Can Chinese Herbs Help Clients with Depression?

Townsend Letter for Doctors and Patients, April, 2001 by Andrew Gaeddert

Depression is a mood disorder characterized by feelings of sadness, discouragement, and despair. All of us have experienced such feelings at one time or another, perhaps after a death, a major disappointment, or other trauma. This is a natural and healthy response, and most of us overcome these feelings after a time. However, when these feelings occur without any precipitating factors and are persistent, depression has set in.

Over 28 million (Textbook of Natural Medicine, p. 1040) Americans take antidepressant and antianxiety agents. This is truly an astounding figure. Depression is among the most common of behavioral disorders. Some have even said that it is the "common cold" of psychiatric/psychological problems (What You Need to Know About Psychiatric Drugs, p. 23). In 1994 it was reported that 17.1% of the general American population had a lifetime history of a major depressive episode (Archives of General Psychiatry, 1994;51:8-19). Major depression is one of the fifteen leading causes of disability in developed countries and is projected to become the second leading cause of disability worldwide by 2020 (Lancet, 1997;349:1498-1504).

From another viewpoint, since publication of the Diagnostic and Statistical Manual in 1959, the bible of American psychiatrists, the number of "psychiatric" and "behavioral disorder" cases has increased exponentially.

The inference is that a good portion of these individuals have not been diagnosed, but merely labeled. By diagnosis, one means that an actual cause is found for the presenting emotional symptoms. There are many diseases that have psychological manifestations as part of their symptomatologies. For example, persons with Brill-Zinsser disease, also known as recrudescent rickettsial infection, often show signs of paranoia and despondency. The disease is due to a rickettsial pathogen that lies dormant for years, and then resurfaces to cause rash, fever, headache, and emotional problems such as paranoia, despondency, and hopelessness. In addition to laboratory tests, the key to diagnosis is the often-cyclical onset of these symptoms. Clearly, treatment with antidepressants and anxiolytics does not relieve the condition, only antibiotic therapy does. Other "emotional" problems that are frequently misdiagnosed include "hyperactivity" caused by low-level carbon monoxide toxicity, "conduct disorder" due to asymptomati c beriberi, and even "anxiety" from a thyroid disorder. Therefore, when a person goes to the doctor complaining of an emotional difficulty, in all likelihood he or she will be quickly prescribed a medication to "relieve" the difficulty, instead of being carefully diagnosed to ascertain the root cause.

As Chinese medicine practitioners, we can learn a valuable lesson from this. When diagnosing a patient, we do so through the four techniques of looking, listening and smelling, asking, and palpating. These techniques should be applied across the board to all patients, whether they present with an organic symptomatology, or with emotional problems. In Chinese medicine, emotional presentations are treated just like any other disease, since the seven emotions are intimately connected with the health of an individual. The health of the emotions affects the health of the physical body, and vice versa. In biomedicine, only in recent years has this concept become more accepted, with increasing research focusing on the mind-body connection. Of course, in Chinese medicine this is established empirical knowledge that is now a fundamental part of diagnosis and treatment.

In this article, we discuss how depression is treated with Chinese herbs, and in particular, we address how herbs should be administered to individuals who are also taking pharmaceutical agents such as antidepressants and anxiolytics. Recently, this has become an issue of intense concern in the biomedical community. As practitioners we should be aware of this and make every effort to work with patients who are taking such medications.

Biomedical Perspective of Depression

Symptomatology: There are several types of depression ranging from the normal "blues" to mild depression (dysthymia) to major depression. Normal depressed mood is a healthy reaction to loss or change. It often provides impetus for one to make changes that will render the new situation bearable. Persons with more debilitating depression have feelings of doom and gloom, despair, and hopelessness. They also experience crying for no apparent reason, loss of appetite, fatigue, difficulty concentrating, and insomnia. Another typical complaint is loss of interest in activities they previously found pleasurable. For some, thoughts of suicide are prevalent. Persons with manic-depressive illness, or bipolar disorder, exhibit alternating bouts of depression with episodes of intense excitement and mania. Those with psychotic depression, an extremely severe depression, often have psychotic symptoms such as hearing voices (auditory hallucinations), or delusions.