Treatment for Depression

BUT! Not many people like it. They find the medication has unpleasant side-effects or they drop out of treatment before it completes. Others apparently recover then relapse unexpectedly.

So although it seems to work, its reputation long-term is not good. Research conducted under the USA National Institutes of Mental Health treatment showed that between one-third and two-thirds of those participating had no real symptom relief.

(Just to repeat: if the original condition was mild, and had persisted for less than two years, then the right medication might be very effective and not lead to relapse. That still doesn’t answer the problem of the side-effects, however.)

Compare SSRIs with TCAs

Overall, comparisons of the results of the newer SSRIs (Selective serotonin uptake inhibitors) and the older TCAs (Tri-cyclic Antidepressants) shows that the former are about as effective as the latter. About one third of patients on them show improvements that would not have occurred while on placebo, for the second one-third of patients the drugs work about as well as placebo and for the final one-third of patients the drugs don’t work at all.

Similar analyses of results show that psychotherapy is, overall, about as effective as drug-therapy. What is more, although drugs may start work faster, patients on psychotherapy don’t have the same side-effects from drugs, relapse less, and may be better when the reason for the depression isn’t internal: for example if you get depressed because of difficulties at work, not because of a sense of worthlessness that was there beforehand.

Relapse in the long-term

In the short-term, medication treatment for depression works quickly, if it works at all. (But it still takes several weeks to work, usually.)

If after a period of medication you stop taking it because you are better, or continue to take it in a smaller ‘maintenance’ dosage, what do surveys show you can expect?

Not so good. Up to one-third of patients who did well on initial medication fall back on continued medication. Long-term, with some drugs, the relapse rate is up to 70%. So once you have depression, it tends to recur. And cognitive or inter-personal therapy seems as good as anything at preventing relapse.

What are the causes of Depression?

Why do people get depressed, and when might acupuncture treatment for depression work?

There are lots of scientific theories about the causes of depression and there are lots of possible causes in Chinese medicine too. Few patients  have just one absolutely clear cause. Often there is both a psychological and a biological cause.

First, what does Western orthodox medicine suggest might be the causes of depression?

a. Biological

• Daily cycles:  depressed people get disturbance in their daily cycles. They can’t get up in the morning, or they can’t sleep at night; they can’t eat at their usual meal-times, or they can only work in the middle of the night.
• Shifting patterns  Shift workers, or those whose work is sometimes at night and sometimes in the day, are more prone to depression.
• A trigger, eg a shock or separation. Sometimes a trigger occurs when something on which the patient depended is removed. A spouse dies, or a job is lost: the presence of either would have made the patient get up at the usual time, eat breakfast, go to work and return in the evening for more food and social interaction. Without wife or job, the impetus to carry on is lost, triggering depression. Not looking after himself properly, the patient becomes depressed. (Of course, there will be grief and anger too, other triggers: but here we are just looking at the biological causes.)
• Genes play a part. If someone in your biological family has bipolar disorder, you are more likely to have it yourself – although this is not a foregone conclusion.
• Serotonin Regulation Serotonin is a neurotransmitter: it helps you feel good and maintain a good appetite. It also assists digestion, helps constrict blood vessels when a wound is clotting, and helps in learning and memory. When your serotonin regulation system goes awry, you may show some symptoms of depression. That’s why Selective serotonin uptake inhibitors (SSRIs) (eg Prozac) are used to try to regulate your serotonin levels and get you feeling better. One of the ways to increase your levels of serotonin is by increasing exposure to light, especially sunlight. (See more on this below under forms of Qi that help.)

b. Psychological factors

• Social skills   If you haven’t got supportive friends, family, or colleagues who can help to keep you stable, you are more susceptible to depression. The main supportive person is often a close family member, or spouse. Even good support from others may not make up for the loss of that important individual.
• A sense of Helplessness   If you don’t feel you can improve your situation no matter what you try, you’ll tend to get depressed. This can happen when you are in an uncontrollable situation, or if you realise that whatever you do, it will make no difference. The problem is worse if you develop this attitude in one situation but then apply it to all your situations. For example, if work imposes impossible demands on you and you start to feel helpless, you may start feeling helpless in your relationships outside work, even though no such problem exists there. 
• Cognitive causes   Here, you stop being able to look at things from more than one point of view: you become biased negatively, and apply this attitude to everything that happens.

c. Male/Female

There’s a difference between how men and women deal with depression.

• Men often become more active, by doing more, working harder, taking more exercise – sometimes self-destructively.
• Women tend to internalise it and do less physically, which makes them ponder their situation alone and to take less action. This brings up old, unhappy memories which reinforce seclusive habits and the tendency to depression.

Orthodox Treatment for Depression

Medication

Drug treatment for depression means anti-depressants like Tricyclic medications, SSRIs and (still) MAOI (Monamine oxidase inhibitors) antidepressants. All have side-effects, though so far SSRIs seem to have less of them.

For severe cases, ECT – electro-convulsive therapy is still used in some countries.

Psychological treatment for depression

Cognitive therapy is the treatment of choice, although as explained above, other forms of psychological counseling have their part to play.

Often a combination of approaches is used.

For more on the psychological aspects check here.

Acupuncture Treatment for Depression

In traditional Chinese medicine, treatment for ‘depression’ is a short-hand for a wide range of syndromes. Syndromes are descriptions of conditions in Chinese medicine theory when there is an imbalance in, for example, your zang-fu energies, or when describing a condition recognised in Chinese medicine, like ‘damp‘.

Before designing a treatment for depression, the acupuncturist would, like any practitioner in other forms of medicine, carefully take your case.

In addition, the acupuncturist would take your pulses, look at your tongue, examine any painful areas in your body, palpate your abdomen and consider the results of previous treatments on the flow of Qi along your acupuncture channels.

Your condition might then be described in terms of syndromes. There might be more than one syndrome. However, the following are only examples of what might be diagnosed. There are many other possibilities:

Frequent Syndromes

• Qi stagnation
• Qi deficiency, including Stomach Qi deficiency
• Damp
• Liver Qi stagnation
• Lung Qi stagnation
• Weak Shen
• Gallbladder deficiency
• Yang deficiency
• Blockage (‘Bi’ syndrome) in a channel
• Kidney and/or Jing deficiency
• Pericardium deficiency or blockage
• Where you are in Life

In addition, what might be called ‘re-education’ treatment for depression might be required, if you were in China. In the West we might call this counselling, but in the past some might have described it more like brain-washing. To be fair, however, the aim was to make society work better, and only secondarily, perhaps, to control dissent.

As you can see from the above list, there are many possibilities. Each requires a different strategy when using acupuncture, with different acupuncture points being used.

Of course, the personalities of the patient and acupuncturist matter, but probably more in the West than the East, where the authority and  skills of the acupuncturist matter more.

Still, if the diagnosis is correct and the acupuncture treatment for depression performed properly, the syndromes in question should be put right, together with the ‘depression’.

For more on this click on acupuncture for depression. In terms of where you are in life, 5 Elements Acupuncture can often help.

Qi stagnation is very common in depression. You can read my book about it in the link below or on the right.