Holistic Approaches To Overcoming Depression

"A joy, a depression, a meanness, some momentary awareness comes as an unexpected visitor. Welcome and attend them all! Even if they're a crowd of sorrows, who violently sweep your house empty of its furniture, still, treat each guest honorably. He may be clearing you out for some new delight."
Rumi


Depression is a mind-body illness which takes hold not only in the brain but also in the body. And to overcome it , it has to be treated both in mind and body.

Today depression is a pervasive health issue and it can be a terminal illness. It describes conditions ranging from 'the blues', that is minor depression caused by stress, tiredness, poor nutrition or conflict in relationships to severe clinical depression, which can endanger life. People commit suicide caused by depression on a daily basis.

One in four people will suffer depression at some point in their lives. Worldwide, depression is the fourth leading cause of disability, costing billions of dollars in days off work and medical expenses. Despite huge quantities of prescription drugs being taken, people are still depressed. Statistics alone give a strong indication that what we're doing to treat depression is not working effectively.

The traditional approach to treating depression has been drugs - tricyclic antidepressants and then the newer SSRIs (selective serotonin reuptake inhibitors). Recent research shows that, of those with major depression treated this way, only 15% go into remission and have a long period of stay well rate. The other 85% end up with having continuing relapses and become chronically depressed and may suffer from a medicated /depressogenic depression. In simple terms, this means that the drugs cause the depression.

Depression is a very serious condition, however it is not a "disease." Rather, it's a sign that your body and your life are out of balance. This is so important to remember, because as soon as you start to view depression as an "illness," you think you need to take a drug to fix it. In reality, what you need to do is return balance to your life, address the issues, both external and internal which are causing the depression and learn skills to cope with it.

Today Prozac and Xanax are household names, so widespread as their use. Yet, short-term research trials show that antidepressants do NOT provide any clinically significant benefits for mild to moderate depression. And, as we now know, all drugs have benefit-to-risk ratios, so it really doesn't make sense to use it as a first line of defence. Yet doctors tend to prescribe antidepressants as if they were sweets!

We now realise the consequences of overuse/abuse of antibiotics and know that there are alternatives, both preventive and curative. Similarly we need to stop relying on antidepressants so heavily before we face the consequences of overuse. Finding an effective treatment for depression is not something to approach lightly, and having the facts about what actually works, and what doesn't, is imperative.

For serious clinical depression and bipolar depression, medication will, most probably, be necessary, but this too can benefit from the support of additional alternative approaches.

The good news is that there are excellent, safer, more effective alternatives to treat most types of depression for successful, long term outcomes. These alternative treatments involve a holistic approach to regaining wellness: counselling, diet/nutrition, supplements, energy medicine and exercise, all of which are available at IMI.

IMI, Hong Kong's leading integrated medicine clinic, is able to offer a comprehensive, holistic approach to treatment of depression and will manage the process with the different practitioners involved in treatment. It is recommended that a successful treatment plan include all of the following:

Counselling: Therapy is a key factor in understanding the source of your depression Your counsellor will explore your symptoms with you and help you to uncover the underlying emotional issues which have contributed to your depression. An experienced counsellor can identify if you are suffering from a mild form of depression, as can be expected at times from simply living life, or, if it is sufficiently serious and pervasive, to require referral to a specialist.

There are many counselling approaches which are able to address depression, among which are Cognitive Behavioural Therapy, Dialectical Behavioural Therapy, Psychoanalysis, Psychosynthesis, Primal Integration, Narrative Therapy, Positive Psychology and Therapeutic Visualisation. What is essential is to address the issues and alleviate symptoms.

The following are feelings that progressively lead to depression. When you become aware of these feelings, you can monitor them and take responsibility for self care to decrease and eliminate the feelings and the depression they cause: withdrawal from interaction, sad, decreased enthusiasm, lonely, melancholy, sense of helplessness and hopelessness, feeling overwhelmed, despair, excessive crying, feelings of worthlessness, difficulty in concentrating/making decisions, loss of appetite, insomnia, anxiety, weight loss or gain.

Energy Medicine: EFT (Emotional Freedom Technique) - psychological acupressure. This technique combines tapping the energy meridians and voicing positive affirmation to clear the "short-circuit" - the emotional block (of which you may not be consciously aware), from your body's bio-energy system, thus alleviating depression and restoring your mind and body's balance, which is essential for optimal health.

Diet plays an important role in depression. Foods have an immense impact on your mood and mental health, and your ability to cope and be happy. Highly processed foods and unhealthy fats, sugar and grains can affect the onset of depression which can then take hold in those with an unhealthy diet. On the other hand, higher consumption of some foods e.g. fish oils help mood and mental functioning. Pioneering studies show that higher national fish consumption is correlated with lower risk of depression, post partum depression and seasonal affective disorder.

Nutritional Supplements: These play a critical role in supporting the brain, central nervous system and mental health. Omega 3 fish oils have been shown in clinical studies to have a strong connection to improving symptoms of depression. The current depletion of omega-3 and resulting imbalance in fatty acid ratios (Omega 6 strongly outweighs Omega 3) in Western food has had an untold influence on rates of depression firstly the West and now in Asia. Those with depression have lower levels of omega-3 fatty acids in the blood and the lower the level of EPA, the more severe the clinical depression. Omega 3 deficiency also lowers levels and functioning of the two important neurotransmitters serotonin and dopamine.

Vitamin D is a crucial factor in treating depression or keeping it at bay. People with low levels of vitamin D tend to be more prone to be depressed. Deficiency in vitamin D is actually more the norm than the exception, and has previously been implicated in both psychiatric and neurological disorders.

Exercise: There is a substantial body of evidence to show that physical exercise is as effective at treating depression as antidepressant medicines, plus there is the added advantage of exercise having virtually no contraindications. In a study, conducted by Duke University, they found that of the three groups they studied the exercise-only group that had the highest remission and stay-well rate.

The UK NICE (National Inst of Clinical Excellence) for example, no longer routinely recommends antidepressants as the first line of therapy for mild to moderate depression. Doctors there can write out a prescription for a consultation with an EP (exercise physiologist/counsellor) instead. Since 2007, doctors prescribing exercise for depression has increased from 4-25%, and the UK Mental Health Foundation are now making exercise a front line therapy. Studies on exercise as a treatment for depression are showing there is a strong correlation between improved mood and aerobic capacity. There is now a growing acceptance that the mind-body connection is very real, and that maintaining good physical health can significantly lower your risk of developing depression in the first place.

Stress Management: Depression is a sign that your body and your life are out of balance. You need to take proactive steps to return balance to your life. Stress can be internally or externally generated. Either way, it is essential to not feel 'victim' but to make choices that empower, support and enliven you. Making lifestyle changes are important: meditation, yoga, hiking in nature; finding purpose in your life; dealing with relationship issues; handling change and conflict; improving communication; removing negative beliefs: expressing rather than suppressing feelings of anger, resentment, frustration, fear or grief. Focusing on gratitude and appreciation are highly effective to generate feelings of happiness and enhance positive states of mind.

Seeking Treatment: Depression is a common human experience and most people will, in their lifetime, experience it. The most common sign is a lack of pleasure in a normally pleasing life and feeling fatigued. You go on doing what you have to but need to push yourself. When it becomes severe and interferes with your daily activities it is a major depression. You are frustrated, withdraw from people and isolate, avoid people and situations, experience negative thinking, hopelessness, feel overwhelmed and your appetite and sleep are disturbed. You feel a prisoner of this state and believe it will never end. You may even have a death wish and wish something would happen so that you did not need to struggle any more, or actively think about taking your own life.

There is a wide range in the experience of depression. Sometimes we feel sad about something happening, we experience depression with grief when we have experienced a serious loss, or we have a building depression which does not go away when something serious has happened and it is not resolved. Also the following issues relate to the experience of depression:

* You do not express your needs, thoughts, or feelings in order to maintain harmony
* You have lost your sense of identity
* You have lost hope with what you need and feel
* You feel empty and confused
* You stop expressing your hopes and goals & have given up on them

Note that depression, while an emotional symptom, may also trigger disease: worsen diabetes, raise blood pressure, increase the risk of a stroke, weaken your immune system, and cause obesity.

If you are depressed mildly or severely it is recommended that first you have a physical examination to rule out any physical complications that may be contributing to your experience of depression (for example: candida, thyroid malfunction, acute or chronic stress reactions, allergies, drug/alcohol abuse/dependence, recent surgery or PMS).

You should then consult your mental health professional. Therapy is a key factor in understanding the source of your depression. Your counsellor or therapist can help you identify your symptoms and the issues contributing to your depression, determine an appropriate course of interventions, of which there are a number, and set you on a comprehensive path to recovery and wellbeing.


"There is no despair so absolute as that which comes with the first moments of our first great sorrow; when we have not yet know what it is to have suffered and be healed, to have despaired and recovered hope".
George Eliot

Article written by Catriona Rogers, Counselling Psychologist with IMI (Integrated Medicine Institute in Hong Kong) who draws on her experience of many different approaches to assist those suffering from depression. She strongly believes in a holistic approach to treating depression and works closely with IMI colleagues to ensure the needs of  individual clients are met.