The experience of depression is a complicated and highly individualized experience. Over the years, I’ve seen a number of articles (both research and non-research), blog posts, and opinion pieces on the main solution to or cause of depression. Most of these articles and research pieces capture one piece of the puzzle, but inadequately address the complex approach to managing depression. It can feel demoralizing or even angering to see articles that simplify the experience of depression into a tiny box with a simple solution. I’d like to do my best to attempt to sum up the bigger picture. I also realize that I may not be able to capture everyone’s experience and the tools that it often takes to truly manage and overcome depression.
First of all, in East Asian medicine, depression arises from a wide variety of patterns. We can often identify the patterns by feeling a patient’s pulse, looking at their tongue, and pairing these findings with our intake. The pulse tells us similar things as western medicine, some depresion has a genetic component, while others arise from life experiences and biochemistry that is out of balance. Some individuals have all these in combination. It is important to consider the many possibilities of just what caused the depression in the first place when a patient is learning how to heal. It is also equally important to consider teaching tools for managing depression to patients.
Acupuncture and Chinese herbal medicine have long understood the complex interweaving of the above that leads to depression. Each individual is treated as an individual. Acupuncture combines the idea that different organs are related to different emotions, and that our emotions, our thought patterns, and our physical body are interwoven. This means one influences the other. Acupuncture treatment can help the body recover from strong trauma without the need of reliving it repeatedly in treatment. Depression in acupuncture often involves multiple layers, and we chose our treatment plan accordingly, and try to teach patients tools that fit the pattern of depression the patient is presenting with. We’ll discuss this in a follow up blogspot.
Some of the main factors that contribute to depression:
Childhood trauma or ACES (Adverse Childhood events):
Adverse Childhood Events or ACEs are 10 specific traumas that were discovered in a 17,421 participant survey that later informed a smaller study on ACEs. These 10 childhood traumas were found to connect to long term illnesses. The more ACEs a child experienced before the age of 18, the more at risk for developing depression, substance abuse, cancer, heart disease, chronic lung disease, diabetes, and other diseases. This correlation in it of itself may seem depressing, yet hope exists. Along with ACEs, certain situations can build resilience or the ability to overcome the impact of ACEs. The most important way to build resilience is to have strong, positive adult mentors during childhood outside of the home, these can be a coach, a teacher, a volunteer with the Big Brothers, Big Sisters or similar organizations (in Walla Walla we have the Friends of Children Network), or a trusted family friend. If you realize as an adult that you have a high ACE score, you can actively take steps to heal from them. A combination of counseling, working with a primary care physician or psychologist that understands ACEs, and acupuncture can be invaluable at helping to heal from ACEs and manage any health concerns that correlate with the ACEs.
For more about the ACE study, please check out: The Adverse Childhood Event Study: The Largest, most important public health study you’ve never heard of
You can also learn more at the CDC’s ACE Study website
Dysbiosis: (poor ratio of gut bugs in your intestines):
Dysbiosis means too many bad gut bugs are inhabiting your intestines, while the good ones are under represented. Many of our physiologic process rely on certain ‘good’ bacteria populating our intestines. For many years, physicians have seen a correlation between mental and emotional health, and a proper ratio of good vs. bad bacteria in our intestines. This is often referred to as the gut-brain axis. More recent studies are starting to see correlations between childhood trauma, or trauma later in life that leads to dysbiosis developing. Other ways dysbiosis can develop is through repeated use of full spectrum antibiotics, or through a diet made up mostly of highly processed foods. On the positive side, a diet high in natural fibers from vegetables, whole grains, and fruit can quickly improve the number of good bacteria living in your gut, in some instances, it takes as little as a couple weeks of eating high fiber to improve your gut bug ratio. In some situations a healthcare provider may want you to temporarily take a probiotic to jump start improving the gut bugs in your intestines.
MTHFR Gene Mutation:
This gene mutation impacts roughly 25% of the population. There are a few different manifestations of the gene mutation. One directly limits your ability of your body to convert B12 vitamins into its usable form of methylcobalamin, while the other limits your body’s ability to convert folic acid to methyl tetrahydrofolate reductase. B12 and folic acid are important for a wide variety of functions. One of the many symptoms of an MTHFR gene mutation can be depression. Family history can help determine if doing blood work to test for the gene mutation is necessary.
Insomnia is linked to depression, but depression can also cause insomnia at night and fatigue during the day. It is highly useful to address insomnia by trying to look at causes such as eating too late at night, having caffeine too late in the day (for some people noon is the cut off for caffeine with others can drink it much later), having sugar after dinner, stress from work or unfinished projects, screen time too close to bedtime, hormonal imbalances, and a lack of a bedtime routine (AKA sleep hygiene). If you struggle from insomnia, assess the above list and try to make both dietary changes, and changes in the habits around bedtime. Creating a consistent, routine for relaxation at night before bed can be invaluable. Finally, if work/project stress is high and keeps you ruminating at night, consider keeping a notebook by the bed to jot ideas down as they come to you, instead of laying in bed thinking that you need to try to remember that in the morning.
Some triggers for depression are situational. The sudden loss of a loved one, an act of violence against yourself or a loved one when you are an adult, bullying, et cetera can trigger depression in response. Much like addressing ACEs as an adult, support groups, counseling, and acupuncture can be invaluable at helping to heal these experiences.
Overwork is a state of simply working beyond your limits. Overwork can be self driven, such as taking on too many projects on top of your daily responsibilities at school or work and your homelife. It can be working in an office that expects you to work nights and weekends, or to simply work 10+ hours a day. If the work environment is toxic, that will further add to the experience of ‘overwork.’ Overwork will run your body down, make it less resilient to natural stressors, and lead to feel overwhelmed, easily stressed or reactive to stress, and can eventually lead to depression. East Asian medicine has long seen a correlation between work-life balance and our sense of vitality and well being. Secondarily, it is often hard to create time to exercise, cook well, grocery shop, and otherwise take care of ourselves when we are in a situation of overworking. These secondary side effects of overwork, can make anyone more prone to developing depression, anxiety, insomnia, and other illnesses.
Overwork seems to be ingrained in our modern day culture. To overcome it, it takes a degree of self-awareness in assessing what control one has over the pattern of overwork. Are there things you can say no to? Is there work that can be left for later in the week or next week? Can you discuss workload with your boss (sometimes you truly cannot without risk of losing your job)? If none of this is in your control, then is it time to look at other job or career choices? These are not simple answers, but it is worth investigating them to see if there is anything that can change. You might find a few things that you do have control over, and that alone can help bring hope back into your life.
Often overlaps significantly with all of the above. Depression often makes it incredibly hard to have the energy to exercise, to grocery shop, to cook, etc. However, doing those things is incredibly useful in gaining some quality of life back, while also investigating if dysbiosis, ACEs, genetics, overwork, and/or situational factors set the depression in motion. Eating consistently, and well will help improve depression, but it often is not the only answer. Eating consistently throughout the day with a focus on whole foods over processed foods will help keep blood sugar regulated, as well as properly fuel your body for its daily tasks. If blood sugar is allowed to peak and dip, by having long periods between meals or snacks, it often dramatically impacts our mental clarity, mood, and increases fatigue. Patients are often shocked how helpful it is to plan to eat three meals a day, with a few healthy snacks on hand.
Exercise helps immensely by releasing endorphins, changing how your nervous system is firing, and by improving blood circulation throughout your body. If you can strategize ways to make cooking more realistic (perhaps investing a crock pot or meal planning on the weekend), to include exercise (outdoors if possible) 3-5x a week, and to look at improving sleep, you can help give your body an edge at overcoming the other factors contributing to depression. Time outside is also shown to positively impact mood and sense of wellbeing. Again, simply going for a hike will not cure someone struggling with depression, but overtime it helps to support the underlying vitality of your body, and continues to give one an edge towards healing. Think if instead of working out in the gym, can you hike, go for a walk, or bike ride? If it is winter can you layer enough to get out for a winter hike?
In Chinese medicine, the exciting takeaway is that our bodies have amazing abilities to heal themselves when given the proper environment and tools to work with. Depression is, like many illnesses, a complex unique pattern for each individual experiencing it. It often involves both internal factors such as how lifestyle is impacting our biochemistry, and external factors like trauma experienced as children, adults, or both, or toxic stress that adds up over time. Identifying both internal and external factors that contribute to depression can help you find where to start in developing tools to address the depression, and the ability to heal from it. Treating depression often involves combining medical modalities that work for you, such as counseling or psychiatry with treatments that address patterns like acupuncture and East Asian medicine, as well as addressing lifestyle habits that can be holding back progress. Other modalities that can help are reiki, craniosacral, and EMDR therapies. We’ll address how and why acupuncture helps in a future blog. Finally remember, the experience is unique to you, and the combination of treatment modalities will be unique to you as well.
Lindsey Thompson is an East Asian Medicine Practitioner at the Thompson Family Acupuncture Clinic in Walla Walla, WA. She loves growing vegetables, raising chickens, and striving to get the most out of life. Practicing medicine and help people find ways to improve their health at home is one of the most fulfilling aspects of her career.