Depression is the most common mental health condition in the US, affecting approximately 8% of Americans age 12 and older. Signs and symptoms can vary from mild to severe including, feeling sad or empty, loss of interest in hobbies or social activities, hopelessness, difficulty concentrating or making decisions, self-loathing, isolation, irritability, fatigue, insomnia, change in appetite, unmotivated to handle daily activities, anxiety, reckless behavior and suicidal tendencies or thoughts. Even physical symptoms such as chronic aches and pains, headaches or digestive issues that have no clear medical cause can be a manifestation of depression. People often say that depression is just a chemical imbalance but the complexity of the problem goes much deeper. Depression can be caused by genetics, biological, environmental, social and psychological factors as well as medication usage and certain health issues.

Although we know that chemical imbalances in the brain are not the only cause of depression, they still play an important role. There are millions of chemicals located both inside and outside of the nerve cell and chemical messengers (neurotransmitters) drive the communication between these cells. It is the interaction of all the chemicals and neurotransmitters that affect ones mood and perceptions. In a simplified explanation, if the number of chemicals or neurotransmitters are too low or too high, moods can go awry. Some of the neurochemicals involved in this imbalance include serotonin, norepinephrine, dopamine, glutamate and GABA (gamma-aminobutyric acid).

Antidepressants and other mood stabilizing medications are meant to help balance out the chemical levels in the brain. If this imbalance is the only factor in depression, the medications should fix the problem as soon as they are taken, however, that is rarely the case. Research has shown that the levels of neurotransmitters are boosted almost immediately after taking medications but it can take weeks for the mood to stabilize. What experts now realize is that nerve cell connections, nerve cell growth and the functioning of nerve circuits are just as important, if not more so, than the levels of chemicals. It is now believed that antidepressants help spur on new nerve growth and new connections. This process (neurogenesis) can take weeks to occur and this may be why it takes individuals weeks to feel the full effect of the antidepressant.

As in western medicine, traditional Chinese medical (TCM) theory believes depression can have many different roots causes. Typically it is the spleen, liver or kidney meridians at the play in depression. Likened to the biomedical theory of too few or too many neurochemicals, TCM believes there can be too much or too little energy in these meridians. For instance, the spleen or kidney meridian can be deficient or the liver energy stagnated or in excess. Liver qi stagnation or spleen qi deficiency can happen alone or in combination. If the liver becomes too stagnated it can interfere with the spleen’s ability to perform its job of digesting or transforming food. If this process continues for too long and excess phlegm builds up it can lead to a condition we call phlegm misting the orifices. Kidney deficiency is often seen more in depression associated with advanced aging.

Although these diagnoses may sound odd or confusing, depression symptoms in the TCM pattern differentiation mirrors those of biomedicine. For instance, depression that manifests in anger and irritability falls under the diagnosis of liver qi stagnation. Fatigue, lethargy, lack of motivation and inability to concentrate are categorized as spleen qi deficiency. If the liver becomes too excess it can interfere with the functioning of the spleen causing digestive and bowel issues and/or loss of appetite. In TCM, excess phlegm symptoms are similar to a manic-depressive pattern.

Research examining acupuncture’s effects on depression is equivacol, with some saying it helps and others not. Acupuncture research in and of itself is always a difficult task, as the gold standard research methodology is to treat each and every person in the study with the same acupuncture protocol (i.e. every research participants gets treated with the same acupuncture points). The problem with that, as evidenced by this article, is that depression can have many causative factors demanding individualized acupuncture treatments. Despite the incongruence between how we employ acupuncture treatments and biomedicine research paradigms, some studies have shown acupuncture works just as well as anti-depressants or actually makes antidepressants work better. These effects have been shown with generalized depression, pregnancy induced depression or cancer-related depression. The other factor to keep in mind is that depression is rarely just treated with acupuncture. Rather it is a combination of acupuncture and Chinese herbs (discussed below) which has yet to be researched.

Similar to antidepressants, acupuncture affects the chemical balance in the brain. Acupuncture exerts changes in the body via the peripheral, central, and autonomic nervous systems. Like biomedicine, there are no exact mechanisms on how acupuncture may affect the brain neurochemistry but we do know it affects the levels of dopamine, noradrenaline, serotonin, GABA and glutamate which are the neurochemicals found to be at play through biomedical research. Similar to western medicine, it typically takes a few treatments to feel the full affect of the acupuncture treatments.

Chinese herbs can also alleviate symptoms of depression. Our formulas are always a combination of single herbs that are known to work together to harmonize the affected energetic channels. Although there are single channel imbalances that can cause depression, it is rarely that simple. Typically two or more energetic channels are at play and formulas with mulitple herbs are better able to balance out the disharmonies. Some classic formulas for depression used in TCM include Xiao Yao San, Jia Wei Xiao Yao San, Si Ni San, Chai Hu Shu Gan San, Da Zao Wan, Chai Hu Long Gu Mu Li Wan and Yue Ju Wan. Unlike the acupuncture treatments, the effects of the herbs can be felt within one to two days if the right formula is prescribed. It is important to note that these herbs do not cause any side effects.

As can be seen, the use of acupuncture and/or Chinese herbs can be used to treat depression and is often quite effective. They can be used as a first line approach to treatment, as an adjunct to an antidepressant or for those individuals who are wanting to wean off prescription medication. In those instances, patients must first contact the prescribing physician to find out how to safely wean off the medications. It is recommended that individuals receive acupuncture treatments at the same time as they begin to reduce medications to help alleviate withdrawl symptoms. If patients are using just acupuncture as a first line therapy, they should know within two to three weeks if the treatments are working. If patients employ both acupuncture and herbs, the effects can be recognized more quickly. If you or someone you know if struggling with depression, consider consulting with a practitioner of TCM.

Dr. Painovich
Wednesday, February 8th, 2017