Depressive disorders are common in the United States and worldwide – in any particular year, almost 10 percent of the adult population of the U.S. will experience major depression, dysthymic disorder (chronic lowered mood), or bipolar disorder (includes depressive episodes). Depression is also being identified more frequently in children and adolescents. In the past it was underdiagnosed since the criteria for depressive diagnoses failed to recognize that the prevailing mood in children and teens may be irritable or anxious. The rate of increase of depression among children is 20%.
Preschoolers are the newest market for antidepressants. These drugs, which can have significant side effects even for adults, have proven to be extra dangerous for those under the age of 18. Selective serotonin reuptake inhibitors such as Prozac and Zoloft are known to increase the risk of suicidal thoughts and behaviors in this population.
Although psychotherapy is often suggested in addition to medication, not all individuals are willing or able to benefit from common cognitive-behavioral and rational-emotive therapies. This is especially true in those under 18, who may not have developed full capacity to think logically or to identify and express their feelings – skills required for the success of psychotherapy.
Fortunately, holistic treatment is another option. In fact, it may be the best option even for adults with depressive disorders. Holistic medicine focuses on the whole individual, including physical, mental, and spiritual characteristics. Therapeutic options in 5 major categories – lifestyle, mind-body, biochemical, biomechanical, and bioenergetic – have been identified for depression (Kemper, 2007), in addition to standard psychotherapies.
Lifestyle therapies include nutrition, exercise, sleep and environment. Certain nutrients are essential for the production of neurotransmitters that affect mood. Research has shown that aerobic exercise can improve mood by stimulating the release of endorphins in the brain, while exercises such as yoga calm the mind and body (especially helpful when the depression is accompanied by anxiety). Sleep disturbance occurs in almost all cases of depressive disorders. Depending on the individual, this may mean inability to fall asleep, early awakening, or sleeping too long. Establishing a stable sleep pattern can greatly improve mood. Finally, the individual’s environment must be considered. Increased exposure to natural light (preferably sunshine, but light boxes can be used if necessary) has been shown to improve mood in repeated studies. The presence of toxins and allergens in the person’s air, water, and food is frequently associated with depressive disorders, and sometimes removal of these toxins can produce astonishing improvement.
Mind-body therapies include meditation or prayer, relaxation, music, and dance. Meditation, prayer, and relaxation can improve body awareness, calm racing or anxious thoughts, and reduce muscle tension. They are especially helpful for individuals with significant anxiety (commonly associated with depression), insomnia, or reduced ability to concentrate. Music therapy is useful for all ages but particularly with younger and older populations. In receptive music therapy, the depressed person listens to a piece of music then discusses it with the therapist. Music may be chosen to lift the mood, provoke insight, or present alternative ways of thinking. Dance therapy, although not common at present, is another mind-body therapy that allows the depressed person to explore and communicate feelings without words. Since emotions are processed primarily in the right hemisphere of the brain, and language in the left, verbal expression may be almost impossible in some cases.
Biochemical therapy may include conventional psychiatric meds as well as dietary supplements. In a comparison of St. John’s wort, an herbal supplement, with antidepressants, both were found to be equally effective. However, it is more difficult to determine the potential side effects of herbals since they contain many biological compounds, instead of the controlled composition of synthetic drugs. Other supplements, including omega-3 fatty acids, tryptophan, and folate have shown some success in treatment of depression. Omega-3 fatty acids may be particularly appropriate for individuals with bipolar depression since case studies suggest it is helpful in mania as well. More research is needed in this area.
Biomechanical therapy focuses on massage, although exercise and relaxation can also be viewed as biomechanical. Several small studies of massage plus aromatherapy have indicated an improvement in anxiety symptoms in patients with depression and anxiety, but it was impossible to separate the effects of the massage from those of the aromatherapy essential oils. Deep tissue massage has been used to elicit painful memories and subsequent emotional release. This is highly effective in depressions following a death in the family or a similar traumatic event.
Finally, bioenergetic therapy addresses the flow of energy through the body. Acupuncture and acupressure, as well as chakra bodywork, fall into this category. Acupuncture uses tiny needles inserted into the skin at specific points to affect the flow of qi (chi), energy, throughout the body. Research into this approach to depressive disorders is limited. However, it has been shown to reduce many types of chronic pain, which commonly co-occurs with depression. Chakras are especially potent acupuncture points, or energy centers, and are thought to be associated with the endocrine system. Movement of energy through the chakras is accomplished through meditation as well as bodywork.