Alaska Institute of Oriental Medicine, Acupuncture & Massage Therapy

Traditional Chinese Medicine, Western Medicine, and Massage Therapy

Clinical Depression: How We View It and How We Heal It

Isabelle LoPresti

“DSM-IV Criteria for Major Depressive Disorder (MDD)

·             Depressed mood or a loss of interest or pleasure in daily activities for more than two weeks.

·             Mood represents a change from the person’s baseline.

·             Impaired function: social, occupational, educational.

·             Specific symptoms, at least 5 of these 9, present nearly every day:

1. Depressed mood or irritable most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g. appears tearful).
2. Decreased interest or pleasure in most activities, most of each day
3. Significant weight change (5%) or change in appetite
4. Change in sleep: insomnia or hypersomnia
5. Change in activity: psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Guilt/ worthlessness: feelings of worthlessness or excessive or inappropriate guilt
8. Concentration: diminished ability to think or concentrate, or more indecisiveness
9. Suicidality: thoughts of death or suicide, or has suicide plan”

-Diagnostic Criteria for Major Depressive Disorder and Depressive Episodes, Diagnostic and Statistical Manual of Mental Disorders (DSM) IV

 

A woman speaks –

“Depression is messy. It feels like sadness or guilt or anger. It feels illogical and irrational. It doesn’t make sense. It hurts. Depression makes you want to give in, give over, give up. It splits you from yourself and turns on you with anger. Depression makes you angry with your body, your self, your life but it never allows the anger to be released. Depression despairs of hope and cannot see a light at the end of the tunnel. Nothing can make you feel better when you are depressed.

Except maybe...

A soft and gentle hand on your back that asks for nothing and gives only soothing. A quiet voice that gives you direction and helps you to move. A deep release from the tension behind your eyes and the headache and soul ache that wakes you every morning. The salve of kindness that eases low back pain or massages the feet with warm lotion or oil. A respite. A break from the isolation and pain. And after a while, if the dark clouds part and it’s possible to see into the day again, the depression may lift, if only momentarily. In that moment, the isolation fades and it may be possible to connect with another human being – the person behind the hand on the back and the fingers on the brow.”

- Lois

 

Pamela Fitch, RMT, “Depression: How Can Massage Therapy Help”

Depression from a Western Medicine Point of View

Depression can affect someone in many different ways and does not have one specific cause. The range of causes include:

·        Chemical imbalance- Serotonin receptors do not pick up correctly causing a lack of reuptake.

·        Environmental cause- hours of daylight per day and seasons can have an affect on Seasonal Affective Disorder and the presence of depression bouts.

·        Trauma- recovery from trauma can often induce an inability to cope and overwhelming feelings of sadness and hopelessness.

·        Hereditary- the chemical balance of parents can have an effect on the child’s ability to create and maintain proper serotonin levels in the body. Parents also have a large influence on the way that a child views life and the coping mechanisms the child develops in the face of hardship.

·        Nutritional- a lack of proper nutrition can result in worsened mood and an inability to maintain homeostasis in many ways, including serotonin levels and mental state.

·        Social- problems maintaining a healthy mental state can occur when the human need for a proper support group and a feeling of being loved goes unmet.

·        Financial- in a world where money is a large part of every day life, the inability to pay for basic human needs largely factors into one’s mental state.

How Massage Therapy Treats Depression

Well-intended human touch has a variety of positive benefits that treat symptoms of depression. Decreased cortisol (also known as the stress hormone) levels allow for lower presence of stress, whole body and mind relaxation, and better quality and quantity of sleep. A person suffering from depression can benefit greatly from knowing that there is someone there with them, decreasing feelings of loneliness and helplessness. Human connection through touch can help a person experiencing overwhelming negative emotions allow those feelings to release, knowing they are safe. Focusing on the present moment, taking care of the body, and mindfulness are all parts of massage therapy that are greatly beneficial in decreasing symptoms of depression. Swedish massage therapy techniques such as effleurage, petrissage, and compression focus on soothing and relaxing tense muscles and relieving muscle knots. Temporomandibular joint (TMJ) work helps with headaches that are caused by clenching the jaw and teeth, a common side effect of increased stress that comes with depression. Cranio-Sacral Massage techniques are also very helpful to release occipital-axial compression that may cause dizziness, pain, brain fog, and headache. Proprioceptive Neuromuscular Facilitation (PNF) and Passive Range of Motion (PROM) exercises performed by the Massage Therapist help to ease muscle tension as well as provide a simple self-care practice that the client can take home and work on alone. Having a goal and set of exercises can be very beneficial to provide the right amount of responsibility for one’s self that will boost the person’s confidence in their ability to care and love themselves without being too overwhelming. Exercises and stretches done at home, a regular schedule of massage, human connection, and decreased mental and physical stress all provide a perfect atmosphere to ease the symptoms of someone suffering with depression.

Tips for the Massage Therapist

Working on a person affected by depression can be emotionally draining if the Massage Therapist does not take proper measures to secure their own emotional well-being. It is important to remember that counseling and psychiatric help are to be performed by a professional in that field. Massage therapy work for depression can be similar to working on someone with chronic pain- it is key to keep in mind that the focus is to alleviate symptoms and provide a safe atmosphere for healing rather than attempting to cure the condition.

         Easing hypersensitivity through the use of dim lights, weighted blankets (to promote the parasympathetic nervous system’s “rest and relaxation” response), ear plugs or soft music, and relaxing smells such as lavender and peppermint are great tools to utilize during the massage.

         Communication is key! Checking in with the client and being open-minded about treatment options is a highly effective way to ensure maximum comfort, relaxation, and healing.

        

Depression from a Traditional Chinese Medicine Point of View

Depression is described as “Yu Zheng” in Traditional Chinese Medicine (TCM). Causes include:

·     Lung Qi Deficiency- deficiency of lung qi is characterized with grief, inability to let go, shortness of breath, and difficulty speaking what needs to be said.

·     Liver Qi Stagnation- liver qi that cannot move can cause irritability and frustration, anger, and tension in the muscles.

·     Kidney Yang Deficiency- irrational fear and anxiety can be the result of an insufficient amount of yang energy in the kidneys.

·     Presence of Phlegm- phlegm creates a fog in the brain that makes it hard to think clearly and make decisions. It makes the body feel heavy, fatigued, and sluggish.

·     Excess Yin- too much calm and grounded energy can leave a person in a depressed state, unable to get the energy that they need to function correctly and feeling lackluster toward life. Yin is characterized as a feminine energy, explaining why depression affects more women than men.

Yin Organs and Their Related Energies That Manifest in Depression:

Spleen-worry

Liver-anger

Kidneys-fear

Lungs -grief and anxiety

How Traditional Chinese Medicine Treats Depression

Through a variety of treatment options including Qi Gong, herbs, moxa, acupressure and acupuncture as well as energy work, the symptoms of depression can be addressed and treated through TCM. Special attention to the water element, which is considered the life source, aids in the building of zest for life and ability to function and feel happiness toward one’s state of being. Water building exercises in Qi Gong are a great tool for clients to perform with their Massage Therapist and at home.

         Tonifying the Qi in Yin organs mentioned above can ease the negative symptoms that come from stagnation and deficiency. This can be done through acupuncture and acupressure along the specific meridians and points as well as herbal concoctions or burning moxa.

         The 9 Points to Revive Yang treatment taught by Cynthia McMullen is an excellent way to tonify yang and bring energy back to the person experiencing symptoms of depression. Some herbs recommended for Yu Zheng treatment in TCM include:

·     Suan Zao Ren and He Huan Pi for balancing Shen

·     Bai Zhu, Huang Qi, and Wu Wei Zi for tonifying Lung Qi

·     Chai Hu, Bai Shao, Bai Zhu, and Dang Shen for moving Liver Qi stagnation

·     Ban Xia, Fu Ling, and Hou Po for treating Phlegm and Phlem/ Qi clashing.

·     Gan Cao, Fu Xiao Mai, and Da Zao for Yin and Blood Deficiency

The most important thing in treating depression through TCM is to regain balance in whatever form is best for the client. Many treatments can be used simultaneously and allow for a multi-faceted approach to healing the body and mind.

Sources:

“Depression & Traditional Chinese Medicine”, Stanley J. Swierzewski, III, M.D.

“Depression: How Can Massage Therapy Help”, Pamela Fitch, RMT

“Depression: Causes and Treatment by Traditional Chinese Medicine” by FEMTC of biomanantial.com

Diagnostic Criteria for Major Depressive Disorder and Depressive Episodes, Diagnostic and Statistical Manual of Mental Disorders (DSM) IV