Compiled by John G. Connor, M.Ac., L.Ac. Edited by Barbara Connor, M.Ac., L.Ac.
TABLE OF CONTENTS
Introduction
Western Medical Description
Anxiety and Panic Attacks
Bipolar DisorderDepression
Use of SPECT Imaging
Classification and Treatment Based on the Work of Drs. Amen and Routh
Chinese Medical Perspective
Treating Emotions Using Chinese Herbs
Chinese Medical Pattern Discrimination
Acupuncture Treatment of Mental-Emotional Disorders
Research on the Benefits of Acupuncture
Anxiety
Depression
Depression & Anxiety
Schizophrenia
Treatment with Craniosacral Therapy & Visceral Manipulation
Useful Supplements and Herbs
Anxiety and Panic Attacks
Bipolar Disorder
Depression
Dietary Recommendations
Lifestyle Recommendations
References
INTRODUCTION
v Since the very beginning of our practices in 1996 Barbara and I have treated many patients suffering from depression, anxiety and other mental-emotional disorders. We treat these conditions using a combination of acupuncture, craniosacral therapy, hara visceral work, herbs, supplements and lifestyle recommendations. We hope this article gives you a better understanding of these conditions and how we treat them.
v According to the National Institutes of Health anxiety and depression affect 38 million Americans each year. Twice that number will suffer from anxiety or depressive illness at some point in their lives.
v Depression is a serious condition, and by self-treating it, you risk misdiagnosing yourself or misjudging the severity of the problem. Be sure to get an accurate diagnosis from a health professional before taking mood-boosting supplements or herbs, some of which can interact with prescription drugs. Mild depression that passes quickly may not require any diagnosis or treatment. However, when depression becomes recurrent, constant, or severe, it should be diagnosed by a licensed counselor, psychologist or psychiatrist. Diagnosis may be crucial to determining appropriate treatment.
WESTERN MEDICAL DESCRIPTION
v Anxiety
Anxiety disorders are the most common psychiatric disorders in the US. They are characterized by numerous physical symptoms such as: excessive sweating, muscle tension, numbness and tingling, shallow breathing, fainting and rapid heart rate. The emotional symptoms of anxiety disorders occur simultaneously with the physical ones and include agitation, feelings of unreality, fearfulness, feelings of impending doom, irritability, nervousness and shyness. Anxiety disorders are classified into various categories such as generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder and social phobia/social anxiety disorder. (Prousky, 2005)
v Bipolar Disorder
Bipolar disorder (manic-depressive illness) is a disorder of the brain characterized by extreme changes in mood, energy, thinking and behavior. Among psychiatric illnesses, bipolar disorder ranks second only to major unipolar depression as a cause of global disability. Bipolar patients may spend as much as 20% of their lives in episodes, most of this lost time taken up by depression. Between episodes, some 30-60 percent suffer psychosocial impairment. Even for those patients under apparent control, the relapse rates range as high as 40% in one year, 60% in two years and 73% in five or more years. While certain behavioral interventions such as cognitive-behavior therapy and cell membrane nutrients have shown promise the medical management of bipolar disorder remains overwhelmingly pharmacological. Most bipolar disorder patients require a combination of mood stabilizers to remain in remission. (Kidd, 2004)
Bipolar disorder is much more common in multiple sclerosis patients than in the general population. (Horrobin & Bennett, 1999) Bipolar disorder has a substantial overlap with major depressive disorder. (Kidd, 2004)
CT and MRI studies suggest cerebellar atrophy tending to be more extreme in brains with greater numbers of recorded bipolar disorder episodes. Cerebellar abnormalities could contribute to dysregulation of limbic and cortical regions that partly determine mood. (Kidd, 2004) PET and SPECT studies demonstrate low glucose metabolism and blood flow in the cortex (prefrontal and paralimbic) of moderately to severely depressed bipolar patients. In contrast, subcortical paralimbic structures such as the ventral striatum, thalamus and amygdale show abnormally high metabolism in moderately to severely depressed bipolar patients. (Ketter & Drevets, 2002)
v Depression
In a given one-year period up to 9.5% of the US population (nearly 19 million people) may suffer from depression. The three most common types of depression include: major depression, dysthymia (you simply don’t feel happy for extended periods of time), and bipolar disorder (mania alternating with periods of depression). (Hobbs, 2002)
A diagnosis of depression requires feelings of profound sadness or loss of interest in everyday activities for at least two weeks plus at least four of the following symptoms: a change in appetite or weight, an inability to sleep or over sleeping, restlessness, reduced energy, difficulty concentrating or making decisions, feelings of guilt or worthlessness, or thoughts of death or suicide. These symptoms must be severe enough to interfere with daily functioning. Conventional medicine typically treats depression with antidepressant drugs, psychotherapy or a combination of these two. (Weil, 2005)
After the diagnosis of depression has been made it is important to rule out the simple organic factors which are known to contribute to depression such as: nutrient deficiency, drug-induced depression, oral contraception, caffeine, smoking, hypoglycemia, thyroid function, adrenal function and various environmental factors. (Murray, 1991)
Depression may be triggered by tension, stress, a traumatic life event, chemical imbalances in the brain, thyroid disorders, upset stomach, headache, nutritional deficiencies, poor diet, the consumption of sugar, mononucleosis, lack of exercise, endometriosis, any serious physical disorder, food allergies or hypoglycemia. Heredity also plays a role. (Balch & Balch, 1997)
While the exact mechanisms involved in the pathogenesis of depression remain obscure, there is an indication of involvement of the frontal cortex and limbic system, including the hippocampus and the nucleus accumbens. (Nestler et al 2002)
A growing body of research indicates that depression is associated with excessive production of proinflammatory cytokines. These cytokines, including interleukin-1beta, -2 and –6, interferon-gamma, and TNF-α, can have direct and indirect effects on the CNS. Psychological stress, infection, trauma, allergies, toxins and various other factors can be responsible for a rise in these cytokines. Interestingly, various tricyclic and serotonin re-uptake inhibiting antidepressant medications can inhibit the release of the above-mentioned cytokines. (Maes & Smith, 1998)
USE OF SPECT IMAGING
v Based on research involving thousands of patients using SPECT (Single Photon Emission Computed Tomography) imaging Drs. Daniel Amen and. Lisa Routh have been able to see the major anxiety and depression centers in the brain. They have written a fascinating book detailing their findings entitled Healing Anxiety and Depression. The five major systems of the brain involved with behavior they have identified are:
1. The Basal Ganglia – a set of large structures near the center of the brain which helps integrate feelings, thoughts and movement. People with underactive basal ganglia frequently have problems with energy, motivation and decision making. On the other hand, excessive basal ganglia activity may be associated with heightened anxiety, or alternatively, with increased motivation.
2. The Deep Limbic System – lies near the center of the brain and helps to set a person’s emotional tone. When the deep limbic system is underactive, there is generally a positive, more hopeful state of mind. When it is overactive negativity can take over.
3. The Anterior Cingulate Gyrus – runs lengthwise through the deep aspects of the frontal lobes. When there are problems with the anterior cingulate gyrus, usually caused by a lack of serotonin, people become unable to shift their attention and become rigid, overfocused and cognitively inflexible. When this part of the brain works well, it is easier to plan and set reasonable goals. Difficulties in this part of the brain can cause a person to see fear, predict negative events and feel very unsafe in the world. They may become worriers and continually obsess. Clinical problems associated with this area of the brain include Obsessive-Compulsive Disorder, eating disorders, addictive disorders, and Oppositional Defiant Disorder.
4. The Temporal Lobes – are located underneath our temples and behind our eyes and are largely responsible for processing memories into long-term storage. When they are overactive we tend to be too reactive to the situations in our lives, and when they are underactive, we tend to act inappropriately. The nondominant temporal lobe has been associated with religious experiences, such as flashes of religious intuition and spiritual experiences.
5. The Prefrontal Cortex – is the most evolved part of the brain and makes up nearly 30% of the human brain. When it works properly, we are thoughtful, empathic and able to express our feelings appropriately, as well as to be organized and goal directed. When it is underactive, there is less of a filtering mechanism available and distractibility becomes a problem. Damage or underactivity in this part of the brain leads to an increased vulnerability to depression.
CLASSIFICATION AND TREATMENT BASED ON THE WORK OF DRS. AMEN AND ROUTH
v Drs. Amen and Routh have divided mental-emotional disorders into seven categories based on abnormalities found in the five areas of the brain together with the symptom clusters associated with each. Although I do not subscribe to everything they say, I find their ideas thought-provoking and presented from a fresh perspective. The following is a summary of the description and treatment of the seven categories as described in their book Healing Anxiety and Depression:
1. Pure Anxiety – is based on excessive activity in the basal ganglia.·
Symptoms of this category include: Frequent feelings of nervousness or anxiety; panic attacks; avoidance of places for fear of having an anxiety attack; heightened muscle tension; periods of heart pounding, nausea or dizziness; tendency to predict the worse; multiple, persistent fears or phobias; conflict avoidance; excessive fear of being judged or scrutinized by others; easily startled or tendency to freeze in anxiety-provoking or intense situations; seemingly shy, timid and easily embarrassed, and bites fingernails or picks skin.·
Treatment for pure anxiety includes medications for moderate to severe cases and nutritional supplements for mild cases.
Useful supplements for mild cases include:
o Gamma-amino butyric acid (GABA) functions as a neurotransmitter in the brain and helps stabilize nerve cells by decreasing their tendency to fire erratically or excessively.
o Vitamin B-6 supports the action of the enzymes that convert the amino acid L-glutamine to GABA in the brain. Anxious people may not have enough L-glutamine or they may have vitamin B-6 deficiency.
o Valerian is a well-recognized herb with anti-anxiety properties. It appears to work by enhancing the activity of GABA. CAUTION: Do not take valerian with alcohol, barbiturates or benzodiazepines; or during pregnancy or breast-feeding.
2. Pure Depression – is based on excessive activity in the deep limbic system.·
Symptoms of this category include persistent sad or “empty” mood; loss of interest or pleasure in activities that are usually fun including sex; restlessness, irritability, or excessive crying; feelings of guilt, worthlessness, helplessness, hopelessness, pessimism; sleeping too much or too little, early-morning awakening; appetite and/or weight loss, or overeating and weight gain; decreased energy, fatigue, feeling “slowed down”; thoughts of death or suicide, or suicide attempts; difficulty concentrating, remembering or making decisions; persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain; persistent negativity or chronic low self-esteem; and persistent feeling of dissatisfaction or boredom.·
Treatment for severe pure depression is with antidepressant mediations. Mild cases may be treated with supplements. It is also very important to incorporate the use of other interventions such as therapy, diet and exercise, education and support groups.
Useful supplements for mild cases include:
o D-L phenylalanine (DLPA) is the amino acid precursor for norepinephrine. A number of studies show norepinephrine and epinephrine are low in patients with depression. CAUTION: People who have phenylketonuria should not take DLPA because they do not have the enzyme that metabolizes it.
o L-tyrosine is an amino-acid building block for dopamine, epinephrine and norepinephrine. It helps to boost energy levels, mood and metabolism. It may also increase motivation and improve concentration.
o SAMe is involved with the production of several neurotransmitters. When a person is depressed, the synthesis of SAMe from methionine is impaired. SAMe is one of the best natural antidepressants, and in a number of recent studies it has performed as well as conventional antidepressant mediations. It has been found to increase the neurotransmitters that are low when people have depression.
3. Mixed Anxiety and Depression – is based on excessive activity in the basal ganglia and the deep limbic system.
· Symptoms of this type are a combination of both pure anxiety symptoms and pure depression symptoms.
· Treatment is best done with psychological interventions targeted at both anxiety and depression such as biofeedback, interpersonal psychotherapy and cognitive therapy as well as antidepressant medications or supplements that have a calming effect on the basal ganglia and the deep limbic areas. A combination of SAMe and GABA is often helpful for these types of patients.
4. Overfocused Anxiety/Depression – is based on excessive activity in the anterior cingulate gyrus, the basal ganglia and/or the deep limbic system.
Symptoms include at least four items from the pure anxiety and/or pure depression checklists, plus at least four of the following: Excessive or senseless worrying; upset when things are out of place or don’t go the way you planned; tendency to be oppositional or argumentative; tendency to have repetitive negative or anxious thoughts; tendency toward compulsive or addictive behaviors; intense dislike of change; tendency to hold grudges; difficulty seeing options in situations; tendency to hold on to own opinion and not listen to others; need to have things done a certain way or you become very upset; others complain that you worry too much and a tendency to say no without first thinking about the question.·
Treatment is best done with interventions that increase the neurotransmitter serotonin. Treatment can include medication, such as SSRIs and antidepressants, behavior therapy, dietary changes, intense aerobic exercise and supplements such as 5-HTP and St. John’s wort.
o St. John’s wort may be the most potent of all the supplements at increasing serotonin availability in the brain. CAUTION: Do not use St. John’s wort with antidepressants as it may overload the system with serotonin.
o L-tryptophan and 5-HTP are amino acid building block for serotonin therefore taking these supplements can increase cerebral serotonin. L-tryptophan is a naturally occurring amino acid found in milk, meat and eggs. One of the problems with dietary L-tryptophan is that a significant portion of it does not enter the brain.
o 5-HTP is a step closer in the serotonin production pathway. It is also more widely available than L-tryptophan and is more easily taken up in the brain. Seventy percent is taken up into the brain, as opposed to only 3 percent of L-tryptophan. 5-HTP is about 5 to 10 times more powerful than L-tryptophan. Decreased serotonin levels in the brain have been correlated with depression, aggressive feelings, and violence. 5-HTP boosts serotonin levels in the brain and helps to calm anterior cingulate gyrus hyperactivity. CAUTION: Because 5-HTP increases serotonin, you should not take other medications concurrently that also increase serotonin such as St. John’s wort, L-tryptophan or prescribed antidepressants.
5. Cyclic Anxiety/Depression – is based on focal (a discrete area) increased activity in the deep limbic system and/or in the basal ganglia. Cyclic disorders such as bipolar disorder, cyclothymia and premenstrual dysphoric disorder, along with panic attacks, fit in this category because they are episodic and unpredictable.·
Symptoms include at least four items from the pure anxiety and/or pure depression checklists plus at least four of the following: Periods of abnormally elevated, depressed or anxious mood; periods of decreased need for sleep, feeling energetic on dramatically less sleep than usual; periods of grandiose notions, ideas or plans; periods of increased talking or pressured speech; periods of too many thoughts racing through the mind; periods of markedly increased energy; periods of poor judgment that lead to risk-taking behavior (separate from usual behavior); periods of inappropriate social behavior; periods of irritability or aggression and periods of delusional or psychotic thinking.·
Treatment is best accomplished with mood stabilizers such as lithium or anticonvulsant mediations. Psychological interventions can also help decrease the stressors that may trigger an episode. Antidepressant therapy may be necessary, but this needs to be very closely monitored because of the risk of triggering mania. The following supplements may be helpful:
o Omega-3 fatty acids supplementation can be helpful. An insufficiency of omega-3 fatty acids has been linked to depression and mood instability. In a study done at Harvard and reported in the Archives of General Psychiatry, supplementation with high-dose purified fish oils provided a statistically significant improvement in bipolar disorder.
o Taurine is an inhibitory neurotransmitter, which stimulates the neurotransmitter GABA. It has a calming effect on the nervous system.
6. Temporal Lobe Anxiety/Depression – is based on increased or decreased activity in the temporal lobes and increased activity in the basal ganglia and/or deep limbic system.
Symptoms of this type include at least four items from the pure anxiety and/or pure depression checklists, plus at least four of the following: Short fuse or periods of extreme irritability; periods of rage with little provocation; often misinterprets comments as negative when they are not; periods of spaciness or confusion; periods of panic and/or fear for no specific reason; visual or auditory changes, such as seeing shadows or hearing muffled sounds; frequent periods of déjà vu; sensitivity or mild paranoia; headaches or abdominal pain of uncertain origin; history of a head injury or family history of violence or explosiveness; dark thoughts that may involve suicidal or homicidal thoughts; and periods of forgetfulness or memory problems.·
Treatment is best accomplished with a combination of anticonvulsants and antidepressant medications. Psychological interventions, such as interpersonal psychotherapy and cognitive therapy can be helpful. Useful supplements for this type include the following:
o Gamma-amino butyric acid (GABA): Many individuals who have temporal lobe symptoms also struggle with temper control, irritability and anxiety, and GABA produces a calming effect in these cases.
o Phosphatidyl serine is useful in cases of memory problems. There are 18 double-blind studies supporting the effectiveness of phosphatidyl serine supplementation for memory issue complaints. Low levels of phosphatidyl serine are associated with memory problems and depression in the elderly.
o Ginkgo biloba has been shown to improve energy, concentration, focus and memory.
7. Unfocused Anxiety/Depression – is based on decreased activity in the prefrontal cortex and increased activity in the basal ganglia and/or deep limbic system. This type is often seen in conjunction with Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD).
Symptoms of this type include at least four items from the pure anxiety and/or pure depression checklists, plus at least four of the following: Trouble staying focused; spaciness or feeling in a fog; overwhelmed by tasks of daily living; feeling tired, sluggish, or slow-moving; procrastination, failure to finish things; chronic boredom; loses things; easily distracted; forgetful; poor planning skills; difficulty expressing feelings and difficulty expressing empathy for others.
Treatment is best accomplished with stimulating antidepressants such as Wellbutrin. Intense aerobic exercise is also helpful, as is a high-protein, low-carbohydrate diet. Useful supplements include the following:
o D-L phenylalanine (DLPA) is the amino acid precursor for norepinephrine. A number of studies show norepinephrine and epinephrine are low in patients with depression. CAUTION: People who have phenylketonuria should not take DLPA because they do not have the enzyme that metabolizes it.
o L-tyrosine is an amino-acid building block for dopamine, epinephrine and norepinephrine. It helps to boost energy levels, mood and metabolism. It may also increase motivation and improve concentration.
o SAMe is involved with the production of several neurotransmitters. When a person is depressed, the synthesis of SAMe from methionine is impaired. SAMe is one of the best natural antidepressants, and in a number of recent studies it has performed as well as conventional antidepressant mediations. It has been found to increase the neurotransmitters that are low when people have depression.
o Omega-3 fatty acids are helpful in that they boost cellular transmission.
* * * TABLE OF CONTENTS
Introduction
Western Medical Description
Anxiety and Panic Attacks
Bipolar DisorderDepression
Use of SPECT Imaging
Classification and Treatment Based on the Work of Drs. Amen and Routh
Chinese Medical Perspective
Treating Emotions Using Chinese Herbs
Chinese Medical Pattern Discrimination
Acupuncture Treatment of Mental-Emotional Disorders
Research on the Benefits of Acupuncture
Anxiety
Depression
Depression & Anxiety
Schizophrenia
Treatment with Craniosacral Therapy & Visceral Manipulation
Useful Supplements and Herbs
Anxiety and Panic Attacks
Bipolar Disorder
Depression
Dietary Recommendations
Lifestyle Recommendations
References
INTRODUCTION
v Since the very beginning of our practices in 1996 Barbara and I have treated many patients suffering from depression, anxiety and other mental-emotional disorders. We treat these conditions using a combination of acupuncture, craniosacral therapy, hara visceral work, herbs, supplements and lifestyle recommendations. We hope this article gives you a better understanding of these conditions and how we treat them.
v According to the National Institutes of Health anxiety and depression affect 38 million Americans each year. Twice that number will suffer from anxiety or depressive illness at some point in their lives.
v Depression is a serious condition, and by self-treating it, you risk misdiagnosing yourself or misjudging the severity of the problem. Be sure to get an accurate diagnosis from a health professional before taking mood-boosting supplements or herbs, some of which can interact with prescription drugs. Mild depression that passes quickly may not require any diagnosis or treatment. However, when depression becomes recurrent, constant, or severe, it should be diagnosed by a licensed counselor, psychologist or psychiatrist. Diagnosis may be crucial to determining appropriate treatment.
WESTERN MEDICAL DESCRIPTION
v Anxiety
Anxiety disorders are the most common psychiatric disorders in the US. They are characterized by numerous physical symptoms such as: excessive sweating, muscle tension, numbness and tingling, shallow breathing, fainting and rapid heart rate. The emotional symptoms of anxiety disorders occur simultaneously with the physical ones and include agitation, feelings of unreality, fearfulness, feelings of impending doom, irritability, nervousness and shyness. Anxiety disorders are classified into various categories such as generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder and social phobia/social anxiety disorder. (Prousky, 2005)
v Bipolar Disorder
Bipolar disorder (manic-depressive illness) is a disorder of the brain characterized by extreme changes in mood, energy, thinking and behavior. Among psychiatric illnesses, bipolar disorder ranks second only to major unipolar depression as a cause of global disability. Bipolar patients may spend as much as 20% of their lives in episodes, most of this lost time taken up by depression. Between episodes, some 30-60 percent suffer psychosocial impairment. Even for those patients under apparent control, the relapse rates range as high as 40% in one year, 60% in two years and 73% in five or more years. While certain behavioral interventions such as cognitive-behavior therapy and cell membrane nutrients have shown promise the medical management of bipolar disorder remains overwhelmingly pharmacological. Most bipolar disorder patients require a combination of mood stabilizers to remain in remission. (Kidd, 2004)
Bipolar disorder is much more common in multiple sclerosis patients than in the general population. (Horrobin & Bennett, 1999) Bipolar disorder has a substantial overlap with major depressive disorder. (Kidd, 2004)
CT and MRI studies suggest cerebellar atrophy tending to be more extreme in brains with greater numbers of recorded bipolar disorder episodes. Cerebellar abnormalities could contribute to dysregulation of limbic and cortical regions that partly determine mood. (Kidd, 2004) PET and SPECT studies demonstrate low glucose metabolism and blood flow in the cortex (prefrontal and paralimbic) of moderately to severely depressed bipolar patients. In contrast, subcortical paralimbic structures such as the ventral striatum, thalamus and amygdale show abnormally high metabolism in moderately to severely depressed bipolar patients. (Ketter & Drevets, 2002)
v Depression
In a given one-year period up to 9.5% of the US population (nearly 19 million people) may suffer from depression. The three most common types of depression include: major depression, dysthymia (you simply don’t feel happy for extended periods of time), and bipolar disorder (mania alternating with periods of depression). (Hobbs, 2002)
A diagnosis of depression requires feelings of profound sadness or loss of interest in everyday activities for at least two weeks plus at least four of the following symptoms: a change in appetite or weight, an inability to sleep or over sleeping, restlessness, reduced energy, difficulty concentrating or making decisions, feelings of guilt or worthlessness, or thoughts of death or suicide. These symptoms must be severe enough to interfere with daily functioning. Conventional medicine typically treats depression with antidepressant drugs, psychotherapy or a combination of these two. (Weil, 2005)
After the diagnosis of depression has been made it is important to rule out the simple organic factors which are known to contribute to depression such as: nutrient deficiency, drug-induced depression, oral contraception, caffeine, smoking, hypoglycemia, thyroid function, adrenal function and various environmental factors. (Murray, 1991)
Depression may be triggered by tension, stress, a traumatic life event, chemical imbalances in the brain, thyroid disorders, upset stomach, headache, nutritional deficiencies, poor diet, the consumption of sugar, mononucleosis, lack of exercise, endometriosis, any serious physical disorder, food allergies or hypoglycemia. Heredity also plays a role. (Balch & Balch, 1997)
While the exact mechanisms involved in the pathogenesis of depression remain obscure, there is an indication of involvement of the frontal cortex and limbic system, including the hippocampus and the nucleus accumbens. (Nestler et al 2002)
A growing body of research indicates that depression is associated with excessive production of proinflammatory cytokines. These cytokines, including interleukin-1beta, -2 and –6, interferon-gamma, and TNF-α, can have direct and indirect effects on the CNS. Psychological stress, infection, trauma, allergies, toxins and various other factors can be responsible for a rise in these cytokines. Interestingly, various tricyclic and serotonin re-uptake inhibiting antidepressant medications can inhibit the release of the above-mentioned cytokines. (Maes & Smith, 1998)
USE OF SPECT IMAGING
v Based on research involving thousands of patients using SPECT (Single Photon Emission Computed Tomography) imaging Drs. Daniel Amen and. Lisa Routh have been able to see the major anxiety and depression centers in the brain. They have written a fascinating book detailing their findings entitled Healing Anxiety and Depression. The five major systems of the brain involved with behavior they have identified are:
1. The Basal Ganglia – a set of large structures near the center of the brain which helps integrate feelings, thoughts and movement. People with underactive basal ganglia frequently have problems with energy, motivation and decision making. On the other hand, excessive basal ganglia activity may be associated with heightened anxiety, or alternatively, with increased motivation.
2. The Deep Limbic System – lies near the center of the brain and helps to set a person’s emotional tone. When the deep limbic system is underactive, there is generally a positive, more hopeful state of mind. When it is overactive negativity can take over.
3. The Anterior Cingulate Gyrus – runs lengthwise through the deep aspects of the frontal lobes. When there are problems with the anterior cingulate gyrus, usually caused by a lack of serotonin, people become unable to shift their attention and become rigid, overfocused and cognitively inflexible. When this part of the brain works well, it is easier to plan and set reasonable goals. Difficulties in this part of the brain can cause a person to see fear, predict negative events and feel very unsafe in the world. They may become worriers and continually obsess. Clinical problems associated with this area of the brain include Obsessive-Compulsive Disorder, eating disorders, addictive disorders, and Oppositional Defiant Disorder.
4. The Temporal Lobes – are located underneath our temples and behind our eyes and are largely responsible for processing memories into long-term storage. When they are overactive we tend to be too reactive to the situations in our lives, and when they are underactive, we tend to act inappropriately. The nondominant temporal lobe has been associated with religious experiences, such as flashes of religious intuition and spiritual experiences.
5. The Prefrontal Cortex – is the most evolved part of the brain and makes up nearly 30% of the human brain. When it works properly, we are thoughtful, empathic and able to express our feelings appropriately, as well as to be organized and goal directed. When it is underactive, there is less of a filtering mechanism available and distractibility becomes a problem. Damage or underactivity in this part of the brain leads to an increased vulnerability to depression.
CLASSIFICATION AND TREATMENT BASED ON THE WORK OF DRS. AMEN AND ROUTH
v Drs. Amen and Routh have divided mental-emotional disorders into seven categories based on abnormalities found in the five areas of the brain together with the symptom clusters associated with each. Although I do not subscribe to everything they say, I find their ideas thought-provoking and presented from a fresh perspective. The following is a summary of the description and treatment of the seven categories as described in their book Healing Anxiety and Depression:
1. Pure Anxiety – is based on excessive activity in the basal ganglia.·
Symptoms of this category include: Frequent feelings of nervousness or anxiety; panic attacks; avoidance of places for fear of having an anxiety attack; heightened muscle tension; periods of heart pounding, nausea or dizziness; tendency to predict the worse; multiple, persistent fears or phobias; conflict avoidance; excessive fear of being judged or scrutinized by others; easily startled or tendency to freeze in anxiety-provoking or intense situations; seemingly shy, timid and easily embarrassed, and bites fingernails or picks skin.·
Treatment for pure anxiety includes medications for moderate to severe cases and nutritional supplements for mild cases.
Useful supplements for mild cases include:
o Gamma-amino butyric acid (GABA) functions as a neurotransmitter in the brain and helps stabilize nerve cells by decreasing their tendency to fire erratically or excessively.
o Vitamin B-6 supports the action of the enzymes that convert the amino acid L-glutamine to GABA in the brain. Anxious people may not have enough L-glutamine or they may have vitamin B-6 deficiency.
o Valerian is a well-recognized herb with anti-anxiety properties. It appears to work by enhancing the activity of GABA. CAUTION: Do not take valerian with alcohol, barbiturates or benzodiazepines; or during pregnancy or breast-feeding.
2. Pure Depression – is based on excessive activity in the deep limbic system.·
Symptoms of this category include persistent sad or “empty” mood; loss of interest or pleasure in activities that are usually fun including sex; restlessness, irritability, or excessive crying; feelings of guilt, worthlessness, helplessness, hopelessness, pessimism; sleeping too much or too little, early-morning awakening; appetite and/or weight loss, or overeating and weight gain; decreased energy, fatigue, feeling “slowed down”; thoughts of death or suicide, or suicide attempts; difficulty concentrating, remembering or making decisions; persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain; persistent negativity or chronic low self-esteem; and persistent feeling of dissatisfaction or boredom.·
Treatment for severe pure depression is with antidepressant mediations. Mild cases may be treated with supplements. It is also very important to incorporate the use of other interventions such as therapy, diet and exercise, education and support groups.
Useful supplements for mild cases include:
o D-L phenylalanine (DLPA) is the amino acid precursor for norepinephrine. A number of studies show norepinephrine and epinephrine are low in patients with depression. CAUTION: People who have phenylketonuria should not take DLPA because they do not have the enzyme that metabolizes it.
o L-tyrosine is an amino-acid building block for dopamine, epinephrine and norepinephrine. It helps to boost energy levels, mood and metabolism. It may also increase motivation and improve concentration.
o SAMe is involved with the production of several neurotransmitters. When a person is depressed, the synthesis of SAMe from methionine is impaired. SAMe is one of the best natural antidepressants, and in a number of recent studies it has performed as well as conventional antidepressant mediations. It has been found to increase the neurotransmitters that are low when people have depression.
3. Mixed Anxiety and Depression – is based on excessive activity in the basal ganglia and the deep limbic system.
· Symptoms of this type are a combination of both pure anxiety symptoms and pure depression symptoms.
· Treatment is best done with psychological interventions targeted at both anxiety and depression such as biofeedback, interpersonal psychotherapy and cognitive therapy as well as antidepressant medications or supplements that have a calming effect on the basal ganglia and the deep limbic areas. A combination of SAMe and GABA is often helpful for these types of patients.
4. Overfocused Anxiety/Depression – is based on excessive activity in the anterior cingulate gyrus, the basal ganglia and/or the deep limbic system.
Symptoms include at least four items from the pure anxiety and/or pure depression checklists, plus at least four of the following: Excessive or senseless worrying; upset when things are out of place or don’t go the way you planned; tendency to be oppositional or argumentative; tendency to have repetitive negative or anxious thoughts; tendency toward compulsive or addictive behaviors; intense dislike of change; tendency to hold grudges; difficulty seeing options in situations; tendency to hold on to own opinion and not listen to others; need to have things done a certain way or you become very upset; others complain that you worry too much and a tendency to say no without first thinking about the question.·
Treatment is best done with interventions that increase the neurotransmitter serotonin. Treatment can include medication, such as SSRIs and antidepressants, behavior therapy, dietary changes, intense aerobic exercise and supplements such as 5-HTP and St. John’s wort.
o St. John’s wort may be the most potent of all the supplements at increasing serotonin availability in the brain. CAUTION: Do not use St. John’s wort with antidepressants as it may overload the system with serotonin.
o L-tryptophan and 5-HTP are amino acid building block for serotonin therefore taking these supplements can increase cerebral serotonin. L-tryptophan is a naturally occurring amino acid found in milk, meat and eggs. One of the problems with dietary L-tryptophan is that a significant portion of it does not enter the brain.
o 5-HTP is a step closer in the serotonin production pathway. It is also more widely available than L-tryptophan and is more easily taken up in the brain. Seventy percent is taken up into the brain, as opposed to only 3 percent of L-tryptophan. 5-HTP is about 5 to 10 times more powerful than L-tryptophan. Decreased serotonin levels in the brain have been correlated with depression, aggressive feelings, and violence. 5-HTP boosts serotonin levels in the brain and helps to calm anterior cingulate gyrus hyperactivity. CAUTION: Because 5-HTP increases serotonin, you should not take other medications concurrently that also increase serotonin such as St. John’s wort, L-tryptophan or prescribed antidepressants.
5. Cyclic Anxiety/Depression – is based on focal (a discrete area) increased activity in the deep limbic system and/or in the basal ganglia. Cyclic disorders such as bipolar disorder, cyclothymia and premenstrual dysphoric disorder, along with panic attacks, fit in this category because they are episodic and unpredictable.·
Symptoms include at least four items from the pure anxiety and/or pure depression checklists plus at least four of the following: Periods of abnormally elevated, depressed or anxious mood; periods of decreased need for sleep, feeling energetic on dramatically less sleep than usual; periods of grandiose notions, ideas or plans; periods of increased talking or pressured speech; periods of too many thoughts racing through the mind; periods of markedly increased energy; periods of poor judgment that lead to risk-taking behavior (separate from usual behavior); periods of inappropriate social behavior; periods of irritability or aggression and periods of delusional or psychotic thinking.·
Treatment is best accomplished with mood stabilizers such as lithium or anticonvulsant mediations. Psychological interventions can also help decrease the stressors that may trigger an episode. Antidepressant therapy may be necessary, but this needs to be very closely monitored because of the risk of triggering mania. The following supplements may be helpful:
o Omega-3 fatty acids supplementation can be helpful. An insufficiency of omega-3 fatty acids has been linked to depression and mood instability. In a study done at Harvard and reported in the Archives of General Psychiatry, supplementation with high-dose purified fish oils provided a statistically significant improvement in bipolar disorder.
o Taurine is an inhibitory neurotransmitter, which stimulates the neurotransmitter GABA. It has a calming effect on the nervous system.
6. Temporal Lobe Anxiety/Depression – is based on increased or decreased activity in the temporal lobes and increased activity in the basal ganglia and/or deep limbic system.
Symptoms of this type include at least four items from the pure anxiety and/or pure depression checklists, plus at least four of the following: Short fuse or periods of extreme irritability; periods of rage with little provocation; often misinterprets comments as negative when they are not; periods of spaciness or confusion; periods of panic and/or fear for no specific reason; visual or auditory changes, such as seeing shadows or hearing muffled sounds; frequent periods of déjà vu; sensitivity or mild paranoia; headaches or abdominal pain of uncertain origin; history of a head injury or family history of violence or explosiveness; dark thoughts that may involve suicidal or homicidal thoughts; and periods of forgetfulness or memory problems.·
Treatment is best accomplished with a combination of anticonvulsants and antidepressant medications. Psychological interventions, such as interpersonal psychotherapy and cognitive therapy can be helpful. Useful supplements for this type include the following:
o Gamma-amino butyric acid (GABA): Many individuals who have temporal lobe symptoms also struggle with temper control, irritability and anxiety, and GABA produces a calming effect in these cases.
o Phosphatidyl serine is useful in cases of memory problems. There are 18 double-blind studies supporting the effectiveness of phosphatidyl serine supplementation for memory issue complaints. Low levels of phosphatidyl serine are associated with memory problems and depression in the elderly.
o Ginkgo biloba has been shown to improve energy, concentration, focus and memory.
7. Unfocused Anxiety/Depression – is based on decreased activity in the prefrontal cortex and increased activity in the basal ganglia and/or deep limbic system. This type is often seen in conjunction with Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD).
Symptoms of this type include at least four items from the pure anxiety and/or pure depression checklists, plus at least four of the following: Trouble staying focused; spaciness or feeling in a fog; overwhelmed by tasks of daily living; feeling tired, sluggish, or slow-moving; procrastination, failure to finish things; chronic boredom; loses things; easily distracted; forgetful; poor planning skills; difficulty expressing feelings and difficulty expressing empathy for others.
Treatment is best accomplished with stimulating antidepressants such as Wellbutrin. Intense aerobic exercise is also helpful, as is a high-protein, low-carbohydrate diet. Useful supplements include the following:
o D-L phenylalanine (DLPA) is the amino acid precursor for norepinephrine. A number of studies show norepinephrine and epinephrine are low in patients with depression. CAUTION: People who have phenylketonuria should not take DLPA because they do not have the enzyme that metabolizes it.
o L-tyrosine is an amino-acid building block for dopamine, epinephrine and norepinephrine. It helps to boost energy levels, mood and metabolism. It may also increase motivation and improve concentration.
o SAMe is involved with the production of several neurotransmitters. When a person is depressed, the synthesis of SAMe from methionine is impaired. SAMe is one of the best natural antidepressants, and in a number of recent studies it has performed as well as conventional antidepressant mediations. It has been found to increase the neurotransmitters that are low when people have depression.
o Omega-3 fatty acids are helpful in that they boost cellular transmission.
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For more information on the use of supplements and herbs in the treatment of anxiety and panic attacks, depression and bipolar disorder we refer you to the section on Useful Supplements and Herbs below.
CHINESE MEDICAL PERSPECTIVE
v In Traditional Chinese Medicine (TCM) it is the Mind or Shen which is most closely connected with the mental and emotional side of an individual’s make-up. The Mind is the most subtle and non-material type of Qi or energy. The word Shen has two main meanings: As “Mind” it indicates the activity of thinking, consciousness, insight and memory, and as “Spirit” it indicates the complex of all five mental-spiritual aspects of a human being, i.e., the Mind itself, the Ethereal Soul (or Hun), the Corporeal Soul (or Po), the Intellect and Will Power.
v Kidney Yin essence makes the “Marrow”, which is the counterpart of the Western Central Nervous System. Essence in TCM is considered as the foundation of the body and root of the Mind. However, one’s state of Mind can also affect Qi and Essence. For example, if the Mind is disturbed by emotional stress, or if it becomes unhappy, depressed, anxious or unstable, it will affect Qi and/or Essence. Emotions can become the cause of disease when they are excessive and/or prolonged. And vice versa. For example, if Liver Yin is deficient and causes Liver Yang to rise, this may cause a person to be irritable all the time. And, on the other hand, if a person is frustrated and irritable all the time it can affect the Liver giving rise to Liver Qi Stagnation or Liver Yang Rising.
v According to Leon Hammer, in his book, Dragon Rises, Red Bird Flies, the Nervous System in Chinese medicine is simply another name for what is generally considered Tai Yang; that is, the outermost, light and volatile energy of the body, which in some ways might also be equated with the Wei Qi or the defensive energy of the body. He believes that the integrity of the Tai Yang or Nervous System is the primary factor in the etiology of all psychological disorders.
v The following list shows which emotions are related to the different organs and their corresponding element:
○ Anger, frustration, resentment, inspiration, decisiveness and control are related to the Liver or Wood element
○ Joy, love, compassion, clarity and craving are related to the Heart or Fire element
○ Over-thinking, thought, reflection, memory and preoccupation are related to the Spleen or Earth element
○ Sadness, grief, sensitivity, sustainability and strength are related to the Lungs or Metal element
○ Fear, destiny, truth, will and intuition are related to the Kidneys or Water element
○ Shock affects the Kidneys and Heart
○ Hatred affects the Heart and Liver
○ Guilt affects the Kidneys and Heart
○ Worry affects the Lungs and Spleen
v Leon Hammer believes that bipolar disorder involves the stagnation of Liver Qi and Heart Qi that burns the Wood and builds the Fire to the point that the Water is eventually unable to control it. The manic phases occur when the Water is sufficiently depleted to allow the Fire to burn out of control. The Heart Qi then becomes wild and Heart Yin is unable to control the Yang. The crash into the depths of depression occurs when the Wood is burned past the point where it can continue to feed the Fire.
TREATING EMOTIONS USING CHINESE HERBS
The following Chinese herbs are recommended by Sean Tuten, DOM, for treating emotions connected with the Lung, Liver, Spleen, Kidney and Pericardium:
v Lung – Bai He, Lily Bulb (Lilium brownii): For grief and sadness. It helps to allow for experience of grief. It moves sorrow through the system more quickly.
v Liver – He Huan Hua, Mimosa Flower (Albizzia julibrissin): For anger and irritability. It pacifies the resentful child inside. “…makes one happy and worry-free…as if one had acquired whatever one desired.”
v Spleen – Shi Chang Pu, Sweetflag (Acorus gramineus): For forgetfulness, pensiveness and worry. Intervenes in circular cycles of preoccupation. It opens up the connection between one’s self and the world. ‘Reality check.’
v Kidney – Wu Wei Zi, Schisandra (Schisandra chinensis): For fear, shock and anxiety. Feeling like things are falling apart. “Having the rug pulled from under you.” Feelings of insecurity, both emotional and material.
v Pericardium – Wild Oats (Avena sativa): For clarity, presence and joy (or lack thereof). Letting things in. Reassures the pericardium that the heart can handle the truth. Has a relaxing effect on ‘heart protector’.
CHINESE MEDICAL PERSPECTIVE
v In Traditional Chinese Medicine (TCM) it is the Mind or Shen which is most closely connected with the mental and emotional side of an individual’s make-up. The Mind is the most subtle and non-material type of Qi or energy. The word Shen has two main meanings: As “Mind” it indicates the activity of thinking, consciousness, insight and memory, and as “Spirit” it indicates the complex of all five mental-spiritual aspects of a human being, i.e., the Mind itself, the Ethereal Soul (or Hun), the Corporeal Soul (or Po), the Intellect and Will Power.
v Kidney Yin essence makes the “Marrow”, which is the counterpart of the Western Central Nervous System. Essence in TCM is considered as the foundation of the body and root of the Mind. However, one’s state of Mind can also affect Qi and Essence. For example, if the Mind is disturbed by emotional stress, or if it becomes unhappy, depressed, anxious or unstable, it will affect Qi and/or Essence. Emotions can become the cause of disease when they are excessive and/or prolonged. And vice versa. For example, if Liver Yin is deficient and causes Liver Yang to rise, this may cause a person to be irritable all the time. And, on the other hand, if a person is frustrated and irritable all the time it can affect the Liver giving rise to Liver Qi Stagnation or Liver Yang Rising.
v According to Leon Hammer, in his book, Dragon Rises, Red Bird Flies, the Nervous System in Chinese medicine is simply another name for what is generally considered Tai Yang; that is, the outermost, light and volatile energy of the body, which in some ways might also be equated with the Wei Qi or the defensive energy of the body. He believes that the integrity of the Tai Yang or Nervous System is the primary factor in the etiology of all psychological disorders.
v The following list shows which emotions are related to the different organs and their corresponding element:
○ Anger, frustration, resentment, inspiration, decisiveness and control are related to the Liver or Wood element
○ Joy, love, compassion, clarity and craving are related to the Heart or Fire element
○ Over-thinking, thought, reflection, memory and preoccupation are related to the Spleen or Earth element
○ Sadness, grief, sensitivity, sustainability and strength are related to the Lungs or Metal element
○ Fear, destiny, truth, will and intuition are related to the Kidneys or Water element
○ Shock affects the Kidneys and Heart
○ Hatred affects the Heart and Liver
○ Guilt affects the Kidneys and Heart
○ Worry affects the Lungs and Spleen
v Leon Hammer believes that bipolar disorder involves the stagnation of Liver Qi and Heart Qi that burns the Wood and builds the Fire to the point that the Water is eventually unable to control it. The manic phases occur when the Water is sufficiently depleted to allow the Fire to burn out of control. The Heart Qi then becomes wild and Heart Yin is unable to control the Yang. The crash into the depths of depression occurs when the Wood is burned past the point where it can continue to feed the Fire.
TREATING EMOTIONS USING CHINESE HERBS
The following Chinese herbs are recommended by Sean Tuten, DOM, for treating emotions connected with the Lung, Liver, Spleen, Kidney and Pericardium:
v Lung – Bai He, Lily Bulb (Lilium brownii): For grief and sadness. It helps to allow for experience of grief. It moves sorrow through the system more quickly.
v Liver – He Huan Hua, Mimosa Flower (Albizzia julibrissin): For anger and irritability. It pacifies the resentful child inside. “…makes one happy and worry-free…as if one had acquired whatever one desired.”
v Spleen – Shi Chang Pu, Sweetflag (Acorus gramineus): For forgetfulness, pensiveness and worry. Intervenes in circular cycles of preoccupation. It opens up the connection between one’s self and the world. ‘Reality check.’
v Kidney – Wu Wei Zi, Schisandra (Schisandra chinensis): For fear, shock and anxiety. Feeling like things are falling apart. “Having the rug pulled from under you.” Feelings of insecurity, both emotional and material.
v Pericardium – Wild Oats (Avena sativa): For clarity, presence and joy (or lack thereof). Letting things in. Reassures the pericardium that the heart can handle the truth. Has a relaxing effect on ‘heart protector’.
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For more information on the use of Chinese herbs in the treatment of mental-emotional disorders we refer you to the section on Useful Supplements and Herbs below.
CHINESE MEDICAL PATTERN DISCRIMINATION
The following are some Chinese Medical patterns that are often involved in mental and emotional problems:
v Liver Qi Stagnation From an emotional perspective the most characteristic and common signs are mental depression, alternation of moods, irritability, “snapping” easily, an intense feeling of frustration, PMS tension, annoyance and impatience. Although depression is experienced in the mind it is usually rooted in a stagnant Liver. If the Liver Qi Stagnation is not resolved it will continually permeate one’s emotional being with its depressive energy.
v Heart and Lung Qi Stagnation The person will feel very sad and depressed and will tend to weep. The person will also be very sensitive to outside psychic influences.
v Heart Blood Deficiency The person may feel depressed and tired, and the Mind may be confused and lack concentration.
v Liver Blood Deficiency The person may feel depressed and tired, and may lack a sense of direction in life and “vision”. He or she may be confused as to what aims in life they should follow. Alternatively, he or she may be fearful of making decisions lest they make the wrong one.
v Heart Blood Stasis This person will feel very anxious with an acute sense of anxiety in the chest, and even up to the throat. The person will be restless and prone to be easily startled. The person may also experience depression, palpitations, insomnia, a suffocating sensation in the chest, irritability, mood swings, and in severe cases psychosis.
v Liver Blood Stasis The person will be very anxious, restless and confused about his or her aims in life. He or she will also be very irritable and prone to outburst of anger. The person may also experience depression, severe mood swings, intense irritability, propensity to violent outburst of anger, obsessive jealousy and in severe cases, manic-depression.
v Liver Blood Heat The person will feel very angry and tend to shout at other people a lot; may also be violent and hit people, may also feel angry and frustrated about their life and may tend to be impulsive.
v Heart Yin Deficiency The person will feel very anxious, particularly in the evening, with a vague and fidgety sense of anxiety, uneasy without knowing why. The person will also feel dispirited, depressed and tired. Memory and concentration will be poor and the sleep will also be poor.
v Liver Yin Deficiency may cause a deep depression, a lack of purpose in life and confusion about objectives and aims.
v Phlegm Obstructing the Mind In this pattern Phlegm obstructs the Mind and thinking but it does not agitate the Mind. Thus the person will not be restless, but on the contrary, tired, subdued, depressed and quiet.
v Phlegm Fire Harassing the Mind In this pattern Phlegm-Fire obstructs the Mind, but is also agitates it. It therefore makes the person agitated, restless and anxious. In some cases, the person may alternate between periods of depression and confusion (due to Phlegm) and periods of abnormal elation, agitation and manic behavior (due to Fire). In severe cases this leads to manic-depression. Manic-depression can also be seen as an alternation between excess plus irregularity and deficiency plus stagnation as in Heart Fire plus Disturbance of Spirit alternating with Deficient Heart Fire plus Stagnant Heart Qi. (Ross, 1995)
v Empty Heat Empty Heat agitates the Mind and causes severe anxiety, insomnia, agitation, mental restlessness and fidgetiness. It is frequently caused by excess joy, craving, jealousy and excessive love.
ACUPUNCTURE TREATMENT OF MENTAL-EMOTIONAL DISORDERS
Some useful acupuncture points for the treatment of mental-emotional problems are:
BL-42 calms the Mind and settles the Corporeal Soul
BL-47 settles and roots the Ethereal Soul in the Liver
BL-52 strengthens will power, drive and determination.
BL-23, BL-52 and BL-44 strengthen will power and drive, calm the mind and relieve anxiety, depression, mental restlessness and insomnia.
HT-8 and HT-9 for severe mental restlessness, anxiety and insomnia.
PC-7 is useful for emotional problems from breaking of relationships.
PC-6 calms the Mind and settles the Ethereal Soul when they are affected by Liver Qi Stagnation resulting from anger, resentment or frustration. It also relieves unhappiness.
KI-9 relieves anxiety and depression
SI-3 strengthens the will power, drive and determination.
GB-13 is useful for severe anxiety and mental restlessness.
LU-7 has a releasing effect on sadness, worry and grief.
REN-4 is a very grounding point and is good for anxiety and mental restlessness.
DU-20 clears the Mind, lifts the mood, relieves depression and stimulates the memory and concentration.
REN-17 is useful for dispersing stagnant qi.
An example of an acupuncture point prescription for Heart Yin Deficiency is: REN-4, SP-6, KI-6, REN-14, REN-17, Ht-7, DU-20 and REN 24
An example of an acupuncture point prescription for Liver Qi Stagnation is: LIV-3, LI-4, LIV-14, PC-6, PC-7, TB-6, DU-24 and GB-13
RESEARCH ON THE BENEFITS OF ACUPUNCTURE
v Anxiety.
o According to a study on 55 participants by Want and Kain entitled “Auricular acupuncture: a potential treatment for anxiety” published in Anesth Analg 2001 Feb;92(2):548-53 the authors concluded that auricular acupuncture at the “relaxation” point can decrease the anxiety level in a population of healthy volunteers.
o According to a study by Lo and Chung entitled “The sedative effect of acupuncture” published in Am J Chin Med 1979 Autumn;7(3):253-8 it was found that out of 8 patients with anxiety neurosis who were treated with acupuncture 6 of them showed good to moderate response while 2 had no change.
o In a study by Paraskeva et al entitled “Needling of the extra 1 point decreases BIS values and preoperative anxiety” published in Am J Chin Med 2004;32(5):789-94 in which 50 patients were randomly assigned to receive acupuncture at the extra 1 point or to a control point, it was found that needling of the extra1 point preoperatively significantly decreased the BIS (Bispectral Index) values and the VSS (verbal score scale) for anxiety but needling the control point decreased only VSS values.
v Depression.
o In a single-blind placebo-controlled study by Roschke et al entitled “The benefit from whole body acupuncture in major depression” published in J Affect Disord. 2000 Jan-Mar;57(1-3):73-81 seventy inpatients with a major depressive episode were randomly included in 3 different treatment groups: verum acupuncture, placebo acupuncture and a control group. All three groups were pharmacologically treated with the antidepressant mianserin. Patients who experienced acupuncture improved slightly more than patients treated with mianserin along. Additionally applied acupuncture improved the course of depression more than pharmacological treatment with mianserin alone. However, they could not detect any differences between placebo and verum acupuncture.
o In a clinical trial by MacPherson et al entitled “Acupuncture for depression: first steps toward a clinical evaluation” published in J Altern Complement Med. 2004 Dec;10(6):1083-91 ten patients received up to 10 individualized acupuncture treatments from one of two acupuncturists. In the case series, only 6 patients both received treatment and completed 10-week questionnaires; however, significant improvements between before and after were found in their levels of depression. Many facts, as well as acupuncture, may have contributed to these improvements. No serious adverse events occurred.
o In a study by Han, Li and Luo in Chinese entitled “Comparative study of electro-acupuncture and maprotiline in treating depression” published in Zhongguo Zhong Xi Yi Jie He Za Zhi 2002 Jul;22(7):512-4, 521 it was found that both electro-acupuncture and maprotiline are effective in treating depression.
o In a study by Han, Li, Luo and Zhao entitled “Clinical study on electro-acupuncture treatment for 30 cases of mental depression” published in J Tradit Chin Med 2004 Sep;24(3):172-6 it was concluded that electro-acupuncture therapy can produce the same clinical therapeutic effect as that produced by the drug maprotiline, giving less side effects and better symptomatic improvement.
o According to two consecutive clinical studies by Luo et al entitled “Clinical research on the therapeutic effect of the electro-acupuncture treatment in patients with depression” published in Psychiatry Clin Neurosci 1998 Dec;52 Suppl:S338-40 if was found that the results from both studies showed that the therapeutic efficacy of electro-acupuncture was equal to that of amitriptyline for depressive disorders. Electro-acupuncture had a better therapeutic effect for anxiety somatization and cognitive process disturbance of depressed patients than amitriptyline. Moreover the side effects of electroacupuncture were much less that than of amitriptyline. The article suggested that electro-acupuncture treatment was an effective therapeutic method for depressive disorders. Particularly, it was a treatment of choice for depressed patients who were unable to comply with the classic tricyclic antidepressants because of their anticholinergic side effects.
o In a three year study of three case histories by Kurland entitled “ECT and Acu-EST in the treatment of depression” published in Am J Chin Med 1976 Autumn;4(3):289-92 it was found that individual Acu-EST (Acupuncture Electric Stimulation Therapy) treatments were often less effective than individual ECT (electroconvulsive therapy). However, series of Acu-EST did assist in producing significant remissions in depressive symptomatology. Because it did not produce the temporary disabling memory defects which occurred with ECT, Acu-EST was more easily adaptable to outpatient treatment.
o In a study on the effectiveness of acupuncture treatment on 167 patients with depression associated with manic-depressive psychosis and schizophrenia by Poliakov in Russian entitled “Acupuncture in the treatment of patients with endogenous depression” published in Zh Nevropatol Psikhiatr Im S S Korsakova. 1987;87(4):604-8 acupuncture was found to be effective in some patients showing resistance to antidepressants.
o In a study by Manber et al entitled “Acupuncture: a promising treatment for depression during pregnancy” published in J Affect Disord. 2004 Nov 15;83(1):89-95 sixty-one pregnant women with major depressive disorder were assigned to one of three treatments: an active acupuncture group, an active control acupuncture group or a massage group. Response rates at the end of the acute phase were statistically significantly higher for the active acupuncture group (69%) than for the massage group (32%) with an intermediate active control acupuncture response rate of 47%. The active acupuncture group also exhibited significantly higher average rate of reduction in Beck Depression Inventory (BDI) scores from baseline to the end of the first month of treatment than the massage group. The authors concluded that acupuncture holds promise for the treatment of depression during pregnancy.
v Depression and Anxiety
o A placebo-controlled, randomized, modified double-blind study on 43 patients with minor depression and 13 patients with generalized anxiety disorders by Eich et al in German entitled “Acupuncture in patients with minor depressive episodes and generalized anxiety. Results of an experimental study” published in Fortschr Neurol Psychiatr 2000 Mar;68(3):137-44 indicated that needle acupuncture (Du.20, Ex.6, He.7, Pe.6 Bl.62) leads to a significant clinical improvement as well as to a remarkable reduction in anxiety symptoms in patients with minor depression or with generalized anxiety disorders.
v Schizophrenia
o A study by Zhuge and Chen in Chinese entitled “Comparison between electro-acupuncture with chlorpromazine and chlorpromazine alone in 60 schizophrenic patients” published in Zhongguo Zhong Xi Yi Jie He Za Zhi 1993 Jul;13(7):408-9, 388 showed that the total curative effects of the two groups were similar. However, the marked effects appeared earlier in combined therapy than that of using chlorpromazine alone, less chlorpromazine was needed, hence displayed fewer side effects.
o A study on 33 patients by Zhang in Chinese entitled “A controlled study of clinical therapeutic effects of laser acupuncture for schizophrenia” published in. Zhongguo Zhong Xi Yi Jie He Za Zhi 1991 Apr;24(2):81-3 found that laser acupuncture was as effective as chlorpromazine in the treatment of schizophrenia.
TREATMENT WITH CRANIOSACRAL THERAPY & VISCERAL MANIPULATION
v According to John Upledger in his book, Craniosacral Therapy “We have yet to examine a case of depression, be it endogenous or reactive, that has not shown severe anterior-posterior compression of the cranial base. Further, we have yet to see the first case which has not responded favorably and usually dramatically to successful decompression of the cranial base.” He adds that “Another cause of severe craniosacral system dysfunction is compression of the lumbosacral junction (L5-S1). This problem is often the underlying cause of recurrent cranial base compression, which results in head pain, intellectual dysfunction and psychoneurotic depression.”
v Dr. Upledger goes on to say that “Anxiety is the other area in which we had major success. However, the anxious patient does not seem to present with as consistent and characteristic a craniosacral system restriction pattern as does the depressive patient. In anxiety treat what you find. Restrictions will have a tendency to recur. Treat them again, and over a period of weeks the anxiety level seems to dissipate. Occasionally, a crisis will occur as the corrections are carried out. Be prepared to support the patient through the crisis. It usually signals the release of some repressed emotional matter which will ultimately be beneficial to the patient.”
v Jean-Pierre Barral in his book, Visceral Manipulation, states that “people suffering from depression are prone to ptosis (dropping of an organ) for at least two systemic reasons. The depression of the central nervous system causes a generalized decrease in tonus, and the weight loss that is so often a part of the depressive syndrome results in a decrease in the supportive fat around the organs.”
v Barral feels that an “important indication for manipulation of the liver is nervous depression. The relationship between depression and the liver is well known in traditional Oriental medicine. In this tradition, as understood in modern France, the liver deficiency is derived from a lack of energy in the brain, particularly from the right frontal areas, this in turn depletes the brain’s energy. The finding of biliary pigments in cerebral tissue would tend to support this concept.”
USEFUL SUPPLEMENTS AND HERBS
v Anxiety and Panic Attacks.
o Inositol has been reported to control panic attacks in people with anxiety. A double-blind, placebo-controlled, crossover study of 21 individuals with panic disorder found that those given 12 g of inositol daily had fewer and less severe panic attacks compared with the placebo group. (Benjamin, 1995)
o Inositol: A double-blind, crossover study of 20 individuals compared inositol (up to 18 g daily) with fluvoxamine (up to 150 mg daily) for the treatment of panic disorder. The results over 4 weeks of treatment with each agent suggest that inositol was as least as effective as fluvoxamine. (Palatnik et al, 2001)
o Melatonin: In a randomized, double-blind, placebo-controlled study, perioperative effects of melatonin compared to midazolam were evaluated in 75 women. Patients who received either midazolam or 5 mg melatonin had a significant decrease in anxiety levels before and after surgery, as compared with placebo. (Naquib & Samarkandi, 1999)
o Multivitamin and Mineral Supplement: A double-blind, placebo-controlled trial of 80 healthy male volunteers founds that 28 days of treatment with a multivitamin and mineral supplement (containing calcium, magnesium and zinc) significantly reduced perceived anxiety and stress, (Carroll et al 2000)
o Passion Flower: A double-blind, placebo-controlled trail of 36 individuals compared a passion flower extract (45 drops per day) with oxazepam (30 mg/day) for the treatment of generalized anxiety disorder. Oxazepam showed a more rapid onset of action, but the end of the 4-week trial, both treatments resulted in statistically equivalent improvements in HAM-A scores. Oxazepam use was associated with more problems relating to job performance. (Aknondzadeh et al, 2001)
o Selenium has been shown to elevate mood and decrease anxiety. These effects were more noticeable in people who had lower levels of selenium in their diets to begin with. (Balch& Balch, 1997)
o Suan Zao Ren Tang may be effective in treating anxiety. This Chinese herbal preparation was tested in a time-series design in which a placebo was alternated with the herbal preparation in 30 individuals with reported high anxiety scores. Anxiety scores decreased significantly after the week of active treatment and returned to previous high levels when taking the placebo.(Chen HC et al, 1985) Suan Zao Ren Tang, also known as Sour Jujube Decoction, contains the following herbs: zizyphus, poria, anemarrhena, ligusticum and licorice. In Chinese medical terms it nourishes the blood, calms the spirit, clears heat and eliminates irritability. The primary strategy of the formula is to nourish the Heart and calm the spirit. (Bensky & Barolet, 1990)
o Valerian: A double-blind, placebo-controlled crossover study of 48 participants placed under social stress situations evaluated the effects of valerian and propranolol, as well as their combination. Although propranolol reduced both physical and subjective sensations of stress, valerian improved subjective sensations only. (Kohnen & Oswald, 1988) CAUTION: There is a possible risk of potentiation of sedation when using valerian along with sedatives.
o 5-HTP is useful for anxiety (Kahn et al, 1987) CAUTION: There is a possible risk of serotonin syndrome if 5-HTP is used concurrently with SSRIs and other serotonergic drugs. *Serotonin syndrome is a toxic reaction requiring immediate medical attention and is associated with too much serotonin. Symptoms may include anxiety, restlessness, confusion, weakness, tremor, muscle twitching or spasm, high fever, profuse sweating and rapid heart beat.
v Bipolar Disorder
CAUTION: Case reports of manic episodes have been reported with the use of herbs and supplements thought to possess antidepressant properties such as inositol, St. John’s wort, fish oil, SAMe and L-glutamine. (Bratman & Girman, 2003) Bipolar patients should be careful of flaxseed oil, based on reports that continued intake can trigger mania. (Kidd, 2004)
o Choline: Weak evidence suggests that choline may be helpful for bipolar illness. (Stoll, Locke et al, 1999)
o Fish oil: Preliminary evidence suggests that fish oil, a source of omega-3 fatty acids, may be helpful for bipolar disorder. In a double-blind study, 30 individuals with bipolar disorder were given either placebo or fish oil capsules for 4 months, in addition to their existing treatment. The results showed longer symptom-free periods in the treated group. . (Stoll, Severus et al, 1999) This trial employed fish oil in rather high doses: 7 capsules twice daily, each capsule containing 440 mg of EPA and 240 mg of DHA. By comparison, most fish oil capsules contain no more than 300 mg of total omega-3 fatty acids.
o Lecithin: Weak evidence suggests that lecithin may be helpful for bipolar illness. (Cohen et al, 1982)
o Vitamin C: In a double-blind trial on 40 institutionalized psychiatric patients (including four manic-depressives) with 1 g vitamin C daily versus placebo for three weeks, the bipolar patients on vitamin C experienced significant symptomatic improvement. (Milner G, 1963) Vitamin C and other antioxidants modulate the types of prostaglandins and other eicosanoids that come from membrane fatty acids. This property directly supports membrane normalization as a basis for successful bipolar management.
v .Depression
o 5-HTP has shown efficacy in treating depression in some trials. A 6-week, double-blind trial of 63 individuals given either 5-HTP (100 mg three times daily) or fluvoxamine (50 mg three times daily) showed equivalent improvements in depressive symptomatology. (Poldinger et al, 1991)
o Acetyl-L-Carnitine: A double-blind study of 60 seniors with dysthymia found that treatment with acetyl-L-carnitine, 3 g/day, over a 2-month period significantly improved symptoms as compared with placebo. (Bella, 1990)
o B vitamins: Studies have found that depressed people tend to have low blood levels of vitmains B-6, B-12 and folic acid, which are needed for the health of nerve cells and for the manufacture of chemical messengers like serotonin. B vitamins are safe to take with conventional antidepressants and may actually help your body use 5-HTP and SAMe more efficiently.(Weil, 2005)
o Chai Hu Shu Gan San (Bupleurum Soothe the Liver Powder): In a study conducted in China in 2003 involving 58 patients suffering from post-stroke depression. It was found that the Chinese medical protocol was more effective overall than the Western medical protocol. In the Chinese medical protocol the treatment group of 30 patients received an augmented version of Chai Hu Shu Gan San which contained the following herbs: Chai Hu, Bai Shao, Zhi Ke, Xiang Fu, Yu Jin, Chuan Xiong, Ju Hong, Fu Ling, Ban Xia, He Huan Hua, Ye Jiao Teng andSuan Zao Ren. A total of 155 gm of the formula was decocted in 300 ml of water down to 100 ml which was decocted again down to 100 ml. These two decoctions were then added together and administered in divided doses morning and evening. 30 days equaled one course of treatment with two courses of treatment given. The Western medical protocol which the comparison group of 28 patients received consisted of 20 mg of Prozac once a day for 60 days. (Flaws, 2004)
o DL-phenylalanine: Small comparative studies suggest that D-phenylalanine (Heller B, 1978) or DL-phenylalanine (Beckmann H et al, 1979; Beckmann H, 1983) may be comparably effective to imipramine, 100 mg, for relief of depression symptoms. CAUTION: People who have phenylketonuria should not take DL-phenylalanine because they do not have the enzyme that metabolizes it.
o Folate: A 10-week, double-blind, placebo-controlled trial of 127 individuals with severe major depression found that folate supplements at a dose of 500 µg daily significantly improved the effectiveness of fluoxetine in female participants. (Coppen & Bailey, 2000)
o Ginkgo: In a double-blind, placebo-controlled trial, 60 inpatients with “cerebral insufficiency” (impaired cerebral blood supply) manifesting primarily as depression were given either placebo or 160 mg of ginkgo extract daily for 6 weeks. The results showed significantly greater improvements in the treated group. (Eckmann F, 1990)
o Inositol: In a parallel-group, double-blind, placebo-controlled trial, 28 depressed individuals were given a daily dose of 12 g of inositol for 4 weeks. By the fourth week, the group receiving inositol showed significant improvement compared with the placebo group. (Benjamin et al, 1990)
o L-phenylalanine: Preliminary research reported that L-phenylalanine improved mood in most depressed people studied. (Sabelli, 1986)
o Omega-3 oils found in fish, particular DHA, are needed for normal functioning of the nervous system. Depressed people have been reported to have lower DHA levels than people who are not depressed. (Edwards R, 1998) Low levels of the other omega-3 oil from fish, EPA, have correlated with increased severity of depression. (Adams PB, 1996) A study of 20 individuals with recurrent depression found that use of fish oil improved depression-index scores significantly compared to placebo. (Nemets 2002)
o Omega-3 oils: The results of an 8-week, double-blind, placebo-controlled trial investigating the use of EPA in women with borderline personality disorder found that 1 g EPA led to a reduction in scores assessing both aggression and depressive symptoms. (Zanarini & Frankenburg, 2003)
o Omega-3 oils: An 8-week, double-blind, placebo-controlled trial comparing high doses of fish oil (9.6 g/day) to placebo in addition to standard antidepressant therapy in 28 patients with major depressive disorder found that the patients who received the omega-3 fish oil capsules (each capsule contained 440 mg EPA and 220 mg DHA taken twice daily) had a significantly decreased score on the Hamilton Rating Scale for Depression compared to those on placebo. (Su KP et al, 2003)
o Omega-3 oils: In a 12-week, randomized, double-blind, placebo-controlled trial, patients receiving ethyl-EPA were divided into 3 dosage groups (1,2 or 4 g daily). Subjects had experienced persistent depression, despite ongoing standard pharmacotherapy at adequate dosages. The patients who received 1 g EPA had the best outcome, with 53% achieving a 50% reduction on Hamilton depression scores. This was the only group that showed statistical significance. The 1 g EPA dose led to improvements in depression, anxiety, sleep, lassitude, libido and suicidal ideation. (Peet & Horrobin, 2002)
o Omega-3 oils: In conclusion it is unclear whether the most clinically active component is EPA, DHA or a combination of both. For now the bulk of clinical evidence indicates the EPA component of fish oils may be the most important in mood stability, and that relatively low levels of 1 g daily are required for successful outcomes. CAUTION: It should be noted that administration of omega-3 fatty acids most often via high does of flaxseed oil, may induce hypomania, mania or other behavioral changes in a small percentage (less than 3%) of individuals. (Logan, 2003)
o Phosphatidylserine (PS) may be helpful for depression. In a controlled trial, older women given 300 mg of PS had significantly less depression compared with placebo. After 45 days, the level of depression in the PS group was more than 60% lower than the level achieved with placebo. (Maggioni, 1990)
o SAMe appears to raise levels of dopamine, an important neurotransmitter in mood regulation, and higher SAMe levels in the brain are associated with successful drug treatment of depression. Oral SAMe has been demonstrated to be an effective treatment for depression in most (Bell, 1994; Bressa, 1994; Salmaggi, 1993) but not all, (Kagan, 1990) controlled studies.
o St. John’s wort: In an 8-week, double-blind trial of 263 individuals comparing St. John’s wort against placebo and imipramine it was found that St. John’s wort was more effective at reducing HAM-D scores than placebo and as effective as imipramine. (Philipp et al, 1999)
o St. John’s wort: A 6-week, double-blind trial of 240 individuals with mild to moderate depression compared St. John’s wort with fluoxetine. The results showed that St. John’s wort was equally effective on the HAM-D scale, more effective on the CGI, and significantly superior in type and number of adverse events. (Schrader, 2000)
o St. John’s wort: A 6-week, double l-blind study of 149 seniors with mild to moderate depression also found St. John’s wort equally effective to fluoxetine. (Harrer et al 1999)
o St. John’s wort CAUTIONS:
§ Like other antidepressants, St. John’s wort can cause episodes of mania.
§ Hypericin, found in St. John’s wort, is a known photosensitizing agent. Photactivation of hypericin in the lens of the eye might lead to increased risk of cataracts.
§ A case report suggests that St. John’s wort may not be safe for individuals with Alzheimer’s disease. (Bratman & Girman, 2003)
o St. John’s wort DRUG INTERACTIONS:
§ St. John’s wort can reduce serum concentrations of protease inhibitors, nonnucleoside reverse transcriptase inhibitors such as nevirapine, cyclosporine, digoxin, warfarin, tricyclic antidepressants, simvastatin and theophylline. Numerous cases of transplant rejection (heart, kidney, liver) have been reported in individuals using cyclosporine and St. John’s wort concurrently.
§ A growing body of evidence suggests that St. John’s wort decreases the effectiveness of oral contraceptives.
§ Interaction with numerous other drugs such as etoposide, teniposide, mitoxantrone, doxorubicin, clozapine and olanzapine are also suspected. Several case reports suggest that the combined use of St. John’s wort and other serotonergic drugs may result in serotonin syndrome*. (Bratman & Girman, 2003)
*Serotonin syndrome is a toxic reaction requiring immediate medical attention and is associated with too much serotonin. Symptoms may include anxiety, restlessness, confusion, weakness, tremor, muscle twitching or spasm, high fever, profuse sweating and rapid heart beat.
o Tyrosine: Preliminary research suggests that supplementation with tyrosine might help people with depression. (Gelenberg, 1980)
o Xiao Chai Hu Tang (Minor Bupleurum Decoction): A study done on 70 cases of depression in China in 2003 found that the Chinese medical protocol was markedly more effective than Prozac and with no side effects. The treatment group of 40 patients received the Xiao Chai Hu Tang which consisted of the following herbs: Chai Hu, 10 g, Huang Qin, 10g, Ban Xia, 6g,Tai Zi Shen, 10g, Gan Cao, 3g, Sheng Jiang, 3 slices, and Da Zao 5 pieces. The herbs were decocted in 300 ml of water down to 100 ml which was decocted again down to 100 ml. These two decoctions were then added together and administered in divided doses morning and evening. 30 days equaled one course of treatment with two courses of treatment given. Members of the comparison group received 20 mg of Prozac one time each day orally for 60 days. (Flaws, 2004)
DIETARY RECOMMENDATIONS
v Useful Foods for Anxiety
o Include in the diet apricots, asparagus, avocados, bananas, broccoli, blackstrap molasses, brewer’s yeast, brown rice dried fruits, dulse, figs, fish, garlic, green leafy vegetables, legumes, raw nuts and seeds, soy products whole grains and yogurt. These foods supply valuable minerals such as calcium, magnesium phosphorus and potassium which are depleted by stress. (Balch & Balch, 1997)
Foods to Avoid for Anxiety
Avoid all sources of caffeine, including coffee, tea, chocolate, caffeinated sodas and caffeine-containing mediations because people with anxiety appear to be more susceptible to the actions of caffeine. (Bruce et al, 1992) It is also advisable to avoid all simple sugars, carbonated soft drinks and alcohol. Chromium deficiency, which can produce nervousness and other symptoms of anxiety, is common among alcoholics and people who consume large amounts of refined sugars. Brewer’s yeast is a good source of chromium. (Balch & Balch, 1997)
v Foods to Avoid for Bipolar Disorder
o Avoid refined foods with high burdens of sucrose, trans (hydrogenated) fats, poor nutrient content and potentially toxic additives. (Kidd, 2004)
v Useful Foods for Depression
o Eat a diet that includes plenty of raw fruits and vegetables, with soybeans and soy products, brown rice, millet and legumes. A diet too low in complex carbohydrates can cause serotonin depletion and depression. (Balch & Balch, 1997) These foods are also useful for minor depression: cucumber, apples, cabbage, fresh wheat germ and apple cider vinegar. (Pitchford, 1993)
v Foods to Avoid for Depression
Although some research has produced mixed results (Gettis, 1989), several double-blind studies have shown that food allergies can trigger mental symptoms, including depression. (King, 1981; Brown et al, 1981) Restricting sugar and caffeine in people with depression has been reported to elevate mood in preliminary research. (Christensen, 1988)
Avoid foods high in saturated fats such as hamburgers and French fries as these tend to cause sluggishness, slow thinking and fatigue by interfering with the blood flow resulting in poor circulation especially to the brain. Avoid all forms of sugar as the increase in energy supplied by the sugars is quickly followed by fatigue and depression. Omit wheat products from the diet as wheat gluten has been linked to depressive disorders. (Balch & Balch, 1997)
v Omega-3 Fatty Acids
o According to Drs. Amen and Routh more than half of the brain is composed of fat, nearly 1/3 of which is made up of the long-chain omega-3 fatty acid known as docosahexaenoic acid (DHA). It is an essential fatty acid, which means your body cannot manufacture it. You must get it from your diet. Omega-3 fatty acids are vital for the development of new neural pathways and for the maintenance of membrane fluidity at the neuronal synapse. Without omega-3 fatty acids, your brain can’t learn and it can’t transmit signals. For more information on omega-3 fatty acids we invite you to read our article entitled Inflammation and its Role in Disease.
v Protein and Carbohydrates
o Eat proteins at every meal because proteins are required for the manufacture of the neurotransmitters that make the brain function smoothly. Substitute complex carbohydrates for the simple sugars and simple carbohydrates in your diet. Complex carbohydrates are broken down in the gut more slowly than simple carbohydrates and they also provide more fiber and nutrients. Eliminate most simple carbohydrates such as sugar, fruit juice, bread or pasta made with while flour, white rice, white potatoes, corn syrup, honey and candy. You can keep your metabolic rate at a constant level throughout the day by eating five meals a day. (Amen & Routh, 2003)
o Researchers have found that protein and carbohydrate content of food has a significant impact on the production of serotonin. Eating a diet balanced between carbohydrates and protein can raise cerebral serotonin and dopamine levels. However one must be careful because the high protein, low carbohydrate diets that are recommended for other types of anxiety and depression increase dopamine and often make people with cingulate problems, i.e., overfocused anxiety/depression, worse. (Amen & Routh, 2003)
o Eating complex carbohydrates is important because it raises the level of tryptophan in the brain (thereby increasing serotonin production) resulting in a calming effect. High-protein foods, on the other hand, promote the production of dopamine and norepinephrine, which promote alertness. (Balch & Balch, 1997)
v Avoid Alcohol, Cigarettes and Caffeine etc.
o Cigarette smoking is a significant contributor to depression. Nicotine stimulates adrenal stress hormones. (Kidd, 2004)
o Alcohol is also a brain depressant. It increases adrenal hormone output as well as interfering with many brain cell functions, disrupting normal sleep cycles and contributing to hypoglycemia. (Kidd, 2004)
o A person who consumes more caffeine also has a higher risk for depression. (Kidd, 2004)
o There is some evidence that caffeine increases anxiety levels and precipitates panic attack among people with anxiety disorders. (Jorm et al, 2004)
o Steroid drugs and oral contraceptives may cause serotonin levels in the brain to drop. (Balch & Balch, 1997)
LIFESTYLE RECOMMENDATIONS
v Cognitive Therapy
Every time you have an angry, unkind, sad or cranky thought, your brain releases negative chemicals that activate your deep limbic system and make your body feel bad. But every time you have a good thought, a happy thought, a hopeful thought or a kind thought your brain releases chemicals that calm your deep limbic system and help your body feel good. So why not have the latter thoughts? Thoughts are powerful and can make your mind and body feel good or bad. That is why emotional upsets can manifest themselves in physical symptoms such as headaches and stomachaches. The good news is that you can train your thoughts to be positive and hopeful. (Amen & Routh, 2003)
Thoughts and desires are part and parcel of the mind. Peace is our natural state, but it is the mind that obstructs this natural state.
v Benefits of Close Relationships
In his book, Love and Survival, Dean Ornish details the many benefits from having close relationships. He cites numerous studies indicating that those who feel close, connected, loved and supported have a lower incidence of depression, anxiety, suicide, heart disease, infections, hypertension and cancer. Love enhances brain function, and a healthy brain enhances our ability to love and be connected to others.
v Exercise
Exercise alone has been demonstrated to have a tremendous impact on improving mood and the ability to handle stress. In a study in 1988 it was found that increased participation in exercise, sports and physical activities is strongly associated with decreased symptoms of depression, anxiety and malaise. (Moss & Hayes, 1988)
o Exercise may be the most powerful antidepressant available. Various community and clinical studies clearly indicate regular exercise decreases symptoms of depression, anxiety, insomnia and malaise. (Weyerer & Kupfer, 1994) These benefits are perhaps related to the release of endorphins in the brain. More than 100 studies have been conducted establishing regular exercise as a powerful antidepressant. (Murray, 1995)
v Yoga
o One study showed that yoga was superior to diazepam for generalized anxiety, but patients were assigned to yoga treatment based on preference rather than random assignment. (Sahasi, 1989)
o In a randomised trial, test anxiety was treated with a set of yoga exercises combined with one of the following – autosuggestion, progressive muscle relaxation or a control taking session. Yoga treatment was found to be superior to both relaxation and control treatments on one outcome measure, but not on another. (Broota & Sanghvi, 1994)
o A randomized, controlled trial compared yogic breathing with no treatment in students who had a high level of depressive symptoms. After training, the students were instructed to practice for 30 minutes each morning for 30 days. The treated group was found to improve significantly more than the control group. (Khumar, Kaur & Kaur, 1993)
o A randomized, controlled trial was conducted on hospitalized patients with melancholic depression who were randomly assigned to receive training in yogic breathing, electroconvulsive therapy (ECT) or imipramine. All groups were found to improve, with the greatest improvement after ECT. Yogic breathing did not differ from imipramine. (Janakiramaiam et al, 2000)
v Meditation
o Five randomized, controlled trials have examined the effect of meditation in generalized anxiety disorder or high trait anxiety. Four of the five trials found that meditation produced equivalent effects to other forms of relaxation, including applied relaxation, progressive muscular relaxation and biofeedback. (Jorm, 2004)
o A study by Shannahoff-Khalsa (1999) reported that a yogic meditation technique (based on kundalini yoga) was more effective than a standard relaxation procedure in the treatment of obsessive-compulsive disorder.
v Get plenty of Light
o A series of well-controlled trials has shown that light therapy is effective for winter depression, particularly if given in the early morning. A meta-analysis of trials showed that the brighter the light, the better the response. A review of trials of light therapy with non-seasonal depression also showed positive effects, although the evidence is more limited. (Jorm, 2002)
REFERENCES
Alloy, Lauren B, Joan Acocella & Richard R. Bootzin, Abnormal Psychology – Current Perspectives, New York: McGraw, 1996
Amen, Daniel G., M.D. & Lisa C. Routh, M.D., Healing Anxiety and Depression, New York: G.P. Putnam’s Sons, 2003
Balch, James F & Phyllis A. Balch, Prescription for Nutritional Healing, Garden City Park, NT: Avery Publishing, 1997
Barral, Jean-Pierre & Pierre Mercier, Visceral Manipulation, Seattle: Eastland Press, 1997
Bensky, Dan & Randall Barolet, Chinese Herbal Medicine, Formulas and Strategies, Seattle: Eastland Press, 1990
Bing-Shan, Huang, Syndromes of Traditional Chinese Medicine, Harbin, China: Heilongjiang Education Press, 1993
Bratman, Steven, MD & Andrea M. Girman, MD MPH, Mosby’s Handbook of Herbs and Supplements and their Therapeutic Uses, St Louis: Mosby, 2003
Dharmananda, Subhuti, PhD “SSRI Withdrawal Procedure” Institute for Traditional Medicine, Portland, OR: Sept. 2004
Dharmananda, Subhuti, PhD “Acupuncture and Herbs for Mind and Brain Disorders – I. Acupuncture” Institute for Traditional Medicine, Portland, OR: May 2000
Dharmananda, Subhuti, PhD “Acupuncture and Herbs for Mind and Brain Disorders – II. Herbs” Institute for Traditional Medicine, Portland, OR: May 2000
Entrez-PubMed (Medline) website: http://www.ncbi.nlm.nih.gov/PubMed/
Flaws, Bob, “Depression & Chinese Medicine”, Townsend Letter for Doctors & Patients, /#249, April 2004:46-49
Halonen, Jane S & John W. Santrock, Psychology – Contexts of Behavior, Boston: McGraw Hill, 1996
Hammer, Leon, M.D., Dragon Rises, Red Bird Flies, New York: Station Hill Press, 1990
Han C, Li XW, Luo HC. “Comparative study of electro-acupuncture and maprotiline in treating depression”, Zhongguo Zhong Xi Yi Jie He Za Zhi. 2002 Jul;22(7):512-4, 521
Hobbs, Christopher, “TCM and Depression” Herbs for Health, Nov/Dec 2002 p.26-27
Jorm AF, Christensen H, Griffiths KM, Parslow RA, Rodgers B, Blewitt KA. Med J Aust. 2004 Oct 4;181(7 Suppl):S29-46.
Kelly, Gregory S., ND, “Rhodiola rosea: A Possible Plant Adaptogen”, Altern Med Rev., 2001 June;6(3):293-302
Kidd, Parris M., PhD, “Bipolar Disorder as Cell Membrane Dysfunction. Progress Toward Integrative Management”, Altern Med Rev, 2004 June;9(2):107-135
Larson, Joan Mathews, PhD, Depression-Free, Naturally, New York: Random House, 1999
Lininger, Schuyler W, Jr. DC, Editor in-Chief, The Natural Pharmacy, Rocklin, CA: Prima Publishing, 1999
Logan, Alan C. ND, FRSH, MS (Cand.), “Neurobehavioral Aspects of Omega-3Fatty Acids: Possible Mechanisms and Therapeutic Value in Major Depression”, Alt Med Review, Vol. 8, No. 4, Nov. 2003, 410-425
Maciocia, Giovanni, The Practice of Chinese Medicine, Edinburgh: Churchill Livingstone, 1994
Miller, Alan L, ND, “Epidemiology, Etiology and Natural Treatment of Seasonal Affective Disorder”, Alter Med Rev, Vol. 10, No.1, March 2005:5-13
Mindell, Early & Virginia Hopkins, Prescription Alternatives, New Canaan, CT: Keats Publishing, 1998
Murray, Michael, N.N. and Joseph Pizzorno, N.D., Encyclopedia of Natural Medicine, Rocklin, CA: Prima Publishing, 1991
Murray, Michael, N.D., Natural Alternatives to Prozac, New York: Quill, William Morrow, 1999
Pert, Candace B., PhD, Molecules of Emotion, New York: Scribner, 1997
Pitchford, Paul, Healing with Whole Foods, Berkeley: North Atlantic Books, 1993
Prousky, Jonathan E., ND, “Orthomolecular Treatment of Anxiety Disorders”, Townsend Letter for Doctors & Patients, Feb/Mar 2005, /#259/260;82-87
Ross, Jeremy, Acupuncture Point Combinations, Edinburgh: Churchill Livingstone, 1995
Skidmore-Roth, Linda, Mosby’s Handbook of Herbs & Natural Supplements, 2nd edition, St. Louis: Mosby, Inc., 2004
Tuten, Sean A., DOM, RH (AHG), “Herbal Energetics & Men’s Health”, Golden Flower Chinese Herbs, 2004
Upledger, John E, SomatoEmotional Release and Beyond, Palm Beach Gardens: UI Publishing, 1999
Upledger, John E., D.O., O.M.M., SomatoEmotional Release, Berkeley: North Atlantic Books, 2002
Upledger, John E & Jon D. Vredevoogd, Craniosacral Therapy, Seattle: Eastland Press, 1995
Weil, Andrew, “Six Supplements for Treating Depression” Self Healing, Feb. 2005 p. 4-5
Weil, Andrew, “Coping with Depression: An Integrative Approach” Self Healing, Nov. 2002, p. 4-5
CHINESE MEDICAL PATTERN DISCRIMINATION
The following are some Chinese Medical patterns that are often involved in mental and emotional problems:
v Liver Qi Stagnation From an emotional perspective the most characteristic and common signs are mental depression, alternation of moods, irritability, “snapping” easily, an intense feeling of frustration, PMS tension, annoyance and impatience. Although depression is experienced in the mind it is usually rooted in a stagnant Liver. If the Liver Qi Stagnation is not resolved it will continually permeate one’s emotional being with its depressive energy.
v Heart and Lung Qi Stagnation The person will feel very sad and depressed and will tend to weep. The person will also be very sensitive to outside psychic influences.
v Heart Blood Deficiency The person may feel depressed and tired, and the Mind may be confused and lack concentration.
v Liver Blood Deficiency The person may feel depressed and tired, and may lack a sense of direction in life and “vision”. He or she may be confused as to what aims in life they should follow. Alternatively, he or she may be fearful of making decisions lest they make the wrong one.
v Heart Blood Stasis This person will feel very anxious with an acute sense of anxiety in the chest, and even up to the throat. The person will be restless and prone to be easily startled. The person may also experience depression, palpitations, insomnia, a suffocating sensation in the chest, irritability, mood swings, and in severe cases psychosis.
v Liver Blood Stasis The person will be very anxious, restless and confused about his or her aims in life. He or she will also be very irritable and prone to outburst of anger. The person may also experience depression, severe mood swings, intense irritability, propensity to violent outburst of anger, obsessive jealousy and in severe cases, manic-depression.
v Liver Blood Heat The person will feel very angry and tend to shout at other people a lot; may also be violent and hit people, may also feel angry and frustrated about their life and may tend to be impulsive.
v Heart Yin Deficiency The person will feel very anxious, particularly in the evening, with a vague and fidgety sense of anxiety, uneasy without knowing why. The person will also feel dispirited, depressed and tired. Memory and concentration will be poor and the sleep will also be poor.
v Liver Yin Deficiency may cause a deep depression, a lack of purpose in life and confusion about objectives and aims.
v Phlegm Obstructing the Mind In this pattern Phlegm obstructs the Mind and thinking but it does not agitate the Mind. Thus the person will not be restless, but on the contrary, tired, subdued, depressed and quiet.
v Phlegm Fire Harassing the Mind In this pattern Phlegm-Fire obstructs the Mind, but is also agitates it. It therefore makes the person agitated, restless and anxious. In some cases, the person may alternate between periods of depression and confusion (due to Phlegm) and periods of abnormal elation, agitation and manic behavior (due to Fire). In severe cases this leads to manic-depression. Manic-depression can also be seen as an alternation between excess plus irregularity and deficiency plus stagnation as in Heart Fire plus Disturbance of Spirit alternating with Deficient Heart Fire plus Stagnant Heart Qi. (Ross, 1995)
v Empty Heat Empty Heat agitates the Mind and causes severe anxiety, insomnia, agitation, mental restlessness and fidgetiness. It is frequently caused by excess joy, craving, jealousy and excessive love.
ACUPUNCTURE TREATMENT OF MENTAL-EMOTIONAL DISORDERS
Some useful acupuncture points for the treatment of mental-emotional problems are:
BL-42 calms the Mind and settles the Corporeal Soul
BL-47 settles and roots the Ethereal Soul in the Liver
BL-52 strengthens will power, drive and determination.
BL-23, BL-52 and BL-44 strengthen will power and drive, calm the mind and relieve anxiety, depression, mental restlessness and insomnia.
HT-8 and HT-9 for severe mental restlessness, anxiety and insomnia.
PC-7 is useful for emotional problems from breaking of relationships.
PC-6 calms the Mind and settles the Ethereal Soul when they are affected by Liver Qi Stagnation resulting from anger, resentment or frustration. It also relieves unhappiness.
KI-9 relieves anxiety and depression
SI-3 strengthens the will power, drive and determination.
GB-13 is useful for severe anxiety and mental restlessness.
LU-7 has a releasing effect on sadness, worry and grief.
REN-4 is a very grounding point and is good for anxiety and mental restlessness.
DU-20 clears the Mind, lifts the mood, relieves depression and stimulates the memory and concentration.
REN-17 is useful for dispersing stagnant qi.
An example of an acupuncture point prescription for Heart Yin Deficiency is: REN-4, SP-6, KI-6, REN-14, REN-17, Ht-7, DU-20 and REN 24
An example of an acupuncture point prescription for Liver Qi Stagnation is: LIV-3, LI-4, LIV-14, PC-6, PC-7, TB-6, DU-24 and GB-13
RESEARCH ON THE BENEFITS OF ACUPUNCTURE
v Anxiety.
o According to a study on 55 participants by Want and Kain entitled “Auricular acupuncture: a potential treatment for anxiety” published in Anesth Analg 2001 Feb;92(2):548-53 the authors concluded that auricular acupuncture at the “relaxation” point can decrease the anxiety level in a population of healthy volunteers.
o According to a study by Lo and Chung entitled “The sedative effect of acupuncture” published in Am J Chin Med 1979 Autumn;7(3):253-8 it was found that out of 8 patients with anxiety neurosis who were treated with acupuncture 6 of them showed good to moderate response while 2 had no change.
o In a study by Paraskeva et al entitled “Needling of the extra 1 point decreases BIS values and preoperative anxiety” published in Am J Chin Med 2004;32(5):789-94 in which 50 patients were randomly assigned to receive acupuncture at the extra 1 point or to a control point, it was found that needling of the extra1 point preoperatively significantly decreased the BIS (Bispectral Index) values and the VSS (verbal score scale) for anxiety but needling the control point decreased only VSS values.
v Depression.
o In a single-blind placebo-controlled study by Roschke et al entitled “The benefit from whole body acupuncture in major depression” published in J Affect Disord. 2000 Jan-Mar;57(1-3):73-81 seventy inpatients with a major depressive episode were randomly included in 3 different treatment groups: verum acupuncture, placebo acupuncture and a control group. All three groups were pharmacologically treated with the antidepressant mianserin. Patients who experienced acupuncture improved slightly more than patients treated with mianserin along. Additionally applied acupuncture improved the course of depression more than pharmacological treatment with mianserin alone. However, they could not detect any differences between placebo and verum acupuncture.
o In a clinical trial by MacPherson et al entitled “Acupuncture for depression: first steps toward a clinical evaluation” published in J Altern Complement Med. 2004 Dec;10(6):1083-91 ten patients received up to 10 individualized acupuncture treatments from one of two acupuncturists. In the case series, only 6 patients both received treatment and completed 10-week questionnaires; however, significant improvements between before and after were found in their levels of depression. Many facts, as well as acupuncture, may have contributed to these improvements. No serious adverse events occurred.
o In a study by Han, Li and Luo in Chinese entitled “Comparative study of electro-acupuncture and maprotiline in treating depression” published in Zhongguo Zhong Xi Yi Jie He Za Zhi 2002 Jul;22(7):512-4, 521 it was found that both electro-acupuncture and maprotiline are effective in treating depression.
o In a study by Han, Li, Luo and Zhao entitled “Clinical study on electro-acupuncture treatment for 30 cases of mental depression” published in J Tradit Chin Med 2004 Sep;24(3):172-6 it was concluded that electro-acupuncture therapy can produce the same clinical therapeutic effect as that produced by the drug maprotiline, giving less side effects and better symptomatic improvement.
o According to two consecutive clinical studies by Luo et al entitled “Clinical research on the therapeutic effect of the electro-acupuncture treatment in patients with depression” published in Psychiatry Clin Neurosci 1998 Dec;52 Suppl:S338-40 if was found that the results from both studies showed that the therapeutic efficacy of electro-acupuncture was equal to that of amitriptyline for depressive disorders. Electro-acupuncture had a better therapeutic effect for anxiety somatization and cognitive process disturbance of depressed patients than amitriptyline. Moreover the side effects of electroacupuncture were much less that than of amitriptyline. The article suggested that electro-acupuncture treatment was an effective therapeutic method for depressive disorders. Particularly, it was a treatment of choice for depressed patients who were unable to comply with the classic tricyclic antidepressants because of their anticholinergic side effects.
o In a three year study of three case histories by Kurland entitled “ECT and Acu-EST in the treatment of depression” published in Am J Chin Med 1976 Autumn;4(3):289-92 it was found that individual Acu-EST (Acupuncture Electric Stimulation Therapy) treatments were often less effective than individual ECT (electroconvulsive therapy). However, series of Acu-EST did assist in producing significant remissions in depressive symptomatology. Because it did not produce the temporary disabling memory defects which occurred with ECT, Acu-EST was more easily adaptable to outpatient treatment.
o In a study on the effectiveness of acupuncture treatment on 167 patients with depression associated with manic-depressive psychosis and schizophrenia by Poliakov in Russian entitled “Acupuncture in the treatment of patients with endogenous depression” published in Zh Nevropatol Psikhiatr Im S S Korsakova. 1987;87(4):604-8 acupuncture was found to be effective in some patients showing resistance to antidepressants.
o In a study by Manber et al entitled “Acupuncture: a promising treatment for depression during pregnancy” published in J Affect Disord. 2004 Nov 15;83(1):89-95 sixty-one pregnant women with major depressive disorder were assigned to one of three treatments: an active acupuncture group, an active control acupuncture group or a massage group. Response rates at the end of the acute phase were statistically significantly higher for the active acupuncture group (69%) than for the massage group (32%) with an intermediate active control acupuncture response rate of 47%. The active acupuncture group also exhibited significantly higher average rate of reduction in Beck Depression Inventory (BDI) scores from baseline to the end of the first month of treatment than the massage group. The authors concluded that acupuncture holds promise for the treatment of depression during pregnancy.
v Depression and Anxiety
o A placebo-controlled, randomized, modified double-blind study on 43 patients with minor depression and 13 patients with generalized anxiety disorders by Eich et al in German entitled “Acupuncture in patients with minor depressive episodes and generalized anxiety. Results of an experimental study” published in Fortschr Neurol Psychiatr 2000 Mar;68(3):137-44 indicated that needle acupuncture (Du.20, Ex.6, He.7, Pe.6 Bl.62) leads to a significant clinical improvement as well as to a remarkable reduction in anxiety symptoms in patients with minor depression or with generalized anxiety disorders.
v Schizophrenia
o A study by Zhuge and Chen in Chinese entitled “Comparison between electro-acupuncture with chlorpromazine and chlorpromazine alone in 60 schizophrenic patients” published in Zhongguo Zhong Xi Yi Jie He Za Zhi 1993 Jul;13(7):408-9, 388 showed that the total curative effects of the two groups were similar. However, the marked effects appeared earlier in combined therapy than that of using chlorpromazine alone, less chlorpromazine was needed, hence displayed fewer side effects.
o A study on 33 patients by Zhang in Chinese entitled “A controlled study of clinical therapeutic effects of laser acupuncture for schizophrenia” published in. Zhongguo Zhong Xi Yi Jie He Za Zhi 1991 Apr;24(2):81-3 found that laser acupuncture was as effective as chlorpromazine in the treatment of schizophrenia.
TREATMENT WITH CRANIOSACRAL THERAPY & VISCERAL MANIPULATION
v According to John Upledger in his book, Craniosacral Therapy “We have yet to examine a case of depression, be it endogenous or reactive, that has not shown severe anterior-posterior compression of the cranial base. Further, we have yet to see the first case which has not responded favorably and usually dramatically to successful decompression of the cranial base.” He adds that “Another cause of severe craniosacral system dysfunction is compression of the lumbosacral junction (L5-S1). This problem is often the underlying cause of recurrent cranial base compression, which results in head pain, intellectual dysfunction and psychoneurotic depression.”
v Dr. Upledger goes on to say that “Anxiety is the other area in which we had major success. However, the anxious patient does not seem to present with as consistent and characteristic a craniosacral system restriction pattern as does the depressive patient. In anxiety treat what you find. Restrictions will have a tendency to recur. Treat them again, and over a period of weeks the anxiety level seems to dissipate. Occasionally, a crisis will occur as the corrections are carried out. Be prepared to support the patient through the crisis. It usually signals the release of some repressed emotional matter which will ultimately be beneficial to the patient.”
v Jean-Pierre Barral in his book, Visceral Manipulation, states that “people suffering from depression are prone to ptosis (dropping of an organ) for at least two systemic reasons. The depression of the central nervous system causes a generalized decrease in tonus, and the weight loss that is so often a part of the depressive syndrome results in a decrease in the supportive fat around the organs.”
v Barral feels that an “important indication for manipulation of the liver is nervous depression. The relationship between depression and the liver is well known in traditional Oriental medicine. In this tradition, as understood in modern France, the liver deficiency is derived from a lack of energy in the brain, particularly from the right frontal areas, this in turn depletes the brain’s energy. The finding of biliary pigments in cerebral tissue would tend to support this concept.”
USEFUL SUPPLEMENTS AND HERBS
v Anxiety and Panic Attacks.
o Inositol has been reported to control panic attacks in people with anxiety. A double-blind, placebo-controlled, crossover study of 21 individuals with panic disorder found that those given 12 g of inositol daily had fewer and less severe panic attacks compared with the placebo group. (Benjamin, 1995)
o Inositol: A double-blind, crossover study of 20 individuals compared inositol (up to 18 g daily) with fluvoxamine (up to 150 mg daily) for the treatment of panic disorder. The results over 4 weeks of treatment with each agent suggest that inositol was as least as effective as fluvoxamine. (Palatnik et al, 2001)
o Melatonin: In a randomized, double-blind, placebo-controlled study, perioperative effects of melatonin compared to midazolam were evaluated in 75 women. Patients who received either midazolam or 5 mg melatonin had a significant decrease in anxiety levels before and after surgery, as compared with placebo. (Naquib & Samarkandi, 1999)
o Multivitamin and Mineral Supplement: A double-blind, placebo-controlled trial of 80 healthy male volunteers founds that 28 days of treatment with a multivitamin and mineral supplement (containing calcium, magnesium and zinc) significantly reduced perceived anxiety and stress, (Carroll et al 2000)
o Passion Flower: A double-blind, placebo-controlled trail of 36 individuals compared a passion flower extract (45 drops per day) with oxazepam (30 mg/day) for the treatment of generalized anxiety disorder. Oxazepam showed a more rapid onset of action, but the end of the 4-week trial, both treatments resulted in statistically equivalent improvements in HAM-A scores. Oxazepam use was associated with more problems relating to job performance. (Aknondzadeh et al, 2001)
o Selenium has been shown to elevate mood and decrease anxiety. These effects were more noticeable in people who had lower levels of selenium in their diets to begin with. (Balch& Balch, 1997)
o Suan Zao Ren Tang may be effective in treating anxiety. This Chinese herbal preparation was tested in a time-series design in which a placebo was alternated with the herbal preparation in 30 individuals with reported high anxiety scores. Anxiety scores decreased significantly after the week of active treatment and returned to previous high levels when taking the placebo.(Chen HC et al, 1985) Suan Zao Ren Tang, also known as Sour Jujube Decoction, contains the following herbs: zizyphus, poria, anemarrhena, ligusticum and licorice. In Chinese medical terms it nourishes the blood, calms the spirit, clears heat and eliminates irritability. The primary strategy of the formula is to nourish the Heart and calm the spirit. (Bensky & Barolet, 1990)
o Valerian: A double-blind, placebo-controlled crossover study of 48 participants placed under social stress situations evaluated the effects of valerian and propranolol, as well as their combination. Although propranolol reduced both physical and subjective sensations of stress, valerian improved subjective sensations only. (Kohnen & Oswald, 1988) CAUTION: There is a possible risk of potentiation of sedation when using valerian along with sedatives.
o 5-HTP is useful for anxiety (Kahn et al, 1987) CAUTION: There is a possible risk of serotonin syndrome if 5-HTP is used concurrently with SSRIs and other serotonergic drugs. *Serotonin syndrome is a toxic reaction requiring immediate medical attention and is associated with too much serotonin. Symptoms may include anxiety, restlessness, confusion, weakness, tremor, muscle twitching or spasm, high fever, profuse sweating and rapid heart beat.
v Bipolar Disorder
CAUTION: Case reports of manic episodes have been reported with the use of herbs and supplements thought to possess antidepressant properties such as inositol, St. John’s wort, fish oil, SAMe and L-glutamine. (Bratman & Girman, 2003) Bipolar patients should be careful of flaxseed oil, based on reports that continued intake can trigger mania. (Kidd, 2004)
o Choline: Weak evidence suggests that choline may be helpful for bipolar illness. (Stoll, Locke et al, 1999)
o Fish oil: Preliminary evidence suggests that fish oil, a source of omega-3 fatty acids, may be helpful for bipolar disorder. In a double-blind study, 30 individuals with bipolar disorder were given either placebo or fish oil capsules for 4 months, in addition to their existing treatment. The results showed longer symptom-free periods in the treated group. . (Stoll, Severus et al, 1999) This trial employed fish oil in rather high doses: 7 capsules twice daily, each capsule containing 440 mg of EPA and 240 mg of DHA. By comparison, most fish oil capsules contain no more than 300 mg of total omega-3 fatty acids.
o Lecithin: Weak evidence suggests that lecithin may be helpful for bipolar illness. (Cohen et al, 1982)
o Vitamin C: In a double-blind trial on 40 institutionalized psychiatric patients (including four manic-depressives) with 1 g vitamin C daily versus placebo for three weeks, the bipolar patients on vitamin C experienced significant symptomatic improvement. (Milner G, 1963) Vitamin C and other antioxidants modulate the types of prostaglandins and other eicosanoids that come from membrane fatty acids. This property directly supports membrane normalization as a basis for successful bipolar management.
v .Depression
o 5-HTP has shown efficacy in treating depression in some trials. A 6-week, double-blind trial of 63 individuals given either 5-HTP (100 mg three times daily) or fluvoxamine (50 mg three times daily) showed equivalent improvements in depressive symptomatology. (Poldinger et al, 1991)
o Acetyl-L-Carnitine: A double-blind study of 60 seniors with dysthymia found that treatment with acetyl-L-carnitine, 3 g/day, over a 2-month period significantly improved symptoms as compared with placebo. (Bella, 1990)
o B vitamins: Studies have found that depressed people tend to have low blood levels of vitmains B-6, B-12 and folic acid, which are needed for the health of nerve cells and for the manufacture of chemical messengers like serotonin. B vitamins are safe to take with conventional antidepressants and may actually help your body use 5-HTP and SAMe more efficiently.(Weil, 2005)
o Chai Hu Shu Gan San (Bupleurum Soothe the Liver Powder): In a study conducted in China in 2003 involving 58 patients suffering from post-stroke depression. It was found that the Chinese medical protocol was more effective overall than the Western medical protocol. In the Chinese medical protocol the treatment group of 30 patients received an augmented version of Chai Hu Shu Gan San which contained the following herbs: Chai Hu, Bai Shao, Zhi Ke, Xiang Fu, Yu Jin, Chuan Xiong, Ju Hong, Fu Ling, Ban Xia, He Huan Hua, Ye Jiao Teng andSuan Zao Ren. A total of 155 gm of the formula was decocted in 300 ml of water down to 100 ml which was decocted again down to 100 ml. These two decoctions were then added together and administered in divided doses morning and evening. 30 days equaled one course of treatment with two courses of treatment given. The Western medical protocol which the comparison group of 28 patients received consisted of 20 mg of Prozac once a day for 60 days. (Flaws, 2004)
o DL-phenylalanine: Small comparative studies suggest that D-phenylalanine (Heller B, 1978) or DL-phenylalanine (Beckmann H et al, 1979; Beckmann H, 1983) may be comparably effective to imipramine, 100 mg, for relief of depression symptoms. CAUTION: People who have phenylketonuria should not take DL-phenylalanine because they do not have the enzyme that metabolizes it.
o Folate: A 10-week, double-blind, placebo-controlled trial of 127 individuals with severe major depression found that folate supplements at a dose of 500 µg daily significantly improved the effectiveness of fluoxetine in female participants. (Coppen & Bailey, 2000)
o Ginkgo: In a double-blind, placebo-controlled trial, 60 inpatients with “cerebral insufficiency” (impaired cerebral blood supply) manifesting primarily as depression were given either placebo or 160 mg of ginkgo extract daily for 6 weeks. The results showed significantly greater improvements in the treated group. (Eckmann F, 1990)
o Inositol: In a parallel-group, double-blind, placebo-controlled trial, 28 depressed individuals were given a daily dose of 12 g of inositol for 4 weeks. By the fourth week, the group receiving inositol showed significant improvement compared with the placebo group. (Benjamin et al, 1990)
o L-phenylalanine: Preliminary research reported that L-phenylalanine improved mood in most depressed people studied. (Sabelli, 1986)
o Omega-3 oils found in fish, particular DHA, are needed for normal functioning of the nervous system. Depressed people have been reported to have lower DHA levels than people who are not depressed. (Edwards R, 1998) Low levels of the other omega-3 oil from fish, EPA, have correlated with increased severity of depression. (Adams PB, 1996) A study of 20 individuals with recurrent depression found that use of fish oil improved depression-index scores significantly compared to placebo. (Nemets 2002)
o Omega-3 oils: The results of an 8-week, double-blind, placebo-controlled trial investigating the use of EPA in women with borderline personality disorder found that 1 g EPA led to a reduction in scores assessing both aggression and depressive symptoms. (Zanarini & Frankenburg, 2003)
o Omega-3 oils: An 8-week, double-blind, placebo-controlled trial comparing high doses of fish oil (9.6 g/day) to placebo in addition to standard antidepressant therapy in 28 patients with major depressive disorder found that the patients who received the omega-3 fish oil capsules (each capsule contained 440 mg EPA and 220 mg DHA taken twice daily) had a significantly decreased score on the Hamilton Rating Scale for Depression compared to those on placebo. (Su KP et al, 2003)
o Omega-3 oils: In a 12-week, randomized, double-blind, placebo-controlled trial, patients receiving ethyl-EPA were divided into 3 dosage groups (1,2 or 4 g daily). Subjects had experienced persistent depression, despite ongoing standard pharmacotherapy at adequate dosages. The patients who received 1 g EPA had the best outcome, with 53% achieving a 50% reduction on Hamilton depression scores. This was the only group that showed statistical significance. The 1 g EPA dose led to improvements in depression, anxiety, sleep, lassitude, libido and suicidal ideation. (Peet & Horrobin, 2002)
o Omega-3 oils: In conclusion it is unclear whether the most clinically active component is EPA, DHA or a combination of both. For now the bulk of clinical evidence indicates the EPA component of fish oils may be the most important in mood stability, and that relatively low levels of 1 g daily are required for successful outcomes. CAUTION: It should be noted that administration of omega-3 fatty acids most often via high does of flaxseed oil, may induce hypomania, mania or other behavioral changes in a small percentage (less than 3%) of individuals. (Logan, 2003)
o Phosphatidylserine (PS) may be helpful for depression. In a controlled trial, older women given 300 mg of PS had significantly less depression compared with placebo. After 45 days, the level of depression in the PS group was more than 60% lower than the level achieved with placebo. (Maggioni, 1990)
o SAMe appears to raise levels of dopamine, an important neurotransmitter in mood regulation, and higher SAMe levels in the brain are associated with successful drug treatment of depression. Oral SAMe has been demonstrated to be an effective treatment for depression in most (Bell, 1994; Bressa, 1994; Salmaggi, 1993) but not all, (Kagan, 1990) controlled studies.
o St. John’s wort: In an 8-week, double-blind trial of 263 individuals comparing St. John’s wort against placebo and imipramine it was found that St. John’s wort was more effective at reducing HAM-D scores than placebo and as effective as imipramine. (Philipp et al, 1999)
o St. John’s wort: A 6-week, double-blind trial of 240 individuals with mild to moderate depression compared St. John’s wort with fluoxetine. The results showed that St. John’s wort was equally effective on the HAM-D scale, more effective on the CGI, and significantly superior in type and number of adverse events. (Schrader, 2000)
o St. John’s wort: A 6-week, double l-blind study of 149 seniors with mild to moderate depression also found St. John’s wort equally effective to fluoxetine. (Harrer et al 1999)
o St. John’s wort CAUTIONS:
§ Like other antidepressants, St. John’s wort can cause episodes of mania.
§ Hypericin, found in St. John’s wort, is a known photosensitizing agent. Photactivation of hypericin in the lens of the eye might lead to increased risk of cataracts.
§ A case report suggests that St. John’s wort may not be safe for individuals with Alzheimer’s disease. (Bratman & Girman, 2003)
o St. John’s wort DRUG INTERACTIONS:
§ St. John’s wort can reduce serum concentrations of protease inhibitors, nonnucleoside reverse transcriptase inhibitors such as nevirapine, cyclosporine, digoxin, warfarin, tricyclic antidepressants, simvastatin and theophylline. Numerous cases of transplant rejection (heart, kidney, liver) have been reported in individuals using cyclosporine and St. John’s wort concurrently.
§ A growing body of evidence suggests that St. John’s wort decreases the effectiveness of oral contraceptives.
§ Interaction with numerous other drugs such as etoposide, teniposide, mitoxantrone, doxorubicin, clozapine and olanzapine are also suspected. Several case reports suggest that the combined use of St. John’s wort and other serotonergic drugs may result in serotonin syndrome*. (Bratman & Girman, 2003)
*Serotonin syndrome is a toxic reaction requiring immediate medical attention and is associated with too much serotonin. Symptoms may include anxiety, restlessness, confusion, weakness, tremor, muscle twitching or spasm, high fever, profuse sweating and rapid heart beat.
o Tyrosine: Preliminary research suggests that supplementation with tyrosine might help people with depression. (Gelenberg, 1980)
o Xiao Chai Hu Tang (Minor Bupleurum Decoction): A study done on 70 cases of depression in China in 2003 found that the Chinese medical protocol was markedly more effective than Prozac and with no side effects. The treatment group of 40 patients received the Xiao Chai Hu Tang which consisted of the following herbs: Chai Hu, 10 g, Huang Qin, 10g, Ban Xia, 6g,Tai Zi Shen, 10g, Gan Cao, 3g, Sheng Jiang, 3 slices, and Da Zao 5 pieces. The herbs were decocted in 300 ml of water down to 100 ml which was decocted again down to 100 ml. These two decoctions were then added together and administered in divided doses morning and evening. 30 days equaled one course of treatment with two courses of treatment given. Members of the comparison group received 20 mg of Prozac one time each day orally for 60 days. (Flaws, 2004)
DIETARY RECOMMENDATIONS
v Useful Foods for Anxiety
o Include in the diet apricots, asparagus, avocados, bananas, broccoli, blackstrap molasses, brewer’s yeast, brown rice dried fruits, dulse, figs, fish, garlic, green leafy vegetables, legumes, raw nuts and seeds, soy products whole grains and yogurt. These foods supply valuable minerals such as calcium, magnesium phosphorus and potassium which are depleted by stress. (Balch & Balch, 1997)
Foods to Avoid for Anxiety
Avoid all sources of caffeine, including coffee, tea, chocolate, caffeinated sodas and caffeine-containing mediations because people with anxiety appear to be more susceptible to the actions of caffeine. (Bruce et al, 1992) It is also advisable to avoid all simple sugars, carbonated soft drinks and alcohol. Chromium deficiency, which can produce nervousness and other symptoms of anxiety, is common among alcoholics and people who consume large amounts of refined sugars. Brewer’s yeast is a good source of chromium. (Balch & Balch, 1997)
v Foods to Avoid for Bipolar Disorder
o Avoid refined foods with high burdens of sucrose, trans (hydrogenated) fats, poor nutrient content and potentially toxic additives. (Kidd, 2004)
v Useful Foods for Depression
o Eat a diet that includes plenty of raw fruits and vegetables, with soybeans and soy products, brown rice, millet and legumes. A diet too low in complex carbohydrates can cause serotonin depletion and depression. (Balch & Balch, 1997) These foods are also useful for minor depression: cucumber, apples, cabbage, fresh wheat germ and apple cider vinegar. (Pitchford, 1993)
v Foods to Avoid for Depression
Although some research has produced mixed results (Gettis, 1989), several double-blind studies have shown that food allergies can trigger mental symptoms, including depression. (King, 1981; Brown et al, 1981) Restricting sugar and caffeine in people with depression has been reported to elevate mood in preliminary research. (Christensen, 1988)
Avoid foods high in saturated fats such as hamburgers and French fries as these tend to cause sluggishness, slow thinking and fatigue by interfering with the blood flow resulting in poor circulation especially to the brain. Avoid all forms of sugar as the increase in energy supplied by the sugars is quickly followed by fatigue and depression. Omit wheat products from the diet as wheat gluten has been linked to depressive disorders. (Balch & Balch, 1997)
v Omega-3 Fatty Acids
o According to Drs. Amen and Routh more than half of the brain is composed of fat, nearly 1/3 of which is made up of the long-chain omega-3 fatty acid known as docosahexaenoic acid (DHA). It is an essential fatty acid, which means your body cannot manufacture it. You must get it from your diet. Omega-3 fatty acids are vital for the development of new neural pathways and for the maintenance of membrane fluidity at the neuronal synapse. Without omega-3 fatty acids, your brain can’t learn and it can’t transmit signals. For more information on omega-3 fatty acids we invite you to read our article entitled Inflammation and its Role in Disease.
v Protein and Carbohydrates
o Eat proteins at every meal because proteins are required for the manufacture of the neurotransmitters that make the brain function smoothly. Substitute complex carbohydrates for the simple sugars and simple carbohydrates in your diet. Complex carbohydrates are broken down in the gut more slowly than simple carbohydrates and they also provide more fiber and nutrients. Eliminate most simple carbohydrates such as sugar, fruit juice, bread or pasta made with while flour, white rice, white potatoes, corn syrup, honey and candy. You can keep your metabolic rate at a constant level throughout the day by eating five meals a day. (Amen & Routh, 2003)
o Researchers have found that protein and carbohydrate content of food has a significant impact on the production of serotonin. Eating a diet balanced between carbohydrates and protein can raise cerebral serotonin and dopamine levels. However one must be careful because the high protein, low carbohydrate diets that are recommended for other types of anxiety and depression increase dopamine and often make people with cingulate problems, i.e., overfocused anxiety/depression, worse. (Amen & Routh, 2003)
o Eating complex carbohydrates is important because it raises the level of tryptophan in the brain (thereby increasing serotonin production) resulting in a calming effect. High-protein foods, on the other hand, promote the production of dopamine and norepinephrine, which promote alertness. (Balch & Balch, 1997)
v Avoid Alcohol, Cigarettes and Caffeine etc.
o Cigarette smoking is a significant contributor to depression. Nicotine stimulates adrenal stress hormones. (Kidd, 2004)
o Alcohol is also a brain depressant. It increases adrenal hormone output as well as interfering with many brain cell functions, disrupting normal sleep cycles and contributing to hypoglycemia. (Kidd, 2004)
o A person who consumes more caffeine also has a higher risk for depression. (Kidd, 2004)
o There is some evidence that caffeine increases anxiety levels and precipitates panic attack among people with anxiety disorders. (Jorm et al, 2004)
o Steroid drugs and oral contraceptives may cause serotonin levels in the brain to drop. (Balch & Balch, 1997)
LIFESTYLE RECOMMENDATIONS
v Cognitive Therapy
Every time you have an angry, unkind, sad or cranky thought, your brain releases negative chemicals that activate your deep limbic system and make your body feel bad. But every time you have a good thought, a happy thought, a hopeful thought or a kind thought your brain releases chemicals that calm your deep limbic system and help your body feel good. So why not have the latter thoughts? Thoughts are powerful and can make your mind and body feel good or bad. That is why emotional upsets can manifest themselves in physical symptoms such as headaches and stomachaches. The good news is that you can train your thoughts to be positive and hopeful. (Amen & Routh, 2003)
Thoughts and desires are part and parcel of the mind. Peace is our natural state, but it is the mind that obstructs this natural state.
v Benefits of Close Relationships
In his book, Love and Survival, Dean Ornish details the many benefits from having close relationships. He cites numerous studies indicating that those who feel close, connected, loved and supported have a lower incidence of depression, anxiety, suicide, heart disease, infections, hypertension and cancer. Love enhances brain function, and a healthy brain enhances our ability to love and be connected to others.
v Exercise
Exercise alone has been demonstrated to have a tremendous impact on improving mood and the ability to handle stress. In a study in 1988 it was found that increased participation in exercise, sports and physical activities is strongly associated with decreased symptoms of depression, anxiety and malaise. (Moss & Hayes, 1988)
o Exercise may be the most powerful antidepressant available. Various community and clinical studies clearly indicate regular exercise decreases symptoms of depression, anxiety, insomnia and malaise. (Weyerer & Kupfer, 1994) These benefits are perhaps related to the release of endorphins in the brain. More than 100 studies have been conducted establishing regular exercise as a powerful antidepressant. (Murray, 1995)
v Yoga
o One study showed that yoga was superior to diazepam for generalized anxiety, but patients were assigned to yoga treatment based on preference rather than random assignment. (Sahasi, 1989)
o In a randomised trial, test anxiety was treated with a set of yoga exercises combined with one of the following – autosuggestion, progressive muscle relaxation or a control taking session. Yoga treatment was found to be superior to both relaxation and control treatments on one outcome measure, but not on another. (Broota & Sanghvi, 1994)
o A randomized, controlled trial compared yogic breathing with no treatment in students who had a high level of depressive symptoms. After training, the students were instructed to practice for 30 minutes each morning for 30 days. The treated group was found to improve significantly more than the control group. (Khumar, Kaur & Kaur, 1993)
o A randomized, controlled trial was conducted on hospitalized patients with melancholic depression who were randomly assigned to receive training in yogic breathing, electroconvulsive therapy (ECT) or imipramine. All groups were found to improve, with the greatest improvement after ECT. Yogic breathing did not differ from imipramine. (Janakiramaiam et al, 2000)
v Meditation
o Five randomized, controlled trials have examined the effect of meditation in generalized anxiety disorder or high trait anxiety. Four of the five trials found that meditation produced equivalent effects to other forms of relaxation, including applied relaxation, progressive muscular relaxation and biofeedback. (Jorm, 2004)
o A study by Shannahoff-Khalsa (1999) reported that a yogic meditation technique (based on kundalini yoga) was more effective than a standard relaxation procedure in the treatment of obsessive-compulsive disorder.
v Get plenty of Light
o A series of well-controlled trials has shown that light therapy is effective for winter depression, particularly if given in the early morning. A meta-analysis of trials showed that the brighter the light, the better the response. A review of trials of light therapy with non-seasonal depression also showed positive effects, although the evidence is more limited. (Jorm, 2002)
REFERENCES
Alloy, Lauren B, Joan Acocella & Richard R. Bootzin, Abnormal Psychology – Current Perspectives, New York: McGraw, 1996
Amen, Daniel G., M.D. & Lisa C. Routh, M.D., Healing Anxiety and Depression, New York: G.P. Putnam’s Sons, 2003
Balch, James F & Phyllis A. Balch, Prescription for Nutritional Healing, Garden City Park, NT: Avery Publishing, 1997
Barral, Jean-Pierre & Pierre Mercier, Visceral Manipulation, Seattle: Eastland Press, 1997
Bensky, Dan & Randall Barolet, Chinese Herbal Medicine, Formulas and Strategies, Seattle: Eastland Press, 1990
Bing-Shan, Huang, Syndromes of Traditional Chinese Medicine, Harbin, China: Heilongjiang Education Press, 1993
Bratman, Steven, MD & Andrea M. Girman, MD MPH, Mosby’s Handbook of Herbs and Supplements and their Therapeutic Uses, St Louis: Mosby, 2003
Dharmananda, Subhuti, PhD “SSRI Withdrawal Procedure” Institute for Traditional Medicine, Portland, OR: Sept. 2004
Dharmananda, Subhuti, PhD “Acupuncture and Herbs for Mind and Brain Disorders – I. Acupuncture” Institute for Traditional Medicine, Portland, OR: May 2000
Dharmananda, Subhuti, PhD “Acupuncture and Herbs for Mind and Brain Disorders – II. Herbs” Institute for Traditional Medicine, Portland, OR: May 2000
Entrez-PubMed (Medline) website: http://www.ncbi.nlm.nih.gov/PubMed/
Flaws, Bob, “Depression & Chinese Medicine”, Townsend Letter for Doctors & Patients, /#249, April 2004:46-49
Halonen, Jane S & John W. Santrock, Psychology – Contexts of Behavior, Boston: McGraw Hill, 1996
Hammer, Leon, M.D., Dragon Rises, Red Bird Flies, New York: Station Hill Press, 1990
Han C, Li XW, Luo HC. “Comparative study of electro-acupuncture and maprotiline in treating depression”, Zhongguo Zhong Xi Yi Jie He Za Zhi. 2002 Jul;22(7):512-4, 521
Hobbs, Christopher, “TCM and Depression” Herbs for Health, Nov/Dec 2002 p.26-27
Jorm AF, Christensen H, Griffiths KM, Parslow RA, Rodgers B, Blewitt KA. Med J Aust. 2004 Oct 4;181(7 Suppl):S29-46.
Kelly, Gregory S., ND, “Rhodiola rosea: A Possible Plant Adaptogen”, Altern Med Rev., 2001 June;6(3):293-302
Kidd, Parris M., PhD, “Bipolar Disorder as Cell Membrane Dysfunction. Progress Toward Integrative Management”, Altern Med Rev, 2004 June;9(2):107-135
Larson, Joan Mathews, PhD, Depression-Free, Naturally, New York: Random House, 1999
Lininger, Schuyler W, Jr. DC, Editor in-Chief, The Natural Pharmacy, Rocklin, CA: Prima Publishing, 1999
Logan, Alan C. ND, FRSH, MS (Cand.), “Neurobehavioral Aspects of Omega-3Fatty Acids: Possible Mechanisms and Therapeutic Value in Major Depression”, Alt Med Review, Vol. 8, No. 4, Nov. 2003, 410-425
Maciocia, Giovanni, The Practice of Chinese Medicine, Edinburgh: Churchill Livingstone, 1994
Miller, Alan L, ND, “Epidemiology, Etiology and Natural Treatment of Seasonal Affective Disorder”, Alter Med Rev, Vol. 10, No.1, March 2005:5-13
Mindell, Early & Virginia Hopkins, Prescription Alternatives, New Canaan, CT: Keats Publishing, 1998
Murray, Michael, N.N. and Joseph Pizzorno, N.D., Encyclopedia of Natural Medicine, Rocklin, CA: Prima Publishing, 1991
Murray, Michael, N.D., Natural Alternatives to Prozac, New York: Quill, William Morrow, 1999
Pert, Candace B., PhD, Molecules of Emotion, New York: Scribner, 1997
Pitchford, Paul, Healing with Whole Foods, Berkeley: North Atlantic Books, 1993
Prousky, Jonathan E., ND, “Orthomolecular Treatment of Anxiety Disorders”, Townsend Letter for Doctors & Patients, Feb/Mar 2005, /#259/260;82-87
Ross, Jeremy, Acupuncture Point Combinations, Edinburgh: Churchill Livingstone, 1995
Skidmore-Roth, Linda, Mosby’s Handbook of Herbs & Natural Supplements, 2nd edition, St. Louis: Mosby, Inc., 2004
Tuten, Sean A., DOM, RH (AHG), “Herbal Energetics & Men’s Health”, Golden Flower Chinese Herbs, 2004
Upledger, John E, SomatoEmotional Release and Beyond, Palm Beach Gardens: UI Publishing, 1999
Upledger, John E., D.O., O.M.M., SomatoEmotional Release, Berkeley: North Atlantic Books, 2002
Upledger, John E & Jon D. Vredevoogd, Craniosacral Therapy, Seattle: Eastland Press, 1995
Weil, Andrew, “Six Supplements for Treating Depression” Self Healing, Feb. 2005 p. 4-5
Weil, Andrew, “Coping with Depression: An Integrative Approach” Self Healing, Nov. 2002, p. 4-5
