Can Chinese Herbs Help Clients with Depression? Part II

Treatment

Conventional medical treatment of depression, whether mild or severe, is often automatically addressed with medications. While this is an unfortunate sign of the times, there are some bright lights shining the way by advocating non-medicating interventions such as exercise, nutritional approaches, participating in self-help groups and in-counseling. These can be helpful in resolving mild depression, and can be used in combination with medications for more serious forms of depression.

The common psychotherapeutic agents currently used include the selective serotonin uptake inhibitors (SSRIs) such as fluoxetine, paroxetine, sertraline and citalopram; tricyclic antidepressants (TCAs) such as amitriptyline, imipramine, nortriptyline and desipramine; heterocyclics such as amoxapine and trazodone; and monoamine oxidase inhibitors (MAOIs) such as phenelzine, isocarboxazid and tranylcypromine. Other agents such as bupropion and venlafaxine are frequently prescribed for depression in women.

While such medications are undeniably effective when prescribed correctly, adverse effects are all too common. TCAs and MAOIs in particular are known to induce severe side-effects. As such, these are less prescribed, with SSRIs now the first-line therapy for depression in the U.S. Common side-effects of antidepressants include cardiovascular problems; sexual difficulties; weight gain; sleepiness; interactions with other drugs; and hypotension. It is little wonder, then, that an increasing number of people are turning to alternative medicine, including Chinese medicine, for help with depression.

TCM Perspective of the Emotions

According to Chinese medicine, there are seven emotions that a person can experience: joy, anger, worry, pensiveness, sadness, fear and fright. These are normal emotions that are reactions to various life circumstances. Only when they come on suddenly and intensely, or continue for a protracted period, do they lead to pathological consequences. It should be remembered that diseases caused by the emotions arise from the interior and directly affect the corresponding organs. This is different from, for example, the six excesses, which cause disease by entering the body from the exterior. Thus, symptoms caused by emotional disturbances often manifest very soon after onset. Furthermore, the immediate result is a disturbance of the qi mechanism, which if untreated causes further disharmonies depending on the affected organ(s).

Symptomatology of Depression

In terms of the Western concept of depression, among the seven emotions, the three that are most similar in symptomatologies to depression are worry, anger and sadness. While these are simple, descriptive terms, the spectrum of presentation of these emotions, i.e., depression, is very wide indeed, and many of them have already been mentioned above. The associated organs of these emotions are the heart, spleen and liver. The common syndrome patterns include those related to qi deficiency; qi stagnation; blood deficiency; phlegm; and deficiency of both yin and yang.

Etiology of Depression

In Chinese medicine, we more often speak of the emotions being the causing physical symptoms rather than the opposite. Perhaps this is because we see more of these kinds of cases, but practitioners need to be mindful of the fact that physical syndrome patterns can also lead to emotional disharmonies. For instance, a pattern that involves dampness can affect the spleen. In addition to symptoms such as loss of appetite, loose stools, turbid urine and leukorrhea, the individual may have depression-like manifestations, such as excessive sleeping, moodiness or slowing of thinking, or preoccupying thoughts during which the person continually "spins his wheels" without resolution.

Treatment

In Chinese medicine, depression is treated according to the presenting syndrome pattern. In the cases that we present below, we discuss these treatments individually. In general, for many of our clients, a multi-pronged approach is used, including herbal therapy; reduced dosage of antidepressants; counseling; and other modalities. Most individuals are highly motivated to follow through with this regimen, not wishing to dependent on antidepressant agents.

Several empirical herbal formulas used in the treatment of depression. One of the most popular formulas contains polygala (yuan zhi), which is used to quiet the heart. It has been traditionally used for insomnia, palpitations, and restlessness. In addition, this formula contains the herbal antidepressants albizza (he huan) and vervain, which have been used for several hundred years to soothe the emotions. The remaining herbs -- uncaria (gou teng); gardenia (zhi zi); damiana (folium turnerae aphrodisiaciae); white peony (bai shao); tang kuei (dang gui); pinellia (ban xia); poria (fu ling); and aquilaria (chen xiang) -- resolve dampness, phlegm, and liver qi stagnation. Typically, the pulse will be slow and may be soggy. The tongue may be pale and have a white or gray coating.

Another formula, chai hu long gu mu li tang, enters the liver meridian and is therefore best used for liver complaints such as irritability, anger, and frustration. Dragonbone (long gu) and oystershell (mu li) help calm the liver. Empirically, these herbs are used for anxiety states and insomnia. Also present in this formula is bupleurum (chai hu), which invigorates liver qi. The remaining herbs [ginseng (ren shen); ginger (gan jiang); pinellia (ban xia); scute (huang qin); cinnamon (gui zhi); rhubarb (da huang); and saussurea (mu xiang)] balance the specific effects of these herbs. The pulse is wiry or fast and the tongue may be red around the edges.

A popular calming formula based on the traditional formula ding xin wan. This formula is used to address heart yin deficiency. It is particularly useful for anxiety-based depression and insomnia. This formula contains biota (bai zi ren), which is traditionally used for irritability, insomnia and forgetfulness. Enzymes quench free radicals created during stress, and the calming nutrients magnesium and taurine. Poria spirit (fu shen) is especially known for its spirit quieting effects. In addition, the calming formula contains peony (bai shao); tang kuei (dang gui); polygala (yuan zhi); zizyphus (suan zao ren); ophiopogon (mai men dong); codonopsis (dang shen); and succinum (hu po). The pulse may be fast, and the tongue dry.