Everything you need to know about Depression – from Traditional Chinese Medicine, Acupuncture and Western Medicine

Regular sessions of Acupuncture and Traditional Chinese Medicine can treat Depression.

What is Depression

The name depression comes from the late Latin word ‘depressare’ and the classical Latin word

‘deprimere’. ‘Deprimere’ literally means ‘press down’. In essence, the term appears to denote a feeling of

heaviness, of being ‘pressed down’. This is also referred to as ‘sad’, ‘blue’ or simply ‘down’. Depression as a

referent to mood or emotional state appeared as early as 1665 and merely meant a lowering of mood or

spirits.

Depression can range in severity, from mild symptoms of low mood to severe persistent symptoms that

may affect the lifestyle of the person. When a person’s symptoms are persistent and severe and need the

interference of medical attention, it is then categorized as clinical depression.

Difference between Depression and Sadness

Sadness is part of the human experience and one of the emotions that all human feel at certain times in

their lives. It is a natural reaction to issues and situations that can result in feeling down and out. However

just like other emotions such as happiness, joy, anger, worry, fear, the emotions do not stay but are

temporary.

However when the low mood or sadness lingers for weeks to months and start to have reverberations on

the daily functionings of a person such as social or occupational, and also the physical health of the

person becomes deteriorated, that is when sadness crosses the line to depression. And if left untreated or

unaware, the symptoms of depression can have last for a long time.

DSM-5 criteria

In professional medical clinical settings, health professionals use the DSM-5 (Diagnostic and Statistical

Manual of Mental Disorders) criteria to help determine if someone is just sad or have crossed over to the

diagnosis of depression. The DSM- criteria include nine potential symptoms of depression and the

seriousness of each symptom is weighed individually in the diagnosis process.

Symptoms of Depression

Here are the nine potential symptoms of depression that are often used in professional clinical diagnosis

of depression:

1.       Loss of interest and enjoyment in activities that used to be seen as pleasurable

2.       Problem getting into sleep or disrupted sleep or sleeping too much

3.       Feeling depressed and low in mood throughout each day on most or every day

4.       Eating too little or not eating or eating too much, accompanied with sudden weight loss or weight

gain

5.       Feeling tired or fatigued most of the time

6.       Unable to focus, restless and easily agitated or irritated

7.       Unable to concentrate or make decisions

8.       Unwanted or amplified feelings of guilt or worthlessness

9.       Thoughts, plans or actions of suicide or thinking more about death and dying

Types of Depression

Depression can take on many forms and may be categorized in several different ways. There can be up to

10 different types of depression but here I will just talk about the six common kinds in modern society

today.

1.       Major depression – the classic depression which affects most people being diagnosed with

depression.

2.       Persistent depressive disorder – this depression was known as ‘dysthymia’ and the actual clinical

definition goes by the duration of the low mood being at least two years but the severity of the low mood

does not reach that of the major depression.

3.       Bipolar disorder – this is also known as manic-depressive disease in which the patient will have

bouts of unusually high energy and then followed by periods of depression. During the periods of extreme

heightened energy, the symptoms displayed are usually the opposite of depression which can make it

difficult to diagnose. Some of the symptoms during heightened energy in bipolar disorder are risk taking,

unrealistically high self-esteem, reduced time for sleep, thoughts going at high speed, increased pursuit

for pleasure such as having shopping or sex spree.

4.       Seasonal affective disorder – this is common in regions where days are shorter in the fall and winter.

This is as a result of body’s natural daily rhythms changes with the involvement of melatonin and serotonin

and the sensitivity to light.

5.       Postpartum depression – this depression type is common to women during or in the first 12 months

after giving birth. This depression type can be due to the changes in hormones and fluctuations post-natal

which can affect the mood and perspective of the women.

6.       Premenstrual dysphoric depression – This is a more serious form of premenstrual syndrome or PMS.

This is more common in the period between ovulation and the start of menstruation, which is signature of

hormone fluctuations as the major cause for depression occurrence.

Risk Factors and Predisposition to Depression

Although depression can happen to any one of any age, any races or socioeconomic backgrounds, there

are some risk factors that can increase the chances of having depression for some people. It is important

to note that having one or more of the risk factors does not mean that one will definitely have depression.

·       Family history of mental illness such as anxiety, depression or bipolar disorder

·       Early childhood or teenage trauma

·       Substance abuse history such as drugs or alcohol

·       Low self esteem personality

·       Lack of support system from family, friends, coworkers

·       Lack of society or family acceptance for sexual orientation such as being gay, lesbian, bisexual or

transgender (LGBT)

·       Difficulty in adjustment to sudden medical condition such as stroke, chronic pain, cancer, heart

problem

·       Difficulty in adjustment to body injuries such as losing a limb in accidents or paralysis

·       History of prior mental health disorders such as bulimia, anorexia, post traumatic disorder (PTSD),

anxiety

·       Inability to cope with devastating life events such as death in the family

·       Western medications with side effects that can cause depression – beta blockers, corticosteroids,

statins, hormones pills or hormone medications

Causes of Depression from a Western Medicine Perspective


Brain cell connections and growths


In the past, there was a period when depression was described as just a simple imbalance in the brain

chemistry when the neurotransmitter serotonin was thought to be deficient in the person’s brain. Serotonin

is the feel-good hormone that enhances mood and uplifts perspectives in the human body. However this

conclusion was based on the procedure that patients with depression were prescribed medications

which increases serotonin levels and showed that that has helped to improve the symptoms of

depression. Yet this does not clearly explain and fully justify that depression is simply a condition due to

the lack in one hormone. In fact the complexity in the causality of depression is much more than that, even

though neurochemistry is certainly involved.


In recent years research have shown that brain cell neural connections and neural cell growths may be

involved in the cause of depression as well. This is because under rigorous diagnostic scans of the brain

of a patient with depression, the hippocampus looks much smaller than the average size of a

hippocampus of a normal person. The hippocampus controls memory and emotion. Although other areas

of the brain may be affected as well, the hippocampus seems affected more in this respect. Furthermore,

the longer the depression persist, the smaller the hippocampus becomes. This is because the brain neural

cells and connection networks deteriorate and die off, literally. Also stress which is often experienced

along with depression can cause the growth of new neurons to decrease in the hippocampus area.

Conversely, when the hippocampus region of the brain regenerates and grows with new neural cells and

connections created, the mood of the person improves.


Neurochemistry


Although serotonin was thought to be the main hormone that creates the mood improvement and

upliftment effect in a person, the increase in serotonin can also stimulate the release of other

neurochemicals that can contribute to the growth of new neurons and connections. With new neurons and

connections, the brain and especially the hippocampus can regenerate and regrow, ultimately helping to

improve the mood of the person.


Genetics


Genetics is another factor that can predispose a person to depression. The variation of the serotonin

transporter gene can also cause a person to be more susceptible to depression. Scientific studies have

shown that every person has two copies of the serotonin transporter gene, one copy from each parent and

each gene can be short or long. A scientific study done with 800 young adults over 5 years showed that

one third of the individuals with one short version of the serotonin transporter gene became depressed

easily after stressful life events. People with two short versions of the serotonin transporter gene are worse

off than those with only one short version and get depressed even much faster and easily. However,

people with two long versions of the gene are less likely to become depressed under similar stressful life

events.


Cause of depression is multifactorial  

 

The true cause or causes of depression are not yet confirmed by science today. This is because the

condition has a huge array of variables that come into the picture of causality. Nevertheless, we can be

sure that depression has its basis rooted from biological, psychological and social factors.


It is not simply a weakness that somebody should get over or something that we have a say in. Just like

major illnesses such as cancer, shedding light on the subject is of utmost importance for better

understanding of the condition to have more empathy towards depressed patients and to work on wise

solutions that can help bring the person out of the depressed state soonest.


Treatment of Depression using Western Medicine and their Accompanying Side Effects

1.       Selective serotonin reuptake inhibitors (SSRIs)

This is the most commonly prescribed antidepressant class. The drugs are known to prevent the reuptake

of serotonin. Examples of SSRIs are Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac,

Sarafem, Symbyax), Fluvoxamine (Luvox), Paroxetine (Paxil, Pexeva), Sertraline (Zoloft), Vijbryd (Vilazodone

hydrochloride).

Side effects: weight gain, nausea, diarrhea, drowsiness, sexual health conditions

2.       Serotonin and Norepinephrine reuptake inhibitors (SNRIs)

This class of antidepressants work by blocking two brain chemicals from reabsorption, making them more

available to the brain. Examples of SNRIs are Cymbalta (duloxetine), Effecor XR (venlafaxine), Fetzima

(levomilnacipran), Pristiq (desvenlafaxine).

Side effects: dry mouth, nausea, dizziness, headache, excessive sweating, tiredness, constipation,

insomnia, loss of appetite, sexual dysfunction

3.       Cyclic Antidepressants

Tricyclic and tetracyclic antidepressants are older forms of antidepressants that work by blocking the

reabsorption of serotonin and norepinephrine via a different biomechanism than the SNRIs. However

cyclic antidepressants are seldom used today unless other antidepressants do not work. This is because

cyclic antidepressants are prone to causing a range of side effects, some of which may be serious and

result in disorientation or confusion. Examples of cyclic antidepressants are Asendin (amoxapine),

Amitriptyline, Aventyl, Pamelor (nortriptyline), Norpramin (desipramine), Sinequan, Silenor (doxepin),

Tofranil (imipramine), Vivactil (protriptyline), Ludiomil (maprotiline).

Side effects: drowsiness, blurred vision, constipation, dry mouth, urine retention, drop in blood pressure

that can cause light headedness when moving from sitting to standing  

4.       Monoamine oxidase inhibitors (MAOIs)

This is the oldest class of antidepressants and they work by blocking the enzyme monoamine oxidase

which breaks down neurotransmitters such as serotonin, norepinephrine, dopamine. Examples of MAOIs

include Emsam (selegiline), Marplan (isocarboxazid), Nardil (phenelzine), Parnate (tranylcypromine

sulfate).

Side effects: MAOIs are not widely used today as they may result in side effects when used in interaction

with certain foods such as aged cheeses, sauerkraut, cured meats, draft beer, fermented soy products

which contain large amounts of tyramine which can result in dangerous high blood pressure with MAOIs,

or drugs such as other prescription antidepressants, prescription pain relievers, cold and allergy drugs

and herbal supplements such as St John’s wort. They may be used when people do not respond to other

antidepressants.

5.     Other antidepressants

These antidepressants do not fit into any of the above classes and they treat depression through altering

different neurotransmitters in the brain.

Examples of other antidepressants available in the pharmaceutical market today are Wellbutrin

(bupropion), Trazodone (Oleptro), Nefazodone, Mirtazapine (Remeron), Vortioxetine (Brintellix), Spravato

(esketamine), Zulresso (brexanolone).

Side effects: Similar as antidepressants mentioned above.

 

Causes of Depression from Traditional Chinese Medicine Perspective

As mentioned before, depression is when sadness is prolonged and lingered within a person’s emotional

arena to a level when normal daily functioning is affected.

The recognition of emotion playing a part in the causality of illnesses is unique in Traditional Chinese

Medicine and has a history as long as the existence of the medicine. For depression, the condition was

recorded in ancient texts and given the name of “yu” (郁) or “yu zheng” (郁证) which literally means

blocked, stagnated, entangled, not flowing. Many ancient Traditional Chinese Medicine doctors have

proposed the pathophysiology of “yu”.

Depression as recorded in Ancient Traditional Chinese Medicine Classics

Chen Wuzhe, who was a famous Traditional Chinese Medicine doctor, mentioned in ancient texts the

concept of changes in the seven emotions in Traditional Chinese Medicine resulted in disharmony in the

internal organs which then led to “yu” or depression.

Another famous doctor named Zhu Dan Xi proposed the theory of six depression for the pathophysiology

of depression that involved the stagnation of either qi, blood, dampness, phlegm, food, fire. He

emphasized on understanding the disease dynamics first before coming up with the right treatment plan

for the condition.

Depression explained in Traditional Chinese Medicine concepts

Depression as translated into Chinese is known as “yiyu” or 抑郁。As mentioned before, it has the

connotations of blockages or stagnations within the body and emotional systems.

Unlike Western Medicine, Traditional Chinese Medicine diagnosis is based on a process called differential

diagnosis or syndrome differentiation. This is when doctors identify the underlying symptom co-

occurrence patterns of the disorder through techniques of asking, observing, palpating, smelling.

Liver is the main organ affected in Depression

The onset of depression is often because of extreme emotional changes that are highly related to Liver

and Liver qi or energy. In the initial stage of depression, the differential diagnosis is mostly under the

“excessive type” of the imbalance. When depression is prolonged to a state of chronic and relapse, it will

transform to the “deficiency type”. Usually the poor circulation and stagnation of Liver Qi movement are the

main reasons for the build up of depression.  

How Depression is built up In Traditional Chinese Medicine

When a person experiences emotional change, Liver Qi is affected first or imbalanced, either becoming

excessive or sluggish in movement. This change in the Qi or energy flow from Liver will then affect the

other five organs, especially the Spleen and Heart .

If the circulation of the Liver is not rectified in time and the emotional upheaval or change persists, the

function of the Spleen will be affected and repressed as well. At this stage, the person may experience loss

of appetite, bloatedness, indigestion, nausea. Eventually this dysfunction in Spleen or the digestion will

start to affect and hurt the Heart Qi mainly. When the Heart loses its nourishment from the energy or qi that

is from digestion or the Spleen, the “shen” or the spirit which is one of the five ethereal souls governed by

each organ will become restless. This will be displayed as unstable and depressed in mood.

As time goes by with the imbalance still not treated or rectified, the Liver qi that is stagnated and blocked

will accumulate and transformed to fire, in which the person will start to experience inflammatory

symptoms in the body more, such as aches and pain, soreness, gastric reflux, ulcers and many other

symptoms related to fire.

Therefore we can see that if the Liver is unable to maintain its free and unobstructed flow, depression will

be experienced and the consequential effects will be mainly at the Spleen and Heart.

Treatment of Depression using Traditional Chinese Medicine

The treatment of depression is initiated through the process of differential diagnosis first to identify which

syndrome pattern of depression is the patient suffering from before a suitable treatment plan is drawn up

for the individual condition. Nevertheless, acupuncture and herbal medicine are definitely two of the main

modalities that can help with curing depression.

Acupuncture

There are multiple scientific papers that have shown that acupuncture helps in the recovery of depression.

You can read more about the scientific papers that have supported this in my blog post .

The effects of how Acupuncture can help with Depression can be described from a Western Medicine

point of view and Traditional Chinese Medicine point of view.

How Acupuncture works for Depression from a Western Medicine perspective:

For depression, there is a pathophysiology theory that states that this condition is related to glutamate

dysregulation. This dysregulation is marked by a high rate of glutamate release and increased expression

of glutamate receptors and glutamate transporters in the central nervous system. Acupuncture

stimulation is able to regulate and modulate glutamate receptors, which supports how Acupuncture can

help to treat Depression through intervening the dysregulated glutamate system.

How Acupuncture works for Depression from a Traditional Chinese Medicine perspective:

Acupuncture works by stimulating the acupoints as a formula suitable to the differential diagnoses made

for depression.

Nonetheless, as mentioned above, the main organ out of balance with depression is the Liver. The

secondary organs affected are mainly Spleen and Heart. The acupoints that can usually help with

Depression are to help with enhancing Liver Qi circulation, Heart nourishment and Spleen invigorating. 

Herbal Medicine

Herbal Medicine can help to enhance Liver Qi circulation. Some of the common herbs that can do that are

Bupleurum, Cyperus Rhizome, Turmeric Tuber.

For Heart nourishment, some common herbs used in formulas are Arbor vitae seed, Senega Root.

For Spleen rejuvenating and invigorating, Atractylodes Maccrocephala Rhizoma, Glycyrrhiza Uralensis

Radix, Astragali Sinesis Radix. These herbs help to clear dampness which has the characteristic of

heaviness and can cause one to feel sluggish and low mood.

Yoga Poses to help with Depression

Bridge Pose

Bridge pose is a heart opener and an inversion which can help to increase focus and clarity. When done in

the right way, it can assist in making one feel lighter and upliftment of mood.

Self Help Tips from Traditional Chinese Medicine and other Ancient Medicine for Depression

Acupressure Point for Depression

Nei Guan

Nei Guan (PC 6 ) is an acupoint that can help to

open the chest, regulate Heart Qi and Blood,

calms the mind, harmonizes Stomach Qi and

improve general body circulation and the

clearance of dampness.


Directions: Press on this point for 3 to 5 minutes everyday or whenever one feels low in mood.


Further Reading: How do acupuncture and acupressure work and which is the better one


Breathing exercise for Depression


Kapalabhati


This is a traditional internal cleansing technique, also known as kriya. It is also known as Skull Shining

Breath or Breath of Fire.


The practice consists of alternating short and explosive exhales in which the lower belly will contract

inwards while inhales are passive responses to the release of this contraction, which sucks air back into

the lungs.


This practice is a powerful method to uplift mood as it boosts the production of endorphins within the

body.

Conclusion

It is important to note that depression is not something just in the head and that it does have physiological

effects on the person suffering from this condition. Causes of depression are complex and can stem from

biological, psychological and social reasons. Considering the solutions from Western Medicine are

accompanied by a spectrum of side effects that can excerbate depression itself, Traditional Chinese

Medicine and other ancient medicines provide a more holistic and humanistic approach to treat from the

inside and root causes without side effects.


Basics of TCM, TCM Wellness, TCM(Traditional Chin Med), TCM and ScienceXiang Jun LimDr (TCM) Xiang Juntcm, traditional chinese medicine, acupuncture, depression, western medicine, herbs