Major Depressive Disorder (MDD), also commonly known as Clinical Depression, is a mental disorder characterized by feelings of intense sadness.

The ancient Chinese too suffered from depression and felt, according to a 2,000 year old medical text called “Classic on Medical Problems“, that depression was caused by excessive “yin”.

The understanding of the causes of depression has evolved over the centuries, but today more people than ever are suffering from the condition.

According to the American Medical Association, the modern medical understanding of depression is incomplete. Many various aspects of depression are the subject of vigorous debates and further clinical research studies are clearly needed.

How is Depression Currently Treated?

Today, psychotherapy and drugs are the treatments most doctors utilize. Drugs to treat depression include:

monoamine oxidase inhibitors (MAOI’s)
tricyclic anti-depressants (TCA’s)
tetracyclic anti-depressants (TeCA’s)
selective serotonin reuptake inhibitors (SSRI’s)
serotonin-norepinephrine reuptake inhibitors (SNRI’s)

The effectiveness of these drugs is controversial and studies show inconsistent findings. In addition, antidepressant medications often cause adverse side effects, and difficulty tolerating these side effects is the most common reason for discontinuing the medications.

In 2005, antidepressants became the most prescribed class of drugs in the U.S., bringing in over $11 billion dollars annually, causing even more debate on the issue.

As more and more research comes in, one thing that has become crystal clear is that diet, lifestyle, and non-drug treatments can play a big role in reducing the symptoms of this common, often debilitating, condition.

What About Nutrition?

“Those who take medicine but neglect their diet waste the skill of the physician”

- Ancient Chinese Proverb

According to a recent study which has major implications for Americans, individuals who consume diets with elevated levels of trans-fats had a 48% increased risk for depression (www.medscape.com/viewarticle/736460 )

Lead study author Dr. Almudena Sanchez-Villegas, PhD, stated:

“The message is clear- try to eat healthy. Avoid some types of fats, such as trans-fats and saturated fatty acids, and increase intake of polyunsaturated and monosaturated fats. It’s better to consume olive oil than margarine or butter, better to use low-fat dairy than high-fat dairy, and better to eat fish than to consume meat or meat products. Avoid fast food and processed foods and commercial bakery, and increase your consumption of fruits, vegetables, and nuts.”

Another study from 2010 had similar findings: The typical Western diet is associated with a 50% increase in the liklihood of depression. According to the lead researcher of this study:

“Simply put, if you habitually eat a healthy diet of fruit, vegetables, whole grains, and a high-quality lean meat, then you may cut your risk of depression and anxiety.”

However, as the researcher notes:

“High quality meat is hard to come by in the United States because most of the cattle in North America are raised (from birth to death) in feed lots, where they are fed a corn-based diet.  This method of raising cattle may have a profound effect on the quality of the meat.” (www.medscape.com/viewarticle/715239 )

What About Exercise?

Exercise has been shown to have a dramatic effect on depression.  In one current study, after four months of aerobic exercise, 41% of patient achieved remission of their depression, causing the researcher to state:

 ”The efficacy of exercise in patients seems generally comparable with patients receiving antidepressant medication.” (http://www.ncbi.nlm.nih.gov/pubmed/17846259 )

What About Supplements?

There are several supplements that can be used to help reduce symptoms of depression.  Some of the most promising include these:

SAMe (S-adenosyl-L-methionine) is involved in the synthesis of various neurotransmitters.  A small number of clinical trials with oral SAMe has shown that at doses of 200-1600 mg/d, SAMe is superior to placebo and is as effective as tricyclic antidepressants. 

SAMe is well tolerated and relatively free of adverse effects (American Journal of Clinical Nutrition, Vol. 76, No. 5, 11585-11615, Nov. 2002).

Salvia 10 Formula (Dan Shen Jia Si Jun Zi Pian) is a Chinese herbal formula used in modern China for the treatment of depression.   One of the primary ingredients, salvia root (radix salvia miltiorrhizae) has been shown to reduce depressive symptoms in animal studies.  This is not to be confused with the salvia leaf which is smoked or eaten recreationally in certain subcultures. 

In my practice, I have had success with this formula in treating many patients with mild to moderate depression.  However, it is not to be taken by pregnant women. 

What About the Placebo Effect?

The placebo effect is often used to explain the effectiveness of anything outside of mainstream medicine, but few people realize that this powerful effect is actually responsible for 30% of all healing. 

Yes, studies show that in all modalities of medicine, including drugs and surgery, placebo effects account for their positive outcomes in 30% of all cases.

For example, in clinical trials, antidepressant monotherapy (using a single antidepressant) typically results in remission rates of 30-35%.  Placebo response rates in depression consistently fall between 30%-40% and up to 50% for short term depression. 

This leads many medical researchers to conclude that the placebo response rate is often indistinguishable from the response rate of antidepressants and many researchers are urging doctors to use sugar pills as the first line of treatment of mild to moderate depression (http://www.ncbi.nlm.nih.gov/pubmed/7945737 ).

In a 2002 article in the American Psychological Associations’s Prevention and Treatment, University of Connecticut professor Dr. Irving Kirsch found that 80% of the effect of antidepressants, as measured in clinical trials, could be attributed to the placebo effect (for an excellent summary, see www.forbes.com/2010/01/05/antidepressant-paxil-placebo-business-healthcare-depression.html ). 

Dr. Kirsch had to invoke the Freedom of Information Act in 2001 to get information on the clinical trials of the top antidepressants- this data was not forthcoming from the Food and Drug Administration (FDA). 

According to Dr. Kirsch, the data shows that in more than half of the clinical trials for the six leading antidepressants, the drugs did not outperform sugar pills. For an excellent, eye-opening newscast from the CBS news program “60 Minutes” on this subject, see www.cbsnews.com/video/watch/?id=7399362n . 

What About Acupuncture?

There are several studies on the effects of acupuncture on depression, but the results have been mixed.  Acupuncture research is difficult for many reasons, some of which seem political.  An interesting example is a study recently published which, contrary to the study’s headline, showed that acupuncture treatment provided a 40% reduction in depressive symptoms. 

This is equivalent to top antidepressents and would seem like a breakthrough, but the study headline reads “Acupuncture No Better than Placebo for Major Depression” (www.medscape.com/viewarticle/743803 ).

As good as the results were, they could have been even better had the study been designed differently.  When actually reading the study (which many wouldn’t do based on the headline), it becomes obvious that the study method is flawed. 

First, the only acupuncture they used in the study was two needles placed in the scalp.  This is not a standard acupuncture treatment for depression.  Only using two needles placed on the scalp is “undertreatment”, much like taking only 20 mg of a drug when 100 mg is the effective dosage. 

Secondly, the “placebo” they were comparing acupuncture to was “sham acupuncture” in which needles were placed in the scalp in non-acupuncture points.  They did not compare acupuncture to using “no acupuncture” (in other words, they did not use a “control group”). Since they only list the points in this group as “sham acupuncture points”, we don’t know where they are and if they really are “sham” points or actually effective acupoints.

Lastly, the general consensus for completing clinical trials in acupuncture is using “sham needles” which do not pierce the skin (in order to make the study “blind”).  This study did not use sham needles.

Regardless of these design issues, they still had a 40% average reduction in depressive symptoms, which the authors consider a failure!  Compare this with large clinical trials for antidepressants and acupuncture is favorably comparable to standard medication therapy, and unlike medications, has minimal side effects.

What About Depression During Pregnancy?

Unlike psychotropic medication, acupuncture is especially indicated in certain population groups, such as pregnant women.  Antidepressant use during pregnancy doubled between 1999 and 2003, and at the time, medical doctors thought they were safe.  Today we see advertisements on TV urging patients to sue because of the birth defects caused by these medications.  A safer alternative for pregnant women is clearly needed. 

Luckily, twelve treatments of acupuncture has been shown to produce a 63% response rate in depression in pregnant women, probably through its effects on hormonal regulation (www.medscape.com/viewarticle/717616 ).

New Theories on Depression

We have all been taught that depression is the result of a “chemical imbalance” in the brain.  But is this actually the case?  A revealing study published in 2003 in Science challenges the theory that depression is simply the result of a “chemical imbalance” affecting the brain’s production of monoamine signaling chemicals, specifically serotonin (http://www.ncbi.nlm.nih.gov/pubmed/14593164 ).

According to cellular biologist Dr. Bruce Lipton, PhD, more researchers are “pointing to the inhibition of neuronal growth by stress hormones as the source of depression” (The Biology of Belief, ISBN 0-9759914-7-7, 2005).

New Technology for Treating Depression

Microcurrent cranial electrostimulation (CES) is a relatively unknown yet effective treatment modality for several psychiatric conditions such as depression, anxiety, insomnia, and chronic pain.  CES uses extremely low levels of electricity administered through ear clips for anywhere from 20 minutes to one hour per day. 

I have seen dramatic effects on various disorders (such as severe post-traumatic stress disorder and depression) with patients using the Alpha-stim 100.  With this treatment, which I have written about previously on the blog, there is no chance of getting tardive dyskinesia, increased suicidal ideation, addiction, hepatic failure, or death (all of which are serious concerns with psychotropic drugs).

How We Treat Depression in Our Clinic

First, we have the patient complete a standardized test called The Major (ICD-10) Depression Inventory in order to get a pre-treatment baseline score of the severity of their depression.  Patients who are beyond the scope of acupuncture are referred to the appropriate providers.

Second, an examination is conducted.  A questionarre on diet and lifestyle is administered to determine possible lifestyle factors, and bloodwork may or may not be ordered (based on patients history) to look at hormone levels and other possible biological causes. 

We also obtain diagnostic information from traditional Chinese medicine examination techniques, such as tongue and pulse diagnosis.  An Acugraph digital meridian imaging test (using bioimpedence to measure skin resistance changes on acupuncture points) is often completed as well.

Next, a treatment plan is developed.  The plan will be discussed with the patient and adjusted as necessary to fit with the patient’s goals.  The treatment plan may or may not include further diagnostics, dietary recommendations, nutritional supplements, Chinese herbal medicine, exercise orders, an initial course of acupuncture treatment, Alpha-stim microcurrent cranial stimulation, and/or referrral to other medical providers.

At the end of the initial course of treatment, a second Major (ICD-10) Depression Inventory will be completed and the patients progress will be assessed.  At this stage, many patients are able to enter a maintenance phase of acupuncture treatment, only coming in for occasional “tune ups”.

There are many non-pharmacological treatments available for the treatment of depression.  If you would like to see if non-drug treatments may provide relief for your symptoms of depression, feel free to call and schedule a free consultation.