A slideset covering depression, spirituality and recovery

1. DEPRESSION SPIRITUALITY &
RECOVERY
Javed Mohammed
July 2019

3. A few personal thoughts
We all probably know someone in our family, friends, co-
workers, or community who has or had depression
Like any chronic illness, there are remedies, relief, cure, or
maybe just learning to live with it
A lot of mysteries and things neither lay people, doctors or
scientists or counselors fully understand
It is challenging for the sufferer as well as the family and
support group
Difference between feeling down (temporary feeling) and being
depressed, where you cannot lift yourself out and need to seek
professional help.
Depression builds up over time, and then a small (or large)
trigger changes the mental state of a person from which they
cannot get out

4. A few personal thoughts
Usually a loss of some kind that triggers it, death of a loved
one, job loss, divorce, financial setback, …
There are so many factors that cause depression, & there are
no easy answers, but you don’t have to go it alone
It is a journey, that requires hard work, patience and prayer
Depression is personal and no two peoples journey is the same
There is hope and all we can do is strive to give it our best
Thank you to all the care workers, nurses, doctors, family
members, neighbors, and friends who are support team
Loneliness is one of the major factors in depression but not the
only one.

5. Depression Iceberg
Thinking
Emotions
Personal Values
Basic Emotional Needs

7. “The great error of our day is
that physicians separate the
soul and body, when they
treat the body.”
Plato (427-347 BCE)

8. Maslow’s Hierarchy of Needs

10. 10

11. 11
Epidemiology:
Major Depression-
Major Public Health Impact
• Depression is common
• Twice as many women are affected as men.
• Lifetime, Female (F)=21%; Male (M)=12%
• Annual, F=13%, M=8%
• Depression is the leading cause of disability
worldwide, and a major contributor to the global
burden of disease.
• Depression is associated with suicide.
• There are effective treatments for depression!
www.who.int/mediacentre/factsheets/fs369/en/index.ht
ml

12. Common Symptoms

13. Risk of Depression by Age & Sex
0.000
0.002
0.004
0.006
0.008
0.010
0.012
0.014
0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54
Hazardrate
Age (y)
Female Male
Kessler R, et al. J Affect Disord. 1993; 29:85-96.

15. Copyright © 2010 Pearson Education, Inc.

17. The varieties of depression
Dysthymia
Depression caused by physical disorders
Severe Monopolar or Bipolar Depression
Old Age Depression
Exhaustion / Burnout
Reactive Depression

18. 0
1
2
3
4
5
6
7
Premenopause Early perimenopause Late perimenopause
Riskofdepressiveonset(%)
Timing of Increased Risk
for Depressive Onset
Risk for Depressive Onset Starts Increasing in Early Perimenopause
With Greatest Risk in Late Perimenopause
0-24 months
surrounding final menstrual period
2-5 years prior
to final menstrual period
6-36 years prior
to final menstrual period
Risk for Depressive Onset Starts Increasing in Early Perimenopause
With Greatest Risk in Late Perimenopause
1. Schmidt PJ, et al. Am J Psychiatry. 2004;161:2238-2244.

19. What’s Going On?
Hot
Flushes
Lack of
Sleep
Depression
Domino Theory
Source: Joffe H et al. Estrogen, serotonin, and mood disturbance:
where is the therapeutic bridge? Biol Psychiatry. 1998;44(9):798-811.

20. Signs of Depression
Depressed Mood (loss of interest or
pleasure, feelings of guilt or
worthlessness, helplessness,
hopelessness, or pessimism
Physical complaints (lack of energy and
initiative, disturbed sleep or appetite)
Cognitive disorders ( lack of
concentration, difficulties in planning and
decision making)

21. Depression can be treated!
We have a responsibility to reduce
stigma and to help those who are
suffering.
21

22. STRESS OF MODERN LIFE
Long transfer to work
Multiple tasks that cost a lot of
time and strength
unfair boss, chaotic colleagues
Desire to be a good employee
Lack of positive feedback,
constant pressure
Too much noise, lack of
privacy, excessive distractions,
and unreasonable deadlines.
Broken friendships
Distress in the family

23. MARITAL PROBLEMS
Being confined to the house,
In-laws: no positive
feedback, unreasonable
demands, disrespect,
cosntant criticism
«shouting man / crying
woman» – ingredient of
every Bollywood movie
Unfulfilled wish to have a
child
No time for yourself, no time
to relax
Worry / financial problems
Sexual problems

24. TRAUMA & LOSS
Childhood trauma
Partner with alcohol
problem
Threats and beatings
Losing a close relative or
friend
Losing husband or wife =
losing support in life
Any Trauma

25. Depression can darken the
faithLike a dark cloud
before the sun,
depression can be a
dark filter not only in
daily life but also in
the life of faith.
25

26. Mild, moderate, or severe?
Experts judge the severity of depression by assessing
the number of symptoms and the degree to which they
impair your life.
Mild: You have some symptoms and find it takes more
effort than usual to accomplish what you need to do.
Moderate: You have many symptoms and find they
often keep you from accomplishing what you need to do.
Severe: You have nearly all the symptoms and find they
almost always keep you from accomplishing daily tasks.

27. Beck Depression Inventory (BDI)
1. Sadness
2. Hopelessness
3. Past failure
4. Anhedonia
5. Guilt
6. Punishment
7. Self-dislike
8. Self-blame
9. Suicidal thoughts
10. Crying
11. Agitation
12. Loss of interest in activities
13. Indecisiveness
14. Worthlessness
15. Loss of energy
16. Insomnia
17. Irritability
18. Decreased appetite
19. Diminished concentration
20. Fatigue
21. Lack of interest in sex
Interpretation:
Score <15: Mild Depression - Score 15-30: Moderate Depression - Score >30: Severe Depression

28. Depression vs Menopause
Depressed
Weight change
Energy
Sleep
Libido
Thoughts
of death
Worthlessness
Concentration
Anhedonia
Hot flushes
Perspiration
Vaginal dryness
1. Soares CN, Cohen LS. CNS Spectrums. 2001;6:167-174.
2. Joffe H et al. Psychiatr Clin North Am. 2003;26:563-580.
Irritable
Depression Menopause

30. Negative thoughts about:
 the self («I am a failure»)
 the world/environment
(«everything is against me»)
 the future («there is no way
out, no hope!»
THE COGNITIVE TRIAD (A. Beck):Expectations
Self Image
Real
Condition
Cognitive
Dissonance
Depressive Thinking Patterns

31. Cognitive Triad of Depression:
Self, World & Future

33. Coping with Depression

35. Spiritual Health: Inner Quest for
Well-Being
Spirituality refers to a belief in some unifying force that gives meaning to life.

36. What Is Spirituality?
• Healthy relationships, treating
ourselves and others with respect,
honesty, integrity, and love, are a sign
of spiritual well-being.
• Values are our principles—not only
the things we say we care about, but
also the things that cause us to
behave the way we do.
• People who are spiritually healthy are
able to articulate their purpose in
life, and make choices that manifest
that purpose.
 Spirituality Integrates Three Facets

37. Defining Psychosocial Health
The mental,
emotional,
social, and spiritual
dimensions of health
Goal
Feel good about themselves
Feel comfortable around other people
Control tension and anxiety
Meet the demands of life
Curb hate and guilt
Maintain a positive outlook
Enrich the lives of others
Cherish the things that make them smile

38. Environment
DEPRESSION
FACTORS
childhood
Life events
Thinking
Basic assumptions
„belief system“
Physical symptoms
Pain syndromes
Physical discomfort
STRESS
BRAIN
Genetics
contributing to
Depression

39. STRESS
Thinking
Body
4
1
3
2
1
2
3
4
Talking
Support
Activation
Medication
Therapy of Depression

41. Causes of Depression
Genetic: risk increases with heredity
Biochemical: Too little or too much of a brain
chemical affecting mood and sleep.
Environmental: Significant loss, difficult
relationships, financial problems, drugs, or a
major change in a life pattern.
Psychosocial: Persons with certain traits.
Pessimistic thinking, low self-esteem, a sense
of having little control over life.

42. Season Affective Disorder
Results from changes in the season.
Most cases begin in the fall or winter, or
when there is a decrease in sunlight
Pattern of onset at the same
time each year
Full remissions occur at a
characteristic time of year

43. Depression in Elderly
NOT a normal part of aging
2 million Americans over age 65
have depressive illness
Sub-syndromal depression
increases the risk of developing
depression
Leads to early relapse and
chronicity
Often co-occurs with other
serious illnesses
Under-diagnosed and under-
treated
Suicide rates in the elderly are
the highest of any age group.

44. Treating Depression
Depression is treatable and recovery is
possible
Treatment options include:
• Counseling
• Psychotherapy
• Medication
Ω A mental health professional can work with you to
design a treatment plan that best fits your
individual needs

45. Managing Anxiety

46. Maintaining Positive Mental
Health
Ω Strategies that doctors recommend for
maintaining positive mental health include:
• Keeping in touch with friends and family who can
provide emotional support
• Engaging in physical activity every day
• Saying “no” to new responsibilities when your
plate is full
• Getting enough sleep
• Seeking help from a mental health professional
when stress becomes overwhelming

47. Psychotherapy
Very helpful in mild to moderate depression
Response time slower
Relapse less frequent
CBT
As effective as antidepressants
IPT
more effective than antidepressants
in treating mood suicidal ideations,
and lack of interest, whereas
antidepressants are more
effective for appetite and
sleep disturbances

48. Electro-convulsive Therapy
Indications:
Failure of antidepressant trials
Severe depression with catatonic or psychotic
features
High risk of suicide
Poor tolerability of oral meds
Response rates from 70-90%
Most efficacious antidepressant
Contraindication: ICP, intracranial tumors
3x/wk with avg number of treatments
8-12, may need maintenance therapy
Side effects: Short term memory loss

49. Faith can be a part of healing

50. A Mutual Journey of Care and Growth
“When people are overwhelmed by illness, we
must give them physical relief, but it is
equally important to encourage the spirit
through a constant show of love and
compassion. It is shameful how often we fail
to see that what people desperately require
is human affection. Deprived of human
warmth and a sense of value, other forms of
treatment prove less effective. Real care of
the sick does not begin with costly
procedures, but with the simple gifts of
affection, love, and concern.”
His Holiness, The Dalai Lama in A Time for Listening and Caring:Spirituality and the Care of
the Chronically Ill and Dying by Christina M. Puchalski © 2006 Oxford University Press..

52. Resources
Mental Health Resources
Ω National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
Ω Substance Abuse Mental Health Services Administration (SAMHSA) Treatment Referral Helpline:
1-877-SAMHSA7 (1-877-726-4727)
Ω National Alliance on Mental Illness (NAMI) HelpLine: 1-800-950-NAMI (6264)
https://stepfeed.com/this-sheikh-perfectly-shut-down-treat-depression-with-quran-argument-6300
https://archive.islamonline.net/?p=5267
https://beyondhijab.sg/2018/04/26/what-not-to-say-to-a-muslim-struggling-with-their-mental-health/
https://www.independent.co.uk/voices/mental-health-muslim-south-asian-women-uk-a8158571.html
https://thriveglobal.com/stories/muslim-and-depressed/
https://www.mentalhealth.org.uk/sites/default/files/impact-spirituality.pdf
https://www.actaspsiquiatria.es/repositorio/suplements/14/ENG/14-ENG-418865.pdf

53. Key Questions for Depression
I feel sad or irritable.
I have lost interest in activities I used to enjoy.
I'm eating much less than I usually do and have lost weight, or I'm eating
much more than I usually do and have gained weight.
I am sleeping much less or much more than I usually do
I have no energy or feel tired much of the time.
I feel anxious and can't seem to sit still.
I feel guilty or worthless.
I have trouble concentrating or find it hard to make decisions.
I have recurring thoughts about death or suicide, I have a suicide plan, or I
have tried to commit suicide.
Scoring Key: If you checked a total of five or more statements on the
depression checklist, including at least one of the first two statements, you (or
your loved one) may be suffering from an episode of major depression. If you
checked fewer statements, including at least one of the first two statements, you
may be suffering from a milder form of depression or dysthymia.

54. What NOT to say to someone
Suffering from Depression
What do you have to be depressed about, you have everything
A lot of people have it worse than you.
You just need to get out and do something
Don't think like that stay positive
You need to remember God more, say this dua (prayer)
These natural supplements will cure you
Think happy thoughts, everythings going to be ok
It's a sin to be hopeless
Be strong, snap out of it, it's all in your head
It’s all in your head.
You’re just having a bad day.
I’m sure it’s nothing to worry about.
Man up. You can deal with this on your own.
Why are you talking about this stuff?
You don’t want people to think you’re crazy.
Counseling is for sissies.
What will your family say?

55. What to say to someone
Suffering from Depression
Ω Reach out. You may want to say
• I’ve been worried about you. How are you—really?
• I’ve noticed some changes in you lately, and I wanted to check
in with you.
• It sounds like you’re having a tough time. It must be really hard
to try to hold everything together when you’re feeling this bad.
• When did you start feeling like this? Did something happen that started it?
• I understand. How can I help you to find help?
• Feeling depressed isn’t a sign of weakness. It takes courage
to speak up.
• Do you want to talk about it? I’m here when you’re ready.
• What can I do to help today?
• How are you managing? How is your depression?
• You’re not alone. I may not understand exactly how you feel, but you’re not alone.
• You’re important to me.
• That sounds like it’s really hard. How are you coping?
• I’m really sorry you’re going through this. I’m here for you if you need me

56. What to say to someone
Suffering from Depression
I’m here for you
What can I do to help?
I like/love xxx about you
Yeah, that is lousy, life sometimes sucks
There are ways to get through this difficult time
I want you to know you're not alone
I (or a close family member pr friend) been through it, too)
It's a journey, a marathon, but we can get through it.
I can see this is a really hard time for you
Do you feel like doing something together to help take your mind off things?
I have noticed you seem to be doing better lately. Is that how it feels for you?
I'm sorry if I said the wrong thing. Can we start again?
This conversation is between you and me
Have you thought about seeing your doctor or calling a help line? There is support available
What can I do to help? Just tell me how.
I’m not sure what to do, but I’m sure we can figure it out together
I can see this is a really hard time for you