March 2007

The Treatment of Depression with Acupuncture and Chinese Medicine

By Elliot Wagner, O.M.D., L.Ac., Doctor of Oriental Medicine

Depression is defined as sad mood that lasts longer than expected when people have normal sadness or grief. In addition, the symptoms occur alongside the emotional ones. Depression is characterized not only by negative thoughts, moods, and behaviors, but also by specific changes in bodily functions (e.g., eating, sleeping, and sexual activity). Depression has the tension also characteristic of anxiety, and many people who suffer from depression, although they seem torpid, cannot relax and sleep poorly. Whether we are describing dysthymia — so-called mild depression — or deep clinical depression, it is one of the most painful and disabling ailments that we know.

In the view of Chinese medicine, different people with the same illness will manifest different imbalances, or pathological patterns. In depression, the two essential patterns are: liver qi stagnation, and combined spleen and heart qi deficiency.

People with liver qi stagnation (qi — pronounced "chee" — means vitality; in this case the normal vitality of the liver organ) often describe two ongoing feelings: a sense of frustration, and a feeling of lack of movement in life. Liver qi stagnation is caused by emotional suppression, feeling unsatisfied by one's life circumstances; excessive eating, drinking, or drug use; and living out of balance with life's rhythms.

Last month's column described the relationship of the liver in Chinese medicine to the body's master clock, the pineal gland, and how living out of harmony with life's natural rhythms can create a susceptibility to mood swings and imbalances. Here is what I wrote:

Liver metabolism has a diurnal cycle of functioning, activated by daylight and inhibited at night. These events are known to be mediated by melatonin, a neurotransmitter produced from serotonin in the pineal gland. The pineal is a pea-sized gland that sits in the brain above the optic chiasm, where the right and the left optic nerves cross. It is sensitive to light and is considered the master oscillator, or clock, in the body. It interprets the light levels coming from the eyes and communicates that information in the form of entrained oscillations or cycles to the rest of the body, so that there is order to our walking and sleeping, digestion, hunger, and reproductive cycles. A disruption in this rhythm causes a disruption in the entire system. This is first noticed in the emotions as a change in mood. If these moods are ignored; if, for example, we live in such a way that natural rhythms are disregarded, then we may find ourselves chronically sad and depressed. It is well known that depression may increase in the winter, when there is less available light, and is improved as spring approaches. Or, if we go to bed late and get up late, disregarding the normal day and night cycles, we may feel tired the whole day no matter how long we have slept, because the pineal gland requires early morning light to fully shut off the melatonin required for sleep.

The treatment of liver qi stagnation requires focusing on all elements: mental, emotional and physical. Treatment with herbal medicine and acupuncture is combined with exercise and specific life changes to disrupt the entrenched habits of negative thought patterns, sedentary and out-of-phase lifestyle, and emotional eating or drinking."

People with combined spleen and heat qi deficiency often have digestive disturbances, an excess of dampness often manifested as excess weight, and a feeling of heaviness and lack of energy. Often there is a feeling of muddled thinking, and lack of clarity, said to be caused by phlegm obstructing the orifices of the heart which, in Chinese medicine stores the spirit, and is the master of vitality. The spleen is in charge of the transformation and distribution of food essence and fluids, as well as the transformation of pathological dampness. An unhealthy and bogged-down spleen will digest food inefficiently, and generate unhealthy fluids — phlegm.

Effective spleen and heart qi deficiency treatment requires herbal medicine and acupuncture, a change in eating habits (particularly reducing foods which are cold, damp, fatty or sweet), proper food supplementation (vitamin D helps many people), exercise, regularity in eating and sleeping, and a shift in outlook from negative to creative.