Anxiety and Depression: Modern Roots, and the Science and Theology of Sabr (صبر), Shukr (شکر), and Tawakkul (توکل)
- 17 hours ago
- 21 min read
Updated: 9 hours ago
A Believer's Perspective Supported With Psychiatric Research
Sabr (patience), shukr (gratitude) and Tawakal (reliance upon God) : three classical Arabic terms this essay argues can fill a real gap in how anxiety and depression are treated today
Author: Qaisar J. Qayyum, MD
Clinical Assistant Professor, Internal Medicine and Geriatric Medicine, USA.
Chief Editor, Noor Journal of Complementary and Contemporary Medicine
Pictured: Hazrat Mirza Masroor Ahmad, Khalifatul Masih V, the fifth Caliph of the Ahmadiyya Muslim Community. Photo credit: Makhzan-e-Tasaweer, https://makhzan.org/en/search/?q=2645938F
Abstract
Anxiety and depression are among the most common problems encountered in clinical practice. Their causes are multifactorial and may include biological vulnerability, medical illness, medications, social circumstances, loss, trauma, uncertainty, sleep disturbance, substance use, and maladaptive patterns of thought. Pharmacotherapy and psychotherapy remain currently established treatment options when clinically indicated.
For a person of faith, however, religious concepts can provide an additional framework through which ordinary distress, uncertainty, disappointment, and loss are not merely endured, but actively understood and managed.
This article examines three classical Islamic disciplines: sabr (patience, steadfastness, and perseverance), shukr (gratitude), and tawakkul (reliance upon God after appropriate effort). These concepts are considered alongside modern research on "intolerance of uncertainty", "delay discounting", gratitude interventions, cognitive restructuring, neuroplasticity, mindfulness, and habit formation. The central claim is not that anxiety simply represents insufficient sabr or that depression simply represents insufficient shukr.
Psychiatric conditions are heterogeneous and multifactorial, and this article does not argue otherwise. The proposition is more focused: modern psychiatric evidence is frequently presented in ways that shape how readers interpret the findings, sometimes beyond what the underlying data themselves justify, and low-risk, non-pharmacological disciplines deserve to be considered early, rather than only after medication, in appropriate cases.
Background
This perspective grows from decades of clinical experience caring for patients with psychiatric symptoms in inpatient psychiatric settings, nursing homes, and general medical practice in the United States and the United Kingdom.
Anxiety and depression occur across the lifespan. The circumstances differ, but the underlying human experiences of uncertainty, perceived loss, frustration, and disappointment are often remarkably similar.
This article also draws on Friday sermons and video question-and-answer sessions of Hazrat Mirza Masroor Ahmad (aba), Fifth Caliph of the Ahmadiyya Muslim Community, broadcast on Muslim Television Ahmadiyya (MTA).
The purpose is not to replace psychiatry, nor to reduce psychiatric illness to a spiritual deficiency. It is to ask whether a believer's framework of patience, gratitude, and reliance upon God can perform meaningful clinical work alongside established treatment and, in appropriate cases, before pharmacological treatment is introduced.
The Central Hypothesis, Stated Plainly
In this author's clinical experience, a recurring pattern emerges: patients whose habitual response to uncertainty is impatience, and who find it especially difficult to tolerate not knowing, often develop a persistent cycle of worry. When this pattern is repeated over time, it may become less a response to one particular stressor and more a habitual way of responding to uncertainty itself.
This is not a claim that patience protects every person from anxiety, nor that someone who develops anxiety must therefore have lacked sabr. Sufficiently severe circumstances can overwhelm even a naturally patient person.
The claim is narrower: habitual impatience and intolerance of uncertainty may represent one important pathway through which ordinary uncertainty becomes chronic anxious vulnerability.
Depression, Attention, and Shukr
Gratitude and Mental Health
A parallel clinical pattern appears in depression. Patients whose attention becomes persistently fixed on what is missing, lost, disappointing, or unfair may develop a low mood that continues well beyond the original event. This is again offered first as a clinical observation, with the research literature providing supporting evidence.
A systematic review and meta-analysis of "gratitude interventions" found measurable benefit across several mental-health outcomes, including anxiety and depressive symptoms [5]. Other meta-analyses report similar findings, although the average effect is generally modest, and gratitude should not be presented as a stand-alone cure for major depressive disorder [6,7].
Interventions incorporating spirituality, connection with God, forgiveness, and gratitude have also shown improvement in psychological outcomes in selected populations [8]. These findings do not demonstrate that depression is caused by ingratitude. Major depressive disorder is biologically, psychologically, and socially complex. Severe depression itself can impair a person's ability to experience pleasure, hope, or gratitude, which is one reason gratitude practice should not be presented as a primary treatment for severe or psychotic depression.
The clinically useful point is more specific: deliberately directing attention toward what remains present can counter, to a measurable degree, the distressed mind's tendency to remain fixed on loss, deficiency, and threat. For a believer, this deliberate redirection of attention is shukr.
Tawakkul, and the Idea Underneath
Tawakkul: What Cannot Be Controlled
Sabr applies most directly to something that must be endured or awaited. But much everyday anxiety is not simply waiting for a known outcome. It is worry about something that has not yet been decided at all: an unpaid bill next month, a biopsy result not yet available, an uncertain job offer, or the safety of a loved one.
For this kind of uncertainty, the Qur'an offers another concept: tawakkul 'ala Allah, trust and reliance upon God.
The Holy Qur'an teaches that whoever places trust in Allah will find Him sufficient and that Allah may provide from directions a person could not have anticipated (65:3-4) [58].
Tawakkul does not mean passivity. The same teaching assumes appropriate effort and recognition that everything has its proper measure. Reasonable action still matters. What tawakkul seeks to remove is something different: the exhausting habit of mentally replaying the same unresolved worry after every useful action has already been taken. Plan reasonably for what lies within your control. Then recognize where your control ends.
One idea sits underneath all three disciplines. Health, relationships, career, and family life all require genuine effort, yet none is completely under human control. We act, but outcomes depend on many factors beyond us.
This is why sabr and tawakkul make sense. The timing and outcome were never fully ours to command. It is also why shukr makes sense. Much of what we possess cannot honestly be credited to personal effort alone.
The Three Tools, Introduced Together
The Qur'an repeatedly presents patience and gratitude as companion disciplines rather than isolated remedies.
Sabr addresses what must be endured or awaited.
Shukr addresses what is already present but has become less visible because familiarity or disappointment has shifted attention elsewhere.
Tawakkul addresses a third category: genuine uncertainty in which there is no fixed outcome to wait for and no specific loss to reinterpret. Will the biopsy be malignant? Will the job offer come? Will the child remain safe?
All three act, in different ways, upon attention and habitual response. They train the mind to respond differently from the pattern that otherwise sustains worry, frustration, and dissatisfaction.
Putting It Into Practice
The moments when attention becomes idle deserve particular attention because these are often the moments when negative thought moves fastest to fill the space.
After finishing a task, at a red light, before reaching for the phone, while waiting for an appointment, or while lying down to sleep, the mind often begins searching automatically for unfinished problems.
These small openings can instead become deliberate cues for shukr.
Not merely the word Alhamdulillah spoken reflexively, but the specific recognition behind it:
Alhamdulillah that I walked here without assistance.
Alhamdulillah that this person is still in my life.
Alhamdulillah that although this problem remains, this particular part of it has improved.
The Arabic phrase is the cue. Conscious recognition is the exercise.
A simple example comes from the life of the Prophet Muhammad, peace be upon him ("sa" is the abbreviation traditionally used for this phrase in Islamic writing). Once, he found a piece of bread that had been sitting out. Rather than throwing it away, he cleaned it and ate it, then told his wife Hazrat A'ishah that one should honor that which is honorable. And when he drank water, he never gulped it down, he took it in three separate breaths, pausing to give thanks after each one [27].
His daily practices likewise turned ordinary activities such as eating, drinking, sleeping, waking, and dressing into occasions for remembrance and gratitude.
The lesson is not merely about bread. It is that repeated blessings become easy to overlook precisely because they are repeated.
The same structure applies to sabr. Instead of the automatic thought, Why has this not happened yet?, the trained response becomes: I have done what I reasonably can. The outcome has its own timing. My responsibility now is sabr.
For genuinely uncertain outcomes, the response becomes tawakkul: I will do what is within my control and leave what is beyond it to Allah.
This is not a technique of suppression. Psychologist Daniel Wegner's classic "thought-suppression" research demonstrated this: he told people not to think about a "white bear" for five minutes. Almost everyone found the white bear popping into their mind anyway, more than if they'd never been told to avoid it. His conclusion: telling yourself "don't think about X" tends to backfire. The instruction itself keeps bringing the thought back [47,48].
Sabr, shukr, and tawakkul operate differently. They do not simply command the mind to stop thinking. They give attention a different direction. That is why they should be practiced proactively, before distress appears, rather than only used as emergency tools after the anxious or negative thought has already taken hold.
Because negative thought can arise throughout the day without deliberate effort, the counter-practice must eventually compete on the same terms. It cannot remain confined to isolated moments such as prayer time or meals.
Faith Across Traditions
The pairing of patience and gratitude is not unique to Islam. The Psalms teach patient waiting upon God and thanksgiving [16]. Jewish teaching asks who is truly rich and answers: the person who is content with what he already has [20]. The New Testament instructs believers to bring their requests to God together with thanksgiving, before the answer is known [17].
The Bhagavad Gita describes steadiness during pleasure and pain, together with contentment, as signs of spiritual maturity [18]. Buddhist teaching also treats patience as active strength and gives gratitude a central place in moral and contemplative life [19].
These traditions are not theologically identical, and they should not be treated as though they are. What is noteworthy is that different religious traditions, arising in different cultures and centuries, repeatedly identified similar disciplines for dealing with uncertainty, adversity, desire, and dissatisfaction.
That convergence deserves attention.
Modern Variables: The Chemical Shortcut
Human beings naturally seek rapid relief from distress. That tendency can lead toward alcohol, cannabis, sedatives, or inappropriate use of prescription medication, essentially a chemical shortcut to a state that sabr, shukr, and tawakkul attempt to reach through a very different route.
Some psychiatric medications carry genuine risks of physiological dependence and withdrawal. Others do not produce addiction in the conventional medical sense. Medication can be appropriate and, at times, lifesaving in moderate-to-severe psychiatric illness.
The concern here is narrower: medication should not automatically substitute for understanding the psychological, social, medical, and spiritual circumstances contributing to a patient's distress.
Benzodiazepines
Benzodiazepines such as alprazolam and diazepam warrant particular caution.
Long-term use can produce "tolerance" and "physiological dependence," and abrupt or overly rapid discontinuation may trigger withdrawal, including rebound anxiety and insomnia [9,10].
This is especially important when benzodiazepines are used chronically for insomnia. Tolerance to the sedative effect may develop while dependence makes discontinuation progressively more difficult [36-38]. Older adults are particularly vulnerable to cognitive impairment, falls, fractures, and sedation.
Benzodiazepines also alter normal sleep architecture, including slow-wave sleep. Deep non-rapid-eye-movement sleep is closely linked with restorative brain physiology, including the "glymphatic system" [59]. On this basis, it is biologically reasonable to ask whether chronic disruption of normal deep sleep could adversely affect these processes over time. Direct long-term impairment of human glymphatic clearance from benzodiazepine use has not yet been established, but the question deserves further study.
Hours of pharmacologically induced sedation should not automatically be assumed to be physiologically identical to hours of natural restorative sleep. Cannabis is also not psychiatrically neutral. Evidence linking cannabis exposure, particularly heavier use, to serious psychiatric harm is strongest for psychotic outcomes in susceptible individuals [13]. Clinical experience points to cannabis causing harm across a broader range of domains than the published literature currently captures, worsened anxiety, reduced motivation, impaired cognition, and disrupted mood among them, though the strength of published evidence for each of these specific harms varies.
On the depression side, polypharmacy, the use of multiple medications at once, is closely associated with depression in older adults and may function both as a contributor to and consequence of poor health and depressive illness [11,12].
Evidence and Its Presentation
How Numbers Get Framed
Skepticism toward psychiatric evidence is not the same as rejecting science. The issue is more specific: data can be technically accurate while their presentation and framing still creates a misleading clinical impression.
A treatment may reduce an outcome from 3% to 2%. That can be reported as a 33% "relative risk reduction." The statement is mathematically correct. The same result can also be reported as a 1% "absolute risk reduction." That is equally correct.
Yet the two statements do not create the same impression. This is why the phrase the evidence shows should not end the discussion.
It should begin it.
The physician should still ask:
What were the actual event rates?
What was the absolute benefit?
How many patients needed treatment for one additional patient to benefit?
How many were harmed?
Was the endpoint clinically meaningful to patients, or mainly a surrogate measure?
How long did the study last?
Who was included and who was excluded?
Who funded the study?
Were unfavorable studies equally likely to be published?
Does the conclusion accurately reflect the magnitude of the underlying result?
These questions are not an attack on evidence-based medicine.
They are evidence-based medicine.
The Serotonin Story
The serotonin story is one of the clearest examples of why this distinction matters.
For decades, depression was frequently explained to patients as low serotonin corrected by medication. Moncrieff and colleagues' umbrella review concluded that the evidence did not support a simple "serotonin-deficiency" model of depression [56]. Others challenged aspects of that interpretation and emphasized that the biology of depression and the clinical effectiveness of antidepressants are separate questions [57].
The important conclusion is that their effects cannot be adequately explained by the simple model of a serotonin deficiency being corrected by medication. That distinction matters because the simplified explanation was often framed with much greater certainty than the evidence justified. A related observation further complicates the picture: psychiatric drugs with very different, and in some cases apparently opposite, effects on serotonin regulation have demonstrated antidepressant effects.
If treatments acting in substantially different chemical directions can produce similar clinical outcomes, the simple chemical-imbalance explanation was never sufficient. How much of an antidepressant's measured benefit reflects pharmacology and how much may be influenced by trial design remains debated.
Because antidepressants often produce noticeable effects, some researchers have questioned whether participants can sometimes guess which treatment arm they are in. If so, imperfect "blinding" could theoretically influence measured benefit over placebo [62,63].
A Critical Voice From Within Psychiatry
Dr. James Davies, a psychotherapist and academic, has examined the expansion of psychiatric diagnoses and the historical development of the DSM [21-23]. He has also discussed concerns surrounding confidentiality agreements during DSM development and objections raised by prominent figures such as Robert Spitzer.
Financial relationships between DSM panel members and pharmaceutical companies have been independently documented in peer-reviewed research [60]. These findings do not prove that all psychiatric diagnoses are invalid . They do, however, justify careful scrutiny of how diagnostic boundaries are established and how social and economic distress may become medicalized.
Davies' broader argument is that modern economic and social pressures generate real suffering, while the system can sometimes relocate that suffering into an individual biological model without adequately addressing the circumstances that produced it.
Psychiatric prescribing has increased dramatically over recent decades while reported mental-health problems have not disappeared. That observation alone does not establish causation. It does, however, justify asking whether symptom control, without attention to underlying social, psychological, spiritual, and behavioral causes, is sufficient.
None of this means the evidence base is worthless. It means that readers and prescribers should ask not only: Is this statement technically true? but also: What did the way it was presented lead me to believe, and do the underlying numbers support that impression?
Antidepressants and Suicidality
Regulatory review of randomized trials led to FDA warnings concerning increased suicidal thoughts and behavior among children and adolescents receiving antidepressants, with later warnings extending concern to young adults [31].
At the same time, untreated major depression is itself an important risk factor for suicide [32]. The lesson is not that antidepressants should never be used.
It is that initiation and dose changes require thoughtful assessment and appropriate monitoring, particularly in younger patients and in anyone with suicidal ideation.
For less severe depression, NICE guidance specifically states that antidepressants should not routinely be offered as first-line treatment unless this represents the informed preference of the patient.
Nutritional Approaches: Omega-3 and Dark Chocolate
Meta-analytic evidence suggests that omega-3 preparations with relatively higher "EPA:DHA ratio," including EPA-predominant formulations, may have antidepressant effects in some populations [39,40].
Dark chocolate and cocoa show a real, consistently reported mood benefit, an effect widely noticed outside the lab as well and worth taking seriously in its own right even as the formal evidence base continues to build [41-43].
The evidence is stronger and more mature for omega-3 fatty acids than for dark chocolate, but both are relevant to the broader discussion because they are food-based interventions with biological activity and relatively low treatment burden.
The logical approach is to exhaust low-risk, side-effect-free options before reaching for medication carrying documented risks, including the antidepressant suicidality signal discussed above.
This does not mean that every food is a treatment or that severe depression should be managed nutritionally. It means that the hierarchy of treatment should take into account not only efficacy, but also risk, tolerability, reversibility, nutritional value, patient preference, and the severity of illness.
Clinical Safety
Several safeguards remain non-negotiable and stand outside the rest of this discussion. Any patient expressing hopelessness must be assessed directly for suicidal or homicidal ideation. Asking clearly about abnormal thinking is not merely appropriate; it is essential in clinical practice.
Immediate safety takes priority over every intervention discussed in this article.
It is also important to state plainly that not every psychiatric presentation is anxiety or depression. People commonly group many forms of psychological distress under these labels, yet a range of other conditions, some far more serious and requiring urgent specialized care, fall outside this article's scope. Bipolar disorder is one example. It should be considered whenever depressive symptoms coexist with a history of "mania," an abnormally elevated, energized, impulsive, or reckless mood state, or "hypomania," a milder form of the same pattern.
Antidepressant treatment can trigger mood switching in susceptible patients [44,45].
Schizophrenia, psychotic depression, and other major psychiatric illnesses fall outside the scope of this article in the same way and require specialized psychiatric evaluation.
Medication review is particularly important in older adults, where polypharmacy and depression frequently coexist and interact [11,12]. Substance use should be actively screened. Medical causes of anxiety or depressive symptoms, including endocrine disease, neurologic disease, medication effects, sleep disorders, and pain, should be investigated where clinically appropriate.
The practices described in this article, sabr, shukr, tawakkul, careful examination of evidence, and the preference for low-risk interventions where appropriate, all operate within this safety framework. None justifies delaying necessary assessment or treatment once serious illness is suspected.
Take-Home Message
When a patient presents with anxiety or low mood, the first task is to determine what is actually driving it: ordinary adjustment, a correctable medical or substance-related factor, a habitual way of responding to uncertainty, or a psychiatric disorder requiring specific treatment. Address what can be corrected.
Where the wait itself is the problem, practice sabr.
Where attention has become fixed on what is missing, practice shukr.
Where the outcome is genuinely uncertain and reasonable effort has already been made, practice tawakkul.
Where symptoms are severe, persistent, psychotic, manic, or suicidal, obtain psychiatric care without delay. Faith-based practice is not a substitute at that threshold. For everyday anxiety and low mood, this article draws on theological tradition together with a growing body of literature on "intolerance of uncertainty," gratitude, neuroplasticity, and habit formation to argue that these disciplines deserve to be considered early, before medication is automatically chosen.
Faith and medicine are not competing here. They address different dimensions of the same suffering.
For a believer, the practice carries an additional dimension: it may ease distress while simultaneously drawing the person closer to God.
Scope of This Discussion
This discussion concerns common symptoms of anxiety and low mood associated with everyday life stress, uncertainty, disappointment, and loss, particularly as encountered in primary care and general medical settings. Anxiety disorders are common in this setting. One large U.S. primary-care study found that approximately 19.5% of patients met criteria for at least one of four common anxiety disorders [33]. Depressive symptoms are similarly frequent [34].
An important distinction must be maintained throughout. Ordinary worry, adjustment-related distress, and everyday low mood are not simply milder forms of panic disorder, major depressive disorder with suicidal ideation, bipolar disorder, or schizophrenia. These conditions may share surface features, but they differ in diagnostic criteria, risk profile, biology, and treatment.
This article adds one further specific point: under sufficient additional stress, sleep loss, bereavement, illness, the habitual impatience described earlier may contribute to an acute panic episode in some individuals. This is a claim about one possible contributing pathway, not a universal explanation for panic.
Any patient with persistent, severe, recurrent, disabling, psychotic, manic, or suicidal symptoms requires formal psychiatric assessment, independent of the framework discussed here.
This article does not attempt to treat bipolar disorder, schizophrenia-spectrum illness, severe or psychotic major depression, or any condition presenting with suicidal or homicidal ideation.
Those conditions require professional psychiatric care without delay.
A large genomic study found substantial shared genetic architecture between schizophrenia and bipolar disorder, while depression and anxiety show different patterns of genetic clustering [35], further supporting the distinction between major psychotic illness and the everyday distress addressed in this essay.
Conclusion
Habitual intolerance of uncertainty is probably not the sole cause of anxiety. Clinical observation, common sense, and a growing body of evidence nevertheless suggest that it can become an important root from which chronic anxious vulnerability develops, much as an occasional drink, repeated and unaddressed, can harden into alcoholism.
Repeated patterns become easier to repeat. A mind that repeatedly responds to uncertainty with worry may gradually become more efficient at worrying.
Sabr attempts to train that mechanism in the opposite direction. The same principle applies to shukr and tawakkul. Sabr addresses the wait for an outcome whose timing was never fully ours to control. Tawakkul addresses what remains outside our control after reasonable effort has been made. Shukr addresses what is already present in life but has become less visible because familiarity, disappointment, or loss has captured attention.
These practices draw upon the same principle of neuroplasticity that underlies any form of habit development: repeated response strengthens future response.
For a believer, however, they carry an additional meaning. They are not merely techniques of behavioral training. They are acts of worship.
The Holy Qur'an describes sincere effort as capable of being multiplied far beyond its apparent scale, using the image of a grain producing seven ears, each carrying a hundred grains (2:262) [46].
For the believer, then, the practice is not only psychological. It is also spiritual.
Robert Jastrow, an astrophysicist who directed NASA's Goddard Institute for Space Studies, wrote about this from an unusual position: he described himself as agnostic, not religious. Yet the physical evidence itself, not any theological argument, had led him to conclude the universe had a definite beginning rather than existing eternally, a conclusion he found personally unsettling. He described the scientist who spends a career climbing the mountain of ignorance through reason alone, only to reach the final peak and find theologians already there, waiting, as though they had known the answer for centuries [29]. For a scientist with no religious stake in the outcome, that was an uncomfortable place to land.
For everyday anxiety and low mood, sabr, shukr, and tawakkul are offered here not as substitutes for necessary medical care, but as disciplines that deserve to be taken seriously and, in appropriate patients, tried early rather than relegated to the margins of treatment.
Acknowledgment:
This article was written with AI assistance. All claims are supported by credible, peer-reviewed references, which were validated for accuracy and authenticity. The AI synthesized information were reviewed by author, ensuring scientific integrity throughout. In the event of any inadvertent errors, the responsibility lies with the AI/authors, and corrections will be made promptly upon identification. I would like to express my sincere gratitude to -- for her thoughtful review and invaluable feedback, -- for his valuable feedback. Their expertise and guidance have played a pivotal role in refining and enhancing this article.
Conflict of Interest Statement:
The author is the developer of a herbal formula and the owner of Dr. Q Formula/Insulinn LLC. However, this affiliation has not influenced the content, analysis, or conclusions of this article
Author’s Note on Scope and Intent:
This article does not advocate the replacement of evidence-based conventional care modalities. All complementary interventions are intended to supplement, not supplant, standard clinical practice, and are implemented within a physician-governed, ethically reviewed, and fully documented medical framework.
References
Probert-Lindström S, Perrin S. An examination of distress tolerance, anxiety sensitivity, and intolerance of uncertainty in adults in routine psychiatric care. Acta Psychologica. 2023;235:103902. https://doi.org/10.1016/j.actpsy.2023.103902
Laposa JM, Collimore KC, Hawley LL, Rector NA. Distress tolerance in OCD and anxiety disorders, and its relationship with anxiety sensitivity and intolerance of uncertainty. Journal of Anxiety Disorders. 2015;33:8-14. https://doi.org/10.1016/j.janxdis.2015.04.003
Domínguez Rojas M, Velo Higueras C. Delay discounting and anxiety: a systematic review. Frontiers in Psychology. 2025;16:1645442. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12666684/
Schulz van Endert T, Mohr PNC. Likes and impulsivity: Investigating the relationship between actual smartphone use and delay discounting. PLoS ONE. 2020;15(11):e0241383. https://pubmed.ncbi.nlm.nih.gov/33206673/
Diniz G, Korkes L, Tristão LS, Pelegrini R, Bellodi PL, Bernardo WM. The effects of gratitude interventions: a systematic review and meta-analysis. einstein (São Paulo). 2023;21:eRW0371. https://doi.org/10.31744/einstein_journal/2023RW0371
Cunha LF, Pellanda LC, Reppold CT. Positive Psychology and Gratitude Interventions: A Randomized Clinical Trial. Frontiers in Psychology. 2019;10:584. https://doi.org/10.3389/fpsyg.2019.00584
Cregg DR, Cheavens JS. Gratitude Interventions: Effective Self-help? A Meta-analysis of the Impact on Symptoms of Depression and Anxiety. Journal of Happiness Studies. 2021;22(1):413-445. https://doi.org/10.1007/s10902-020-00236-6
Leung J, Li K-K. Spiritual Connectivity Intervention for Individuals with Depressive Symptoms: A Randomized Control Trial. Healthcare (Basel). 2024;12(16):1604. https://doi.org/10.3390/healthcare12161604
Ogbonna CI, Lembke A. Curbside Consultation: Tapering Patients Off of Benzodiazepines. American Family Physician. 2017;96(9):606-610. https://www.aafp.org/pubs/afp/issues/2017/1101/p606.html
Pétursson H. The benzodiazepine withdrawal syndrome. Addiction. 1994;89(11):1455-1459. https://doi.org/10.1111/j.1360-0443.1994.tb03743.x
Wiersema C, Oude Voshaar RC, van den Brink RHS, Wouters H, Verhaak P, Comijs HC, Jeuring HW. Determinants and consequences of polypharmacy in patients with a depressive disorder in later life. Acta Psychiatrica Scandinavica. 2022;146(1):85-97. https://doi.org/10.1111/acps.13435
Alwhaibi M. Inappropriate Medications Use and Polypharmacy among Older Adults with Anxiety Disorder. Journal of Clinical Medicine. 2023;12(13):4195. https://doi.org/10.3390/jcm12134195
Burke C, Freeman TP, Sallis H, Wootton RE, Burnley A, Lange J, Lees R, Sawyer K, Taylor GMJ. Associations of cannabis use, tobacco use, and incident anxiety, mood, and psychotic disorders: a systematic review and meta-analysis. Psychological Medicine. 2024;54(15):4287-4301. https://doi.org/10.1017/S0033291724002587
Gage SH, Hickman M, Heron J, Munafò MR, Lewis G, Macleod J, Zammit S. Associations of Cannabis and Cigarette Use with Depression and Anxiety at Age 18: Findings from the Avon Longitudinal Study of Parents and Children. PLoS ONE. 2015;10(4):e0122896. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4395304/
The Holy Qur'an (21:38; 2:153-154; 3:200; 5:91-92), Sher Ali translation. https://www.alislam.org/quran/
Psalm 37:7; Ecclesiastes 3:1; James 1:2-4.
Philippians 4:6.
Bhagavad Gita 12:13-14; 2:14-15.
Anguttara Nikaya 2:31-32, Kataññu Sutta.
Mishnah, Pirkei Avot 4:1.
Davies J. Cracked: Why Psychiatry Is Doing More Harm Than Good. London: Icon Books; 2013.
Davies J. Sedated. London: Atlantic Books; 2021.
Davies J. "The Origins of the DSM" [recorded lecture]. Council for Evidence-Based Psychiatry.
Ren X, et al. Activation Likelihood Estimation Meta-Analysis of the Effects of Cognitive Behavioral Therapy on Brain Activation in the Treatment of Depression and Anxiety Disorders. Depression and Anxiety. 2025;2025:3557367. https://doi.org/10.1155/da/3557367
Hölzel BK, Carmody J, Vangel M, Congleton C, Yerramsetti SM, Gard T, Lazar SW. Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research: Neuroimaging. 2011;191(1):36-43. https://doi.org/10.1016/j.pscychresns.2010.08.006
Lally P, van Jaarsveld CHM, Potts HWW, Wardle J. How are habits formed: Modelling habit formation in the real world. European Journal of Social Psychology. 2010;40(6):998-1009. https://doi.org/10.1002/ejsp.674
Friday Sermon: "The Holy Prophet's (sa) Teachings & Practical Example of Expressing Gratitude." Hazrat Mirza Masroor Ahmad, August 7, 2026. https://www.reviewofreligions.org/48442/friday-sermon-summary-7th-august-2026-the-holy-prophets-sa-teachings-practical-example-of-expressing-gratitude/
Friday Sermon: "The Promised Messiah (as): The Perfect Follower and Reflective Exemplar of the Prophet (sa)." Hazrat Mirza Masroor Ahmad, February 13, 2026.
Jastrow R. God and the Astronomers. New York: W.W. Norton; 1978.
McLellan AT, Lewis DC, O'Brien CP, Kleber HD. Drug Dependence, a Chronic Medical Illness. JAMA. 2000;284(13):1689-1695. https://doi.org/10.1001/jama.284.13.1689 · Desai Boström AE, Cars T, Hellner C, Lundberg J. Recovery and Recurrence From Major Depression in Adolescence and Adulthood. Acta Psychiatrica Scandinavica. 2025;151(5):625-633. https://doi.org/10.1111/acps.13785
Hammad TA, Laughren T, Racoosin J. Suicidality in pediatric patients treated with antidepressant drugs. Archives of General Psychiatry. 2006;63(3):332-339. https://doi.org/10.1001/archpsyc.63.3.332
Fornaro M, Anastasia A, Valchera A, et al. The FDA "Black Box" Warning on Antidepressant Suicide Risk in Young Adults. Frontiers in Psychiatry. 2019;10:294. https://doi.org/10.3389/fpsyt.2019.00294
Kroenke K, Spitzer RL, Williams JBW, Monahan PO, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine. 2007;146(5):317-325. https://doi.org/10.7326/0003-4819-146-5-200703060-00004
Olfson M, Shea S, Feder A, et al. Prevalence of Anxiety, Depression, and Substance Use Disorders in an Urban General Medicine Practice. Archives of Family Medicine. 2000;9(9):876-883. https://doi.org/10.1001/archfami.9.9.876
Grotzinger AD, Werme J, Peyrot WJ, et al. Mapping the genetic landscape across 14 psychiatric disorders. Nature. 2026;649(8096):406-415. https://doi.org/10.1038/s41586-025-09820-3
Longo LP, Johnson B. Addiction: Part I. Benzodiazepines, Side Effects, Abuse Risk and Alternatives. American Family Physician. 2000;61(7):2121-2128. https://pubmed.ncbi.nlm.nih.gov/10779253/
Brett J, Murnion B. Management of benzodiazepine misuse and dependence. Australian Prescriber. 2015;38(5):152-155. https://doi.org/10.18773/austprescr.2015.055
Modesto-Lowe V, Chaplin MM, León-Barriera R, Jain L. Reducing the risks when using benzodiazepines to treat insomnia. Cleveland Clinic Journal of Medicine. 2024;91(5):293-299. https://doi.org/10.3949/ccjm.91a.23061
Kelaiditis CF, Gibson EL, Dyall SC. Effects of long-chain omega-3 polyunsaturated fatty acids on reducing anxiety and/or depression in adults. Prostaglandins, Leukotrienes and Essential Fatty Acids. 2023;192:102572. https://doi.org/10.1016/j.plefa.2023.102572
Liao Y, Xie B, Zhang H, et al. Efficacy of omega-3 PUFAs in depression: A meta-analysis. Translational Psychiatry. 2019;9(1):190. https://doi.org/10.1038/s41398-019-0515-5
Dehnad A, Akhlaghi M, Mahdavi R, Abbasi MM, Abbasalizad Farhangi M. A clinical trial of the effects of cocoa rich chocolate on depression and sleep quality in menopausal women. Scientific Reports. 2024;14(1):23935. https://doi.org/10.1038/s41598-024-74804-8
Shin JH, Kim CS, Cha J, Kim S, Lee S, Chae S, Chun WY, Shin DM. Consumption of 85% cocoa dark chocolate improves mood in association with gut microbial changes in healthy adults: a randomized controlled trial. Journal of Nutritional Biochemistry. 2022;99:108854. https://doi.org/10.1016/j.jnutbio.2021.108854
Jackson SE, Smith L, Firth J, et al. Is there a relationship between chocolate consumption and symptoms of depression? A cross-sectional survey of 13,626 US adults. Depression and Anxiety. 2019;36(10):987-995. https://doi.org/10.1002/da.22950
Tondo L, Vázquez G, Baldessarini RJ. Mania associated with antidepressant treatment: comprehensive meta-analytic review. Acta Psychiatrica Scandinavica. 2010;121(6):404-414. https://doi.org/10.1111/j.1600-0447.2009.01514.x
Barbuti M, Pacchiarotti I, Vieta E, et al. Antidepressant-induced hypomania/mania in patients with major depression: Evidence from the BRIDGE-II-MIX study. Journal of Affective Disorders. 2017;219:187-192. https://doi.org/10.1016/j.jad.2017.05.035
The Holy Qur'an (2:262), Sher Ali translation. https://www.alislam.org/quran/
Wegner DM. Ironic processes of mental control. Psychological Review. 1994;101(1):34-52. https://doi.org/10.1037/0033-295X.101.1.34
Wegner DM. Setting free the bears: escape from thought suppression. American Psychologist. 2011;66(8):671-680. https://doi.org/10.1037/a0024985
The Holy Qur'an (3:192), Sher Ali translation. https://www.alislam.org/quran/
Friday Sermon: "Gratitude, Patience & Prayer." Hazrat Mirza Masroor Ahmad, July 17, 2026. https://www.reviewofreligions.org/48408/friday-sermon-summary-17th-july-2026-gratitude-patience-prayer/
Friday Sermon: "The Lofty Standards of Gratitude One Must Adopt." Hazrat Mirza Masroor Ahmad, August 14, 2026. https://www.reviewofreligions.org/48468/friday-sermon-summary-14th-august-2026-the-lofty-standards-of-gratitude-one-must-adopt/
Psalm 37; Psalm 100; Mishnah, Pirkei Avot 4:1.
James 1:2-4; Philippians 4:6.
Bhagavad Gita 2:14-15; 12:13-14.
Anguttara Nikaya 2:31-32, Kataññu Sutta.
Moncrieff J, Cooper RE, Stockmann T, Amendola S, Hengartner MP, Horowitz MA. The serotonin theory of depression: a systematic umbrella review of the evidence. Molecular Psychiatry. 2023;28(8):3243-3256. https://doi.org/10.1038/s41380-022-01661-0
Möller HJ, Falkai P. Is the serotonin hypothesis/theory of depression still relevant? European Archives of Psychiatry and Clinical Neuroscience. 2023;273(1):1-3. https://doi.org/10.1007/s00406-022-01549-8
The Holy Qur'an (65:3-4), Sher Ali translation. https://www.alislam.org/quran/
Corbali O, Levey AI. Glymphatic system in neurological disorders and implications for brain health. Frontiers in Neurology. 2025;16:1543725. https://doi.org/10.3389/fneur.2025.1543725
Cosgrove L, Krimsky S. A Comparison of DSM-IV and DSM-5 Panel Members' Financial Associations with Industry. PLoS Medicine. 2012;9(3):e1001190. https://doi.org/10.1371/journal.pmed.1001190
American Psychiatric Association. DSM-5-TR. Washington, DC: APA Publishing; 2022.
Kirsch I, Sapirstein G. Listening to Prozac but hearing placebo: A meta-analysis of antidepressant medication. Prevention & Treatment. 1998;1(1):Article 2a. https://doi.org/10.1037/1522-3736.1.1.12a
Hieronymus F, Lisinski A, Nilsson S, Eriksson E. Efficacy of selective serotonin reuptake inhibitors in the absence of side effects. Molecular Psychiatry. 2018;23(8):1731-1736. https://doi.org/10.1038/mp.2017.147
Comments