Can Chinese Herbs Help Clients with Depression?

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

Etiology: Depression can be either primary or secondary in occurrence. Primary depression comes about without other precipitating physical conditions or diseases, whereas secondary depression is usually the development of preexisting physical or mental disease, or of medications. In terms of the cause of primary depression, the precise pathogenesis is not clear. Bio-psychosocial factors including heredity, stressful life events, personality type, and gender (women have a higher incidence of depression), may interact with each other to cause depression. Research is currently underway to elucidate the biological underpinnings of depression.

Secondary depression can be caused by a medical condition, pharmaceutical medications, recreational drugs, and even by other psychiatric disorders. Physical problems that can lead to depression include infectious diseases, endocrine problems, neurologic conditions, as well as nutritional deficiencies, and cancer. Medications that can cause depression include steroids, amphetamines, certain antibiotics, and narcotic analgesics, among others. Compounding the problem, discontinuing certain medications can also lead to depression. Psychiatric conditions that often have depression as a symptom includes anxiety disorders, schizophrenic disorders, antisocial personality, and alcohol and substance abuse disorders. Therefore, one cannot overstate enough the importance of a thorough diagnosis whenever a patient presents with signs of depression. Often by treating the somatic illness, the depression can be concomitantly resolved.

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 illuminating the way by advocating non medication 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 medication for more serious forms of depression.

The common psychotherapeutic agents that are currently used include the selective serotonin uptake inhibitors (SSRIs) such as fluoxetine, paroxetine, sertraline, 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 US. Common side effects of antidepressants include cardiovascular problems, sexual difficulties, weight gain, sleepiness, interactions with other drugs, and hypotension. Little wonder then, that an increasing number of people are turning to alternative medicine, including Chinese medicine, for help with depression.