Depression- a TCM perspective.
Depression is a common mental health condition, with an estimated 1 in 6 Australians experiencing it in their lifetime. It is more than just feeling sad. There are different types, however we will be discussing Major Depressive Disorder here. It is characterised by (6) persistent lowered mood, changes in sleep, weight and appetite changes, loss of interest or pleasure in things, feeling tired, feeling restless or irritable, feeling worthless, having difficulty making decisions, increased alcohol or drug use, and thinking about death repeatedly. Symptoms of depression such as these become more noticeable when they interfere with daily living.
Getting help for depression can be challenging as sometimes it doesn’t feel like we need help or deserve to feel better. Typical treatment involves psychological therapy and/or antidepressant medication. Support groups and complimentary therapies also play a role in the treatment and management of depression as it is a long-term condition. This is where acupuncture and TCM can come in to it.
In TCM, depression is seen as stagnation either from a deficiency or from excess. This can occur*:
When emotions aren’t flowing freely (e.g. anger, stress, resentment, frustration, grief/sadness, worry). This is often called ‘reactive depression’ in WM.
Due to constitutional factors (genetic tendencies). This can sometimes be seen as a midline heart crack on the tongue.
If diet is improper. Such as excessive amounts of dairy, sweets, breads, raw & cold foods/drinks. Or if on restrictive diets or not eating enough food or variety (e.g. vegan/vegetarian).
Due to overwork without adequate rest.
This manifests in a range of symptoms both physically and mentally.
Some patterns of depression in TCM:
Liver Qi deficiency- this occurs when not enough Qi and Blood rises to the head to nourish the mind and move the Ethereal Soul (which is all about life path and purpose), and therefore results in depression, lack of inspiration, lack of life dreams, confusion about life direction, timidity, indecisiveness.
Liver Qi stagnation- this is commonly due to stress or repressed emotions such as anger or resentment. Mostly in young people from teenager to 35. It manifests with depression, moodiness, bloating, muscle tension and aches (neck and shoulders), irregular bowel movements, irregular periods, PMS. This can further generate Heat which can result in short temper, headache, red eyes, tense feeling, constipation.
Heart and Lung Qi stagnation- This is typically due to sadness, grief (due to loss) and worry and more common in young people up to 35yo. It manifests with depression, sadness, palpitations, slight lump in throat, slight SOB, sighing, stomach and chest distension, dislike lying down, pale complexion.
Phlegm heat harassing the mind- This is usually due to long standing emotional stress combined with irregular poor diet, especially in those over 45 with a tendency to obesity. It manifests as depression, restlessness, anxiety, agitation, restless sleep, excessive dreaming, insomnia, palpitations, dizziness, heavy head, nausea.
Blood stasis obstructing the mind- usually due to prolonged emotional stress. It manifests as depression, restlessness, agitation at night, short temper, restless sleep, chest pain.
Spleen and Heart deficiency- this is more common in younger women. It manifests as depression, brooding, always thinking, palpitations, timidity, difficulty falling asleep, pale face, dizziness, poor appetite.
There are others and combinations of all. This is where a qualified practitioner is great- to give you an individualised diagnosis and treatment.
Health issues are often calling us to listen in to our inner wisdom and change how we are living or thinking (e.g. if we aren't happy with something in our lives we need to make changes so it aligns with our core values and life path). Therefore the path of healing is often deeply rooted in introspection and transformation.
The 5 spirits & depression.
In TCM there are five ‘souls’ or ‘spirits’ which correspond to the five main organs. These are each responsible for different areas of our psyche. Each can play a role in depression.
Zhi- The spirit of the Kidneys. It relates to a lack of will power, drive, initiative, enthusiasm, momentum to break out of depression. We can use acupuncture points BL23, BL52, KI3 to address and strengthen the Kidneys and inner strength.
Hun (ethereal soul)- The spirit of the Liver. When there is not enough movement of Hun, it results in lack of plans, ideas, life dreams, hope, inspiration and sense of direction. We can use acupuncture points GB40, BL47.
Shen- This is the spirit of the Heart and also termed as the 'Mind'. It has a close relationship with the Hun as it helps to focus and control the free-spirited planner and dreamer that is the Hun. It is affected by angst, anxiety, despair, sadness. We can use DU24, CV15, HT7.
Po (corporeal soul)- The spirit of the Lungs. Issues here result in morbid thoughts about death. We can use DU24, BL13, DU12, BL42.
Yi (intellect)- The spirit of the Spleen. It is affected by overthinking, obsessive thinking, pensiveness and brooding. We can use GB15, BL49.
So, what does the research say?
Studies (1) show that acupuncture appears to be more effective and safer than typical treatments (antidepressants) or no treatment. The quality of these studies is quite low however, but it is promising. Particularly, with less side effects of treatment. TCM can also be given in combination with SSRI’s (a common anti-depressant medication) as a study (2) on depression in Parkinson’s disease found that TCM formulas in combination with SSRIs had a more positive effect compared to SSRIs alone. There is also potential in post-natal depression (3) but again, studies are limited. The major benefit of acupuncture and TCM is the lack of side effects as opposed to medication, particularly in older adults (4). The odds of remission after anti-depressants are quite low and decrease with each change of medication (5), therefore a long-term treatment plan is advisable.
What does a TCM practitioner do for depression?
In a treatment for depression, we will ask questions to get a better idea of what your pattern of depression is like for you and how it affects your life. From there we will use acupuncture and herbal medicine to address your individual pattern. Treatments are best to be weekly for a period of 1-3 months to get things under control, and then continue with fortnightly/monthly appointments to maintain and prevent relapses.
A personal note.
If you are struggling at the moment, I understand where you're coming from as I experience this myself and have seen a family member suffer it too. You are not alone. You deserve to feel good. You are worthy of help, no matter how severe or mild your condition is. Please reach out if you would like support with this. I am happy to work within a team with other health professionals and there is never judgement on your decision for medication. Please contact Lifeline on 13 11 14 if you need someone else to talk to. You are loved and worthy of living, there is always hope.
*All Chinese medicine patterns: Maciocia, G. (2009). The psyche in chinese medicine : Treatment of emotional and mental disharmonies with acupuncture and chinese herbs.
Li, M., Niu, J., Yan, P., Yao, L., He, W., Wang, M., Li, H., Cao, L., Li, X., Shi, X., Liu, X., & Yang, K. (2020). The effectiveness and safety of acupuncture for depression: An overview of meta-analyses. Complementary therapies in medicine, 50, 102202. https://doi.org/10.1016/j.ctim.2019.102202
Feng, S. T., Wang, X. L., Wang, Y. T., Yuan, Y. H., Li, Z. P., Chen, N. H., Wang, Z. Z., & Zhang, Y. (2021). Efficacy of Traditional Chinese Medicine Combined with Selective Serotonin Reuptake Inhibitors on the Treatment for Parkinson's Disease with Depression: A Systematic Review and Meta-Analysis. The American journal of Chinese medicine, 49(3), 627–643. https://doi.org/10.1142/S0192415X21500282
Li, W., Yin, P., Lao, L., & Xu, S. (2019). Effectiveness of Acupuncture Used for the Management of Postpartum Depression: A Systematic Review and Meta-Analysis. BioMed research international, 2019, 6597503. https://doi.org/10.1155/2019/6597503
Sobieraj, D. M., Baker, W. L., Martinez, B. K., Hernandez, A. V., Coleman, C. I., Ross, J. S., Berg, K. M., & Steffens, D. C. (2019). Adverse Effects of Pharmacologic Treatments of Major Depression in Older Adults. Agency for Healthcare Research and Quality (US).
Kverno, K. S., & Mangano, E. (2021). Treatment-Resistant Depression: Approaches to Treatment. Journal of psychosocial nursing and mental health services, 59(9), 7–11. https://doi.org/10.3928/02793695-20210816-01