Depression

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 medicine perspective.

For Chinese Medicine perspectives on Depression, see these articles:

• Chinese Herbal Prozac: Depression and Traditional Chinese Medicine
• Q&A: Endogenous Depression, Psychiatric Meds, and Chinese Herbs

Depression

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:

1. Feelings of sadness or irritability that don't go away
2. Loss of interest or pleasure in activities formerly enjoyed
3. A change in weight or appetite (either increased or decreased)
4. Sleep disturbances, such as trouble falling asleep, awakening too early, or oversleeping
5. Feelings of guilt, lack of self-worth, or helplessness
6. Decreased ability to concentrate
7. Fatigue or loss of energy
8. Restlessness or slowed activity noticed by others
9. Thoughts of life not being worthwhile, or thoughts of suicide or death.

Dysthymia

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 clinical depression.

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 and depression.

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 adjust.

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 insulin.

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:

• Chinese Herbal Prozac: Depression and Traditional Chinese Medicine
• Q&A: Endogenous Depression, Psychiatric Meds, and Chinese Herbs

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 for you.
• 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.

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