Mild to severe depression is experienced by up to one-third of all patients seen in any medical practice, including Oriental Medicine clinics. Although depression and its negative effects on health and recovery from illness are more generally recognized now, still many patients with long-term chronic or serious illnesses experience depression without realizing it is a part of their illness syndrome. Others come into the clinic for minor ailments, such as a sprained muscle, and are surprised to learn that the mood problems and low energy or fatigue they may have experienced for many years can be diagnosed as depression and can be treated effectively through Chinese medicine; for them, the experience of depression is so common and such a part of everyday life that they do not even report it as a complaint or think it worth mentioning. That is one of the difficulties of treating depression; patients often have difficulty finding the energy and initiative to seek out and stick with treatment, particularly in cases of severe depression. It is important for everyone to realize that effective treatments for depression do exist in both Western and Chinese medicine, and that Chinese medicine in particularly is effective in stabilizing mood, increasing energy and enhancing quality of life.
The symptoms of depression are wide-ranging, and the primary problem that the patient brings to a medical practitioner often is not lowered mood. Instead the patient may complain of insomnia, or something as seemingly unrelated to mood as constipation. Both of these complaints are common in depression. Symptoms of depression include:
- Lowered Mood This is the primary or defining complaint; it includes feelings of guilt, worthlessness, or hopelessness. It is interesting to note the distinction between grief and depression. Each denotes sadness and lowered mood, possibly quite severe. However, in depression there is a loss of self-esteem.
- Anhedonia This is defined as the inability to take pleasure from life. The depressed patient finds himself unable to enjoy experiences or activities including those previously favored.
- Difficulty in structuring daily activities This includes poor motivation and poor concentration. Success in personal relationships and work activities is impaired; difficulty in these areas, an inability to cope with every day life, serves to reinforce or deepen the depression and to increase stress and isolation. This cycle can be difficult for the patient to break out of without help.
- Physical Symptoms These include general muscular or body pains, poor energy, low libido, insomnia, constipation, lack of appetite or compulsive eating,. These symptoms, though recognized in western medicine as part of a depressive syndrome, are often thought of as “hypochondriac” symptoms, or as “not being real”. In Oriental medicine, these symptoms are seen as very important clues for determining the type of depression and the proper treatment.
More serious depression may produce withdrawal or suicidal ideation. In cases where suicidal thoughts are present, careful evaluation is called for and a course of antidepressant drugs, such as Prozac, may be necessary to provide immediate control of symptoms. The concurrent use of acupuncture and medicinal herbs helps to control medication side effects and to harmonize the patient so that long-term dependence on antidepressants is not necessary. Many patients, who come to oriental medical practitioners after years of antidepressant therapy, find that they are able to wean themselves off of their medication, with the assistance of their prescribing physicians. Milder depressive syndromes may be treated with Chinese medicine alone. Depression may be complicated by periods of mania, during which energy is high and judgment may be poor.
In western medicine, depression is a psychological complaint. In Chinese medicine, the mind and body dualism does not exist to the same degree. The mind, representing mental, emotional, and spiritual aspects of the personality, is seen as being intimately related to and existing within the 5 primary solid, or Yin, organs: the Heart, the Lungs, the Liver, the Kidneys, and Spleen. Disturbance in any of these organ functions may produce mental or spiritual problems such as depression, and may be treated by harmonizing that function. For example, the Heart spirit, or Shen, is the aspect of spirit mostly closely corresponding to our western idea of mental function. When shen is disturbed, sleep is poorly regulated and thinking is difficult; when fire flares to the heart, manic symptoms may occur. Deficiency in the Kidneys disturbs Kidney spirit, or Zhi, affecting will power, motivation, and the ability to concentrate. Disturbance of Spleen spirit, or Yi, may lead to obsessive negative thoughts. Possibly the most important is the Liver spirit, or Hun. The hun is responsible for balancing the emotions and for connecting the outside world with the interior world of intuition and thought.
The causes of depression include anything that disturbs the energy or blood of any of the organs. An example is excessive thinking or worrying. Excessive worry damages the Spleen function. In Chinese medicine the spleen is seen as representing the digestive system, including the intake and proper distribution and use of fluids. When this function is disturbed, fluids may accumulate and condense to produce phlegm. Phlegm may exist in a concrete sense, such as excess mucus or sinus congestion, or in a more metaphorical sense as a substance that may rise to cloud the mind. It is this latter type of phlegm that causes depression. The spleen is also responsible for the intake and conversion of food into energy and the constituents of blood. Disturbance produces poor appetite and inadequate nutritional absorption; fatigue occurs and the blood is less robust. Irregular eating habits and poor diet may produce a similar situation, including a tendency to worry. In like manner, excessive anger, frustration, or suppressed resentment inhibits Liver function. The Liver is responsible for the regulation of energy flow through the body, and for the storage of blood during sleep. Stagnation of energy flow and lack of adequate blood distribution can produce body and joint pains as well as depression. Stagnation may turn to heat or fire. When fire is mixed with phlegm, manic symptoms result; the alternation of manic with depressive episodes seen in manic-depressive syndrome reflects the changing predominance of deficiency and stagnated fire in the body. In addition, basic constitutional predispositions, or heredity, play a major role in depression.
For treatment of depression, an accurate determination of organ disharmonies is necessary, as well as a determination of whether deficiency or stagnation is predominant. In deficient depression, the patient lacks the energy necessary for enhanced mood and motivation. Harmonizing the organs and restoring energy through herbs and needle treatments relieves depressive symptoms. For some deficient patients, as energy is restored, they begin to experience feelings of anger or grief which they had previously been unable to support. Acupuncture can be very helpful in releasing and reconciling these emotions. In a patient for whom stagnation predominates, though the symptoms may seem very similar, the underlying energy is adequate, but obstructed and unavailable. Releasing the blockage is all that is necessary to relieve symptoms; tonifying energy without releasing the blockage may actually increase symptoms. These patients may be recognized by the fact that they feel better after exercise, or any type of activity. Most patients are a mixture of deficiency and stagnation and treatment must be varied as these factors change in relationship to each other.