Question: I am 25 years old and have been feeling quite low and depressed for the past six months. I have told my family about it but they have told me that I should just pray and I will get over it. I feel guilty as I feel that I am actually getting worse and I’m not sure about what I can do or who to talk to?
Dr Hina J Shahid:
I’m sorry to hear about how you are feeling. Unfortunately, this is a common scenario. About one in four people have a mental health problem at some point in their lives and that more than three quarters are too embarrassed or guilty to seek help for it, so you are not alone. Contrary to what some people may say, depression is a real illness. It is one of the commonest conditions and there is a lot that can be done to make you feel better.
What is depression?
Depression is more than just feeling down and blue. While it is normal to feel a bit down and experience low mood during difficult times of our lives, in the majority of cases this lifts after a few days.In depression however, the low mood persists, usually for at least two weeks, and is accompanied by a range of other symptoms. These include feeling tearful, guilty, helpless and hopeless about the future, and not enjoying the things you previously used to enjoy. You may also notice that you have broken sleep or problems going to sleep, feel constantly tired, are not eating losing weight unintentionally, and have difficulty concentrating or remembering things. There are also “atypical symptoms” including excessive sleeping and eating, weight gain and having mood swings. In very severe cases, people may have recurrent thoughts of death, harm themselves or make plans to end their lives. They may also have unusual experiences or feel as though someone is interfering with their thoughts or they may have rapid mood swings and feel out of control of their thoughts and actions. These are fortunately rare but if any of these apply, the person must be taken urgently to their GP or A&E.
What causes depression?
Depression is a condition caused by an interaction between genes, the environment and neurobiological and chemical changes in the brain. The understanding around the neurobiology and chemical changes is an active field of study. It is thought that various parts of the brain are involved which cause the symptoms. These include the brainstem, amygdala and related brain areas (involved in emotional memory, pleasure and anxiety), the hippocampus and neocortex (involved in higher level brain function including memory and feelings of guilt and worthlessness), and hippocampus (involved with sleep, appetite, energy). These areas moderate levels of chemicals such as serotonin (commonly known as the “happy hormone”) and noradrenaline, both which have been found to be low in depression.
There is evidence that depression runs in families, but it is unclear how much of this is due to the home environment and parenting, as no genes have been identified. The role of stressful life events and emotional trauma in triggering a depressive episode is widely recognised. In certain communities, including the Muslim community, there is a lot of stigma around mental illness, including depression, which can lead to denial about its existence or an attempt to hide it. Depression is also not understood properly as many languages have words for sad and crazy, but not for depression. These issues create confusion and misunderstanding around depression, and dismissive attitudes such as lack of willpower to just “get over it”. Some people also believe that depression occurs because of ingratitude and/or a weak faith, or that there has been jinn possession or the effect of the evil eye. While these phenomena exist, they are extremely rare, but depression is very common and is a clinical diagnosis with recognisable symptoms and signs which requires proper treatment. This has also been advocated by the Prophet SAW himself, who said “O worshippers of Allah, you should seek medical treatment, for indeed Allah has not set forth a disease without setting forth for it its cure, with the exception of one disease (Old age).” [Tirmidhi]
The treatment of depression
Treatment can broadly be divided into three main categories: self help, talking therapy and medication
It is important to look after your mental health and wellbeing to keep your mind healthy and resilient, in the same way that you take steps to look after your physical health. Getting enough rest, a good night’s sleep, doing exercise, eating healthy, taking time out for yourself can help you to feel more in control and able to cope with difficult situations. Taking time out to do a creative activity or hobby, breathing exercises and meditation can also be helpful. Salat with khushoo is an excellent way to focus your mind, and there are may adhkar, which if performed with concentration and sincerity may help lift your mood. You may also find it helpful to speak to trusted friends or consider speaking to MIND or the Samaritans who provide confidential advice.
There are many online resources that you may find helpful, which comprise a mixture of books, leaflets and online courses, such as the “Overcoming” series by the Royal College of Psychiatrists and “Reading Well” series by NHS choices which are books on prescription that can be found in your local library or online. There are also private, including Islamic, counselling services online or by telephone and email. Some online services are covered by the NHS, such as leso digital health and Silver Cloud. There are also apps such as MoodGym or Headspace which some people find helpful.
When depression can not be self managed, treatment will need to be supplemented by other methods and you should visit your GP who will formally assess your mood. Your GP may refer you for talking therapies. In some areas, you may be able to refer yourself directly through the Improved Access for Psychological Therapies scheme. Talking therapy consist of many different types of therapies. The most commonly used for depression are cognitive behaviour therapy (CBT), behavioural activation and mindfulness-based therapies. These may be offered on a 1:1 or group setting depending on the severity of your depression.They are all delivered by qualified therapists who are very skilled, non-judgemental and will keep information confidential. The relationship between the patient and therapist is very important, and it is crucial for you to feel at ease and be honest about how you are feeling and what the triggers and stressors in your life are as this will determine the most effective approach.
In cases of moderate- severe depression, or where other treatments have not produced the desired response, antidepressant medication may be given in conjunction with psychological therapy and self-help. There are many different types of antidepressants that your GP can prescribe for you depending on the nature and severity of your symptoms and your medical history. Sometimes more that one may have to be tried. The medications work by boosting the concentration of serotonin and noradrenaline in parts of the brain that need them to function. Antidepressant medication is not addictive in the conventional sense, but it should not be stopped suddenly as your body can experience withdrawal effects due to sudden changes in chemicals. It is recommended that medication is taken for a minimum of 6 months from the time you start feeling better as this prevents relapse. You may have to be on medication for much longer, especially if you have a history of previous episodes of depression.
Long term outlook
A one off episode of depression is common at some stage of people’s lives, and if treated properly, most people will recover. However some people have recurrent episodes. This tends to be more common in people who stop medication too soon. It is important to recognise potential triggers for a relapse and and have a prevention action plan. Triggers might be excessive rumination, major life events such as bereavement, children leaving home, moving house, a new job, having a physical illness, relationship problems or simply feeling overwhelmed. Self-care is extremely important; recognising negative thoughts, feelings and behaviours, not bottling up feelings, speaking to trusted people (whether family, friends, therapist or GP) can all prevent you from feeling overwhelmed which can trigger a downward spiral.
NHS Improving Access to Psychological Therapies- you can put your postcode in and search the services near you using the NHS website https://www.nhs.uk.
MIND- Provide advice and support through providing information, campaigns, support groups and helpline national mutual support group for people suffering from depression running self help groups. Telephone 03001233393, text 86463.
Inspirited Minds- A UK based charity offering a range of services by telephone, email, skype and face to face to those who are suffering from mental health problems. http://inspiritedminds.org.uk/get-help/
Royal College of Psychiatrists “Overcoming” Series – http://www.overcoming.co.uk
Sakoon Counselling- Islamic counselling services. Contact 07943 561 561.
National Samaritans- A confidential listening service available all around the year for those experiencing distress, depression or feeling suicidal. Freephone 116 123
Dr Shahid is a GP and Chairperson of the Muslim Doctors Association. She qualified with a distinction in Medical Sciences at University College London and also holds a Bachelors of Science in Pharmacology from University College London, and a Masters of Science in Public Health from the London School of Hygiene and Tropical Medicine. She has also completed a one-year course in Fiqh and Aqeedah at Ebrahim College, London. She currently works as a GP in Central and West London and has an interest in women and children’s health, mental health and public health. She is an honorary clinical tutor at Imperial Medical School and an honorary faculty member at An Najah National University, Palestine at the Department of Community and Family Medicine. She has also worked in research and humanitarian settings in Lebanon, Greece and Calais. In the UK she delivers outreach clinics and health promotion workshops to ethnic minority groups. She is a keen traveller and linguist and enjoys reading and spending time with her family in her free time. She is currently learning Arabic.
Dr Hina J Shahid MBBS BSc (Hons) MScPH MRCGP DFRSH DRCOG DCH
“The advice offered in this column is intended for informational purposes only. Use of this column is not intended to replace or substitute a formal medical assessment, diagnosis, counselling, therapy or any other treatment. The opinions or views expressed in this column are not intended to treat or diagnose; nor are they meant to replace the treatment and care that you may be receiving from a licensed healthcare professional. This column, its author, the magazine and publisher are not responsible for the outcome or results following any advice in any given situation. If you have specific medical questions, you should consult your own GP. You should never delay seeking medical advice, disregard medical advice or commence any medical action without consulting your GP.”