Treating Depression: Western and Eastern Models and Perspectives

Depressive disorders are defined by the Western medical model as persistent low mood,   “unremitting feelings of sadness and despair, loss of interest and enjoyment,” and reduced energy often impairing day to day functioning. (2)  The Diagnostic and Statistical manual of Mental Disorders (DSM-IV) divides depression into major depressive disorder and dysthymic depressive disorder.  Major depressive disorder is characterized by one or more major depressive episodes of at least two weeks in duration plus four additional symptoms of depression.  Dysthymic depression is characterized by two years of depressed mood for more days than not plus additional depressive symptoms. 

Depressive disorder is common, with a prevalence of major depression between 5% and 10% of people seen in primary care settings. (2)  Though the lifetime prevalence rate for depression ranges from 8% to 20% of the population. (3) Women are affected twice as often as men in all patterns of depression.  People born after World War II have almost ten times the depression rate of their parents and grandparents. (9) While the disorder is often stigmatized and minimized by Western medicine, depressive disorders are the fourth most important cause of disability worldwide and they are expected to become the second most important cause by 2020. (2)  There is also a strong genetic basis for the development of mood disorders and the strong tendency for mood disorders to run in families has encouraged a search for the abnormal gene or genes although no definitive study has yet emerged. (3)

Treatments abound in Western Psychiatry with varying results.  Antidepressants such as monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, and selective serotonin reuptake inhibitors (SSRIs) act by increasing the level of monoamines through different mechanisms.  However, depression does not appear to result simply from a reduction in monoaminergic activity, and thus it is still unclear how exactly these drugs affect the mood.  Further, these drugs have significant side effects including sedation or agitation, insomnia, dry mouth, significant weight gain, cardiac dysfunction, nausea, and sexual dysfunction including impotence in men. (3)

Other Western treatments for depression include interpersonal psychotherapy, cognitive therapy, and when patients are not responding to antidepressant medication, are pregnant, psychotic, or suicidal, ECT or electorconvulsive therapy is implemented.  In individuals with recurrent depression, lithium sometimes is used during long-term maintenance to prevent further relapses.  Additional therapies listed in BJM include St. Johns Wort, exercise, and befriending. (2)

Eastern medicine approaches depressive disorders quite differently.  Historically in Chinese medicine, depression was called Yin Yu, ‘gloominess’ or Yu Zheng, ‘depression pattern’ with Yu presenting a double meaning of ‘depression’ and ‘stagnation’. (7)  In Simple Questions, Chapt 71 mentions the five stagnations of Wood, Fire, Earth, Metal, and Water.  The Complete Book of Jing Yue discusses six emotional stagnations of anger, pensiveness, worry, sadness, shock and fear. “In the six stagnations, stagnation is the cause of the disease.  In emotional stagnation, the disease [i.e. the emotion] is the cause of the stagnation.”

Zhu Danxi (13^th Century) discussed six depressions (liu yu)  similarly discussing depression from a perspective of the physical and emotional aspects as one and the same, or resultant of each other. These were outlined by Liu Yiren in the 19^th Century book Heart Transmission of Medicine:  “So long as the qi and blood enjoy harmonious flow, none of the hundreds of diseases can arise. Once they are depressed and suppressed, various diseases are produced.’ In general, depression is part of any disease. If depression endures, it will generate disease, or, if a disease has endured, depression will be generated. Therefore, to treat any disease, one has to take depression into account in the treatment scheme.” (1)

The liver is generally considered to function similarly to the nervous system in Western medicine and depression in modern Chinese medical theory generally centers around the liver, usually in the form of liver qi stagnation with or without complicating heat and phlegm. In these cases qi regulating and stagnation reducing formulas like Xiao Yao Wan, Yu Ju Wan, and others are very important. However, empty patterns appear in long term depression with such patterns as spleen and heart blood deficiency, heart-yang deficiency, and liver blood deficiency. (7) In these cases herbal formulas that tonify qi and blood are effective. Treatment of depression in Chinese medicine, therefore, primarily involves treating a pattern or disharmony with a carefully considered point prescription in conjunction with an herbal prescription based on that pattern. 

However, there are some treatments for depression that do not seem to have been conceived in the context of a pattern of disharmony. In Acumoxa Therapy Treatment of Disease, depressive disorder is categorized in a more Western approach as its own pattern with symptoms such as “dejection, mental dullness, progressing to incoherent speech, mood swings, taciturny, somnolence, and anorexia.”  The treatment principle is to clear the heart with Bl-15, remove liver stagnation with Bl-18, promote spleen qi circulation with Bl-20, fortify the heart with Ht-7 and transform phlegm in the middle burner with ST-40. (8)  This point prescription looks very much as if it were treating the five stagnations.

Another contemporary perspective explores the use of local points.  In the majority of cases, it can be said that shen disorders are treated by a combination of local points of the head and neck, especially GV-20 and sishencong at the top of the head, GV-14 and GV-15 at the neck- where the meridian enters the brain; and GV-23 and GV-26 at the face) plus distal points, with a focus on points of the wrist/hand and ankle/feet. Some acupuncture points were named for their effect on shen disorders, such as shenmen (HT-7), shenting (GV-24), shentang (BL-24), shendao (GV-11), shenzhu (GV-12), benshen (GB-13), and sishensong (M-HN-1). So, these are often included today as part of a treatment based on traditional indications for the points. (6)

Contemporary Eastern herbal studies with depressed patients have also yielded many positive results.  One such study using Chai Hu Gui Zhi Gan Jiang Tang (a formula in the harmonize shao yang stage disorder category) documented in the American Journal of Chinese Medicine, was tested on peri- and post-menopausal women for the treatment of the symptoms of insomnia, menopausal symptoms and DVM-IV classified depression.  The results were dramatic.  Plasma IL-6 and sIL-6R concentrations were significantly lower (i.e. alleviation of symptoms) in the Chai Hu Gui Zhi Gan Jiang Tang tested group than the group prescribed antidepressants after three months of treatment. (5) And given what we know about the side effects of antidepressants versus those of Chinese Herbs, the results are doubly successful.  

Another herbal study found Cyperus to be particularly helpful in the treatment of depression alone as well as in combination with other minor herbs.  Saffron too, it has been discovered, is proven to be successful in treating depression as well as autism, ADD, Parkinsons and others. (3) 

Lifestyle changes can also be quite important in treating depression from the perspective of Chinese medicine.  Regular exercise like qi gong which helps to tonify and move qi is extremely important to the wellbeing of the patient.  Walking daily moves liver qi and is also quite helpful.  Yoga, the precursor of Qi Gong is also highly beneficial.  Meditation and colored light therapy have also been successful in the treatment of depression. Adequate sleep, taking care not to exhaust the body with work, and avoiding excessive sexual activity are also important in allaying depression in Chinese medicine. (1)

Diet is of the utmost importance in treating depression from the perspective of Chinese Medicine.  Excess sugar, alcohol, and fats which all compromise the liver should be avoided.  Also excess sour foods take their toll on the liver and should be avoided.  Diet should be tailored to the specific pattern of the patient depending on the pattern of disharmony.  In the case of depression due to blood deficiency, for example, blood building foods should be incorporated such as beets, lean red meats, and millet.  Foods should also all be cooked and served warm to benefit the spleen for blood production.  In general there are foods that relieve depression in the short-term according to Paul Pitchford:  brown rice, cucumber, apple, cabbage, fresh wheat germ, kuzu root, wild blue-green micro-algae, and apple cider vinegar. (9)  These can be taken while the liver is being renewed.

There is an enormous amount of research, study, and a sea of treatment strategies for depression in both Western and Eastern medicine.  The primary difference between the two systems is that in Eastern medicine depression is considered part and parcel of the physical disharmony.  There is no distinction of a mental disorder because it cannot be divided from the body. In Western medicine depression is considered the domain of psychology and psychiatry, carries quite a stigma both medically and socially, and doesn’t lend itself to be categorized as a disease process as such.  In general, combining some components of Western therapy with Eastern medicine to treat depression appears to be the most effective approach.

References:

1.  Yang Shouzhong (translator), The Heart Transmission of Medicine, 1997 Blue Poppy Press, Boulder, CO

2. United Health Foundation, BMJ Clinical Evidence Concise, December 2004

3.      Subhuti Dharmananda, Ph.D., Saffron, an Anti-depressant Herb  ITMonline.org

4.      Kathryn L. McCance, Sue E. Huether.  Pathophysiology: The Biologic Basis for Disease in Adults and Children.  Mosby. St. Louis. 1997

5.      Ushiroyama, Takahisa, et al., Chai-Hu-Gu-Zhi-Gan-Jiang-Tang Regulates Plasma Interleukin-6 and Soluble Interleukin-6 Receptor Concentrations and Improves Depressed Mood in Climacteric Women with Insomnia. The American Journal of Chinese Medicine 2005; 33 (5): 703-711

6. Gu Shizhe, et al., Four acupuncture methods for treating mental disorders, Journal of Traditional Chinese Medicine 2001; 21(3): 207-210.
7. Maciocia, Giovanni.  Diagnosis in Chinese Medicine: A Comprehensive Guide 1988. Elsevier Ltd.
8. Feit, Richard and Zmiewski, Paul.  Acumoxa Therapy Treatment of Disease vol II.  1990.  Paradigm Publications.
9. Pitchford, Paul.  Healing with Whole Foods: Asian Traditions and Modern Nutrition. 2002. Berkeley. North Atlantic Books.

Chinese Medicine for my Littlest Patients

Eleanor McLamb, Lutea's littlest fan.

If you are a parent you have probably known the worry, the anxiety, and the absurd exhaustion from sleepless nights up with a sick child.  You have probably made hard decisions about what doctor to see, what medicine to take, and what alternatives to try.  As a mother I've struggled with difficult healthcare decisions for my daughter even as I was studying Chinese Medicine from some of the greatest pediatric acupuncturists in the country.  The question shouldn't be: should I use conventional or natural medicine, but to know when each is appropriate.

When my daughter was three-years-old she became suddenly ill with a fever of 104 and began to have trouble breathing until she began turning purplish-red gasping for breath.  I was not yet a practitioner so I bundled her quickly into the car and rushed her to our acupuncturist, Rachel.  Once in the treatment room, Rachel put in four needles and applied suction cups to her little back and within moments she was breathing normally.  We administered an herbal tincture and by the time we got home her fever was down and she was fast asleep.  I become overwhelmed with gratitude when I think of this incident and saddened thinking of the parents who don't know of this option that might have rushed their child to the emergency room to receive steroids, fever reducers, inhalers, and likely charged far more than the $30 that I paid for the amazing and compassionate service we received that night.  The most gratifying thing for me as an acupuncturist now, is being on the other end and helping children just as my daughter has been helped. 

Of course, not all acupuncture treatment for children is so dramatic.  But in my experience gained from treating many children, they respond even better and more quickly to acupuncture than adults.  This, for me, is the best argument that acupuncture is not placebo.   I see real results everyday with absolutely no side effects.  I talk to parents who are worried that their child would not accept an acupuncture treatment.  To that I respond that the needles I use for children are hair-thin, and if the child is apprehensive I can work just on the child's back so they aren't worried by seeing the needle.  Essential oils are also quite effective for children and I use a wide array with great results.  Cupping, massage and acupressure, gua sha (gentle scraping with a porcelain edge), and even a tuning fork are some of the other methods I use for children.  I also teach parents many of these techniques to do at home. Some of the more common childhood ailments that I have successfully treated include:

• Nausea and vomiting.  This can be relieved in moments with a few points.  Though care must be taken.  If there is food poisoning or some other toxin, vomiting is an appropriate response.  But if the nausea or vomiting is ongoing or related to a stomach bug or other virus it can be easily remedied with acupuncture and herbs.
• Upper Respiratory Infection (URI, common cold)  this can be helped easily with acupuncture best at the beginning signs of illness
• Asthma.  As mentioned above, cupping and a few empirical points can stop an acute attack in its tracks, and regular acupuncture can prevent attacks.  I have seen the seemingly miraculous effect this has for children and the relief it brings to parents as well.
• Ear Infections.  Ear pain can be eased immediately with acupuncture and recurrent use of antibiotics for repeated infections can be lessened and even stopped.  Some medical literature coming out now even reports that antibiotic use can create a cycle of ear infections.  
• Night Terrors and other sleep disturbances.  I so frequently hear parents frustrated that their children just won't go to sleep, won't stay asleep, and sometimes wake up screaming from night terrors.  Acupuncture is very effective at leveling out sleep in children and adults.  
• Chronic Cough.  Walk into any elementary school classroom this time of year and you will often hear a chorus of coughing.  Often this is worse at night.  Chinese Medicine can work almost immediately for this malady.  Try rubbing a little Eucalyptus Radiata or German Chamomile essential oil on the bottoms of the feet of a coughing child.  In mild cases this usually works quickly.
• Diarrhea, constipation, and "tummy ache".  Herbal remedies work quite well and quickly for this.  Often I can do two points on a child and there is change within an hour.  Hand and foot massage can also work wonders in chronic cases.  This is something the parent can learn quickly and use at home on a daily basis.

These are just the most common. Chinese Medicine can help colic, thrush, teething, strep throat, bed-wetting, allergies, eczema, hives, nosebleeds, and many others.  My daughter has become used to asking for "a treatment" whenever she doesn't feel well.  She just knows that it makes her feel better.  She has also never had a round of antibiotics and never taken a fever reducer.  She also knows that we limit our sugar intake, our dairy intake, and eat fermented foods everyday to stay healthy.  (I will talk more about dietary therapy in a future post.)  

For the record, I greatly value Western medicine.  It has many redeeming qualities.  If I sustain a serious wound, don't take me to an acupuncturist.  I prefer the ER.  If I have a life-threatening infection I will probably take antibiotics.  But all too often, the medications prescribed by MDs for mild conditions are overkill for children.  I liken it to killing a fly with a hammer.  Our children are sacred and beloved to us and we as parents deserve to know our options.  Chinese Medicine isn't the only option, but it is an ancient system of medicine that has many options within it.  It is what my family and many others use as primary health care with great results.  It isn't expensive, it is completely safe, and it doesn't have side effects.  As my friend Todd asks, "When did natural become the alternative?"