonna discuss with someone, uh, whether they want to stop their medication.

So let's say that that is the case. You've been in counseling for a while, they're learning problem solving, uh, Avenues and they're learning about Christ and they're gaining, uh, confidence in the scripture and confidence in doing things biblically. Um, what do you do if they wanna come off the medication?

You will only discuss it if they are in that place, but if they want to come off, you send them back to the doctor who started them. So you don't ever talk to somebody about coming off their medication. You don't ever say, well, why don't you just try taking a half of it next week, or something like that.

We don't talk about the medications. You send them back to the doctor who started them. This is very important. Underline this. Note it. Take it away from today for sure. This is the thing you need to know. Biblical counselors should never, ever instruct a counselee to come off their medication, ever. That is equivalent to practicing medicine without a license.

And it's illegal, so do not do that in counseling. Your strength is in the word of God. We are there to use the Bible to help them. You are not there to deal with the meds. You're there to help them deal with the life situations that they are taking the medications for. Do not practice medicine by recommending that a person begin taper down or discontinue his use of medications.

And co correlates to that is what, if you have a. Christian House or center, and you had a policy that you can only be here if you don't take drugs or we're gonna restrict you from taking drugs. That can actually be a trouble from a liability point of view, because what if somebody that was under your care committed suicide and then in your.

Uh, uh, charter, it says No drugs. I think that, that you would be in, in significant trouble for that and churches have gotten in trouble for that, where the counselor perhaps, uh, inappropriately steered them away from drugs. Uh, I would say spend our effort lifting up the truths of the God of the Bible, don't spend our effort tearing down psychotropic drugs.

There's, that's just a wasted effort. Spend your effort lifting up God's truth and, and applying it to their lives. And I would also say, you know, Dan asked me at the beginning of this talk, how many people come to you on medications? And I said, about 60%. You're probably wondering at this point, how many get off of them and about half.

About half of the people I counsel decide that their medications are no longer necessary. So that's increasing. Even though that's not our goal, it's not our goal. It's not our goal to get them off meds. That's, to us, that's not important. And another thing to think about, these drugs are not gospel blockers.

You know, on our computers we have blockers to prevent viruses and so forth. People on these medications, they can still hear the gospel. They can still hear God's word in that message still. Now, is there a use for drugs? Yes, there is. Some people do not respond to God's word and they may have to settle for a second option.

Those who are psychotic, who are delusional hallucinations, they have a severely disorganized mind. The use of antipsychotic tru uh, drugs for short term may help to quiet their mind. Does a cure their problem? No. But it might be helpful. What about those with severe anxiety, inappropriate that yes, perhaps a drug can help them for a while.

What if they haven't slept in a week? Or they have tremendously terrible sleep patterns? Yes. Then a short term use of a sleeping pill might be help, help for them. What if their behavior potentially is harmful to others and themselves? Then I, I'm not afraid of them, uh, turning towards the use of medication.

So in summary, I. Is it a sin to take a psychotropic drug? No. I don't believe it is a sin. But could it be sinful? And the answer would be yes. If somebody refuses to address heart issues, refuses to address sin. If it is there and refuses to turn to God and instead their new God is the drug. I think that is sinful.

Our psychotropic drugs necessary to treat a disease? No. Do antidepressant medications have effects? Absolutely. They have effects and they have side effects. Can they sometimes be useful and helpful? Yes. Do psychotropic drugs address heart issues? No, the Bible does. Should we be intimidated of those taking psychotropic drugs or having, uh, labels psychotropic?

And the answer is no, and medications are not gospel blockers. Now in our notes there, we have recommended resources and I just want to close, I know we're just a minute or two over Jim, but I just wanna close. With some, uh, because this is our last time, we'll have a chance to talk to you. And I want to encourage you in your journey towards, uh, uh, biblical counseling and how it can be used in your life and in the lives of others.

And all of us will say, well, I'm not ready. I'm not competent. God can't use me. Well, I have a few, a list of people in the Bible that God has used. He uses a great variety of people to accomplish his will. For example, Noah. Noah was a drunk. Abraham was too old. Isaac was a liar. Jacob was a liar. Leah was ugly.

Joseph was abused. Moses had a stuttering problem. Gideon was afraid. Sampson was a womanizer. Rahab was a prostitute. Jeremy and Timothy were too young. Sarah was too old. David was an adulterer and a murderer. Elijah was suicidal. Isaiah preached naked. Jonah ran from God. Naomi was a widow. John. Or job went bankrupt.

John the Baptist ate bugs. Peter denied Christ three times. The disciples fell asleep at prayer. Martha was worried about everything. Mary Magdalene was a prostitute. The Samaritan woman was divorced many times. Zacchaeus was too small. Paul was too righteous. Timothy had an ulcer and Lazarus was dead, and God could use Lazarus when he was dead.

So God can use all of us in this room. So I just wanna, uh, Give you that message that God's word is sufficient and will take joy in that.










Thank you for having us back. Our topic this afternoon will be about psychotropic drugs, counseling, psychotropic counseling, people on psychotropic drugs. How a, as biblical counselors, how should we think about psychotropic drugs? And let's, uh, we wanna talk a little bit about that. First of all, definition, psyche, we heard already talks about really the soul is the study of the soul.

But in modern vernacular, perhaps we would say it's the study of the mind. Tropism is to form, so it is a mind forming or mind altering drug. Some people call them psychoactive drugs, and uh, it is the area of antidepressants, antipsychotics, anti-anxiety medications and mood stabilizers. This is a hot topic because many people have strong feelings for and against the use of psychotropic drugs.

So how should we address them? Many counselors are taking them already. Pam, do you have Yeah, we probably, uh, most of the people that I see, maybe 60% of the ladies that I counsel are already on them by the time they come to see me. So we want to be sensitive. We wanna approach this topic with compassion and humility.

And there are four, uh, passages of scripture that are labeled in your notes there, listed in your notes. Um, two Timothy 2 24. The Lord's servants must not be quarrelsome, but must be kind, able to teach patient gentle, and then those who are opposing him. God may grant them repentance and lead them to the knowledge of truth.

It's not necessarily, it's not our job. God does it, but God can use us. Another, uh, scripture, Matthew 10 16. We need to be wise, but gentle wise as serpents and gentle as doves. Acts 17. We want to be noble bes. We want to study the scripture first. Ians 5 21. We want to examine everything carefully and hold onto that, which is good.

And these scriptures are pertinent to this topic this morning. We already talked a little bit about medical versus psychological diagnosis. Uh, diagnosis. By the way, that word, uh, dia is like diagrams a straight line, and Osis is knowledge. So we want straight knowledge about a topic. Uh, in contrast, prognosis is knowledge about something.

Projected in the future. So future knowledge about a disease. So that's prognosis, but what about a diagnosis? Uh, how is it made medically versus psychologically? Medically? We talked already this morning about a disease or an illness, has an identifiable pathology that can be measured. Uh, you can, uh, get a blood test such as a SED rate or a C R P for inflammation.

You can do a, a cbc, a complete blood count to look for anemia. You can get, there are some specific lab tests such as ANA or, uh, that might look for a specific, uh, disease and, uh, Rheumatoid factors can be done. And uh, so blood tests can be used to measure and to make a diagnosis medically. And of course X-rays.

And we talked about bone scans, CAT scans, MRIs, and this morning we talked quite a bit about the functional MRIs and P E T scans. And there will be many other variations on neurodiagnostic studies that, you know, they might look at altered blood flow, they might label a particular glucose or other molecule and then inject it into a person and then, Uh, scan it and see where does the brain change with various activities and to various stimulations.

And remember that important study we, we talked about this morning about, uh, O C D and they have, uh, altered pa uh, functional MRI scans, but then when they counseled them over a period of time, the brain changed back towards normal without any particular drugs. So just because, uh, neuro radiographic study shows an altered.

Pattern or, or even signature, they might call it. Just because that is present, it doesn't mean that that's the cause. Perhaps it's the result of the behavior. And this is gonna be hitting us in the decades to come. And of course, biopsies can be used to, uh, look at tissues to see, do you ha, is this tissue cancerous?

So forth. So that's a medical diagnosis or excuse me, that's a psych, yeah, that's a medical diagnosis. So a psychological diagnosis is made in a different way in a psychological diagnosis, people have been labeled with a condition from the dsm, the Diagnostic and Statistical Manual of Mental Disorders. So, And the currently accepted diagnoses are listed in there, and they, they talk about features, they talk about patterns of thoughts, typical course, familial patterns.

It gives lots of information about each label, age limits, and so forth. So psychological diagnoses are made on the basis of the symptoms of a person. The symptoms of a person in feelings, thoughts, behaviors, not the reason for the symptoms. That point is actually acknowledged In the DSM itself, it says A psychiatric diagnosis does not carry any necessary implications regarding the cause of an individual's mental disorder or its associated impairments nor treatment.

It doesn't talk about treatment either, so the point of that is that psychological diagnosis are basis. On a person's thinking, a person's feelings and a person's behavior, that's how they're diagnosed, not on a known pathology. Now, many people who had come to biblical counseling as, as Dan mentioned earlier, and that asked me about.

Many of them who come to me in counseling have already been put on psychotropic drugs. They already have a psychological diagnosis. Um, they could be given this diagnosis from another doctor, from a counselor from the internet. Do you know that you can type in your symptoms and come up with a possible label on the internet?

Uh, so some of them are self-diagnosed and generally people who have a label of, of some kind of psychiatric diagnoses. Are on one or more medications. So let's look at what a diagnosis actually says. I'm just gonna run with, run through with you the diagnostic criteria for adhd, and I'm gonna summarize it.

It's kind of long, but I'll just give the high points here. First of all, you have to have a person with inattention. So often fails to give close attention to detail. Trouble holding attention on tasks. Does not seem to listen. Does not follow through on instructions. Often has trouble organizing tasks and activities.

Often avoids dislikes or is reluctant to do tasks that require mental effort over a long period of time, often loses things necessary for tasks, easily distracted, often forgetful. And then there's hyperactivity also kind of symptoms. Fidgets with hands taps. The hands and feet squirms in the seat leaves the seat in situations when remaining seat is as expected.

Often runs about or climbs on things, unable to play or take part in things quietly on the go. Talks excessively blurts out an answer before the question is done. Often has trouble waiting. His or her turn often interrupts and intrudes on others. Now what does that sound like? A lot of people say that sounds like a boy.

I've heard that a few times. It sounds like a child. It really does, but the main point that I have given you those symptoms is because the point is they're descriptive. They're describing something. They're not diagnostic, and they're not prescriptive. They're not telling you why it's happening, and they're not telling you what to do about it.

It's. Descriptive, it describes things. So we've got these descriptions in the DSM with all the lists of behaviors and things, and then they make theories up to account for the behavior. There's lots of different theories out there. There's social theories and, and uh, there's biological theories. The one that we're gonna talk about today is called the medical model.

The medical model of psychiatric problems presumes a biological cause for disordered emotions, thoughts, and behavior. And with that assumption, there must be a biological treatment i e drugs prescribed by a specialist. So thoughts and behaviors and emotions are thought to be due to brain physiology or genetic inheritance, or perhaps a combination of the two.

There's no inner person. Do you notice this? There's no inner person to bother with. Here we're just a physical body, so brain chemicals are thought to determine our choices and our feelings. If we're feeling badly, we're given a disease label. Our mood problems are seen as due to brain malfunction. In this way, we are subject to our emotions and thoughts and not responsible for them.

They happen to us physically or chemically or genetically, we're a victim of them rather than an active player. So belief in this theory promotes research to seek a chemical fix so that that's the only way to deal with these emotions that are just uh, uh, not normal. So this has led to a generation of people who believe that the only answer to troubling motions.

And behavior is found in medicine Now. Having said all that, just as we spoke about this morning, there are some physical causes. For disruptive behavior. There are organic causes of altered behavior. Certain disease states and medications we talked about can have behavioral effects such as fatigue and sleeping and insomnia and racing mind and jitters, all of that.

You can have anemia, you can have hyperthyroid, diabetes, electrolyte imbalances. You can have infections. You can have brain disease, actually brain tumors or injury, Parkinson's, dementia, multiple sclerosis, epilepsy. Um, also some medications, and we talked about that. But whenever something is actually physically wrong with the body, it is not given a psychiatric label.

It's given a medical diagnosis. So if I'm acting fatigued and the lab work shows, I have a low thyroid, I'm not called depressed, I'm called hypothyroid, and they treat it with th uh, thyroid hormones. And again, the point I wanna make is even if there is an organic disease associated with any of our behavior, that disease cannot cause sin.

It doesn't cause sin in our thoughts, in our feelings, in our behavior. It may tempt us towards sin, but it doesn't cause the sin. It may expose our sin, but it's not the cause. Okay, I wanna talk about the chemical imbalance theory. And by the way, I don't want to minimize. How severe and profound that mental disorders can affect people.

It can destroy their lives. It can destroy the lives of the families taking care of them. So these can be profoundly destructive and people suffer tremendously. Um, chemical imbalance theory is the theory that abnormal neurotransmitters. Are the cause of emotional or mental disorders. Now we're not talking about electrolytes.

Electrolytes are salts in our bodies. That can be measured such as sodium, potassium, calciums, et cetera, and low, uh, abnormal levels of electrolytes can cause, uh, problems and changes in our behavior. Those can be measured and those can be corrected. We're not talking about hormone imbalance. Hormones can be measured in our bloodstream.

They are substances secreted by the glands in our bodies, such as pituitary gland, adrenal gland. When we have abnormal AL levels, they are a medical illness and that can be identified as an as a specific pathology. But the chemical imbalance theory is that the neurotransmitters. Are problematic now, neuro is nerve and obviously we want to transmit a signal from one nerve to another.

So how does a nerve talk? It is somewhat electrical down its axon or length of, uh, Body, and then it forms a junction or a synapse with another nerve, and it talks to that other nerve, and it sends a signal, and it does this by a chemical means a neurotransmitter, and there are probably 200 different neurotransmitters, serotonin, dopamine, and nore.

Norepinephrine are a few of them, but it is the theory that an abnormal level is the cause of the problem. Now it's kind of like I. Boats like say hundreds of years ago, how did you send a signal to the town across the river from you? You didn't have cell phones, so you maybe somebody would get in a rowboat and they would go to the other side and yell out the signals the British were coming or something.

And if there was a really important signal that had to be sent, the nerve cell might send all kinds of boats across blue boats, red boats, yellow boats. And they're all trying to get this really important message across the other side. Well then they want the boats to come back after they send their signals.

Now what if they blocked the pier and say, okay, all you boats, you have to keep sending your signals. We're not gonna take you back up. We're not gonna re-uptake your, but you keep staying out there. Well, there's gonna be a lot of complications cuz the boats are gonna run into one another. So the earlier drugs were non-selective.

They kept, they blocked the neurotransmitters from being taken back up from the sending cell. So there's a lot of complications. So the pharmacological industry pharmacy tried to, uh, address that and they say, we need fewer side effects of our psychotropic drugs. So they say, let's just be selective on a few of the boats.

Let's just block the yellow boats. So all the other boats that were out there, they're gonna come back in. We're gonna re-uptake them. But we're gonna be selective on a particular kind. So the pharmaceutical companies, they made these selective in re-uptake inhibitors. In other words, they were selective against serotonin, for example.

So they formed a class of drugs called the selective serotonin re-uptake inhibitors. That's a mouthful. But as I explained it, they just were selective against the yellow boats coming back in. So only the yellow boats, there's plenty of space for them. So there's fewer side effects. That's kind of in a nutshell now what we are getting now, you could be selective against norepinephrine reuptake.

You can be selective against do dopamine, and uh, a whole classes of drugs then came about because of this pharmaceutical gymnastics that came about. But anyway, I'm gonna show a video here that talks about the drugs. Now this is a pharmaceutically made video, and you can tell that they kind of hedge a little bit.

They say it may cause this. It may cause that. The problem is we cannot measure neurotransmitters at the synapse. We cannot measure them at the synapse. Now, serotonin can be measured perhaps in other ways in platelets, maybe in the csf, uh, maybe in the urine, but we don't know how that correlates to true, uh, emotional disorders at the synapse because we cannot measure them.

The human brain has about 10 billion brain cells. Each brain cell can have as many as 25,000 connections with other cells. Messages, which direct many functions throughout your body, travel through your brain from cell to cell. Through these connections, for these signals to move from a sending cell to a receiving cell, they must cross a small gap called the synapse chemicals called neurotransmitters, located at the ends of the sending cells.

Help the signal cross this gap. Serotonin is one such neurotransmitter, a very important one that helps regulate mood, emotions, and other body functions. After the serotonin has done its job, it's reabsorbed by the sending cell and is soon back in position to help with the next nerve signal. If you have depression, you may have a serotonin imbalance.

Your overall level of serotonin may be low, and some of it may be reabsorbed too soon. As a result, communication between the brain cells is impaired and SS R I or selective serotonin reuptake inhibitor is a medication designed to help increase the amount of serotonin in the synapse by blocking its reabsorption.

As serotonin builds up, normal communication between cells can resume and your symptoms of depression may improve. So you notice they have a lot of hedging words there, but the pharmaceutical industry put out a lot of these sort of direct to patient advertising and they made sense to people. Say, I have low serotonin.

Uh, but is that really the case? And we want to address that a little bit. Of course, the pharmaceutical companies could make a lot of money on this, and, and it was many different companies were involved and, uh, they made all different sorts of psychotropic drugs and it's difficult to classify them. But we'll just call, we'll have these six categories that we'll deal with today.

Uh, T c A, the tricyclic antidepressants, the mono immune antidepressants. Excuse me. The monoamine oxidase inhibitors, the SSRIs, the SNRIs, and the S DRIs selected dopamine up, uh, which are considered atypical. And then miscellaneous. So first of all, this tca and you can, if you remember organic chemistry, if any of you have taken that there are three carbon rings up there and hence the name tricyclic or a three ring as its base formula.

And these are very old from the 1950s Amitriptyline, uh, used to be called ville. That was, its generic, or excuse me, trade name. And now generically it's called Amitriptyline, uh, Pamela and some of those others, and they are used for a wide variety of. Of, uh, uh, emotional problems, but there are tremendous amount of side effects.

Remember, that's, they're not selective. So all those boats that are out in the river, were out there sending their signals at the same time, and there was, it was chaos at the nerve cell level. And the same thing with Maos monoamine oxidase inhibitors. They're an older class of drugs from the fifties. Um, an amine comes from the word ammonia, and that's a nitrogen with two hydrogens attached to a six carbon ring.

Uh, so that is an amine, and serotonin is an amine, but, so if you have that one amine monoamine, uh, normally it's digested by an oxidase, but if you wanna stop that digestion oxidase inhibitor, then you have more of the amine. Uh, remaining. So that's what the class of drug M AO stands for is monoamine oxidase inhibitor.

So it leaves more serotonin, re re, uh, behind. There is gonna be a quiz after this. That's right. All right. But again, these first two classes of drugs, many side effects because they are non-selective. So out of that came the, uh, pharmaceutical effort to do selective re-uptake inhibitors. And here are the most common ones that are today.

We see. The SSRIs, exa Lexapro. Paxil, Prozac is probably the, the biggest and one to me, the biggest splash. Zoloft Luvox, they're all SSRIs. There are some complications. They were very costly at first when, when they're, uh, under a patent. The SNRIs are different class. They're selectively, uh, norepinephrine uptake inhibitors, Cymbalta, Effexor, Alteram, Pristiq.

As dri selective against dopamine. Wellbutrin used for smoking cessation, uh, Ritalin even is in that category. Now, these categories, they are selective only to a variable degree, and the exact mechanism, how that translates into the synapse is still unknown. So when you, uh, look at the drugs, Uh, and they have this little long white, uh, piece of paper that, uh, tells about, you know, all the complications and what is their mechanism of action.

They always say it, the mechanism of action is unknown, but it might do this. And so that, that's, they're being honest in that regard. Uh, the miscellaneous category of psychotropic drugs could include mood stabilizers like lithium, which is commonly used for bipolar tegratal de Depakote. Adderall, uh, even.

And, uh, Dexedrine, uh, busbar, the anti-anxiety, the middle column there is, uh, Valium. We all know the benzodiazepines for anxiety. Valium, Librium, Xanax, transgene, erox, uh, Abilify Antipsychotic Drugs, uh, Haldol and Thorazine. We've heard of those. They are around for a long time, from the forties and fifties, and they are still being used, uh, newer versions of the.

Uh, antipsychotic drugs would be, uh, listed there. Psychosis, let me just define that, is it's really a thinking that is out of touch with reality. Uh, schizophrenia has altered thinking and altered perceptions, hence hallucinations, and they have, uh, behavior or actions that are not appropriate. And so that would be a psychosis and that can be, uh, very debilitating.

Okay, let's go back to the SSRS for RIS for just a second. Let's look at this list up here. This is not in your notes, so you have to look up on this on the screen. These are the potential side effects of SSRIs. Now remember that category of drugs is designed to have fewer side effects, right, than the meos.

Uh, look at the on the left column. I'm not gonna read 'em all. Uh, GI bone fractures, uh, depression. Oh, wait a minute. Depression, that's a potential side effect of an antidepressant. Isn't that interesting? So what if somebody that a physician started on an antidepressant, came back a month or two later and said, I feel I'm worse.

The physician will say, well, I think you need to double your dose. Right? Or is it a side effect? Yeah, of the antidepressant. So that's a conundrum and there's really no easy way for the physician to determine that. Uh, perhaps they'll say, well, I think I'm gonna add another drug, another category. So I'm gonna give you this and I'm gonna add a second one now.

Well now you're on two drugs. And, uh, so it's difficult for the physician to know what the right thing to do is weight gain of, uh, Uh, of course on the bottom right it would be sexual dysfunction and the loss of libido is a common, uh, potential side effect for SSRIs. But you can see that there are many, uh, potential problems, uh, that would take in these medications.

And what about the cost? Uh, you just talked to a, a person that I was counseling last week. And he is diagnosed with bipolar one and I would say yes, he has fit that criteria. He has had a manic episode to the point of psychosis that required him to be hospitalized for, uh, 10 days, and that would be one of the hallmark descriptors of bipolar one.

Well, he's been on Lithium and Depakote and other ones that he was spending a thousand dollars a month on his medications. Um, He quit on his own. Uh, but I did not tell him to do that. But, um, uh, so the cost of these medications are significant. What about the spectrum of usage? Is there a set? Perfect. Uh, you know, the psychiatrist, they got it down.

They know exactly how much to do and what dose. The answer is no. Uh, some psychiatrists or psychologists, actually, psychologists cannot prescribe medications, at least not in the state of Montana. Most states, a psychiatrist is an, is a medical doctor or a do that has prescriptive rights. A psychologist is typically a PhD, uh, that does not have prescriptive rights.

But anyway, as far as prescribing some, uh, some psychiatrist will always use x. Uh, a psychotropic drug and on the far end of the other spectrum would be they never use it. Well, that most commonly it's some, or in the middle where a psychiatrist, they'll say, well, I'll usually use it, or I'll sometimes use it.

But then the duration, the, do they believe that you need this medication for a lifetime or is it a temporary utilization of the psychotropic drugs? Some that believe this is a biological problem. It is. I always prescribe it and you need it for a lifetime. That's actually a minority of psychiatrists would do, would, but there are a few, but some would say never.

So anyway, the point is that there's not a consensus exactly of how to use these medications. Now the question is, do they work? Do they work? Journal of American Medical Association, January, 2010. The true drug effects were non-existent to negligible amongst depressed patients with mild, moderate, uh, and even some severe baseline symptoms.

So even the medical literature is, is starting to question it. Here's an article from 2002. Journal of American Medical Association. Uh, does it eliminate depression? And they con, they compared an ssri, Zoloft, which cured, that's an unusual parameter, but they considered cured depression, 25%. St. John's Ward, which is a natural herbal supplement, cured at 24% of the time.

But then look at placebo. Placebo. In other words, people given a false drug, a sugar pill, they actually had a higher rate of so-called cure. So does it really work? Uh, Irving Kirsch, PhD from Harvard, uh, psychologist said, uh, the biochemical theory of depression is in a state of crisis. The data just do not fit the theory.

And Irving Kirsch specialized in studying the placebo effect and in particular placebo effect of drugs. And he found it to be extremely high, as high as 75% of the effect of the drug was placebo. Uh, Tom Insole, uh, uh, Jim talked about Tom Insole a medical doctor at the National Institute of Mental Health as chief psychiatrist, if you will, of the United States.

The theory that is foundational for our current view of the cause of, and treatment for depression has never been established as fact. There's no biochemical imbalance that we've been able to demonstrate. N I M H is moving from investigating into medications. Towards research in other therapies. CBT is what was listed in this quote.

So even the psychiatrists in certain groups do not think that it is, that the antipsych, that the psychotropic drugs are all that helpful. In truth, the chemical imbalance notion was always a kind of an urban legend. Never a theory seriously propounded by a well-informed psychiatrist. Well, that's interesting because we that we are still hearing that today about the chemical imbalance theory.

Uh, what about, uh, psychosis in the long term? Many diagnoses with psychosis may do better without anti-psychotic drugs. Sometimes they do well with anti-psychotic drug, but sometimes they do better without them, and you're better off probably with low dose or cessation of the drug. They had a higher recovery than those with a regular dose of the antipsychotic, uh, use of medications.

So we're going to show a video by Dr. Kelly Brogan, who is a psychiatrist. She's not a Christian, but she's gonna be talking about, uh, depression is not a serotonin deficiency. Uh, she talks about the placebo effect and she talks about drugs may actually cause a change in our nervous system even when the drug is stopped.

That's an interesting concept that's been rarely teased out in the literature, uh, medical literature. In other words, we stop these drugs, is our brain, does it recover or go back towards normal? Um, and there is a better way to identify the, uh, root cause. So we'll listen to this video if it plays. So, Hi, I'm Dr.

Kelly Brogan, and I'd like to spend a few minutes speaking to you about my perspectives on psychiatric medications, which I began to investigate based on my perceptions of the severe limitations of this treatment model. So I'll tore you through four tenets that I appreciate in my daily practice. So the first is that depression is not a serotonin deficiency, and it surprises me to learn how much of the population believes that serotonin deficiency causes depression.

And this notion first came into existence through observations of medication, side effects in tuberculosis patients, but in six decades, Since we have yet to confirm in human studies the role of the monoamines, serotonin, dopamine, and norepinephrine, or the 100 other neurochemicals in depression, and this has LED leaders in the field to begin to admit that we need to abandon the monoamine hypothesis, which makes sense.

Because high levels of serotonin and low metabolite have been associated with very undesirable outcomes, such as suicide and bulimia. So you might wonder, well, how is it that antidepressants work so well? And that brings me to the second tenet, which is that the active placebo effect is responsible for antidepressant benefit.

And this is an idea that was pioneered through the research of Dr. Irving Kirsch, which demonstrated that up to. 73% of the perceived benefit of antidepressants is attributed to the active placebo effect, and the passage of time and the active placebo effect is when in a clinical trial, a patient becomes aware that they are not receiving placebo, that they are receiving the treatment, and they become aware of that through the side effects.

That they're experiencing. And when he uncovered unpublished data, more than half of which was negative in nature and included that this even this benefit disappeared. And even in the most severe depression, one point on a 52 point scale was all that distinguished treatment from placebo. And this one point could easily be attributed to side effects rather than the actual me.

Mechanism of the medication. So you can see how we have a scientific vacuum here and in psychiatry there are no objective tests. To diagnose. We use a manual that's a, a, you know, list of descriptors. And we have created an opportunity for pharmaceutical companies to infect a vulnerable host. And what I mean by that is that we have patients who are suffering, they're looking for answers, and they're looking for a cure.

And they are led to believe by direct to consumer advertising that all of these things are known and available. So what are the problems with this? With the placebo effect. Well, that leads me to the third te, which is that these medications cause significant and lasting perturbations to the nervous system.

And this happens because when you're chronically exposed to a pharmaceutical product, your body makes adaptations to accommodate that. It creates a new normal state rather than actually resolving a pathology And. When you discontinue a medication, the adaptation back to previous baseline can be very difficult, and this has been termed relapse and data suggests that those who are treated with medications relative to those who are not, are much, much more likely to relapse.

And in fact, moreover, they're more likely to experience decline in functioning and a compromised quality of life long term. And there has never been a study that has demonstrated that medication treatment, long-term provides better outcomes. So this brings me to my fourth and final te, which is that there is a better way.

Through personalized diagnostics and lifestyle medicine, you can identify the actual root cause of a depression. So Dr. Brogan was, uh, going on to another theory about, uh, what's the actual root cause but biblical counselors would want to go after what's the actual root cause of our depression? We remember we talked about heart issues and, uh, Pam talked about Sue and that you, she didn't seem to have normal sadness.

She seemed to have disorder sadness cuz there was no identifiable circumstances. But as Pam teased it out, there were heart issues there involved. There was a cause to Sue's depression, and that's where the biblical counseling can come into play. And what is the problem with, so what if the placebo, it's affect, you know, as long as they get better.

I don't care if it's placebo. What's wrong with that thinking?

Yeah, I see a few people, Dr. Brogan talked about perhaps long-term effects on our nervous system, but also we're exposing them to cost. So, $500 a month, a thousand dollars a month that the, if their health plan does not cover that, that's a huge effect on their family. Uh, what about the side effects? But most importantly, either they're, they have a false hope, their hope is in the drug rug.

They don't have a realization that there's a heart issue that needs to be addressed and can be addressed, and then that they can have true hope. So do antidepressants work from a biblical perspective, Dan talked about the secular perspective of whether they work or not. Let's talk about a biblical perspective.

And I think that in order to begin answering this question, we have to be sure that we're defining things carefully. So what do you mean by the word work? Do they work? What do you mean by work? What's the goal of our life? Honor God, right? Glorify God, become like Christ, grow in Christ likeness. So the question is then if they work biblically, has this person developed a closer walk with Christ through the suppression of their difficult emotions?

Chemically, are they growing in progressive sanctification and showing more of the fruit of the spirit? Galatians 5 22. Are they dealing with their heart issues or are they just suppressing the outward manifestation of those heart issues? John 1717 says, we are sanctified by the truth of the word, so we would ask, do psychotropic medications work?

In the way that God desires people to change in the heart by progressive sanctification, by remembering the gospel, by identifying sin, confessing, repenting, put off, put on, renew your mind. Persevere in gle teaching reproof correction, training, and righteousness by the word of God. I like to, uh, use the tack analogy when it comes to, um, Antidepressant medications.

If you sit on attack, it hurts. That's depression. Tylenol may help the symptoms. Ibuprofen may help. Oxycodone may help if you sit on that attack long enough and get cellulitis. Keflex may help with the infection, but what's the real answer?

Yes. Stand up, identify the tack, pull it out, and now other words address the heart issue. Mm-hmm. Mike Emmett's book, there is a very good book, uh, about descriptions and prescriptions that's in the available. He is a medical doctor and he has an excellent address of drugs also. He tends to have a little bit warmer embracing of the drugs than I would have, and I'll explain it in this nuance he uses.

He doesn't use the tack analogy. He uses a crutch analogy. Now listen to the slight difference. He says, if you have an injured ankle, perhaps you want to use crutches for a while. And I would say as an orthopedist, if you have a broken ankle, you must use crutches. Okay for a while. So that analogy is a subtle difference of an identifiable physical injury of a broken ankle.

And temporarily use crutches. Well, perhaps you need crutches for six weeks. You must use it. If you don't use crutches, there will be cru problems. Your ankle will get worse. That's how he uses that analogy to, uh, towards psychotropic drugs and antidepressants in particular. But I would use the, the TAC analogy as a slight nuanced difference.

I dunno if you can see that difference. If attack. Yes, the medications may help, but they're not essential. Crutches might be essential, but when you have TAC the medications are not essential. You must address the tac. So how do we counsel someone who's on psychotropic medications? First of all, you do need to encourage appropriate medical care.

If somebody's coming into you with new symptoms of any kind that are physical symptoms, it's always right to send them to the doctor. They may come back on psychotropic drugs if they find nothing wrong with them physically, but that's okay. We can, we can deal with that in counseling. So do encourage appropriate medical care for any new symptoms.

Uh, we are free to use legitimate medical means, uh, but don't be distracted by the fact that somebody comes in and they are on psychotropic medications. Heart issues are the target. It's important to remember that your primary goal in counseling a person with any really issue is to help them to become more like Christ.

That's our goal. I want to help, you know, Jesus better follow Jesus better become more like him. Two Corinthians five talks about us being ambassadors for Christ, so that we're pleading with people to be reconciled to God. That's our job. So what are some potential heart issues with, uh, people in, with a psychiatric diagnosis?

There's a bunch of them. Fear, worry, unrighteous, anger, unbelief, idols of the heart, unresolved guilt, uh, could be. But since those heart issues that we wanna go after are the target, we want to use biblical terminology instead of the psychological terms. And, and you guys have heard a little bit about this, but we're gonna get a little more specific about it.

We want to substitute biblical terminology for the secular words and categories. So we talked about a medical model, we wanna talk about a biblical model now. And, uh, this, this verse was quoted to you one Corinthians two 13. It's talking about using spiritual words for spiritual things rather than man's words for, for spiritual things.

So one Corinthians two 13. So, addiction becomes enslavement to sin and o d D becomes rebellion against authority and panic attacks become episodes of fear. Now Counselees people that we are trying to help might be hesitant to kind of change their label to what the Bible says about it, because the label does two things.

It takes away responsibility because I'm sick, I have a disease, but it also takes away hope because I can't cure that right? Without some kind of cocktail of medication. So we want to help them. We want to be sympathetic while we're trying to change this. I know some people are very, um, very, uh, loyal to their label.

They really believe it. And so we need to be sympathetic, but we do need to lead them to the truth, patience, sympathy, lead them to the truth. So how are we gonna do this? We have some slides from Garrett Higby, who was a clinical psychologist who kind of saw the light and had a radical change of heart and became a biblical counselor.

He now works up at Harvest, uh, in Chicago. But he, um, shows us from these slides. This is kind of an example of what the DSM descriptors are alike, so they kind of. Categorize behaviors into four different types of disorders. There's disruptive, that's the conduct disorders, oppositional defiant, um, disruptive nos just means not otherwise specified.

So if nothing fits you just put 'em in that category. Sexual disorders, impulsive disorders, ADHD would be under their intermittent explosive disorder, eating disorders. O C D is there. Addictions are there. You have the depressive disorders, which could be major depression. They might call it bipolar dysthymia.

Now dysthymia is kind of like, um, are there any Winnie, the Poo fans in here? Dysthymia is kind of like I, in Winnie the poo. He's just sort of sad but not, you know, not terribly depressed, sort of functioning, but he is just kind of sad all the time. That's dysthymia. And then the anxious disorders, the panic disorders.

PTSD would be there. Generalized anxiety. So that's, that's kind of how the DSM categorizes the different disorders. Now let's take a biblical look at what those things are actually saying. The disruptive disorders actually become anger, rebellion, foolishness. Stiff stiffness. Bitterness. Okay. The impulsive disorders become simple-minded, perverse, faithless, ignorant, divisive.

That's foolishness. The Bible would call the impulsive disorders acting foolishly the despair disorders. The Bible does have a lot of words for our despair, hopelessness, grief, sadness, downcast, soul, the fear. The Bible talks a lot about fear, actually worry, anxiety, double-minded, faint-hearted. So we wanna talk about the issues of the heart that produced or contributed to their struggles, and we yet to use a biblical terminology.

And this morning we talked about Garrett Higby, how he linked these heart topics and he says, uh, like a bipolar one may live in despair, visit foolishness, and, uh, driven by fear of man resulting in anger. So he, he talks about that dynamics of the various heart issues, and that's an interesting way of looking at, uh, our mental disorders.

Sanctification is a process in your notes. You may not have your chart labeled, but the the one that is goes from left to right in a downward manner is man's way. So label that in your notes. And the one that goes in upward is God's way. And as we go from left to right, that is our sanctification, uh, journey.

And we, on the far left would be an atheist would always use 100 percent's man's way. And in heaven, we're gonna be using 100% God's. Uh, wisdom, and that's where we want to get to. The integrationist wants to add the two together, and at first it seems logical. Well, let's do man's wisdom and God's wisdom.

It's A plus B, but I would say to you that we have only a certain amount of energy. Towards problem solving and we can do one or the other or a little bit of both. A plus B does not equal 200%. A plus B is still limited to 100% of the of our efforts. So I would say as Christians, let's use God's wisdom and that would be far superior to, uh, to man's wisdom.

And we talked a little bit about, uh, Chuck Charles Hodge's book, which I really like. Normal. It's a good mood, bad mood that's in available in the back. Normal sadness versus disordered sadness. We talked, uh, about that this morning. 90% of people now that are used in antidepressant drugs could be categorized as normal sadness or bereavement.

Now can there be benefit? To states of despair. We talked a little bit about that earlier. Yes, it, the states of despair or depression can be a tool that God can use to speak to us if we are willing to listen. It can drive us to see God and depend on his grace, and it opened the door for change and repentance.

It can drive us to become more like Christ in our response and it can equip us to help others perhaps, uh, if we go through that journey, we will then be able to, uh, understand others perhaps a bit more. So there, um, So that's something to consider. So we've talked a lot about the general counseling of people with a psychiatric diagnosis, but let's talk specifics here for a moment because if you are gonna get into counseling and you are gonna interact with people, you are gonna be interacting with people who are on medications.

How do we talk to them about their medications? Uh, so first of all, I would say respond carefully to any questions about medications. You need to just be prepared to wisely respond. So what if somebody says, should I start right? I'm having the struggle and I, I just don't know what to do and I've tried everything and I should I just start on medications?

What do you think? Here's exactly what I would say to them. Okay? Feel free to see your doctor who can rule out any physical cause for your problem. The decision whether to take a medication is between you and your doctor, but I believe the Bible has a lot to say about your struggles. Medications aren't gonna solve any heart problems.

And then I would probably use the tac anology. And then if somebody is with you in counseling and they say to you, you know, I'm kind of tired of these medications and the side effects and they're too costly, and all of those things, And I wanna get off of 'em. Well, you wanna know why exactly they want to get off of them if it is just side effects, and if it is just cost, but they haven't really understood that the Bible is sufficient for their issue.

Um, that's not quite the time yet. You wanna work a little bit longer with them. So you might say something like, you know, I, I, I appreciate the question. I think let's do a little bit more work and, and we'll get back to it a little bit later. Um, if they say, if you ask them a question, Uh, okay. Let's say you go off your medications and then the feelings return.

What are you gonna do? And if they say something like, well, I saved a bottle, just in case, you know, it's, it goes bad. That's not the answer you want. You want the answer that sounds something like this. You know what? I wanna get off of these things because I understand that the Bible has principles that can help me with all of the struggles that I have.

And I understand that Christ's grace is sufficient for me to handle my life. And I understand that I've been given everything for life and godliness through the true knowledge of Jesus Christ. That's the kind of answer you want before you're gonna discuss with someone, uh, whether they want to stop their medication.

So let's say that that is the case. You've been in counseling for a while, they're learning problem solving, uh, Avenues and they're learning about Christ and they're gaining, uh, confidence in the scripture and confidence in doing things biblically. Um, what do you do if they wanna come off the medication?

You will only discuss it if they are in that place, but if they want to come off, you send them back to the doctor who started them. So you don't ever talk to somebody about coming off their medication. You don't ever say, well, why don't you just try taking a half of it next week, or something like that.

We don't talk about the medications. You send them back to the doctor who started them. This is very important. Underline this. Note it. Take it away from today for sure. This is the thing you need to know. Biblical counselors should never, ever instruct a counselee to come off their medication, ever. That is equivalent to practicing medicine without a license.

And it's illegal, so do not do that in counseling. Your strength is in the word of God. We are there to use the Bible to help them. You are not there to deal with the meds. You're there to help them deal with the life situations that they are taking the medications for. Do not practice medicine by recommending that a person begin taper down or discontinue his use of medications.

And co correlates to that is what, if you have a. Christian House or center, and you had a policy that you can only be here if you don't take drugs or we're gonna restrict you from taking drugs. That can actually be a trouble from a liability point of view, because what if somebody that was under your care committed suicide and then in your.

Uh, uh, charter, it says No drugs. I think that, that you would be in, in significant trouble for that and churches have gotten in trouble for that, where the counselor perhaps, uh, inappropriately steered them away from drugs. Uh, I would say spend our effort lifting up the truths of the God of the Bible, don't spend our effort tearing down psychotropic drugs.

There's, that's just a wasted effort. Spend your effort lifting up God's truth and, and applying it to their lives. And I would also say, you know, Dan asked me at the beginning of this talk, how many people come to you on medications? And I said, about 60%. You're probably wondering at this point, how many get off of them and about half.

About half of the people I counsel decide that their medications are no longer necessary. So that's increasing. Even though that's not our goal, it's not our goal. It's not our goal to get them off meds. That's, to us, that's not important. And another thing to think about, these drugs are not gospel blockers.

You know, on our computers we have blockers to prevent viruses and so forth. People on these medications, they can still hear the gospel. They can still hear God's word in that message still. Now, is there a use for drugs? Yes, there is. Some people do not respond to God's word and they may have to settle for a second option.

Those who are psychotic, who are delusional hallucinations, they have a severely disorganized mind. The use of antipsychotic tru uh, drugs for short term may help to quiet their mind. Does a cure their problem? No. But it might be helpful. What about those with severe anxiety, inappropriate that yes, perhaps a drug can help them for a while.

What if they haven't slept in a week? Or they have tremendously terrible sleep patterns? Yes. Then a short term use of a sleeping pill might be help, help for them. What if their behavior potentially is harmful to others and themselves? Then I, I'm not afraid of them, uh, turning towards the use of medication.

So in summary, I. Is it a sin to take a psychotropic drug? No. I don't believe it is a sin. But could it be sinful? And the answer would be yes. If somebody refuses to address heart issues, refuses to address sin. If it is there and refuses to turn to God and instead their new God is the drug. I think that is sinful.

Our psychotropic drugs necessary to treat a disease? No. Do antidepressant medications have effects? Absolutely. They have effects and they have side effects. Can they sometimes be useful and helpful? Yes. Do psychotropic drugs address heart issues? No, the Bible does. Should we be intimidated of those taking psychotropic drugs or having, uh, labels psychotropic?

And the answer is no, and medications are not gospel blockers. Now in our notes there, we have recommended resources and I just want to close, I know we're just a minute or two over Jim, but I just wanna close. With some, uh, because this is our last time, we'll have a chance to talk to you. And I want to encourage you in your journey towards, uh, uh, biblical counseling and how it can be used in your life and in the lives of others.

And all of us will say, well, I'm not ready. I'm not competent. God can't use me. Well, I have a few, a list of people in the Bible that God has used. He uses a great variety of people to accomplish his will. For example, Noah. Noah was a drunk. Abraham was too old. Isaac was a liar. Jacob was a liar. Leah was ugly.

Joseph was abused. Moses had a stuttering problem. Gideon was afraid. Sampson was a womanizer. Rahab was a prostitute. Jeremy and Timothy were too young. Sarah was too old. David was an adulterer and a murderer. Elijah was suicidal. Isaiah preached naked. Jonah ran from God. Naomi was a widow. John. Or job went bankrupt.

John the Baptist ate bugs. Peter denied Christ three times. The disciples fell asleep at prayer. Martha was worried about everything. Mary Magdalene was a prostitute. The Samaritan woman was divorced many times. Zacchaeus was too small. Paul was too righteous. Timothy had an ulcer and Lazarus was dead, and God could use Lazarus when he was dead.

So God can use all of us in this room. So I just wanna, uh, Give you that message that God's word is sufficient and will take joy in that.










Thank you for having us back. Our topic this afternoon will be about psychotropic drugs, counseling, psychotropic counseling, people on psychotropic drugs. How a, as biblical counselors, how should we think about psychotropic drugs? And let's, uh, we wanna talk a little bit about that. First of all, definition, psyche, we heard already talks about really the soul is the study of the soul.

But in modern vernacular, perhaps we would say it's the study of the mind. Tropism is to form, so it is a mind forming or mind altering drug. Some people call them psychoactive drugs, and uh, it is the area of antidepressants, antipsychotics, anti-anxiety medications and mood stabilizers. This is a hot topic because many people have strong feelings for and against the use of psychotropic drugs.

So how should we address them? Many counselors are taking them already. Pam, do you have Yeah, we probably, uh, most of the people that I see, maybe 60% of the ladies that I counsel are already on them by the time they come to see me. So we want to be sensitive. We wanna approach this topic with compassion and humility.

And there are four, uh, passages of scripture that are labeled in your notes there, listed in your notes. Um, two Timothy 2 24. The Lord's servants must not be quarrelsome, but must be kind, able to teach patient gentle, and then those who are opposing him. God may grant them repentance and lead them to the knowledge of truth.

It's not necessarily, it's not our job. God does it, but God can use us. Another, uh, scripture, Matthew 10 16. We need to be wise, but gentle wise as serpents and gentle as doves. Acts 17. We want to be noble bes. We want to study the scripture first. Ians 5 21. We want to examine everything carefully and hold onto that, which is good.

And these scriptures are pertinent to this topic this morning. We already talked a little bit about medical versus psychological diagnosis. Uh, diagnosis. By the way, that word, uh, dia is like diagrams a straight line, and Osis is knowledge. So we want straight knowledge about a topic. Uh, in contrast, prognosis is knowledge about something.

Projected in the future. So future knowledge about a disease. So that's prognosis, but what about a diagnosis? Uh, how is it made medically versus psychologically? Medically? We talked already this morning about a disease or an illness, has an identifiable pathology that can be measured. Uh, you can, uh, get a blood test such as a SED rate or a C R P for inflammation.

You can do a, a cbc, a complete blood count to look for anemia. You can get, there are some specific lab tests such as ANA or, uh, that might look for a specific, uh, disease and, uh, Rheumatoid factors can be done. And uh, so blood tests can be used to measure and to make a diagnosis medically. And of course X-rays.

And we talked about bone scans, CAT scans, MRIs, and this morning we talked quite a bit about the functional MRIs and P E T scans. And there will be many other variations on neurodiagnostic studies that, you know, they might look at altered blood flow, they might label a particular glucose or other molecule and then inject it into a person and then, Uh, scan it and see where does the brain change with various activities and to various stimulations.

And remember that important study we, we talked about this morning about, uh, O C D and they have, uh, altered pa uh, functional MRI scans, but then when they counseled them over a period of time, the brain changed back towards normal without any particular drugs. So just because, uh, neuro radiographic study shows an altered.

Pattern or, or even signature, they might call it. Just because that is present, it doesn't mean that that's the cause. Perhaps it's the result of the behavior. And this is gonna be hitting us in the decades to come. And of course, biopsies can be used to, uh, look at tissues to see, do you ha, is this tissue cancerous?

So forth. So that's a medical diagnosis or excuse me, that's a psych, yeah, that's a medical diagnosis. So a psychological diagnosis is made in a different way in a psychological diagnosis, people have been labeled with a condition from the dsm, the Diagnostic and Statistical Manual of Mental Disorders. So, And the currently accepted diagnoses are listed in there, and they, they talk about features, they talk about patterns of thoughts, typical course, familial patterns.

It gives lots of information about each label, age limits, and so forth. So psychological diagnoses are made on the basis of the symptoms of a person. The symptoms of a person in feelings, thoughts, behaviors, not the reason for the symptoms. That point is actually acknowledged In the DSM itself, it says A psychiatric diagnosis does not carry any necessary implications regarding the cause of an individual's mental disorder or its associated impairments nor treatment.

It doesn't talk about treatment either, so the point of that is that psychological diagnosis are basis. On a person's thinking, a person's feelings and a person's behavior, that's how they're diagnosed, not on a known pathology. Now, many people who had come to biblical counseling as, as Dan mentioned earlier, and that asked me about.

Many of them who come to me in counseling have already been put on psychotropic drugs. They already have a psychological diagnosis. Um, they could be given this diagnosis from another doctor, from a counselor from the internet. Do you know that you can type in your symptoms and come up with a possible label on the internet?

Uh, so some of them are self-diagnosed and generally people who have a label of, of some kind of psychiatric diagnoses. Are on one or more medications. So let's look at what a diagnosis actually says. I'm just gonna run with, run through with you the diagnostic criteria for adhd, and I'm gonna summarize it.

It's kind of long, but I'll just give the high points here. First of all, you have to have a person with inattention. So often fails to give close attention to detail. Trouble holding attention on tasks. Does not seem to listen. Does not follow through on instructions. Often has trouble organizing tasks and activities.

Often avoids dislikes or is reluctant to do tasks that require mental effort over a long period of time, often loses things necessary for tasks, easily distracted, often forgetful. And then there's hyperactivity also kind of symptoms. Fidgets with hands taps. The hands and feet squirms in the seat leaves the seat in situations when remaining seat is as expected.

Often runs about or climbs on things, unable to play or take part in things quietly on the go. Talks excessively blurts out an answer before the question is done. Often has trouble waiting. His or her turn often interrupts and intrudes on others. Now what does that sound like? A lot of people say that sounds like a boy.

I've heard that a few times. It sounds like a child. It really does, but the main point that I have given you those symptoms is because the point is they're descriptive. They're describing something. They're not diagnostic, and they're not prescriptive. They're not telling you why it's happening, and they're not telling you what to do about it.

It's. Descriptive, it describes things. So we've got these descriptions in the DSM with all the lists of behaviors and things, and then they make theories up to account for the behavior. There's lots of different theories out there. There's social theories and, and uh, there's biological theories. The one that we're gonna talk about today is called the medical model.

The medical model of psychiatric problems presumes a biological cause for disordered emotions, thoughts, and behavior. And with that assumption, there must be a biological treatment i e drugs prescribed by a specialist. So thoughts and behaviors and emotions are thought to be due to brain physiology or genetic inheritance, or perhaps a combination of the two.

There's no inner person. Do you notice this? There's no inner person to bother with. Here we're just a physical body, so brain chemicals are thought to determine our choices and our feelings. If we're feeling badly, we're given a disease label. Our mood problems are seen as due to brain malfunction. In this way, we are subject to our emotions and thoughts and not responsible for them.

They happen to us physically or chemically or genetically, we're a victim of them rather than an active player. So belief in this theory promotes research to seek a chemical fix so that that's the only way to deal with these emotions that are just uh, uh, not normal. So this has led to a generation of people who believe that the only answer to troubling motions.

And behavior is found in medicine Now. Having said all that, just as we spoke about this morning, there are some physical causes. For disruptive behavior. There are organic causes of altered behavior. Certain disease states and medications we talked about can have behavioral effects such as fatigue and sleeping and insomnia and racing mind and jitters, all of that.

You can have anemia, you can have hyperthyroid, diabetes, electrolyte imbalances. You can have infections. You can have brain disease, actually brain tumors or injury, Parkinson's, dementia, multiple sclerosis, epilepsy. Um, also some medications, and we talked about that. But whenever something is actually physically wrong with the body, it is not given a psychiatric label.

It's given a medical diagnosis. So if I'm acting fatigued and the lab work shows, I have a low thyroid, I'm not called depressed, I'm called hypothyroid, and they treat it with th uh, thyroid hormones. And again, the point I wanna make is even if there is an organic disease associated with any of our behavior, that disease cannot cause sin.

It doesn't cause sin in our thoughts, in our feelings, in our behavior. It may tempt us towards sin, but it doesn't cause the sin. It may expose our sin, but it's not the cause. Okay, I wanna talk about the chemical imbalance theory. And by the way, I don't want to minimize. How severe and profound that mental disorders can affect people.

It can destroy their lives. It can destroy the lives of the families taking care of them. So these can be profoundly destructive and people suffer tremendously. Um, chemical imbalance theory is the theory that abnormal neurotransmitters. Are the cause of emotional or mental disorders. Now we're not talking about electrolytes.

Electrolytes are salts in our bodies. That can be measured such as sodium, potassium, calciums, et cetera, and low, uh, abnormal levels of electrolytes can cause, uh, problems and changes in our behavior. Those can be measured and those can be corrected. We're not talking about hormone imbalance. Hormones can be measured in our bloodstream.

They are substances secreted by the glands in our bodies, such as pituitary gland, adrenal gland. When we have abnormal AL levels, they are a medical illness and that can be identified as an as a specific pathology. But the chemical imbalance theory is that the neurotransmitters. Are problematic now, neuro is nerve and obviously we want to transmit a signal from one nerve to another.

So how does a nerve talk? It is somewhat electrical down its axon or length of, uh, Body, and then it forms a junction or a synapse with another nerve, and it talks to that other nerve, and it sends a signal, and it does this by a chemical means a neurotransmitter, and there are probably 200 different neurotransmitters, serotonin, dopamine, and nore.

Norepinephrine are a few of them, but it is the theory that an abnormal level is the cause of the problem. Now it's kind of like I. Boats like say hundreds of years ago, how did you send a signal to the town across the river from you? You didn't have cell phones, so you maybe somebody would get in a rowboat and they would go to the other side and yell out the signals the British were coming or something.

And if there was a really important signal that had to be sent, the nerve cell might send all kinds of boats across blue boats, red boats, yellow boats. And they're all trying to get this really important message across the other side. Well then they want the boats to come back after they send their signals.

Now what if they blocked the pier and say, okay, all you boats, you have to keep sending your signals. We're not gonna take you back up. We're not gonna re-uptake your, but you keep staying out there. Well, there's gonna be a lot of complications cuz the boats are gonna run into one another. So the earlier drugs were non-selective.

They kept, they blocked the neurotransmitters from being taken back up from the sending cell. So there's a lot of complications. So the pharmacological industry pharmacy tried to, uh, address that and they say, we need fewer side effects of our psychotropic drugs. So they say, let's just be selective on a few of the boats.

Let's just block the yellow boats. So all the other boats that were out there, they're gonna come back in. We're gonna re-uptake them. But we're gonna be selective on a particular kind. So the pharmaceutical companies, they made these selective in re-uptake inhibitors. In other words, they were selective against serotonin, for example.

So they formed a class of drugs called the selective serotonin re-uptake inhibitors. That's a mouthful. But as I explained it, they just were selective against the yellow boats coming back in. So only the yellow boats, there's plenty of space for them. So there's fewer side effects. That's kind of in a nutshell now what we are getting now, you could be selective against norepinephrine reuptake.

You can be selective against do dopamine, and uh, a whole classes of drugs then came about because of this pharmaceutical gymnastics that came about. But anyway, I'm gonna show a video here that talks about the drugs. Now this is a pharmaceutically made video, and you can tell that they kind of hedge a little bit.

They say it may cause this. It may cause that. The problem is we cannot measure neurotransmitters at the synapse. We cannot measure them at the synapse. Now, serotonin can be measured perhaps in other ways in platelets, maybe in the csf, uh, maybe in the urine, but we don't know how that correlates to true, uh, emotional disorders at the synapse because we cannot measure them.

The human brain has about 10 billion brain cells. Each brain cell can have as many as 25,000 connections with other cells. Messages, which direct many functions throughout your body, travel through your brain from cell to cell. Through these connections, for these signals to move from a sending cell to a receiving cell, they must cross a small gap called the synapse chemicals called neurotransmitters, located at the ends of the sending cells.

Help the signal cross this gap. Serotonin is one such neurotransmitter, a very important one that helps regulate mood, emotions, and other body functions. After the serotonin has done its job, it's reabsorbed by the sending cell and is soon back in position to help with the next nerve signal. If you have depression, you may have a serotonin imbalance.

Your overall level of serotonin may be low, and some of it may be reabsorbed too soon. As a result, communication between the brain cells is impaired and SS R I or selective serotonin reuptake inhibitor is a medication designed to help increase the amount of serotonin in the synapse by blocking its reabsorption.

As serotonin builds up, normal communication between cells can resume and your symptoms of depression may improve. So you notice they have a lot of hedging words there, but the pharmaceutical industry put out a lot of these sort of direct to patient advertising and they made sense to people. Say, I have low serotonin.

Uh, but is that really the case? And we want to address that a little bit. Of course, the pharmaceutical companies could make a lot of money on this, and, and it was many different companies were involved and, uh, they made all different sorts of psychotropic drugs and it's difficult to classify them. But we'll just call, we'll have these six categories that we'll deal with today.

Uh, T c A, the tricyclic antidepressants, the mono immune antidepressants. Excuse me. The monoamine oxidase inhibitors, the SSRIs, the SNRIs, and the S DRIs selected dopamine up, uh, which are considered atypical. And then miscellaneous. So first of all, this tca and you can, if you remember organic chemistry, if any of you have taken that there are three carbon rings up there and hence the name tricyclic or a three ring as its base formula.

And these are very old from the 1950s Amitriptyline, uh, used to be called ville. That was, its generic, or excuse me, trade name. And now generically it's called Amitriptyline, uh, Pamela and some of those others, and they are used for a wide variety of. Of, uh, uh, emotional problems, but there are tremendous amount of side effects.

Remember, that's, they're not selective. So all those boats that are out in the river, were out there sending their signals at the same time, and there was, it was chaos at the nerve cell level. And the same thing with Maos monoamine oxidase inhibitors. They're an older class of drugs from the fifties. Um, an amine comes from the word ammonia, and that's a nitrogen with two hydrogens attached to a six carbon ring.

Uh, so that is an amine, and serotonin is an amine, but, so if you have that one amine monoamine, uh, normally it's digested by an oxidase, but if you wanna stop that digestion oxidase inhibitor, then you have more of the amine. Uh, remaining. So that's what the class of drug M AO stands for is monoamine oxidase inhibitor.

So it leaves more serotonin, re re, uh, behind. There is gonna be a quiz after this. That's right. All right. But again, these first two classes of drugs, many side effects because they are non-selective. So out of that came the, uh, pharmaceutical effort to do selective re-uptake inhibitors. And here are the most common ones that are today.

We see. The SSRIs, exa Lexapro. Paxil, Prozac is probably the, the biggest and one to me, the biggest splash. Zoloft Luvox, they're all SSRIs. There are some complications. They were very costly at first when, when they're, uh, under a patent. The SNRIs are different class. They're selectively, uh, norepinephrine uptake inhibitors, Cymbalta, Effexor, Alteram, Pristiq.

As dri selective against dopamine. Wellbutrin used for smoking cessation, uh, Ritalin even is in that category. Now, these categories, they are selective only to a variable degree, and the exact mechanism, how that translates into the synapse is still unknown. So when you, uh, look at the drugs, Uh, and they have this little long white, uh, piece of paper that, uh, tells about, you know, all the complications and what is their mechanism of action.

They always say it, the mechanism of action is unknown, but it might do this. And so that, that's, they're being honest in that regard. Uh, the miscellaneous category of psychotropic drugs could include mood stabilizers like lithium, which is commonly used for bipolar tegratal de Depakote. Adderall, uh, even.

And, uh, Dexedrine, uh, busbar, the anti-anxiety, the middle column there is, uh, Valium. We all know the benzodiazepines for anxiety. Valium, Librium, Xanax, transgene, erox, uh, Abilify Antipsychotic Drugs, uh, Haldol and Thorazine. We've heard of those. They are around for a long time, from the forties and fifties, and they are still being used, uh, newer versions of the.

Uh, antipsychotic drugs would be, uh, listed there. Psychosis, let me just define that, is it's really a thinking that is out of touch with reality. Uh, schizophrenia has altered thinking and altered perceptions, hence hallucinations, and they have, uh, behavior or actions that are not appropriate. And so that would be a psychosis and that can be, uh, very debilitating.

Okay, let's go back to the SSRS for RIS for just a second. Let's look at this list up here. This is not in your notes, so you have to look up on this on the screen. These are the potential side effects of SSRIs. Now remember that category of drugs is designed to have fewer side effects, right, than the meos.

Uh, look at the on the left column. I'm not gonna read 'em all. Uh, GI bone fractures, uh, depression. Oh, wait a minute. Depression, that's a potential side effect of an antidepressant. Isn't that interesting? So what if somebody that a physician started on an antidepressant, came back a month or two later and said, I feel I'm worse.

The physician will say, well, I think you need to double your dose. Right? Or is it a side effect? Yeah, of the antidepressant. So that's a conundrum and there's really no easy way for the physician to determine that. Uh, perhaps they'll say, well, I think I'm gonna add another drug, another category. So I'm gonna give you this and I'm gonna add a second one now.

Well now you're on two drugs. And, uh, so it's difficult for the physician to know what the right thing to do is weight gain of, uh, Uh, of course on the bottom right it would be sexual dysfunction and the loss of libido is a common, uh, potential side effect for SSRIs. But you can see that there are many, uh, potential problems, uh, that would take in these medications.

And what about the cost? Uh, you just talked to a, a person that I was counseling last week. And he is diagnosed with bipolar one and I would say yes, he has fit that criteria. He has had a manic episode to the point of psychosis that required him to be hospitalized for, uh, 10 days, and that would be one of the hallmark descriptors of bipolar one.

Well, he's been on Lithium and Depakote and other ones that he was spending a thousand dollars a month on his medications. Um, He quit on his own. Uh, but I did not tell him to do that. But, um, uh, so the cost of these medications are significant. What about the spectrum of usage? Is there a set? Perfect. Uh, you know, the psychiatrist, they got it down.

They know exactly how much to do and what dose. The answer is no. Uh, some psychiatrists or psychologists, actually, psychologists cannot prescribe medications, at least not in the state of Montana. Most states, a psychiatrist is an, is a medical doctor or a do that has prescriptive rights. A psychologist is typically a PhD, uh, that does not have prescriptive rights.

But anyway, as far as prescribing some, uh, some psychiatrist will always use x. Uh, a psychotropic drug and on the far end of the other spectrum would be they never use it. Well, that most commonly it's some, or in the middle where a psychiatrist, they'll say, well, I'll usually use it, or I'll sometimes use it.

But then the duration, the, do they believe that you need this medication for a lifetime or is it a temporary utilization of the psychotropic drugs? Some that believe this is a biological problem. It is. I always prescribe it and you need it for a lifetime. That's actually a minority of psychiatrists would do, would, but there are a few, but some would say never.

So anyway, the point is that there's not a consensus exactly of how to use these medications. Now the question is, do they work? Do they work? Journal of American Medical Association, January, 2010. The true drug effects were non-existent to negligible amongst depressed patients with mild, moderate, uh, and even some severe baseline symptoms.

So even the medical literature is, is starting to question it. Here's an article from 2002. Journal of American Medical Association. Uh, does it eliminate depression? And they con, they compared an ssri, Zoloft, which cured, that's an unusual parameter, but they considered cured depression, 25%. St. John's Ward, which is a natural herbal supplement, cured at 24% of the time.

But then look at placebo. Placebo. In other words, people given a false drug, a sugar pill, they actually had a higher rate of so-called cure. So does it really work? Uh, Irving Kirsch, PhD from Harvard, uh, psychologist said, uh, the biochemical theory of depression is in a state of crisis. The data just do not fit the theory.

And Irving Kirsch specialized in studying the placebo effect and in particular placebo effect of drugs. And he found it to be extremely high, as high as 75% of the effect of the drug was placebo. Uh, Tom Insole, uh, uh, Jim talked about Tom Insole a medical doctor at the National Institute of Mental Health as chief psychiatrist, if you will, of the United States.

The theory that is foundational for our current view of the cause of, and treatment for depression has never been established as fact. There's no biochemical imbalance that we've been able to demonstrate. N I M H is moving from investigating into medications. Towards research in other therapies. CBT is what was listed in this quote.

So even the psychiatrists in certain groups do not think that it is, that the antipsych, that the psychotropic drugs are all that helpful. In truth, the chemical imbalance notion was always a kind of an urban legend. Never a theory seriously propounded by a well-informed psychiatrist. Well, that's interesting because we that we are still hearing that today about the chemical imbalance theory.

Uh, what about, uh, psychosis in the long term? Many diagnoses with psychosis may do better without anti-psychotic drugs. Sometimes they do well with anti-psychotic drug, but sometimes they do better without them, and you're better off probably with low dose or cessation of the drug. They had a higher recovery than those with a regular dose of the antipsychotic, uh, use of medications.

So we're going to show a video by Dr. Kelly Brogan, who is a psychiatrist. She's not a Christian, but she's gonna be talking about, uh, depression is not a serotonin deficiency. Uh, she talks about the placebo effect and she talks about drugs may actually cause a change in our nervous system even when the drug is stopped.

That's an interesting concept that's been rarely teased out in the literature, uh, medical literature. In other words, we stop these drugs, is our brain, does it recover or go back towards normal? Um, and there is a better way to identify the, uh, root cause. So we'll listen to this video if it plays. So, Hi, I'm Dr.

Kelly Brogan, and I'd like to spend a few minutes speaking to you about my perspectives on psychiatric medications, which I began to investigate based on my perceptions of the severe limitations of this treatment model. So I'll tore you through four tenets that I appreciate in my daily practice. So the first is that depression is not a serotonin deficiency, and it surprises me to learn how much of the population believes that serotonin deficiency causes depression.

And this notion first came into existence through observations of medication, side effects in tuberculosis patients, but in six decades, Since we have yet to confirm in human studies the role of the monoamines, serotonin, dopamine, and norepinephrine, or the 100 other neurochemicals in depression, and this has LED leaders in the field to begin to admit that we need to abandon the monoamine hypothesis, which makes sense.

Because high levels of serotonin and low metabolite have been associated with very undesirable outcomes, such as suicide and bulimia. So you might wonder, well, how is it that antidepressants work so well? And that brings me to the second tenet, which is that the active placebo effect is responsible for antidepressant benefit.

And this is an idea that was pioneered through the research of Dr. Irving Kirsch, which demonstrated that up to. 73% of the perceived benefit of antidepressants is attributed to the active placebo effect, and the passage of time and the active placebo effect is when in a clinical trial, a patient becomes aware that they are not receiving placebo, that they are receiving the treatment, and they become aware of that through the side effects.

That they're experiencing. And when he uncovered unpublished data, more than half of which was negative in nature and included that this even this benefit disappeared. And even in the most severe depression, one point on a 52 point scale was all that distinguished treatment from placebo. And this one point could easily be attributed to side effects rather than the actual me.

Mechanism of the medication. So you can see how we have a scientific vacuum here and in psychiatry there are no objective tests. To diagnose. We use a manual that's a, a, you know, list of descriptors. And we have created an opportunity for pharmaceutical companies to infect a vulnerable host. And what I mean by that is that we have patients who are suffering, they're looking for answers, and they're looking for a cure.

And they are led to believe by direct to consumer advertising that all of these things are known and available. So what are the problems with this? With the placebo effect. Well, that leads me to the third te, which is that these medications cause significant and lasting perturbations to the nervous system.

And this happens because when you're chronically exposed to a pharmaceutical product, your body makes adaptations to accommodate that. It creates a new normal state rather than actually resolving a pathology And. When you discontinue a medication, the adaptation back to previous baseline can be very difficult, and this has been termed relapse and data suggests that those who are treated with medications relative to those who are not, are much, much more likely to relapse.

And in fact, moreover, they're more likely to experience decline in functioning and a compromised quality of life long term. And there has never been a study that has demonstrated that medication treatment, long-term provides better outcomes. So this brings me to my fourth and final te, which is that there is a better way.

Through personalized diagnostics and lifestyle medicine, you can identify the actual root cause of a depression. So Dr. Brogan was, uh, going on to another theory about, uh, what's the actual root cause but biblical counselors would want to go after what's the actual root cause of our depression? We remember we talked about heart issues and, uh, Pam talked about Sue and that you, she didn't seem to have normal sadness.

She seemed to have disorder sadness cuz there was no identifiable circumstances. But as Pam teased it out, there were heart issues there involved. There was a cause to Sue's depression, and that's where the biblical counseling can come into play. And what is the problem with, so what if the placebo, it's affect, you know, as long as they get better.

I don't care if it's placebo. What's wrong with that thinking?

Yeah, I see a few people, Dr. Brogan talked about perhaps long-term effects on our nervous system, but also we're exposing them to cost. So, $500 a month, a thousand dollars a month that the, if their health plan does not cover that, that's a huge effect on their family. Uh, what about the side effects? But most importantly, either they're, they have a false hope, their hope is in the drug rug.

They don't have a realization that there's a heart issue that needs to be addressed and can be addressed, and then that they can have true hope. So do antidepressants work from a biblical perspective, Dan talked about the secular perspective of whether they work or not. Let's talk about a biblical perspective.

And I think that in order to begin answering this question, we have to be sure that we're defining things carefully. So what do you mean by the word work? Do they work? What do you mean by work? What's the goal of our life? Honor God, right? Glorify God, become like Christ, grow in Christ likeness. So the question is then if they work biblically, has this person developed a closer walk with Christ through the suppression of their difficult emotions?

Chemically, are they growing in progressive sanctification and showing more of the fruit of the spirit? Galatians 5 22. Are they dealing with their heart issues or are they just suppressing the outward manifestation of those heart issues? John 1717 says, we are sanctified by the truth of the word, so we would ask, do psychotropic medications work?

In the way that God desires people to change in the heart by progressive sanctification, by remembering the gospel, by identifying sin, confessing, repenting, put off, put on, renew your mind. Persevere in gle teaching reproof correction, training, and righteousness by the word of God. I like to, uh, use the tack analogy when it comes to, um, Antidepressant medications.

If you sit on attack, it hurts. That's depression. Tylenol may help the symptoms. Ibuprofen may help. Oxycodone may help if you sit on that attack long enough and get cellulitis. Keflex may help with the infection, but what's the real answer?

Yes. Stand up, identify the tack, pull it out, and now other words address the heart issue. Mm-hmm. Mike Emmett's book, there is a very good book, uh, about descriptions and prescriptions that's in the available. He is a medical doctor and he has an excellent address of drugs also. He tends to have a little bit warmer embracing of the drugs than I would have, and I'll explain it in this nuance he uses.

He doesn't use the tack analogy. He uses a crutch analogy. Now listen to the slight difference. He says, if you have an injured ankle, perhaps you want to use crutches for a while. And I would say as an orthopedist, if you have a broken ankle, you must use crutches. Okay for a while. So that analogy is a subtle difference of an identifiable physical injury of a broken ankle.

And temporarily use crutches. Well, perhaps you need crutches for six weeks. You must use it. If you don't use crutches, there will be cru problems. Your ankle will get worse. That's how he uses that analogy to, uh, towards psychotropic drugs and antidepressants in particular. But I would use the, the TAC analogy as a slight nuanced difference.

I dunno if you can see that difference. If attack. Yes, the medications may help, but they're not essential. Crutches might be essential, but when you have TAC the medications are not essential. You must address the tac. So how do we counsel someone who's on psychotropic medications? First of all, you do need to encourage appropriate medical care.

If somebody's coming into you with new symptoms of any kind that are physical symptoms, it's always right to send them to the doctor. They may come back on psychotropic drugs if they find nothing wrong with them physically, but that's okay. We can, we can deal with that in counseling. So do encourage appropriate medical care for any new symptoms.

Uh, we are free to use legitimate medical means, uh, but don't be distracted by the fact that somebody comes in and they are on psychotropic medications. Heart issues are the target. It's important to remember that your primary goal in counseling a person with any really issue is to help them to become more like Christ.

That's our goal. I want to help, you know, Jesus better follow Jesus better become more like him. Two Corinthians five talks about us being ambassadors for Christ, so that we're pleading with people to be reconciled to God. That's our job. So what are some potential heart issues with, uh, people in, with a psychiatric diagnosis?

There's a bunch of them. Fear, worry, unrighteous, anger, unbelief, idols of the heart, unresolved guilt, uh, could be. But since those heart issues that we wanna go after are the target, we want to use biblical terminology instead of the psychological terms. And, and you guys have heard a little bit about this, but we're gonna get a little more specific about it.

We want to substitute biblical terminology for the secular words and categories. So we talked about a medical model, we wanna talk about a biblical model now. And, uh, this, this verse was quoted to you one Corinthians two 13. It's talking about using spiritual words for spiritual things rather than man's words for, for spiritual things.

So one Corinthians two 13. So, addiction becomes enslavement to sin and o d D becomes rebellion against authority and panic attacks become episodes of fear. Now Counselees people that we are trying to help might be hesitant to kind of change their label to what the Bible says about it, because the label does two things.

It takes away responsibility because I'm sick, I have a disease, but it also takes away hope because I can't cure that right? Without some kind of cocktail of medication. So we want to help them. We want to be sympathetic while we're trying to change this. I know some people are very, um, very, uh, loyal to their label.

They really believe it. And so we need to be sympathetic, but we do need to lead them to the truth, patience, sympathy, lead them to the truth. So how are we gonna do this? We have some slides from Garrett Higby, who was a clinical psychologist who kind of saw the light and had a radical change of heart and became a biblical counselor.

He now works up at Harvest, uh, in Chicago. But he, um, shows us from these slides. This is kind of an example of what the DSM descriptors are alike, so they kind of. Categorize behaviors into four different types of disorders. There's disruptive, that's the conduct disorders, oppositional defiant, um, disruptive nos just means not otherwise specified.

So if nothing fits you just put 'em in that category. Sexual disorders, impulsive disorders, ADHD would be under their intermittent explosive disorder, eating disorders. O C D is there. Addictions are there. You have the depressive disorders, which could be major depression. They might call it bipolar dysthymia.

Now dysthymia is kind of like, um, are there any Winnie, the Poo fans in here? Dysthymia is kind of like I, in Winnie the poo. He's just sort of sad but not, you know, not terribly depressed, sort of functioning, but he is just kind of sad all the time. That's dysthymia. And then the anxious disorders, the panic disorders.

PTSD would be there. Generalized anxiety. So that's, that's kind of how the DSM categorizes the different disorders. Now let's take a biblical look at what those things are actually saying. The disruptive disorders actually become anger, rebellion, foolishness. Stiff stiffness. Bitterness. Okay. The impulsive disorders become simple-minded, perverse, faithless, ignorant, divisive.

That's foolishness. The Bible would call the impulsive disorders acting foolishly the despair disorders. The Bible does have a lot of words for our despair, hopelessness, grief, sadness, downcast, soul, the fear. The Bible talks a lot about fear, actually worry, anxiety, double-minded, faint-hearted. So we wanna talk about the issues of the heart that produced or contributed to their struggles, and we yet to use a biblical terminology.

And this morning we talked about Garrett Higby, how he linked these heart topics and he says, uh, like a bipolar one may live in despair, visit foolishness, and, uh, driven by fear of man resulting in anger. So he, he talks about that dynamics of the various heart issues, and that's an interesting way of looking at, uh, our mental disorders.

Sanctification is a process in your notes. You may not have your chart labeled, but the the one that is goes from left to right in a downward manner is man's way. So label that in your notes. And the one that goes in upward is God's way. And as we go from left to right, that is our sanctification, uh, journey.

And we, on the far left would be an atheist would always use 100 percent's man's way. And in heaven, we're gonna be using 100% God's. Uh, wisdom, and that's where we want to get to. The integrationist wants to add the two together, and at first it seems logical. Well, let's do man's wisdom and God's wisdom.

It's A plus B, but I would say to you that we have only a certain amount of energy. Towards problem solving and we can do one or the other or a little bit of both. A plus B does not equal 200%. A plus B is still limited to 100% of the of our efforts. So I would say as Christians, let's use God's wisdom and that would be far superior to, uh, to man's wisdom.

And we talked a little bit about, uh, Chuck Charles Hodge's book, which I really like. Normal. It's a good mood, bad mood that's in available in the back. Normal sadness versus disordered sadness. We talked, uh, about that this morning. 90% of people now that are used in antidepressant drugs could be categorized as normal sadness or bereavement.

Now can there be benefit? To states of despair. We talked a little bit about that earlier. Yes, it, the states of despair or depression can be a tool that God can use to speak to us if we are willing to listen. It can drive us to see God and depend on his grace, and it opened the door for change and repentance.

It can drive us to become more like Christ in our response and it can equip us to help others perhaps, uh, if we go through that journey, we will then be able to, uh, understand others perhaps a bit more. So there, um, So that's something to consider. So we've talked a lot about the general counseling of people with a psychiatric diagnosis, but let's talk specifics here for a moment because if you are gonna get into counseling and you are gonna interact with people, you are gonna be interacting with people who are on medications.

How do we talk to them about their medications? Uh, so first of all, I would say respond carefully to any questions about medications. You need to just be prepared to wisely respond. So what if somebody says, should I start right? I'm having the struggle and I, I just don't know what to do and I've tried everything and I should I just start on medications?

What do you think? Here's exactly what I would say to them. Okay? Feel free to see your doctor who can rule out any physical cause for your problem. The decision whether to take a medication is between you and your doctor, but I believe the Bible has a lot to say about your struggles. Medications aren't gonna solve any heart problems.

And then I would probably use the tac anology. And then if somebody is with you in counseling and they say to you, you know, I'm kind of tired of these medications and the side effects and they're too costly, and all of those things, And I wanna get off of 'em. Well, you wanna know why exactly they want to get off of them if it is just side effects, and if it is just cost, but they haven't really understood that the Bible is sufficient for their issue.

Um, that's not quite the time yet. You wanna work a little bit longer with them. So you might say something like, you know, I, I, I appreciate the question. I think let's do a little bit more work and, and we'll get back to it a little bit later. Um, if they say, if you ask them a question, Uh, okay. Let's say you go off your medications and then the feelings return.

What are you gonna do? And if they say something like, well, I saved a bottle, just in case, you know, it's, it goes bad. That's not the answer you want. You want the answer that sounds something like this. You know what? I wanna get off of these things because I understand that the Bible has principles that can help me with all of the struggles that I have.

And I understand that Christ's grace is sufficient for me to handle my life. And I understand that I've been given everything for life and godliness through the true knowledge of Jesus Christ. That's the kind of answer you want before you're gonna discuss with someone, uh, whether they want to stop their medication.

So let's say that that is the case. You've been in counseling for a while, they're learning problem solving, uh, Avenues and they're learning about Christ and they're gaining, uh, confidence in the scripture and confidence in doing things biblically. Um, what do you do if they wanna come off the medication?

You will only discuss it if they are in that place, but if they want to come off, you send them back to the doctor who started them. So you don't ever talk to somebody about coming off their medication. You don't ever say, well, why don't you just try taking a half of it next week, or something like that.

We don't talk about the medications. You send them back to the doctor who started them. This is very important. Underline this. Note it. Take it away from today for sure. This is the thing you need to know. Biblical counselors should never, ever instruct a counselee to come off their medication, ever. That is equivalent to practicing medicine without a license.

And it's illegal, so do not do that in counseling. Your strength is in the word of God. We are there to use the Bible to help them. You are not there to deal with the meds. You're there to help them deal with the life situations that they are taking the medications for. Do not practice medicine by recommending that a person begin taper down or discontinue his use of medications.

And co correlates to that is what, if you have a. Christian House or center, and you had a policy that you can only be here if you don't take drugs or we're gonna restrict you from taking drugs. That can actually be a trouble from a liability point of view, because what if somebody that was under your care committed suicide and then in your.

Uh, uh, charter, it says No drugs. I think that, that you would be in, in significant trouble for that and churches have gotten in trouble for that, where the counselor perhaps, uh, inappropriately steered them away from drugs. Uh, I would say spend our effort lifting up the truths of the God of the Bible, don't spend our effort tearing down psychotropic drugs.

There's, that's just a wasted effort. Spend your effort lifting up God's truth and, and applying it to their lives. And I would also say, you know, Dan asked me at the beginning of this talk, how many people come to you on medications? And I said, about 60%. You're probably wondering at this point, how many get off of them and about half.

About half of the people I counsel decide that their medications are no longer necessary. So that's increasing. Even though that's not our goal, it's not our goal. It's not our goal to get them off meds. That's, to us, that's not important. And another thing to think about, these drugs are not gospel blockers.

You know, on our computers we have blockers to prevent viruses and so forth. People on these medications, they can still hear the gospel. They can still hear God's word in that message still. Now, is there a use for drugs? Yes, there is. Some people do not respond to God's word and they may have to settle for a second option.

Those who are psychotic, who are delusional hallucinations, they have a severely disorganized mind. The use of antipsychotic tru uh, drugs for short term may help to quiet their mind. Does a cure their problem? No. But it might be helpful. What about those with severe anxiety, inappropriate that yes, perhaps a drug can help them for a while.

What if they haven't slept in a week? Or they have tremendously terrible sleep patterns? Yes. Then a short term use of a sleeping pill might be help, help for them. What if their behavior potentially is harmful to others and themselves? Then I, I'm not afraid of them, uh, turning towards the use of medication.

So in summary, I. Is it a sin to take a psychotropic drug? No. I don't believe it is a sin. But could it be sinful? And the answer would be yes. If somebody refuses to address heart issues, refuses to address sin. If it is there and refuses to turn to God and instead their new God is the drug. I think that is sinful.

Our psychotropic drugs necessary to treat a disease? No. Do antidepressant medications have effects? Absolutely. They have effects and they have side effects. Can they sometimes be useful and helpful? Yes. Do psychotropic drugs address heart issues? No, the Bible does. Should we be intimidated of those taking psychotropic drugs or having, uh, labels psychotropic?

And the answer is no, and medications are not gospel blockers. Now in our notes there, we have recommended resources and I just want to close, I know we're just a minute or two over Jim, but I just wanna close. With some, uh, because this is our last time, we'll have a chance to talk to you. And I want to encourage you in your journey towards, uh, uh, biblical counseling and how it can be used in your life and in the lives of others.

And all of us will say, well, I'm not ready. I'm not competent. God can't use me. Well, I have a few, a list of people in the Bible that God has used. He uses a great variety of people to accomplish his will. For example, Noah. Noah was a drunk. Abraham was too old. Isaac was a liar. Jacob was a liar. Leah was ugly.

Joseph was abused. Moses had a stuttering problem. Gideon was afraid. Sampson was a womanizer. Rahab was a prostitute. Jeremy and Timothy were too young. Sarah was too old. David was an adulterer and a murderer. Elijah was suicidal. Isaiah preached naked. Jonah ran from God. Naomi was a widow. John. Or job went bankrupt.

John the Baptist ate bugs. Peter denied Christ three times. The disciples fell asleep at prayer. Martha was worried about everything. Mary Magdalene was a prostitute. The Samaritan woman was divorced many times. Zacchaeus was too small. Paul was too righteous. Timothy had an ulcer and Lazarus was dead, and God could use Lazarus when he was dead.

So God can use all of us in this room. So I just wanna, uh, Give you that message that God's word is sufficient and will take joy in that.