By Andrew Gaeddert
TREATMENT
Conventional medical treatment of depression whether mild or severe, is often automatically addressed with medications. While this is an unfortunate sign of the times, there are some bright lights shining the way by advocating non medication interventions, such as exercise, nutritional approaches, participating in self-help groups and in counseling. These can be helpful in resolving mild depression, and can be used in combination with medication for more serious forms of depression.
The common psychotherapeutic agents that are currently used include the selective serotonin uptake inhibitors (SSRIs) such as fluoxetine, paroxetine, sertraline, citalopram; tricyclic antidepressants (TCAs) such as amitriptyline, imipramine, nortriptyline, and desipramine; heterocyclics such as amoxapine and trazodone; and monoamine oxidase inhibitors (MAOIs) such as phenelzine, isocarboxazid, and tranylcypromine. Other agents such as bupropion and venlafaxine are frequently prescribed for depression in women.
While such medications are undeniably effective when prescribed correctly, adverse effects are all too common. TCAs and MAOIs in particular are known to induce severe side effects. As such, these are less prescribed, with SSRIs now the first-line therapy for depression in the U.S. Common side effects of antidepressants include cardiovascular problems, sexual difficulties, weight gain, sleepiness, interactions with other drugs, and hypotension. Little wonder then, that an increasing number of people are turning to alternative medicine, including Chinese medicine, for help with depression.
TCM PERSPECTIVE OF THE EMOTIONS
According to Chinese medicine there are seven emotions that a person can experience: joy, anger, worry, pensiveness, sadness, fear, and fright. These are normal emotions that are reactions to various life circumstances. Only when they come on suddenly and intensely, or continue for a protracted period do they lead to pathological consequences. It should be remembered that diseases caused by the emotions arise from the interior and directly affect the corresponding organs. This is different from, for example, the Six Excesses, which cause disease by entering the body from the exterior. Thus, symptoms caused by emotional disturbances often manifest very soon after onset. Furthermore, the immediate result is a disturbance of the Qi mechanism, which if untreated causes further disharmonies depending on the affected organ(s).
SYMPTOMATOLOGY OF DEPRESSION
In terms of the western concept of depression, among the seven emotions, the three that are most similar in symptomologies to depression are worry, anger, and sadness. While these are simple, descriptive terms, the spectrum of presentation of these emotions, i.e., depression, is very wide indeed, and many of them have al- ready been mentioned above. The associated organs of these three emotions are the heart, spleen, and liver. The common syndrome pat- terns include those related to Qi deficiency, Qi stagnation, blood deficiency, phlegm, and deficiency of both Yin and Yang.
ETIOLOGY OF DEPRESSION
In Chinese medicine, we more often speak of the emotions being the causing physical symptoms rather than the opposite. Perhaps this is because we see more of these kinds of cases. But practitioners do need to be mindful of the fact that physical syndrome patterns can also lead to emotional disharmonies. For instance, a pattern that involves dampness can affect the spleen. In addition to symptoms such as loss of appetite, loose stools, turbid urine, leukorrhea, the individual may have depression-like manifestations, such as excessive sleeping, moodiness, slowing of thinking, or preoccupying thoughts during which the person continually “spins his wheels” without resolution. Treatment
In Chinese medicine, depression is treated according to the presenting syndrome pattern. In the cases that we present below, we discuss these treatments individually. In general, for many of our clients, a multi-pronged approach is used: herbal therapy, reduced dosage of antidepressants, counseling, and other modalities. Most individuals are highly motivated to follow through with this regimen, not wishing to be dependent on antidepressant agents.
Empirical herbal formulas used in the treatment of depression include Aspiration, Calm Spirit, Ease Plus, Shen Gem, and St. John’s Seng. Aspiration contains Polygala (Yuan Zhi), which is used to quiet the heart. It has been traditionally used for insomnia, palpitations, and restlessness. In addition Aspiration contains herbal antidepressants, Albizzia (He Huan) and Vervain which has been used for several hundred years to soothe the emotions. The remaining herbs: (Uncaria Gou Teng, Gardenia Zhi Zi, Damiana Folium Turnerae Aphrodisiaciae, White Peony Bai Shao, Tang-kuei Dang Gui, Pinellia Ban Xia, Poria Fu Ling Aquilaria Chen Xiang); resolve dampness, phlegm, and liver qi stagnation. Typically, the pulse will be slow and may be soggy. The tongue may be pale and have a white or gray coating.
Ease Plus (Chai Hu Long Gu Mu Li Tang) enters the liver meridian and is there- fore best used for liver complaints such as irritability, anger, and frustration. Dragonbone (Long Gu) and Oystershell (Mu Li) help calm the liver. Empirically these herbs are used for anxiety states and insomnia. Also present in this formula is Bupleurum (Chai Hu) which invigorates liver qi. The remaining herbs: (Ginseng Ren Shen, Ginger Gan Jiang, Pinellia Ban Xia, Scute Huang Qin, Cinnamon Gui Zhi, Rhubarb Da Huang, Saussurea Mu Xiang); balance the specific effects of these herbs. The pulse is wiry or fast and the tongue may be red around the edges.
Calm Spirit is based on the traditional formula Ding Xin Wan. This formula is used to address heart yin deficiency. It is particularly useful for anxiety-based depression and insomnia. This formula contains Biota (Bai Zi Ren) which is traditionally used for irritability, insomnia, and forgetfulness. Enzymes quench free radicals created during stress, and the calming nutrients Magnesium and Taurine. Poria spirit (Fu Shen) is especially known for its spirit quieting effects. In addition, Calm Spirit contains: (Peony Bai Shao, Tang-kuei Dang Gui, Polygala Yuan Zhi, Zizyphus Suan Zao Ren, Ophiopogon Mai Men Dong, Codonopsis Dang Shen, Succinum Hu Po). The pulse may be fast, and the tongue dry.
Part 3 in this series will finish discussing formulas and present case studies.
Andrew Gaeddert is an herbalist and author of the books, Healing Digestive Disorders and Chinese Herbs in the Western Clinic.