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Monday, March 26, 2012

Understanding Depression

Depression is real!
Depression is a disease just like diabetes, cancer, high blood pressure or heart disease.
Depression sucks the life out of the person suffering from it.
Depression also affects those that are close to him/her.
Depression is misunderstood by most!
My intent in writing this post is to help explain the lonely and frustrating experience of a person living with depression, discuss the various causes and types of depression and possible treatment options.
I'll also discuss the stigma of medication and the difference between a psychiatrist and a psychologist.

I started writing this post back in November of 2011 and it has taken me this long to finally complete it. 
This is an extremely long post but I've split it into smaller sections so that it's more palatable.
One might need to read it more than once to digest all the information provided here.
I hope you find it useful.
Q: What causes a person to feel depressed? 
A: There is a spectrum/ range of the types of depressions, onsets (what causes it) and severity of symptoms.
There is short-term depression and long-term depression. 
These are NOT the official diagnostic terminologies from the DSMIV Manual. 
The DSMIV Manual is what psychologists, psychiatrists, social workers and other health-care professionals use to determine a diagnoses.
The terms I am using in this explanation are to help you understand the overall puzzle of depression with the various puzzle pieces.
Short-term depression is usually caused by a critical event such as:
- the death of a loved one
- experiencing a breakup (relationship, divorce or even a close friendship)
- experiencing a traumatic event/incident such as an accident, abusive situation (physical, verbal, sexual abuse), war or a natural disaster such as a hurricane, earthquake, etc.
A person who endures a critical event might experience a short-term depression state that may last anywhere between 6-8 weeks.
Usually during this period, he/she will go through the 5 Stages of Grief as per Elisabeth Kubler-Ross and David Kessler.

The 5 Stages of Grief (not always in this particular order) are:
1. Denial - This is when an individual doesn't want to believe that the person is gone/dead or that a relationship, or their life as they knew it, is over. 
 So they continue to pretend and act as if nothing has changed. 
They don't want to and are not ready to accept the reality that life is different now due to the occurrence of the critical event.

2. Anger - In this stage, the individual begins to realize that the critical event has occurred and they are angry about the fact that it happened. 
They might verbally lash out at those trying to to help him/her make peace with the critical event.
They might express their anger toward God or their Higher Power.

3. Bargaining - In this stage, the individual attempts to make "deals" with God or their Higher Power.
They might agree to "change their ways" in exchange for the undoing of the critical event.
They might agree to do something different just so that things can go back to the way things were prior to the critical event.

4. Depression - In this stage, the individual starts to realize that no matter what "deals" they agree to, there is no undoing what has already occurred. 
This is when they start to feel sad, hopeless, lonely, and depressed.
 Some might cry excessively during this period, 
while others might resort to isolating themselves from others.

5. Acceptance - After a few weeks or months of being depressed, the individual finally begins to accept the reality of their life post the critical event. 
They make peace with it and begin to move on with their life.
They start to recreate a new "normal"and continue their journey in life.
But it is important to note that a person can go back and forth between these stages at any time.
Then there is"Long Term Depression". 
An individual might be genetically predisposed to depression due to having a family history of depression or other mental illnesses.
A person who is predisposed to depression does not necessarily have a cause that triggers depression.
They might just start to feel "out of it", "tired", "fatigued", "angry", or "anxious" due to no logical explanation.

Yet in other individuals, depression might manifest itself due to the occurrence of a critical event such as being sexually molested, experiencing a traumatic event, or even experiencing a hormonal change due to pregnancy in women.
Now within "Long Term Depression" there are 2 distinct types of Depression.
The two types are either: 
1. Extreme sadness 
2. Extreme sadness with anxiety.

1. An individual with "Extreme Sadness" might demonstrate/experience the following symptoms:
 Extreme sadness, hopelessness, being exhausted all day and loss of interest in daily life. 
This person has difficulty finding pleasure in life and feel overwhelmed with the day to day responsibilities of life.

The person who feels sad may also feel very lonely, hopeless, frustrated, tired, sleepy, and might get easily irritated with others around them.
They might either have an increase or decrease in their appetite.
Its important to note that one of the first things a person living with depression does is they stop taking care of their personal hygiene and they isolate from others.
They might not brush their teeth or shower for days. 
They might hang around the house in their pajamas.
They lose interest in making themselves look presentable.
They're simply too tired.

An individual with "Extreme Sadness with Anxiety" still experience extreme sadness, but in addition might experience the following symptoms: Anxiety,  repeated thoughts about what might or might not occur.
This individual's mind might feel like it's going 90 mph.
They are unable to turn their thoughts off and thus are unable to rest, relax and even sleep.
They get frustrated with those around them and often lash out at them.
This person is grouchy and unpleasant to be around.
They are almost like a hamster running on it's never-ending wheel. They want to feel better but just don't know how to get off the wheel of sadness and anxiety.
Possible Treatment Options

 A healthy lifestyle including a balanced diet and regular exercise go a long way in helping create endorphins to make a person feel better.

But this may not be enough for a person living with depression. 
An individual living with depression might simply lack the energy or motivation to make healthy eating choices or work out.

Therapy and/or counseling always help but is not always enough for all.
A person going through Short Term Depression will definitely benefit from counseling/therapy. 
The therapist/ counselor helps the individual, process the incident and the feelings experienced as a response to the incident.
The individual with the therapist's help, is able to move past the incident and make peace with it.

A person living with Long Term Depression will definitely benefit from counseling but they might also need to be on anti-depressants or anti-anxiety medication along with a healthy lifestyle.

It is sad that even in 2012, there is a stigma attached to taking 
anti-depressants or anti-anxiety medications.
Individuals taking the medication might feel judged by others and feel that they are somehow inadequate or broken because they need to take a "happy pill" as some refer to it.


Let me ask you a few questions:
Would we tell a person diagnosed and living with diabetes to NOT take their insulin and other medication?
What about a person who has high blood pressure?
Would we ever suggest to them that they should just "think themselves into getting well".
How about a person living with cancer?
 Would we suggest to them that they just pray themselves to good health and not take any of the recommended treatments options.

See how ridiculous this sounds?

Not this is how one sounds when they suggest to a person living with depression that they should just "be happy". 
Long term depression causes a chemical imbalance in the brain that needs to be balanced by taking medication made specifically for it.

There is nothing wrong with an individual living with Long Term Depression. 
But they do have a disease that needs to be treated.

As far as prayer goes, I strongly believe in the power of prayers. But prayer cannot replace medication.
A person living with depression might not feel much like "praying" or doing anything else. 
That is normal!!!!
This is a symptom of their depression.

There are also other natural alternatives such as Ginkgo Biloba which are said to help with mood disorders such as depression/anxiety.

Also, an individual living with depression MUST be under the constant care of a psychiatrist while taking medications.
Our bodies change and respond differently to the medications over time.
Also, initially we need to figure out which medicine is right for us. There are numerous medications available and the psychiatrist is the only one who is qualified to prescribe the medication, adjust a dose or wean you off the meds.

Quick explanation about the differences between a psychologist and a psychiatrist:
A psychologist has their PhD in psychology and are trained to do counseling with their patients.
Similarly, social workers, mental-health professionals, marriage and family therapists are all trained to counsel individuals, couples or families.
BUT a psychiatrist is a medical doctor who specializes in treating mental illnesses  and disorders with medication.
Therefore, it is extremely important that an individual needing medication be under the direct care of a psychiatrist or their family doctor.

Issues with medications:
- It might be a process to figure out the right medication and dose for a specific individual. 
Also, as time progresses, the medication or dose might need to be increased, decreased or changed depending on the patients response to the medication.
Thus, monthly visits are necessary to discuss the effectiveness of the medication and to explore other options if need be.

One of the biggest mistakes made by a person taking medication is that they stop taking the medication cold-turkey.
For example, a person is depressed, goes to the doctor and gets a prescription, takes the meds for a few months or years and start to feel much better.
In fact, they feel so good that they simply forget how "depressed" they really were. 
They might start skipping doses and notice that they still feel "good" so without the doctor's knowledge or permission, they simply stop taking their medication.
This is the WRONG thing to do!
Because a person taking meds builds up the meds in their body. 
When they first stop taking the meds, they feel good because the stored/built up medication is being used by the body to maintain an equilibrium.
As the stored medicines are exhausted, the individual will experience a "crash". 
They will experience even stronger symptoms than the first time they were depressed or anxious.

A individual taking medication MUST  continue taking medication for as long as need it.
If they decide to stop taking the meds, they need to do so in consultation with their psychiatrist or family doctor.
The suggested plan is to wean oneself off the medication over a period of time instead of just stopping completely.
Medication improves one's quality of life!!!

People try to be helpful to a person living with depression. 
They offer suggestions and ideas to make the person feel better.
But the reality is that these people often annoy and irritate a person living with depression because they simply fail to understand the disease.
If you suspect someone is depressed, encourage them to go see a psychiatrist or family doctor.
Do encourage them to go work out with you but don't be too pushy.
Be supportive, be loving, be non-judgmental!
Be willing to just BE present with a person living with depression.
Give them their space!
And respect and acknowledge their journey with depression.
There is so much to say on this topic but I'll stop for now.
I pray that you find this information helpful.
Wishing you Love and Light,
From one sufi to another,


  1. To my wonderful loving dear friend...
    Anita, you are one phenomenal writer I must say!
    This piece you wrote on depression is so organized and so well written that anyone who doesn't know about the disease will definitely understand it fully just by reading your post.
    I admire you BIGTIME! I feel you are an inspiration to me and to many others who are truly blessed to know you :)

  2. Shukranlillah Walhamdullilah! All thanks is due to Allah, All Praise is due to Allah!