Depression and the Body

by Ronald D. Whitmont, M.D.

The World Health Organization (WHO) estimates that depression affects over 120 million people worldwide with women affected twice as frequently as men across all cultures. U.S. census data suggests that at least 20% of Americans have suffered from depression at one time in their life.

Depression is considered one of a group of mood disorders defined by specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), a reference guide for mental health professionals. The group of mood disorders includes Major Depression, Depression, Dysthymia (a milder form of depression), Bipolar disorder, Cyclothymia (milder manic-depressive/bipolar illness), and others. Criteria for determining Major Depressive episodes must include at least five of the following symptoms: depressed mood, diminished interest in daily activities, weight loss or gain, insomnia (or excessive sleep, agitation (or retardation of activity), fatigue, feelings of worthlessness (or excessive guilt), diminished ability to concentrate (or indecisiveness), and recurrent thoughts of death (or suicidal ideation). To fit the criteria for classification as Major Depression these symptoms must cause significant distress or impairment in social or occupational functioning lasting for at least two weeks. There are no laboratory tests used to determine the presence of depression and there is no consensus regarding the cause of this illness. Even though the cause has not been elucidated there is a well documented familial tendency suggesting some form of genetic predisposition.

A multitude of diagnostic studies do demonstrate physical differences throughout the body (including the brain) in depressed individuals, but there is a great deal of confusion and controversy surrounding the meaning of these changes. So far, no one has been able to determine whether these changes are the cause or the effect of depression. Regardless, strong evidence does point toward an understanding that depression is a powerful force which is able to physically alter the body, making it more susceptible to developing physical illness and worsening the outcome when illness is already present. Depression is one of the risk factors for developing heart disease, hypertension, stroke and congestive heart failure. Depressed individuals are more likely to die after suffering a heart attack. Outcomes following stroke and cases of long term hypertension are much worse if depression is already present. Interestingly, treatment with antidepressant medication does not appear to alter survival statistics in these conditions, but interventions that provide psychosocial support and psychological therapies do appear to statistically improve survival outcomes. An example of this is found in the published work of cardiologist Dean Ornish, MD, who pioneered a program for reversing heart disease using life style changes and group therapy sessions. Ornish was able to show unequivically that the physical changes of heart disease could be reversed following behavioral therapies coupled with lifestyle changes. Ornish has also begun to test these same approaches in the treatment of cancer and other chronic illnesses with promising results.

Depression is a risk factor for developing irritable bowel disease and other common ailments of the gastrointestinal tract. It has been associated with significantly poorer outcomes in all of these ailments. According to the Epidemiologic Catchment Area Survey (ECA), depression is associated with an increased risk of developing Diabetes and a poorer outcome in existing cases of diabetes. In fact, the risk of developing Type 2 diabetes is twice as common in depressed individuals when other factors are controlled.

Depression is also associated with an increased likelihood of developing asthma and a poorer outcome in existing asthma. Improvement in depression scores following treatment aimed at depression have been associated with a secondary improvement in the underlying asthmatic condition. Unfortunately, many antidepressant medications worsen asthma, but the effects of psychological interventions have proven to be safe, effective and enduring.

An example of this is an interesting study that recently looked at the effects of emotional expression using journal writing in asthmatics. Researchers were able to identify improvement in asthmatic symptoms for several months following a series of simple exercises asking asthmatics to explore their own emotional reactions to past traumatic experiences in their lives.

Cancer has been found to be closely linked to depression. There are a number of studies demonstrating that effective, non-drug therapies (including psychoanalysis, group support therapy, hypnosis, and EMDR ?Eye Movement Desensitization and Reprogramming?[order changed, okay?] are associated with dramatic positive effects on life expectancy, survival, and cancer recurrence rates. Research with patients afflicted with breast cancer has revealed that group therapy support is associated with definite changes in the immune system and significant survival benefit many years later.

The mechanism by which depression effects the outcomes in these and other illnesses is not well understood. Depression is clearly associated with changes in the immune system and has been strongly correlated with inhibition of immune cell function in a number of different cell lines (including effects on T-Helper cells and Natural Killer cells). The effects of meaningful, emotive psychological and psychosocial interventions have also been correlated with improvement in these same indices in the immune system.

The treatment of depression and related mood disorders is a controversial topic today. The medical approach offers a potentially low cost, relatively quick form of therapy that can be quite effective in altering the symptoms and signs of depression, but perhaps not the underlying course of the disease. The gold standard of treatment among medically-oriented psychiatrists is electroconvulsive therapy (ECT). This modality involves delivering a relatively brief burst of electricity to the brain while the patient is sedated and paralyzed. This modality is actually quite effective, but it has fallen out of favor largely because it is socially unacceptable. Conventional psychopharmacology is one of the most widely utilized modalities for the treatment of depression in the world today.

It is clearly more socially acceptable than ECT (although significantly less effective) since it allows for the treatment of depression and other mood disorders in the privacy of one's own home. Using conventional psychopharmacology one can keep knowledge of of one's illness relatively private, thereby circumventing the social stigma which we place on mental illness in our society today. By optimistic estimates, conventional psychopharmacology is effective in removing symptoms of depression in about 30% of cases; of minimal benefit in about 40%, and a total failure in doing anything helpful the remaining 30% of patients. Over 50% of patients treated with psychopharmacology suffer from some form of physical or emotional side effect from the medication. These side effects range from the physically uncomfortable and emotionally unsettling to the potentially toxic and fatal. While drug-related benefits generally take several weeks to take effect, there have been numerous cases where depressive symptomatology was actually worsened, directly precipitating suicidal action or other violent behaviors. When drug treatment is discontinued a typical withdrawal syndrome commonly ensues. Following cessation of treatment, it is not uncommon for the original symptoms of depression to return.

In his recent book, Healing the Soul in the Age of the Brain, psychiatrist Elio Frattaroli, MD emphasizes that "psychiatry's current emphasis on brain function ignores the emotional and spiritual dimensions of mental illness... that medication treats only the symptoms, not the underlying cause of depression, and that these medications enable patients to avoid true healing by avoiding full consciousness."

The nonpharmacological approach to the treatment of depression may be more intensive in terms of human manpower. This approach is dependent not only on human interaction, but also the quality of that interaction and is a direct reflection on the level of expertise and training of those delivering this care. The effectiveness of this approach seems related to its ability to directly engage and stimulate individuals by offering perspective on and meaning to their lives. This is a difficult area to quantify and measure in scientific analysis and certainly impossible to manufacture in pill form. The problem with the non-drug approach in treating depression is that it is nearly impossible to standardize it in the same way that medications can be standardized. Non-drug treatment is almost entirely dependent upon the quality and the training of the mental health professionals delivering this care. Here lies the capacity for brilliant and effective healing, but also the risk of inadequate care, and failure. One of the ways to ensure effective progress using non-drug modalities is to use Homeopathic therapy as an adjunctive modality. In the words of Michael R. Glass, MD., a psychiatrist based in Ithaca, New York, in the foreword to the text "Prozac Free," "Psychiatrists, psychologists, social workers, and other psychotherapists may discover an alternative to conventional drugs for those of their clientele who need medication. Homeopathic medicine does not replace psychotherapy . . . [it] removes depression, anxiety, delusions, dissociation and other symptoms so that therapy can do what it really does best: promote growth and development through self knowledge." Many psychological interventions today embrace a holistic approach to the human mind, linking psychological and physical approaches to health and illness. Bioenergetics, body-oriented psychotherapy, dance and movement therapy, rolfing, hypnosis, EMDR and homeopathy are just a few of the modalities that bridge the gap between mind and body in the treatment of depression. In these and other modalities we find our greatest chance of shifting, not just the symptoms of depression, but the entire physical axis that depression and related mood disorders affect in their turn. There is clear and compelling evidence to support the use of these modalities to treat depression and to effect long lasting outcomes from a number of related physical conditions.