Please note: This article
is written by a holistic MD. If you are looking for specific Chinese
medicine information, you will need to look elsewhere. This column
is a general patient-information resource from an integrative
For Chinese Medicine perspectives
on Depression, see these articles:
Everyone feels down at times. Stresses at work, with children
or in relationships can make us sad or irritable at times. Yet
in these situations, we eventually beat the blues and get on with
life. Not so with major depression, also known as clinical depression.
Clinical depression is a medical illness, as are heart disease
and ulcers. It consists of a cluster of signs and symptoms that
have an overall similarity, but which may vary widely from person
to person. Episodes can be disabling, interfering with the ability
to work, sleep, eat and enjoy pleasurable activities. Major depression
can occur as few as one or as many as several times in a lifetime.
As with other medical illnesses, clinical depression is related
to a specific physiological mechanism, commonly abnormal chemical
activity in the brain.
Signs and symptoms of clinical depression include:
- Feelings of sadness or irritability that don't go away
- Loss of interest or pleasure in activities formerly enjoyed
- A change in weight or appetite (either increased or decreased)
- Sleep disturbances, such as trouble falling asleep, awakening
too early, or oversleeping
- Feelings of guilt, lack of self-worth, or helplessness
- Decreased ability to concentrate
- Fatigue or loss of energy
- Restlessness or slowed activity noticed by others
- Thoughts of life not being worthwhile, or thoughts of suicide
There is also a less severe form of depression called dysthymia
with symptoms that do not disable, but keep a person from functioning
at full capacity and feeling good. Dysthymia involves long-term,
chronic symptoms. Persons with dysthymia may also have bouts of
Who Gets Depression?
If you have been diagnosed with a depressive illness, you're
not alone. Some experts estimate that there are currently at least
seven million women in the United States with a diagnosable depression.
Women outnumber men in depression two to one--women of all ages,
races and socioeconomic groups. Several factors may play a role
in the onset of clinical depression, including genetics or family
history, external events and chemical changes in body systems.
Environmental risk factors seem to include physical or sexual
abuse before age 21, being married, having young children and
poverty. Biological factors such as infertility, the menstrual
cycle, childbirth and menopause may also play a role. Researchers
are currently investigating the relationship between female hormones
Biochemical Associations - Chemical Imbalance
In many cases, clinical depression appears to be associated with
a chemical imbalance in the brain. Messages are carried from the
brain to all parts of the body via nerve cells and related chemical
messengers called neurotransmitters. Apparently, it is the disruption
of the normal activity of these neurotransmitters which causes
the various symptoms associated with depression. A particular
psychological profile may also play a role in being vulnerable
to depression. For example, women who have low self-esteem, view
situations negatively, or who are easily overwhelmed by stress
are prone to depression.
Your Physician or Nurse Practitioner
Your physician or nurse practitioner will carefully evaluate
your physical and emotional symptoms in order to determine whether
you are suffering from clinical depression or dysthymia. In some
cases, it is obvious even to the patient that depression is a
problem. She may be suffering from feelings of depression or hopelessness,
changes in sleep patterns, or inability to concentrate. In other
cases, however, sadness may not even be a symptom. Some women
may be bothered by feelings of anxiousness, nervousness, irritability
or anger. Or, they may be troubled by physical symptoms that do
not respond to treatment, such as headaches, digestive disorders
and chronic pain. Finally, your physician or nurse practitioner
will give you a thorough physical examination including health
history and blood work to rule out organic conditions such as
thyroid problems, anemia or menopause as contributing factors.
Treatment usually consists of antidepressant medication, often
with the addition of talk therapy or counseling. Antidepressants
are the appropriate medical treatment to correct the chemical
imbalance associated with clinical depression. These medications
are not addictive and have few side effects. Research has documented
that more than four out of five patients can be successfully treated
for their depression. You may also be prescribed antidepressant
medications for dysthymia. This is a change from years past when
older medications had some significant side effects and were considered
not to be appropriate for treating dysthymia. It will be important
to work with your physician as they check you regularly to determine
the best medication and dosage for you. Some women are tempted
to stop taking their medication as soon as they begin to feel
better. It is important to keep taking medication until your physician
or nurse practitioner says to stop, especially since some medications
may need to be tapered off gradually to give your body time to
Since depression is a medical illness, there is no longer any
reason to feel embarrassed about having to take medication or
to feel that you should be able to "snap out of it"--any
more than a diabetic should be embarrassed about taking their
Counseling and Psychotherapy
Several forms of psychotherapy have proven to be effective in
treating depression. A psychologist or licensed counselor can
provide the appropriate treatment on an outpatient basis. Your
symptoms are generally evaluated in an hour-long interview including
completion of various written inventories to assess the severity
and type of your depression. The Beck Depression Inventory scores
depression from moderate to severe. Other inventories can help
to pinpoint the origins of your depression, such as inherited,
trauma victim, body image or depletion depression.
Treatment involves once to twice per week one-hour sessions of
outpatient therapy and may include your mate and/or family members.
Cognitive therapy, which helps you change the way you think about
yourself and the world, has been found to be the most successful
in dealing with depression. An effective treatment to follow cognitive
therapy is interpersonal therapy, which helps you deal with your
relationships with others.
There are also some things you can do for yourself while undergoing
treatment. Try taking a daily walk, and instead of being 'inside
your head' with your thoughts and feelings, notice nature: colors,
sights and sounds. You may also want to try keeping a journal.
Get a notebook and carry it with you. Write about yourself, what
you are realizing, learning and wanting in your life. Put the
thoughts on paper that you can't tell anyone yet.
Traditional Chinese Medicine (TCM)
TCM practitioners view "depression syndrome" as a
wide variety of symptoms including many physical ones. These include
painful periods and headaches, fatigue and insomnia. TCM attributes
the symptoms to stagnant "Qi" (the body's life energy).
In the depressed patient, the Qi becomes depressed and does not
move. Treatment would include acupuncture twice weekly in two
to three four-week cycles. Herbal formulas may also be indicated
to treat many of the physical symptoms that accompany depression.
Other Pulse of Oriental Medicine articles on more specific Chinese
medicine perspective on TCM are:
Nutrition and Physical Activity
Good nutrition is important in treating depression, yet that
can often be a challenge. Motivation to cook and shop may be lacking,
leading to skipped or unhealthful convenience meals. Some women
find themselves craving sweets. This is likely related to the
fact that eating such carbohydrates leads to the production of
serotonin in the brain, improving the mood. The problem with a
diet high in sugary foods and snacks made from processed flour
is that it can result in blood sugar and energy fluctuations,
weight gain, increased cravings and deficiencies of the B vitamins
(which your body needs to handle stress). One study showed that
participants who eliminated refined sugar and caffeine from their
diet experienced a significant decline in their depression. A
diet full of healthful carbohydrates such as fruits, vegetables
and whole grains complemented by moderate amounts of lean protein
will help tremendously.
Physical activity, especially in the form of regular, aerobic
exercise such as walking and cycling generates a significant antidepressant
effect. Studies have shown that consistent aerobic activity, even
as few as three days per week, makes a measurable difference in
mood. This may be due in part to the endorphins, or "happy
hormones" that exercise generates. Physical activities of
all kinds, including gardening and heavy housework, also bring
many additional health benefits including improved sleep and fitness.
Help Yourself . . .
- Recognize that your negative thinking is part of your depressive
illness and will disappear as your depression responds to treatment.
You do not need to accept your negative thinking as a permanent
part of your life.
- Give yourself time to respond to treatment. Do not expect
yourself simply to "snap out of it."
- Try not to make major life decisions (such as changing jobs,
getting married or divorced) until your depression has lifted.
In the meantime, you may want to rely on people who know you
well and who can give you an objective view.
- Try participating in activities that could make you feel better,
such as mild exercise, movies or social activities. Don't be
discouraged if you don't feel better right away.
- You may wish to spend time with others if being alone is difficult
- Try not to expect too much from yourself, as doing so can
increase feelings of failure.
- If your responsibilities seem overwhelming, try breaking larger
tasks down into smaller ones. Give yourself the time to do what
you can, when you can.
- Try not to set yourself very difficult goals or take on a
great deal of responsibility.
Find a licensed acupuncturist here: "Resources
for Finding Acupuncturists and Herbalists"
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