1	Depression and Anxiety Understanding the Problem and the Islamic Solution Dr. Ali Shehata, DO FACFP
2	The Diagnosis of Depression At least 5 of the following, during the same 2-week period, representing a change from previous function: (a) Depressed mood (b) Diminished interest or pleasure (c) Significant weight loss or gain (d) Insomnia or too much sleep (e) Restless, fidgety or sluggish (f) Fatigue or loss of energy (g) Feelings of worthlessness (h) Less ability to think or concentrate; indecisiveness (i) Recurrent thoughts of death, suicidal ideation, suicide attempt, or specific plan for suicide
3	The Diagnosis of Depression Symptoms are not the direct result of a substance or a general medical condition. Symptoms are not better accounted for by bereavement; the symptoms persist for longer than 2 months or are characterized by marked functional impairment, excess preoccupation with worthlessness, suicidal ideation.
4	More Signs of Depression Overwhelmed, inadequate, helpless, worthless, or hopeless. Unhappy mood expressed as sadness, heaviness, numbness, or sometimes irritability, mood swings. Substance abuse: cocaine, narcotics, amphetamine, and alcohol.
5	Causes of Depression Can arise without any precipitating stressors; but stress and interpersonal losses certainly increase risk Chronic pain, medical illness, and psychosocial stress also play a role in both the initiation and maintenance of Major Depression.
6	Remission vs Response Early studies reporting similar efficacy rates of all the antidepressant classes tended to use response rather than remission rates as the criterion for improvement. Response is generally defined as a 50% decrease in scores on depression scales, Yet significant depressive symptoms are often present after a 50% improvement rate is attained (patient may be symptomatically improved but not feel well)
7	Different Criteria Researchers measure improvement via symptoms of depression - such as sleeping and eating habits, ability to concentrate, and level of interest in normal activities. Patients feel they're well when they return to their usual, normal self; function normally; and feel optimism and self-confidence. [American Journal of Psychiatry]
8	Do Patients Get Better with Medicine Alone? Between 30% and 50% of individuals treated with a given antidepressant do not show a response. Even where there has been a good response, significant continuing depression and dysfunction is common, with relapse rates 3 to 6 times higher in such cases. In addition, antidepressant drugs tend to lose efficacy over the course of treatment.
9	References Tranter, R., O'Donovan, CO., Chandarana, P., Kennedy, S. (2002) Prevalence and outcome of partial remission in depression J Psychiatry Neurosci. July; 27(4): 241–247 Byrne, SE. & Rothschild, AJ. (1999) Loss of antidepressant efficacy during maintenance therapy. J Clin Psychiatry. Jun;59(6):279-88.
10	Medicines Sel. serotonin reuptake inhib. (SSRI) Tricyclics Serotonin-norepinephrine reuptake inhibitor (SNRI)
11	How Much Do They Help? Freedom of Information Act, UConn psychologist Irving Kirsch obtained 47 studies used by the FDA for approval of the six antidepressants rx’d most between 1987-99. Antidepressants worked 18% better than placebos - statistically significant - "but not meaningful for people in clinical settings". Over half of the 47 studies found that pts on antidepressants improved no more than those on placebos, Kirsch says. "The drugs have been touted as much more effective than they are."
12	Twisted Science? He says studies finding no benefit have been mentioned only on labeling for Celexa, the most recently approved drug. The others included in his evaluation: Prozac, Paxil, Zoloft, Effexor and Serzone.
13	Other Research The results of one study indicate that short-term exposure to selective serotonin reuptake inhibitors (SSRIs) results in changes of rat brain cells, which resemble those induced by the recreational drug Ecstasy. Comparative study of fluoxetine, sibutramine, sertraline and dexfenfluramine on the morphology of serotonergic nerve terminals using serotonin immunohistochemistry. Kalia M, et al. Brain Res 2000 Mar 6;858(1):92-105
14	Ecstasy? While Ecstasy-induced brain damage has been well demonstrated in both animal and human studies, there are no data on the effects of SSRIs on brain cells. This study documented that, after only 4 days of intake of SSRIs, rat brain cells underwent morphological changes characterized by swelling and acquisition of a corkscrew shape, indicating damage
15	SSRI discontinuation syndrome Lancet reports that 35% to 78% of individuals who take SSRIs for several months, experience, upon abrupt treatment interruption, physical and psychological symptoms such as: changes in mood, affect, appetite and sleep, dizziness, fatigue, anxiety, agitation, nausea, headache, & sensory disturbance.
16	Antidepressants and suicidal risk SSRIs and other non-lithium antidepressants may increase the risk of suicide in certain patients Induce akathisia (restlessness and psychomotor agitation and associated with self-destructive impulses) and liberate suppressed energies that may be used to act upon suicidal thoughts. Muller-Oerlinghausen B, Berghofer A. J Clin Psychiatry 1999;60 Suppl 2:94-9; discussion 111-6.
17	Suicide and the Young FDA has included Black Box warnings on all SSRIs stating how they double suicidality (from 2 in 1,000 to 4 in 1,000) in children and adolescents who are prescribed these drugs.
18	Other Options? Acupuncture St. John's Wort Tryptophan dietary supplements
19	The Relaxation of the Hearts الَّذِينَ آمَنُواْ وَتَطْمَئِنُّ قُلُوبُهُم بِذِكْرِ اللّهِ أَلاَ بِذِكْرِ اللّهِ تَطْمَئِنُّ الْقُلُوبُ Those who believe, and whose hearts find satisfaction in the remembrance of Allah: for without doubt in the remembrance of Allah do hearts find satisfaction. [13:28]
20	Distancing Self from Quran وَمَنْ أَعْرَضَ عَن ذِكْرِي فَإِنَّ لَهُ مَعِيشَةً ضَنكًا وَنَحْشُرُهُ يَوْمَ الْقِيَامَةِ أَعْمَى But whosoever turns away from My Message, verily for him is a life narrowed down, and We shall raise him up blind on the Day of Judgment. [20:124]
21	Dua عَنْ ابْنِ عَبَّاسٍ أَنَّ رَسُولَ اللَّهِ صَلَّى اللَّهُ عَلَيْهِ وَسَلَّمَ كَانَ يَقُولُ عِنْدَ الْكَرْبِ لَا إِلَهَ إِلَّا اللَّهُ الْعَظِيمُ الْحَلِيمُ لَا إِلَهَ إِلَّا اللَّهُ رَبُّ الْعَرْشِ الْعَظِيمِ لَا إِلَهَ إِلَّا اللَّهُ رَبُّ السَّمَوَاتِ وَرَبُّ الْأَرْضِ وَرَبُّ الْعَرْشِ الْكَرِيمِ
22	The Prophet’s Sunnah In Saheeh it was reported from Ibn ‘Abbas that the Messenger of Allah used to say, when he felt distressed: La ilaaha ill-Allah al-‘Azeem ul-Haleem, Laa ilaaha ill-Allah Rabb il-‘arsh il-‘azeem, Laa ilaaha ill-Allah Rabb is-samawaati wa Rabb il-ard wa Rabb il-‘arsh il-kareem There is nothing worthy of worship except Allah, the All-Mighty, the Forbearing. There is nothing worthy of worship except Allah, the Lord of the Mighty Throne. There is nothing worthy of worship except Allah, Lord of the heavens, Lord of the earth and Lord of the noble Throne.
23	When Something Upset Him يا حي يا قيوم برحمتك أستغيث Yaa Hayyu yaa Qayyoom, bi Rahmatika astagheeth O Ever-Living One, O Everlasting One, by Your mercy I seek help.
24	Except that Allah Will take Away His Sorrow and Grief مَا أَصَابَ أَحَدًا قَطُّ هَمٌّ وَلَا حَزَنٌ فَقَالَ اللَّهُمَّ إِنِّي عَبْدُكَ وَابْنُ عَبْدِكَ وَابْنُ أَمَتِكَ نَاصِيَتِي بِيَدِكَ مَاضٍ فِيَّ حُكْمُكَ عَدْلٌ فِيَّ قَضَاؤُكَ أَسْأَلُكَ بِكُلِّ اسْمٍ هُوَ لَكَ سَمَّيْتَ بِهِ نَفْسَكَ أَوْ عَلَّمْتَهُ أَحَدًا مِنْ خَلْقِكَ أَوْ أَنْزَلْتَهُ فِي كِتَابِكَ أَوْ اسْتَأْثَرْتَ بِهِ فِي عِلْمِ الْغَيْبِ عِنْدَكَ أَنْ تَجْعَلَ الْقُرْآنَ رَبِيعَ قَلْبِي وَنُورَ صَدْرِي وَجِلَاءَ حُزْنِي وَذَهَابَ هَمِّي
25	Except that Allah Will take Away His Sorrow and Grief No person who suffers any anxiety or grief, and says: Allahumma innee ‘abduka wa ibn ‘abdika wa ibn amatika, naasiyati bi yadika, maadin fiyya hukmuka, ‘adlun fiyya qadaa’uka, as’aluka bi kulli ismin huwa laka sammayta bihi nafsaka aw anzaltahu fi kitaabika aw ‘allamtahu ahadan min khalqika aw ista’tharta bihi fi ‘ilm il-ghaybi ‘andak an taj’ala al-Qur’aana rabee’ qalbi wa noor sadri wa jalaa’a huzni wa dhahaaba hammi
26	Except that Allah Will take Away His Sorrow and Grief O Allah, I am Your slave, son of Your slave, son of Your female slave, my forelock is in Your hand, Your command over me is forever executed and Your decree over me is just. I ask You by every Name belonging to You which You named Yourself with, or revealed in Your Book, or You taught to any of Your creation, or You have preserved in the knowledge of the unseen with You, that You make the Quran the life of my heart and the light of my breast, and a departure for my sorrow and a release for my anxiety.
27	Except that Allah Will take Away His Sorrow and Grief … except that Allah will take away his sorrow and grief, and give him in their stead joy.” The Companions asked, “Shall we learn this O’ Messenger of Allah?” He replied, “It is a must that whoever hears this should learn it.” [Ahmad, Tabaraani]