March/April 2007

journey in our search for healing

Alternative perspectives on depression

BY WENDY UNDERHILL

Abraham Lincoln once said, “People are just as happy as they make up their minds to be.” Funny thing: the 16th president spent his life suffering from “melancholia,” as depression was described in the mid-1800s. The concept that happiness is a question of choice has long since been overturned, and yet “buck up” and “try harder” admonitions are routine.

Depression is now primarily viewed as a biologically-based, difficult-to-treat, and oh-so-common condition. About 1 in 20 people in the United States seek treatment for some form of depression-related disorder each year. For many, medication with anti-depressants combined with psychotherapy is a must; depression is a lethal disease, and willpower alone often can’t overcome the darkness and hopelessness.

Of course, there are simple, self-help measures for anyone who suffers from depression (eat right, get enough sleep, be physically active, stay in contact with friends, count your blessings). At a much more sophisticated level, alternative medicine practitioners are offering similar advice—along with medical treatment and a different perspective on the causes of depression.

Ayurveda
Cultural background influences how and how much depression is experienced. Nita Desai, M.D., a board-certified medical doctor in Family Medicine and Holistic Medicine, with equivalent credentials in Ayurvedic medicine, says that in India and the rest of Asia depression is much less common, probably because traditional cultures are reassuring mentally and emotionally. (Cultural norms in Asia are changing rapidly, and with those changes the prevalence of anxiety and depression is on the rise.) In America, she says, “We have this idea that life is supposed to be all roses and beautiful, and we aren’t taught how to handle the inevitable downs life dishes out. I think more people are medicated than necessary, when what they really need are more coping skills, social structure, and social support.”

That said, as a doctor with a practice in Boulder, Desai treats depression medically, which, in Ayurveda, means from a body-mind-spirit basis. She starts with nutrition. The appropriate diet will depend on specifics, but in general she’s likely to suggest giving up refined sugars and looking at possible wheat allergies, both of which can contribute to mood disorders. Sometimes correcting poor nutrition is all it takes for huge changes in happiness.

Next, Desai may encourage yoga or breathing techniques that, she says, “Energetically help the body release emotion and calm the mind.” Herbs such as bhrami can work at both the mind and body level, too.

For those with persistent, very severe depression, she’ll look at the spiritual level. People may feel stuck in an unsatisfactory life, and that deep unhappiness can become a “lifelong pattern,” she says. She can refer patients to others with a more spiritual bent, but in her medically based practice, she would begin to address this by teaching patients to set aside negative thoughts and replace them with positive ones. For those who are severely depressed and not functional–who are not able to get themselves to the store to buy healthy food or off the couch to do Sun Salutations–prescription anti-depressants to stabilize them may be an essential first step.

And what about talk therapy? Desai says that for some it is very helpful, but for others it can be a weekly dose of negative thinking. She’s more enthusiastic about therapy that includes a somatic (body-based) approach such as Hakomi (www.hakomiinstitute.org) or EMDR (Eye Movement Desensitization and Reprocessing, www.emdr.com).

Traditional Chinese Medicine
Another perspective on depression comes from traditional Chinese medicine. The symptom–depression– might be considered a branch off of the root, which is an underlying deficiency or excess of life force, or chi. The idea that treating the branch may be a necessary first step (the patient is suffering, after all) to be followed up with treatments aimed at the roots is not entirely unique.

What to expect? The mind and body will be considered as a whole, and sometimes Western medications will be used to stabilize the mind so other, deeper treatments can have a chance to work. Those treatments will probably include herbs–in bulk to be brewed or in tinctures–and acupuncture. Which herbs and what points for acupuncture will depend on the patterns seen by the practitioner in a whole-body review. A series of appointments over several months or longer could be expected.
Lifestyle and nutritional advice from a Chinese medical perspective are almost a certainty. Dr. Dan Finney, a doctor of Chinese Medicine in Boulder, says that nutritional advice can be quite varied, depending on the patient’s excess or deficiency; one patient with depression as a “branch” might be advised to stay away from garlic, and another to stay away from hot and spicy foods. Overall, though, the “big three” of wheat, sugar and gluten will probably be considered as potential contributors to depression.

As for lifestyle, the one piece of advice that would apply to virtually all patients with depression, says Dr. Finney, is to “get outside in nature more, especially taking walks alongside running water.”

Naturopathy
A naturopathic viewpoint uses different language than Ayurveda, but much of the message is the same, at least regarding behaviors. The goal is to assist the patient in setting up a life structure that supports good mental health, one small step at a time. Even in the face of debilitating depression, people can cultivate good habits such as eating breakfast or getting exercise, one of the greatest anti-depressants of all time.

Other options in the naturopathic medicine chest? First, make sure the body is healthy in other ways. Assessments can be done on thyroid function, adrenal function, heavy metal accumulation, food allergies and more. Only then is it time to look at supplements, starting with a multivitamin to support overall health. Next might come amino acids or other nutrients that can work on neurotransmitters (brain chemicals), just as pharmaceutical anti-depressants do. (Beware: do not mix the two.) A
homeopathic remedy may be offered as well.

Just as with Ayurvedic treatment, the naturopathic approach can include pharmaceutical medications in difficult cases and depending on the patient’s willingness. (Many people seek out a naturopath because they are unwilling to take prescription anti-depressants). And, again like Ayurveda, naturopathy is a whole-person approach that includes a great deal of self-work, with the guidance, support and advice of the medical practitioner.

Other Options
Looking at these three medical systems’ approaches to depression merely scratches the surface of what’s available. A low-functioning person could easily be cast farther down by the plethora of choices. But in virtually all cases, step one is the same: give up all drugs—alcohol, street drugs, tobacco, maybe even caffeine. (Some purists even consider sugar a drug.)

Step two might be any of the following:
• Nutritional supplements: Omega 3 fatty acids are the nutritional cure du jour for depression (and just about anything else that ails you); recommended doses for depression are 1 to 3 grams a day. Other promising supplements include GABA, SAM-e, tyrosine and phenylalanine. Deficiencies of certain vitamins and minerals—especially B vitamins and magnesium—can contribute to the blues, so if your diet isn’t in top condition, take a high-quality, food-based multi.

• Light therapy: especially for people who experience the winter blues (or seasonal affective disorder, with the apt acronym S.A.D.), getting bright lights into the house is a must. Or take a walk on one of Colorado’s plentiful bright days, getting both a dose of exercise and of mood-adjusting sunlight at the same time.

• Self-regulation: Structuring your life with lists, schedules and downtime, and constantly keeping a “Plan B” at hand, may help you manage dark times. These kinds of self-regulatory efforts are often “prescribed” by therapists or physicians. Many workbooks offer exercises that promote similar coping strategies in a concrete, step-by-step way. Books may come in handy in and of themselves; research indicates that reading about depression is as helpful as talking about it, at least for some people, some times.

• Herbs, including St. John’s wort, lemon balm, gotu kola, ginkgo, valerian—can also help fight depression; the Herb Research Foundation website (www.herbs.org) is a wonderful resource. This Boulder-based non-profit organization writes “Green Papers” on herbs and health conditions. In these, the given herbs are rated for their state of knowledge, laboratory research, international acceptance, history of use and safety record. You can order Herb Information Packets from the foundation; each is 30-45 pages long, and costs $7 ($5 for HRF members). Be cautious about mixing medicinal herbs with prescription medications; ask first.

• Self-help groups: Recovery, Inc. (www.recovery-inc.org) is a non-profit, member-run self-help organization for people with mental illness. Help comes in the form of member meetings, which are free and open to the public. Cognitive and behavioral techniques help regular attenders change their thoughts, their behaviors, and eventually their attitudes. Meetings are not intended to replace professional help, but work well as an adjunct.

• Getting help: Depression makes it hard to function, and sometimes the only thing to do is get help. Suicide and crisis hotlines are available 24/7 throughout the United States at 1-800-SUICIDE or 1-800-273-TALK (or www.suicidehotlines.com). The premise is to ensure the “survival of the body while the mind is on the mend.”

What would Lincoln do with so many choices? He’d make up his mind to pursue happiness on the alternative side of depression, one step at a time.