ISLAM AND DEPRESSION

How Islam and Modern Clinical Management can work concomitantly to provide
holistic support to sufferers of depression.

JUNE 17, 2015

IBLAL RAKHA AND DR MENAZ AKHTAR
Iblal_rakha@hotmail.com

Contents

I n t r o d u c t i o n .................................................................................................................................................... 2

H o w d o e s d e p r e s s i o n c o m e a b o u t ....................................................................................................... 2

D i a g n o s i s .......................................................................................................................................................... 4

W h a t g o e s o n i n t h e m i n d o f t h e d e p r e s s e d ? ............................................................................... 4

H o w / w h e r e t o g e t h e l p ............................................................................................................................. 5

C o p i n g t e c h n i q u e s ....................................................................................................................................... 6

S u i c i d e ............................................................................................................................................................... 7

The r o l e o f I s l a m ............................................................................................................................................. 8

C o n c l u s i o n ........................................................................................................................................................ 9

R e f e r e n c e s ....................................................................................................................................................... 9

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Introduc tion
This piece aims to shed light upon a misunderstood condition, and explore the role of Islam in helping Muslim
people to overcome their depressive syndrome. Searches for Islam and depression online yields worrying
advice written by those uneducated in medical sciences, which can often leave the individual experiencing
depression in a more damaged physical, mental and spiritual state than what they were in previously.
Depression is a poorly understood clinical disorder, distinct from feeling sad or down. In the instance of
someone experiencing unhappiness (an emotion felt by all) the feeling subsides, whereas a person suffering
from depression undergoes long periods of time experiencing anxiety, helplessness, hopelessness and lack of
pleasure. The psychological symptoms aforementioned also accompany physical symptoms (moving
slowly/speaking slowly, disturbed sleep, lack of grooming, poor appetite or increased appetite) and social
symptoms (neglecting hobbies/interests, withdrawing from family and friends).1 Depression affects people of
all ages, from all walks of life. One in four people during their lifetime will experience Clinical Depression
severe enough to warrant treatment. Depression a common but severe illness that significantly impacts a
persons quality of life as well as their physical health.
If you suffer from depression you may find it hard to open up to people around you; the thoughts of others
not being able to understand or self-critical thoughts about others judging you are a few of the primary
factors in not reaching out for help. Although to a lesser degree, mental illnesses continue to have a stigma
attached to them as a result of lack of knowledge on the matter, particularly in people from Black and
Minority Ethnic backgrounds. In many cultures these ailments do not receive the attention they deserve;
instead they are often swept under the carpet. This means that people do not receive the treatment they
need to overcome depression.
In some cases people may try being sympathetic by using the classic phrases: itll pass, be patient and the
likes. Even the most sincere advice given by some can be damaging to the one receiving the advice; the ones
suffering from depression very rarely take solace in these types of phrases. Instead, the depressed people
may be left burdened with more guilt on enhanced self-loathing, why cant I rid myself of these feelings and
appreciate the blessings I have?.

How does depression c ome about

If you or someone you know is depressed they may be under the false impression that it is a result of weak
faith. In the beliefs of Muslims as compiled by the renowned Imam Maturidi, he states that an individuals
faith does not fluctuate, therefore depression does not sprout from a weak grounding in the Islamic faith.
People who are afflicted with diseases (such as heart disease) are not said to suffer from weak belief, it is no
different with mental illnesses; a dismissive attitude and lack of knowledge from figureheads in the
community (imams) can be very damaging to say the least.
Narrated Usamah ibn Sharik: I came to the Prophet (peace be upon Him) and his Companions were sitting as
if they had birds on their heads. I saluted and sat down. The desert Arabs then came from here and there.
They asked: Apostle of Allah, should we make use of medical treatment? He replied: Make use of medical
treatment, for Allah has not made a disease without appointing a remedy for it, with the exception of one
disease, namely old age. Taken from Kitab al-Tibb from the Sunan Abu-Dawud.
Religion and modern treatments are not opposed and should not be considered as such. Modern clinical
techniques and religious support must be implemented together. A research project found that men with
mental health problems found ease and peace at the mosque, with the ritual prayers being described as
therapeutic.2 The role of religion in the support of the patient should not be discounted, likewise for the role
of modern techniques used in the management of depression.
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In Muslim communities many cases of mental illnesses are dismissed as possession, the evil eye or the effects
of black magic as the symptoms are very closely tied. Lack of mental health awareness in many uneducated
families can lead to devastating effects on the sufferer. Imams are also guilty of misreading mental illnesses as
spiritual ailments. Imams should take a greater role in spreading awareness amongst their congregations
regarding mental health issues whilst also acknowledging their limitations in the treatment of mental
ailments. But that is not to dismiss their role entirely as they can play a crucial role in the support and
recovery of the patient.
Depression is a syndrome with genetic and environmental factors. There are many theories as to the causes
of depression but none have been proven fully. Research suggests there is a genetic predisposition to
depression, however not everybody with a depressed family member goes on to experience clinical
depression. For some, the condition develops slowly without a cause, whereas others become depressed
having experienced a traumatic event (a divorce, loss of a job etc.).
An important point that needs to be made here is that the triggers that may begin the descent into
depression are different for individuals. Although their onset may have been caused by something specific or
tragic for some people there is no cause or a significant trigger, yet their experience of depression is severe
and serious. Therefore people with depression should not be dismissed or undermined if one cannot
understand the cause instead we should try and understand the severity of symptoms and support them to
manage their symptoms.
One must remember not to discriminate as all are deserving of sympathy, not just those whom we consider to
be. The sufferers find it hard to reach out to those around them, in turn, were they to receive harsh advice or
a dismissive remark it could be fatal. People have different thresholds for stimuli; a rough analogy can be
used: people react differently to drops in temperatures, a drop from 25C to 20C may cause one person to
put on a sweater whereas another would not be effected as much.
The biological causes of depression are linked with abnormal levels of certain chemicals (neurotransmitters) in
the brain, they are serotonin and noradrenaline. These chemicals are important messengers that help
neurons to communicate and play major roles in certain pathways in the brain. A table showing what the
chemicals are believed to be important in can be seen below (the list is not exhaustive). By acknowledging the
part these neurotransmitters have to play, one can see the symptoms that are expressed by those who are
depressed.
Noradrenaline
Believed to be important in:
Controlling wakefulness
Control of mood
Blood pressure regulation

Serotonin
Believed to be important in:
Controlling wakefulness
Control of mood and emotion
Behavioural responses (e.g. hallucinations)
Appetite

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Diagnosis
DSM-IV Criteria for Major Depressive Disorder
and Depressive Episodes
Low mood or loss of interest/pleasure in daily
activities for greater than two weeks
Mood is different from normal
Reduced social/work-related/educational
function
Minimum 5 out of 9 following symptoms present
almost every day with at least one of the core
symptoms:
Core Symptoms:
o Depressed mood or irritable (empty/sad)
o Decreased interest or pleasure
o Other Common Symptoms:
o Weight change or change in appetite
o Changes in sleep (more or less)
o Changes in activity (e.g. Restlessness, or
slowness in thought)
o Fatigue or low energy
o Guilt or self-blame
o Poor concentration
o Suicidal thoughts or plans

ICD-10 Depression Diagnostic Criteria

Persistent sadness or low mood
Loss of interests or pleasure
Low energy
At least one of the above present most days,
majority of the time for longer than two weeks. If
any are present then check for related symptoms:
o Disturbed sleep
o Poor concentration or indecisiveness
o Low self-confidence
o Increased or decreased appetite
o Agitation or slowed movements
o Guilt or self-blame
o Suicidal thoughts or plans

The diagnostic criteria for depression can be seen above. The criteria set by the DSM-IV is used principally in
the US, the ICD-10 is adopted by the UK. This table is not included for self-diagnosis, rather it is to represent
the seriousness of depression and the many aspects of life it encroaches upon. The Impact on life can range
from impairing daily activities to completely debilitating the individual. The physical symptoms that manifest
should not be dismissed, if left untreated the condition may worsen and even lead to death, similar to any
other disease.

What goes on in the mind of the depressed?

Patients find it hard to express themselves about their feelings, the words numb, sad, empty and hollow
are used constantly. The barrier (whatever they may be) that is imposed on the communication of their
feelings limits the understanding of others. Depression phrases are not common in Eastern cultures and
therefore people do not have the language to adequately express how they feel. Some people from south
Asian communities will use metaphors to describe how sad they feel, e.g. my heart feels heavy, my head
feels burdened or my chest feels tight. And quite understandably professionals sometimes do not detect
depression from these phrases. The following statements from anonymous Muslim sufferers of the condition
may help shed light on the feelings experienced. Some quotes have been gathered via blog submissions online
and others through primary research by the author.
Imagine waking up and crying from feelings you dont understand. I feel so helpless, why cant anybody help
me? Why can nobody understand my pain? I feel unbelievably sad, I cry until I become numb and then I feel
nothing. I cant get out of bed because I physically do not have the energy and I dont even know what Id do if
I was to get out of bed.

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I wake up thinking I wish I could sleep again. Ive been like this for months. Theres no joy, no sadness, I feel
numb. I dont even know if this is right but I did a prayer, it went like this: Oh God forgive me for my sins and
take me back.
I dont brush my hair, I wear one outfit for days and days. I dont know what Im doing to myself, I dont sleep
or I sleep for hours on end. I lie in one spot for the entire day or sit just in one spot. My room is a jungle, I
havent cleaned it in months. I move so little, my muscles used to hurt so much from lack of use.
I wish a car would run me over and Id die.
Im so tired, yet no amount of sleep nourishes me. Eating has become work. Brushing my teeth, answering
phone calls, replying to emails; simply existing has become tiresome. I know my pain is not physical to others,
but my pain is real. I feel it in every moment. When I sleep, when I eat, when I laugh, when I cry, when I speak.
My pain is hidden beneath it all.
Im not ungrateful to God. Im grateful for all the blessings I have, but I keep raising my hands to God asking
for the pain and hurt to stop. The silence I receive kills me even more, I keep getting worse, and the pain keeps
getting stronger How long do I have to wait until I get an answer? I dont know if I can keep going. I want to
end my life just so I can stop the pain.
An analogy can be used to illustrate the mental exhaustion suffered by those afflicted with depression and
anxiety. Were you to trap a rat, it would rush around frantically from here to there in every direction possible
until it becomes exhausted. When the rat has run itself into the ground, it falls over on to its side fatigued.
The rat which is rushing around can help to show the over stimulated activity of the brain causing anxiety.
These thoughts play on the minds of the anxious until they wear themselves out and fall into a state of
depression (the rat falling on its side).
The World Health Organisation has a video available on YouTube that describes depression as a black dog, it
is a very insightful clip into how depression can affect the lives of people.

How/where to get help

Getting help is easier said than done; in many instances the sufferer must be coaxed and encouraged to seek
medical attention. Unfortunately depressions is a bit of a catch 22 situation, whereby one must do something
to help the depression but the depression makes it hard to do anything. The road to recovery from
depression is long, therefore setting realistic expectations helps in the long term. The following are sources of
help and what to expect from them.
1. The General Practitioner (GP): One should call their GP asking for an emergency appointment. When
asked the reason, the sufferer should explain they feel low and explain their symptoms. Should they
feel that they may cause harm to themselves they should state this. Generally the GPs are fast acting
when someone calls in with this problem. An appointment will be issued in the very near future to
the patient. The GP will identify the problem and diagnose the condition accurately, talking through
an action plan with the patient.
a. Antidepressants: These drugs are sometimes viewed as causing more harm than good.
Contrary to these beliefs, antidepressants play a very important role in helping the patient to
recover from depression. The medicines help to restore the chemical imbalances in the brain.
Anti-depressants can help to improve motivation and reduce other distressing symptoms.
The National Institute for Health and Care Excellence recommend anti-depressants as an
effective treatment for moderate to severe depression. It cannot be stressed enough that
any worries or side effects from the drugs should be presented to the GP.
b. The GP may be able to offer additional medications to help with other symptoms such as
trouble getting to sleep or staying asleep.
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2. Exercise or self-help: Exercise and self-help is recommended as the first step for mild to moderate
depression. We know that exercise releases chemicals that have an anti-depressant effect and
improve mood. Self-help in the form of reading self-help materials can also be useful in helping to
understand depression better and know what strategies one can use to reduce depressive symptoms.
Improving Access to Psychological Therapies services can also provide guided self-help. The GP
should be able to refer the patient to the local Improving Access to Psychological Therapies Services
(IAPT) service, alternatively a person may be able to self-refer.
3. Counselling: The NHS offer counselling services, university students could be offered a free
counselling service via their educational institution. Counselling is undertaken by a trained therapist
to help the patient to explore the root cause of their depression. In certain instances a psychiatrist
may become involved in the treatment to help find a more accurate diagnosis about the condition.
4. Cognitive Behavioural Therapy (CBT): CBT is a therapy (that may be offered in a computerized or face
to face manner) that can help the patient to better understand their depression and manage their
problems looking at unhelpful thoughts and behaviours that might be contributing to the
maintenance of depression. CBT is recommended as an effective therapy for the treatment of
moderate to severe depression (National Institute for Health and Care Excellence).
5. Interpersonal Therapy (IPT): IPT is a talking therapy that is offered face to face. This therapy focuses
on interpersonal issues that might have contributed to the depression or that have been affected by
Depression. IPT is recommended as an effective therapy for treatment of modern to severe
depression (National Institute for Health and Care Excellence).
Both CBT and IPT are available free on the NHS and are delivered by Improving Access to Psychological
Therapies Services. Although Anti-depressants, IPT and CBT have high success rates for the treatment of
depression compared to other treatments, the combination of anti-depressants and CBT or anti-depressants
and IPT has the highest efficacy of the successful treatment of moderate to severe depression.

Coping techniques
Coping techniques can help the individual in the moment they are suffering from anxiety or to work towards a
goal allowing a longer term distraction. Techniques 1 3 allow for baseline improvement in dealing with some
symptoms of depression whereas 4 7 allow for a quick fix to distract the mind from the thoughts rushing
through.
1. Lifestyle choices:
a. Sleep (too much, too little or poor quality) can have a great impact on mood. One should
observe good sleep hygiene3:
i. Sleep and wake up at regular times each day
ii. Only sleep when tired (avoid staying in bed if youre not sleeping)
iii. Avoid strenuous exercise four hours before bed
iv. Avoid napping during the day
v. Start a bedtime routine (that you do every night in the same order before bed The
mind is set to sleep)
vi. Avoid using the bed for anything other than sleep (dont read, watch TV or work in
bed)
vii. Avoid alcohol, nicotine and caffeine 4-6 hours before bed
b. Diet. A poor diet does not give the body enough nutrients to deal with stress. A good
balanced diet gives the body all it needs to function at its best and giving one energy.
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Potatoes, rice and pasta give the body slow releasing energy and produce serotonin (one of
the chemical hormones addressed previously).
c. Exercise.
i. Release of feel good brain chemicals that can improve mood
ii. Sense of achievement and healthy living
iii. Can help to improve sleep
d. Meditation. Mindfulness techniques, which are underpinned by the philosophy of
meditation (Salah), has a growing evidence base for the successful treatment of depression.
2. Expressing oneself: Many people find expressing themselves through certain means helps to release
the emotions they feel. A few suggestions: Poetry, keeping a journal, painting or drawing. Some also
feel a non-taxing hobby can help to alleviate their symptoms such as gardening, walking, reading or
authoring works of any kind.
3. Setting small achievable goals: Many find setting a target and following through gives them a sense
of achievement and accomplishment.
4. Talking: Being able to speak to a trusted individual about how one feels can help to alleviate
depression of a particular situation. Often the advice given by a second party may offer a different
and more positive outlook. The trusted individual may be a family member or a close friend, in some
instances an Imam who is well practiced in counselling can be a valuable asset.
5. Music/Recitations: Often people find comfort in the recitation of Quran, being able to listen to a
recitation can reduce levels of anxiety. Music therapy is considered promising for those suffering with
depressive syndromes as it can have a positive impact on mood and help alleviate anxiety. 4, 5, 6
6. The microphone and speaker feedback: When a microphone is placed close to a speaker, the
feedback becomes louder and louder to the point it becomes overbearing. In some, the thoughts that
run through their minds become increasingly loud. A technique that can be used to reduce the
power of these thoughts is to imagine moving the microphone away from the speaker, allowing the
thoughts to quietly fade away until they disappear. It is important to move on, preferably by starting
or continuing an activity to allow productive thoughts to dominate in the mind.
7. The Samaritans service: The Samaritans are an undervalued service. They offer a 24 hour anonymous
service where people can call and speak to trained listeners. When the one suffering from depression
needs a person to speak to, whatever the time of day it may be, and feel as though they cannot
approach their family members/friends, they can turn to the Samaritans service which is always
available.

Suic ide
Touching upon a very taboo subject in the Muslim communities, suicide is a very real threat against the lives
of the depressed. Muslims, many who may not even consider themselves as practicing, find that religion is a
very important factor in what prevents them from planning and carrying out the act of ending their lives; this
is often for fear of the consequences of suicide. In the case of a person feeling this way, this mentality should
be nurtured and hope should be instilled.
In other instances the suicidal impulses increase when a person is in the environment that could allow such an
act (live trains, walking by a cliff etc.). In this scenario, judgement becomes impaired; it may be hard for the
sufferer to find reasons at the spur of the moment to prevent themselves. The Samaritans service is of great
use in these situations, offering a shoulder to lean on (so to speak) at the exact moment the thoughts become
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overwhelming. If one suspects they are a threat to themselves, they can also present themselves to the local
accident and emergency (A&E) service, where they can be given help.
The onus is upon Muslims and the communities to create structured support networks for those who express
suicidal tendencies or at the very least create an atmosphere of sympathy. By allowing for those who feel
suicidal to express their feelings without casting judgment on the reasons (for why they feel the way they do)
can most definitely be the difference between life and death. Quran [5:32]: And whoever saves one [soul]
it is as if he had saved mankind entirely

The role of Islam

Depression is not a modern phenomenon, it has been recorded and described by Islamic physicians centuries
ago. Ibn Sina also known as Avicenna (d. 1037 AD) made mention of the treatments of anxiety, depression
and melancholia.7 He also acknowledged that emotional states can lead to physical symptoms.8 Whilst
modern society has brought about a new environment, which could be argued as detrimental to mental
health, there is no shying away from the fact that these issues have been documented in the earlier eras
before such advancement of civilization.
Islam and the principles it promotes are very useful in helping to overcome depression. Religion is seen as a
very useful resource to incorporate into psychological therapies and treatment plans.9 Many assets that can
be offered by religion are important to include alongside modern clinical techniques for holistic support of the
patient.
The five daily prayers that Muslims must observe are completed at certain times throughout the day. It is
common that those suffering from depression lose the normal routine they once had in their lives, these
prayers can help to bring about a structure in the lives of the patient. At the same time is has been
recommended that prayers can be used as an alternative therapy as effectively as meditation or exercise.10
A list of supplications that Muslims would find of use in times of distress and anxiety are listed below:

Quran [21:87]:
There is no God but You, Glorified be You!
Truly, I have been of the wrongdoers.

Quran [28:24]:
My Lord! Truly, I am in need of whatever
good that you bestow on me.

Quran [18:10]:
Our Lord! Bestow on us mercy from
Yourself, and facilitate for us our affair in the
right way.

Quran [21:83]:
Verily, distress has seized me, and You are
the Most Merciful of all who show mercy.

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Quran [3:173]:
Allah is Sufficient for us, and He is the Best
Disposer of Affairs.

Bukhari:
O Allah, I take refuge in You from anxiety
and sorrow, weakness and laziness,
miserliness and cowardice, the burden of
debts and from being overpowered by men.
Muslim:
Allah is sufficient for me. There is no God
but He. I have placed my trust in Him, He is
the Lord of the Majestic Throne.

(Whoever reads this 7 times after Fajr and 7

times after Asr, Allah will take care of
whatever worries them of the matters of this
world and the hereafter).

Conc lusion
Muslims in distress often find themselves diving into religion and waiting for a response. In this period of time
some find themselves falling more deeply into depression and left feeling more hopeless; this is a natural
feeling, by turning to God it is assumed they will become better. Once the depression continues many are left
feeling dejected.
Anas ibn Malik related: A man said, O Messenger of Allah, should I tie my camel and trust in Allah, or should I
untie her and trust in Allah? The Messenger of Allah, peace and blessings be upon him, said, Tie her and
trust in Allah. From at-Tirmidhi.
From this hadith one can understand that a person should take steps to correct their affairs the best they can
and then have faith in God to grant them security in the steps they have taken and there forth. The one
suffering from depressive syndromes should take steps to find help and trust in God that they will get better.
A multifaceted approach is required to robustly tackle depression. Medications, counselling, religion and the
supportive network it grants along with coping techniques provide a holistic approach in dealing with the
condition. The depressed must remember God is near, He is all knowing and all hearing. Quran [2:186]: And
when My servants ask you, [O Muhammad], concerning Me indeed I am near. I respond to the invocation of
the supplicant when he calls upon Me. Allah also states in Hadith Qudsi: I am with the ones whose hearts
are torn.

Referenc es
1 - NHS Choices. Clinical depression Symptoms [Internet]. 19 August 2014. [Accessed 7 June 2015]; Available
from: http://www.nhs.uk/Conditions/Depression/Pages/Symptoms.aspx.
2 - Bobat H. Social Care Institute for Excellence. A user-led research project into Mosque: exploring the
benefits that Muslim men with severe mental health problems find from attending Mosque. London: Mental
Health Foundation; 2001. p.1-16.

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3 - NHS Choices. Insomnia Treatment [internet]. 9 December 2013. [Accessed 9 June 2015]; Available from:
http://www.nhs.uk/Conditions/Insomnia/Pages/Treatment.aspx.
4 - Raglio A, Attardo L, Gontero G, Rollino S, Groppo E, Granieri E. Effects of music and music therapy on mood
in neurological patients. World J Psychiatry. [Internet]. 2015. [Accessed 8 June 2015]; 5(1):68-78. Available
from: http://www.ncbi.nlm.nih.gov/pubmed/25815256.
5 - Klainin-Yobas P, Oo WN, Suzanne Yew PY, Lau Y. Effects of relaxation interventions on depression and
anxiety among older adults: a systematic review. Aging Ment Health. [Internet]. 2015. [Accessed 8 June 2015];
[Epub ahead of print]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25574576.
6 - Erkkil J, Punkanen M, Fachner J, Ala-Ruona E, Pnti I, Tervaniemi M, Vanhala M, Gold C. Individual music
therapy for depression: randomised controlled trial. Brit J Psychiat. [Internet]. 2011. [Accessed 9 June 2015];
199(2):132-139. Available from: http://bjp.rcpsych.org/content/199/2/132.
7 - Taiyab M. Physiological approach of Ibn Sina towards the science of behaviour. IJHS. [Internet]. 1986.
[Accessed 9 June 2015]; 21(4):363-367. Available from:
http://www.new1.dli.ernet.in/data1/upload/insa/INSA_1/20005b5b_363.pdf.
8 - Ahmed MB. Ibn Sina (Avicenna) 980-1037 A Great Physician and Scholar of the Medieval Era. Journal of the
Tarrant County Medical Society. [Internet]. 2008. [Accessed 9 June 2015]. Available from: http://mcchs.org/wp-content/uploads/2014/04/Ibn-Sina-Avicenna-980-1037.pdf.
9 - Meer S, Mir G. Muslims and depression: the role of religious beliefs in therapy. J Integr Psychol Ther.
[Internet]. 2014. [Accessed 10 June 2015]. 2:2. Available from:
http://www.hoajonline.com/journals/pdf/2054-4723-2-2.pdf.
10 - Sabry WM, Vohra, A. Role of Islam in the management of Psychiatric disorders. Indian J Psychiatry.
[Internet]. 2013. [Accessed 10 June 2015]. 55(2):S205-S214. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705684/.

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