Written by Marc Wasserman Ph.D. L.Ac.
Depression, according to the World Health Organization, is the leading cause of disability worldwide. People are affected regardless of gender, ethnicity, age, social standing, lifestyle, etc. Understanding of causation is often complicated due to a mix of factors including genetics, physiology, environment, medication or drug use, infection and chronic disease.
A general outline of depression symptoms can be found on the NIH website by following this link
Below we’ll go through modern and classical explanation of depression, causes and treatments as well as some practices to keep your brain and body healthy.
What causes depression?
Recent research has shown that elevations in pro-inflammatory cytokines have been associated with mood disorders and major depressive disorder. An inflammatory response to viruses, parasites, or bacterial infections, as well as any inflammation resulting from auto-immune diseases, myocardial infarction, diabetes, etc. can all induce short term and chronic changes in the body’s neurological and physiological systems.
Ancient Chinese Medical theory explaining this very phenomenon dates back to the Han Dynasty. The famous text ShangHanZaBingLun written around the year 200 C.E. discusses the possible outcomes of acute infections manifesting into chronic health problems. It begins with an introduction to acute stages of disease, progressing from common respiratory tract infections, digestive tract infections all the way on to life threatening infections of the internal organs, nervous and hematological systems. Following the diagnosis and treatment protocols for acute infections, the text compiles the possible outcomes resultant from infections which are not treated successfully or cleared correctly from the body during the acute stage. Depression is one of the possible outcomes in this situation. Below are two diagnoses of depression from this ancient text.
According to the original text “excessive lingering heat” weakens the body leading to yin deficiency of the heart and lungs. Symptoms of BaiHe disease include intermittent dysregulation of appetite, sleep, movement, and mood; including sleeplessness, lack of appetite with occasional binge eating, unexplained discomfort and no desire for activity. Other symptoms may include palpitations, heat or cold intolerance, withdrawal from social interaction, chronic dry cough, dry mouth, etc.
Bai He disease takes it name from the lily (百合BaiHe) which is used in treatment; including the classical prescriptions BaiHeZhiMu Tang, BaiHeDiHuang Tang, BaiHeJiZi Tang, HuaShiDaiZhi Tang, etc.
BaiHe is a common ingredient in Chinese cuisine. It is sweet and nourishing and can be included as part of a healthy diet, it soothes the body and calms the nerves.
According to the original text, symptoms of this pattern include frequent crying spells, sadness and unexplained discomfort of the body. In addition ZangZao disease patients incline towards anxiety and delusions in severe cases. Along with the chronic depletion of the body’s resources as mentioned above, this syndrome may also be brought on by emotional or psychological trauma. The classical pathology is dual deficiency of the heart and spleen.
Heart system deficiency is consistent across both ZangZao and BaiHe diagnoses, manifesting as the classic depression symptoms of sadness, sleeplessness, fatigue, palpitations, excessive sweating, etc. Whereas BaiHe includes lung yin deficiency manifesting as dry mouth, dry cough, and other respiratory issues; ZangZao includes spleen deficiency manifesting as worry, anxiety, delusions, etc.
Treatment involves supplementing the spleen and heart, the classic prescription for this case is GanMaiDaZao Tang.
Both of these patterns, BaiHe and ZangZao, are due to depletion of the body’s resources and chronic inflammation.
Gut Bacteria: Changes due to infection or antibiotics
Infections or treatment of infections that change bacterial colonies in the digestive tract also influence neurochemistry. This takes place due to changes in what is known as the microbiome-gut-brain axis. The digestive tract environment affects mental health and vice versa, taking place through the enteric nervous system which communicates information to the brain and can influence mood and behavior.
Our guts contain and produce the body’s highest concentration of serotonin. This important neurotransmitter is often targeted for treatment of depression and likewise is implicated in both inflammatory and functional bowel disorders.
This draws strong parallels to the traditional Chinese medical theory of emotions correlated to the organ systems, and to one of the more common treatments of mild depression, supplementing the spleen and stomach. The spleen and stomach paired organ system represents the digestive system’s chemical and physiological processes, and the psycho-emotional state of overthinking and excessive worry. Above we discussed “BaiHe Disease” and “ZangZao Disease,” another common Chinese medical diagnosis of depression is deficiency of the spleen or dual deficiency of spleen and heart. Symptoms of this pattern include excessvie worry, fear and anxiety, palpitations, forgetfulness, trouble focusing, dizziness, and fatigue. Treatment entails supplementing the spleen primarily while simultaneously nourishing the heart and blood. This is one of the most common and most effective treatments for depression. Common prescriptions include GuiPi Tang, BanXiaBaiZhuTianMa Tang, SiJunZi Tang, etc.
Genetics and Neuroanatomy
Imaging studies of the brain have started to show irregular activity associated with depression. These include irregularity of the serotonin transporter, decreased size and activation of the habenula, and both increased and decreased activity in areas of the prefrontal cortex. Irregular function and size of brain regions is what is known in Chinese medicine as qi deficiency or yuan qi deficiency. There are many formulas which can be used for treatment including BuZhongYiQi Tang, ShiQuanDaBu Tang, SiJunZi Tang, LiZhong Wan, etc.
We also commonly see hereditary patterns with depression. Research efforts continue to search for answers, but currently there appears to be correlation between depression symptoms and both irregularities of the serotonin transporter gene and brain derived neutrophic factor. Likewise aging of the brain, toxicity, or disease which leads to loss of dopamine neurons is also implicated in depression pathology. These all generally fall into the category of Yang deficiency or Kidney yang deficiency. Possible treatments include SiNi Tang, BanXiaBaiZhuTianMa Tang, LiZhong Wan, GuiZhiFuZi Tang, etc.
Acupuncture helps to balance the neurological system through stimulation of acupoints which activate specific regions of the brain. Proper needle sensation and placement is necessary to elicit the effect. Research has shown acupuncture to be just as effective as prozac in treatment of depression and other studies have demonstrated how acupuncture interrupts cortisol levels disrupting conditioned stress responses. Additionally as acupuncture can decrease the inflammatory response of the immune system and reduce pain in the body it limits the likelihood of developing worsening depression.
Chinese Herbal Medicine
Chinese herbal medicine can provide long term results for people suffering from depression. It is important to be evaluated by a licensed practitioner who can diagnose your condition and prescribe the appropriate herbal formula. There are specific prescriptions for varying pathologies, through modern imaging and research techniques, these clinically proven formulas are beginning to demonstrate effects on neurochemistry and brain health.
Get outdoors and walk one hour everyday. Movement increases circulation to the brain and being in nature has powerful effects on brain health as well.
Increase intake of nuts, berries, green leafy vegetables, fruits, seafood, eggs, and moderate amounts of wine.
Sleep at least 8 hours a night. Ideally bed time should be no later than 11pm.
Depression is debilitating and often leads to other onset of more severe disease. It is important to get symptoms under control quickly but also to avoid generating addiction behaviors or other imbalances. Many patients find themselves overwhelmed with constantly changing or multiple pharmaceutical prescriptions, when in many cases lifestyle changes and conservative treatment are all that are needed.
Acupuncture and Chinese herbal medicine have a long history of treating mental health diseases. Effects are quick and compliment other efforts of the patient and health care provider to reclaim quality of life.