Depression Is a Hidden Disability

More than “Feeling Down”: A Clinical Overview of Depression

Like other mental illnesses, clinical depression is a hidden disability. It leeches all light from life but does so without visible scars. It skulks behind everyday routines. We go to work and pick up our kids from school but fight to breathe. We force a smile while our regard for life erodes away. As Charles Spurgeon described, “The flesh can bear only a certain number of wounds and no more, but the soul can bleed in ten thousand ways, and die over and over again each hour.”1 Let’s discuss the epidemiology and causes of depression to help cultivate an understanding of this disabling condition.


Depression is especially common in the US, with a twelve-month prevalence of 10 percent and a lifetime prevalence of 21 percent nationwide,2 but the condition by no means restricts itself to American shores. On the contrary, it afflicts three hundred million adults worldwide, approximately 4 percent of the global population.3 Studies estimate a twelve-month prevalence of 5 percent4 and a lifetime prevalence of 12 percent across continents.5 Such statistics hint that no matter where in the world you live, at some point you’ll interface with someone who’s grappling in the darkness.

What Does Depression Mean for My Faith?

Kathryn Butler, MD

In this concise booklet, author and physician Kathryn Butler addresses common misconceptions about clinical depression within the church, offers encouragement for believers who suffer, and equips church leaders with the tools to provide spiritual support.

The global effects of this affliction cannot be overemphasized. Depression has physical and practical ramifications far beyond a melancholy mood, and impairs the basic functions of living and thriving. The World Health Organization (WHO) ranks depression as the single largest contributor to disability worldwide.6 In the US, depression incurs levels of disability similar to those accompanying arthritis, cardiovascular disease, and stroke.7 In the worst cases, the disorder threatens survival; depression is the major cause of suicide deaths across the globe, responsible for eight hundred thousand tragedies per year.8

Such data should alert us to the real possibility that when we lead or participate in worship every Lord’s Day, brothers and sisters among us may be struggling with life-threatening despair. For such individuals, getting out of bed to attend church may require exceptional effort. Compassion in such cases is paramount, as depression preferentially strikes those already vulnerable to the ravages of a fallen world. Young adults, those with less income, and people who are divorced, separated, or widowed are especially prone to the condition.9 Those already suffering and without support can sink into a mire of mood and thought from which they cannot wrench themselves free.

When we lead or participate in worship every Lord’s Day, brothers and sisters among us may be struggling with life-threatening despair.


The diagnosis we call major depression is probably an umbrella term, a catchall phrase encompassing multiple related syndromes with similar effects but distinct causes.10 Numerous neurobiological changes—far more complicated than a “chemical imbalance”—are at work to drag sufferers into despondency. These processes involve changes in large brain structures,11 intricate cell pathways,12 and even molecules communicating between individual nerve cells.13 While we don’t know in all cases whether these changes cause depression or arise as a result of the disorder, they hint at why sufferers struggle to recover. In depression, the architecture of our brains shifts, trapping us in the dark.

And yet, biology doesn’t tell the entire story. Life circumstances also affect our minds and moods. A family predisposition combined with an environmental influence—a devastating life event, substance abuse, medications, a complicating illness, even a spiritual crisis—usually places a person at high risk for that first episode of depression.14 Furthermore, the symptoms of depression are notoriously heterogeneous, and one person’s experience may differ drastically from another’s.15

For example, people with seasonal affective disorder, who contend with depression during the winter months, respond well to bright-light therapy, while those without this temporal pattern don’t. Some sufferers struggle only mildly, while others find themselves incapacitated and unable to function in daily life.16 In my own journey, anhedonia—the inability to glean joy from activities one loves—was unbearable, but others with whom I’ve spoken have lamented their difficulties to read and concentrate, or their struggles to get out of bed, or a persistent heaviness that wouldn’t leave (as if lead encased their limbs).

Triggers may be obvious—the death of a loved one, the loss of a job, a broken relationship—but depression may also descend without any clear inciting event at all. My first—and worst—depressive episode occurred on the tails of a traumatic event that threw my faith into turmoil, but others arrived swift and sudden as an icy breeze, without clear triggers, striking without warning while I watched my kids at a playground or sipped coffee at a sun-soaked breakfast table. I felt as if a switch suddenly flipped in my mind, and as all color and feeling drained away, I looked skyward and prayed: “Oh Lord, please, no. Not this. Not again.”

The important take-home messages are that (1) depression is associated with complex brain changes that impair concentration and mood, and (2) one person’s experience may dramatically differ from another’s. Loving the depressed begins with acknowledging that experiences can vastly differ, even while suffering in all cases is profound. Meeting people in their grief, listening to their unique narratives, and then offering the love and teaching of Christ can serve as lifelines when the shadows descend. If you’re suffering with depression, know that your unique experience doesn’t make you “weak” or imply a meager faith. You are a bearer of God’s image, worthy of love, struggling in a fallen world. Depression is complex, harrowing, and variable, and your suffering is real.


  1. Charles H. Spurgeon, “Psalm 88,” in The Treasury of David, The Spurgeon Archive, http://archive.spurgeon .org/treasury/ps088.php, accessed April 18, 2023.
  2. Deborah Hasin et al., “Epidemiology of Adult DSM-5 Major Depressive Disorder and Its Specifiers in the United States,” JAMA Psychiatry 75, no. 4 (2018): 336–46.
  3. World Health Organization (WHO), Depression and Other Common Mental Disorders: Global Health Estimates (Geneva: World Health Organization, 2017), 5.
  4. Graham Thornicroft et al., “Undertreatment of People with Major Depressive Disorder in 21 Countries,” British Journal of Psychiatry 210, no. 2 (2017): 119–24.
  5. Ronald C. Kessler et al., “Development of Lifetime Comorbidity in the World Health Organization World Mental Health Surveys,” Archives of General Psychiatry 68, no. 1 (2011): 90–100.
  6. WHO, Depression, 5.
  7. Kirsten Penner-Goeke et al., “Reductions in Quality of Life Associated with Common Mental Disorders: Results from a Nationally Representative Sample,” Journal of Clinical Psychiatry 76, no. 11 (2015): 1506–12.
  8. WHO, Depression, 5.
  9. Hasin et al., “Epidemiology,” 336.
  10. Gordon Parker, “The Benefits of Antidepressants: News or Fake News?,” British Journal of Psychiatry 213, no. 2 (2018): 454–55.
  11. P. Cédric M. P. Koolschijn et al., “Brain Volume Abnormalities in Major Depressive Disorder: A Meta-Analysis of Magnetic Resonance Imaging Studies,” Human Brain Mapping 30, no. 11 (2009): 3719–35.
  12. Roselinde H. Kaiser et al., “Large-Scale Network Dysfunction in Major Depressive Disorder: A Meta-Analysis of Resting-State Functional Connectivity,” Journal of the American Medical Association: Psychiatry 72, no. 6 (2015): 603–11.
  13. F. M. Werner and R. Coveñas, “Classical Neurotransmitters and Neuropeptides Involved in Major Depression: A Multi-Neurotransmitter System,” Journal of Cytology & Histology 5, no. 4 (2014): 4853–58.
  14. Patrick F. Sullivan, Michael C. Neale, and Kenneth S. Kendler, “Genetic Epidemiology of Major Depression: Review and Meta-Analysis,” American Journal of Psychiatry 157, no. 10 (2000): 1552–62.
  15. Eiko I. Fried and Randolph M. Nesse, “Depression Is Not a Consistent Syndrome: An Investigation of Unique Symptom Patterns in the STAR*D Study,” Journal of Affective Disorders, 172 (2015): 96–102.
  16. Jeffrey J. Rakofsky et al., “The Prevalence and Severity of Depressive Symptoms along the Spectrum of Unipolar Depressive Disorders: A Post Hoc Analysis,” Journal of Clinical Psychiatry 74, no. 11 (2013): 1084–91.

This article is adapted from What Does Depression Mean for My Faith? by Kathryn Butler, MD.

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