Integrative Medicine & Depression

Integrative Medicine Approach To The Treatment Of Depression

WHAT IS DEPRESSION?

Depression (also known as major depressive disorder) is a serious medical condition that affects how you feel, think, and act. It is a systemic illness meaning it affects the whole body not just the brain. It is a mood disorder that may have a serious negative effect on your mood resulting in reduced energy, positivity, and motivation to perform regular activities. You may no longer enjoy pursuing your hobbies, work, or even routine activities of self-care. It may also affect your health by altering your level of activity, appetite and sleep. (1)

Depression currently has a lifelong global prevalence of 10%. Its prevalence in clinical settings can reach up to 20%. (2) The cause of this illness is multifactorial – a combination of factors often leads to depression such as genetics,  triggered by stressful external events, or a chemical imbalance in the brain. However, there is no one definite cause for depression. Every person is vulnerable to depression. Although women are three times more likely than men to become depressed, men are five times more likely than women to attempt suicide when depressed. (3)

Other types of depression include Persistent depressive disorder, psychotic depression, bipolar disorder, seasonal affective disorder, and postpartum depression. DSM-5 edition includes two more types, namely disruptive mood dysregulation disorder and premenstrual dysphoric disorder (PMDD). The former is diagnosed in children and adolescents. (4)

WHAT ARE THE SYMPTOMS BASED ON DSM-5 CRITERIA?

The DSM-5 lists the following symptoms of depression -

Signs and symptoms of major depressive disorder are:

• Feeling depressed

• Significantly reduced pleasure or interest in most things.

• A decreased or increased appetite almost every day.

• A relevant drop in physical movement and a slowing of thought (as observed by others, not just the individual’s feeling).

• Experiencing fatigue or a loss of energy.

• Feelings of inadequacy or worthlessness or excessive guilt.

• Significantly reduced capacity to think or concentrate

• Recurring death wishes or suicidal thoughts that may be present with or without intent or plan. (5)

The above symptoms are present most of the day, every day for at least 2 weeks for consideration of the diagnosis of Major Depressive Disorder.

If you have symptoms with such severity or milder symptoms of prolonged duration, it is recommended to seek professional help.

FEELING DEPRESSED AND CLINICAL DEPRESSION

Feeling sad or depressed can be somewhat different from the illness. This is known as situational depression. Situational and clinical depression are not the same thing. Recognizing this distinction is vital to help decide when to seek professional treatment. Often, situational depression resolves on its own, and discussing the stressors in therapy can help with the recovery process.

Situational depression occurs as a result of a sudden or recent traumatic event in the individual’s life. It is usually short-term and can be easily treated. Some common triggers include sudden unemployment, an unexpected divorce, a severe accident, any major life changes, death of near and dear, etc. (6)

WHEN TO REACH OUT FOR HELP?

If you have had at least two or more of the symptoms mentioned above over a prolonged period, reach out for help.

Although it may be challenging to reach out for help, this illness may affect your productivity, relationships and overall health. It also often worsens without intervention especially in presence of chronic diseases such as diabetes, heart disease or other life stressors such as relationship stress, financial stress etc.

WHAT INTEGRATIVE MEDICAL APPROACHES EXIST?  

An Integrated medicine approach is the practice of medicine in which elements of complementary and alternative medicine are selectively incorporated into detailed treatment regimens alongside standard western methods of diagnosis and treatment.

It is not the same as complementary medicine. Complementary medicine pertains to treatments that can be used in conjunction with conventional medicine but are not typically taught in medical schools. Integrated medicine has a greater scope and mission, with a focus on health and healing as opposed to disease and treatment. (8)

The commonly used treatment in western medicine includes psychotherapy and medications. Psychotherapy includes cognitive therapy, behavioral therapy or a combination of both, interpersonal therapy, etc. (9) Apart from this, antidepressants are prescribed to patients with severe cases of depression. These medications directly affect certain neurotransmitters (chemicals through which nerve cells communicate), enhance mood and increase growth and repair of neurons.   

Some of the integrative medical approaches are:

LIFESTYLE CHANGES

General lifestyle advice emphasizes the importance of balancing meaningful work, quality rest and sleep, moderate exercise, constructive social interaction, and enjoyable hobbies. A balanced diet rich in complex carbohydrates, fruits and vegetables, lean meats, and low in processed foods has been shown in a few studies to reduce the risk of depression. Although there is currently insufficient evidence to support specific nutritional advice, a basic healthy diet rich in a variety of nutrients can be suggested.

If the patient leads a sedentary lifestyle, steadily increasing physical exercise is recommended, and it is especially important in cases of obesity. There has been evidence of links between increased physical activity and improved mood and well-being. (10)

LIGHT THERAPY

Light therapy involves sitting before a lamp that emits light similar to natural sunlight. Light therapy is typically said to treat the seasonal affective disorder, but it may also be beneficial for clinical depression. The light mimics the effects of natural sunlight and improves brain chemicals associated with mood and sleep. A literature review and meta-analysis of the use of light therapy in patients with non-seasonal depression revealed that not only does it have minimal side effects, but patients also noticed substantial improvement in depressive symptoms. (11)

ACUPUNCTURE

Acupuncture is an ancient Chinese traditional healing approach. According to their traditional medicine, the human body has over 2000 acupuncture points and intervening with them can help heal your body. These points are said to stimulate the CNS – central nervous system. When stimulated the nerves release chemicals into the bloodstream and reach the brain, muscles and so on. These chemicals bring about changes in the system that can enhance natural healing of the body. (15)

A twelve-week acupuncture intervention on the health of patients with depression was analyzed in a randomized, single-blind, placebo-controlled study. The acupuncture group improved significantly in eight quality of life domains, including physical health, pain, energy, mental - interpersonal function, and mental health, according to the study. (11)

RELAXATION TECHNIQUES

There has been some evidence in recent years that have highlighted the positive effects of relaxation techniques on mild to moderate depression. [VS1] A 2009 Cochrane review of 15 randomized or semi-controlled trials of muscle relaxation, calming images, and imagined sensations of warmth or relaxation concluded that relaxation treatments are more effective than no treatment or minimal treatment for reducing depressive symptoms, but not as effective as psychotherapy. (12)

Two other studies conducted in 2015 and 2020 were able to conclude that relaxation interventions did have some effect in reducing depressive symptoms. The patients who took part in the respective studies, reported that they felt more relaxed after repeated sessions of yoga, relaxation training and calming music therapy. They even gave low depression scale scores after undergoing therapy.

NATURAL SUPPLEMENTS AND HERBS

Natural supplements such as herbs and botanicals can be used to improve overall health – both mental and physical. Evidence suggests that specific herbs such as St. John’s wort (SJW), natural supplements and probiotics can be used to improve depressive feelings. SJW is a medicinal plant. Some studies suggest that this plant is more effective than a placebo, and equivalent to antidepressants with minimal side effects in treating depression. St. John’s wort affects levels of many other medications and is not the right supplement for everyone.[VS2]  (13)

Other supplements such as S-Adenosyl Methionine (SAM-e), folate, vitamin D and omega-3 fatty acid levels have been associated with depression. The use of these vitamins and minerals with or without antidepressants may help improve mood and other symptoms of depression. (10,12)

MEDITATION AND DEPRESSION

Stress and anxiety are massive depression triggers, and meditation can help you change your reaction to them. Meditation teaches the brain to focus for long durations and to bring it back to that focus when negative thoughts, emotions, or physical sensations interfere. Scientists have found increased activity in the medial prefrontal cortex (also called the 'me centre') and in the amygdala (the fear center), during the depressed state. Research suggests that meditation affects these parts of the brain and brings them back into balance with each other.. Meditation also increases the number of nerve cells in the hippocampus where memories are stored. Decreased hippocampus size is often noted in conditions like depression and dementia. (14)

Conclusion

The most common types of medical treatment for depression include various types of psychotherapy and antidepressants. Psychotherapy can often help manage mild depression and is commonly used in combination with medication for treatment of moderate and more severe forms of depression. More than 30% of patients do not respond to standard antidepressants when initially treated. The effect of antidepressants is often not long lasting after discontinuation of treatment. For a person with 2 or more lifetime episodes of depression it is recommended that antidepressants be continued indefinitely. Antidepressants should be used judiciously since they are prescription medications. Other causes and contributors to depression should be identified and remedies such as poor diet, vitamin or mineral deficiencies, sedentary lifestyle, stress, toxic relationships etc. Depression is not a disease of an isolated organ, it affects your whole being physically, mentally and spiritually. We believe that to treat this systemic disorder, a more rounded and holistic approach should be adopted. A combination of various approaches alongside psychotherapy and antidepressants can largely help the patient and walk them towards recovery.  

REFERENCES

1. Psychiatry.org - What Is Depression? [Internet]. [cited 2022 Jul 13]. Available from: https://psychiatry.org:443/patients-families/depression/what-is-depression

2. Tolentino JC, Schmidt SL. DSM-5 Criteria and Depression Severity: Implications for Clinical Practice. Front Psychiatry. 2018 Oct 2;9:450.

3. Kandhakatla R, Yarra R, Pallepati A, Patra S. Depression- A common cold of mental disorders. Alzheimers Dement Cogn Neurol. 2018 Jan 1;2.

4. Depression [Internet]. National Institute of Mental Health (NIMH). [cited 2022 Jul 13]. Available from: https://www.nimh.nih.gov/health/topics/depression

5. Depression Definition and DSM-5 Diagnostic Criteria [Internet]. Psycom.net - Mental Health Treatment Resource Since 1996. [cited 2022 Jul 13]. Available from: https://www.psycom.net/depression/major-depressive-disorder/dsm-5-depression-criteria

6. Situational depression vs clinical depression: Difference and diagnos [Internet]. 2018 [cited 2022 Jul 13]. Available from: https://www.medicalnewstoday.com/articles/314698

7. Frontiers | DSM-5 Criteria and Depression Severity: Implications for Clinical Practice [Internet]. [cited 2022 Jul 13]. Available from: https://www.frontiersin.org/articles/10.3389/fpsyt.2018.00450/full

8. Rees L, Weil A. Integrated medicine. BMJ. 2001 Jan 20;322(7279):119–20.

9. How to Choose the Best Type of Therapy to Treat Your Depression [Internet]. Verywell Mind. [cited 2022 Jul 13]. Available from: https://www.verywellmind.com/types-of-psychotherapy-for-depression-1067407

10.  Sarris J. Clinical depression: an evidence-based integrative complementary medicine treatment model. Altern Ther Health Med. 2011;17(4):26.

11. 8 Evidence-based Integrative Approaches to Treating Depression [Internet]. Dr. Wayne Jonas. 2018 [cited 2022 Jul 13]. Available from: https://drwaynejonas.com/8-evidence-based-integrative-approaches-to-treating-depression/

12.  Luberto CM, White C, Sears RW, Cotton S. Integrative Medicine for Treating Depression: An Update on the Latest Evidence. Curr Psychiatry Rep. 2013 Sep;15(9):391.

13. St. John’s Wort and Depression: In Depth [Internet]. NCCIH. [cited 2022 Jul 19]. Available from:   https://www.nccih.nih.gov/health/st-johns-wort-and-depression-in-depth

14. How meditation helps with depression [Internet]. Harvard Health. 2018 [cited 2022 Jul 13]. Available from: https://www.health.harvard.edu/mind-and-mood/how-meditation-helps-with-depression

15. Acupuncture [Internet]. 2021 [cited 2022 Jul 19]. Available from: https://www.hopkinsmedicine.org/health/wellness-and-prevention/acupuncture