More than a temporary affliction of the blues, depression can be a long-lasting, cyclical, debilitating disease. A disorder of the central nervous system (CNS), clinical depression results in a person losing the ability to enjoy one’s life. Statistics suggest that between 10 and 20 percent of the U.S. population experiences an episode of depression every year. Diagnosed twice as frequently as men, women seem to be more susceptible to depression, and are more likely to seek help.
A major depressive disorder can severely disrupt someone’s life. The symptoms that help a physician identify depression, include:
- constant feelings of sadness, emptiness, irritability or tension
- decreased interest or pleasure in usual activities or hobbies
- loss of energy, feeling tired despite lack of activity
- a change in appetite, with significant weight loss or weight gain
- a change in sleeping patterns, such as difficulty sleeping, early morning awakening or sleeping too much
- restlessness or feeling slowed down
- decreased ability to make decisions or concentrate
- feelings of worthlessness, disappointment with oneself, hopelessness or guilt
- thoughts of suicide or death
Often resulting from a combination of factors, depression has no single cause. For some, its arrival comes as a complete surprise. Several distinctive features have been noted in the brain and endocrine system of depressed individuals, but whether they cause the problem or are caused by the problem, is still a mystery. Such features include:
- Neurotransmitter imbalance – Three main neurotransmitters have been associated with depression: serotonin, norepinephrine and dopamine. It is not clear whether these neurotransmitters are deficient, or whether nervous system cells develop resistance to receiving them.
- Hormone imbalance – An imbalance of neurotransmitters causes a disruption of regular hormonal secretion levels. The hormones most affected include progesterone, estrogen, endorphins and cortisol. Endorphins are referred to as the “feel good” hormones while cortisol is considered the “stress” hormone.
- Pituitary-adrenal axis imbalance – This axis connects the central nervous and endocrine systems. Under the direction of the brain’s hypothalamus, the pituitary gland controls the adrenal glands via corticotrophin-releasing factor (CRF). Depressed people tend to secrete excessive amounts of CRF, meaning that they create long-lasting stress responses to minimal stimuli.
Western medicine traditionally approaches depression with a two-pronged method, involving physician-prescribed medication and psychotherapy.
- Medications used for depression usually fall into one of three categories of antidepressants: selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), or tricyclics. These medications aim to make neurotransmitters more easily accessible in the mood-determining areas of the brain.
- To help patients improve coping skills and reduce the effects and recurrence of depressive episodes, psychologists and psychiatrists administer psychotherapy.
Medications and psychotherapy can be lifesavers, especially when someone is considering suicide to escape depression. Bodywork should never be proposed to replace these modalities but, rather, be considered as an adjunct. Massage therapy can help a person return to his/her healthy self more rapidly and minimize the negative consequences of antidepressant drugs.
Aside from a general understanding that massage feels good, bodywork can have significant, therapeutic value in battling depression. Three physiological explanations for massage therapy’s tremendous positive impact on depressed people include:
- Touch improves the efficiency of the pituitary-adrenal axis. A healthfully functioning pituitary-adrenal axis quickly neutralizes the chemical changes that cascade when a threat is present. When this system is not working well, these chemicals remain in the body longer, lengthening the amount of time the person experiences stress. Studies on animals reveal one reason for a sluggish stress response – lack of tactile stimulation. In human society, this translates to touch deprivation capable of causing or exacerbating depression. Ironically, depression tends to cause people to isolate themselves even further from tactile stimulation, potentially worsening their depression.
- Right and left lobe brain symmetry minimizes depression susceptibility. Research about how massage affects mood indicates a shift in electroencephalogram (EEG) activation from the right frontal lobe (usually associated with sad affect) to the left frontal lobe (usually associated with happy affect), or at least towards symmetry between lobes. The redistribution of electrical activity within the brain can exhibit a profound effect on a person’s emotional state.
- The balancing of hormones and neurotransmitters can be encouraged naturally with massage. Shifting people from a sympathetic to a parasympathetic state, massage brings about several physiological and chemical changes in the body, including increases in serotonin and endorphin secretion, and a decrease in cortisol. A majority of studies investigating the effects of massage measure these three chemicals because they are crucial ingredients for each person’s health. In general, serotonin and endorphins function to make people feel good, while cortisol functions to transmit feelings of pain and stress. Nearly every clinical trial evaluating massage therapy reports that bodywork enhances serotonin and endorphin levels, and reduces circulating levels of cortisol.
Massage therapists must be cautious when working with depressed patients. Some clients receiving and enjoying massage may wish to stop taking their medication on their own accord. While well-meaning massage therapists may view this as a positive step and encourage their clients to try it, this is never recommended without a physician’s guidance. Balancing antidepressant medications can be very tricky, and potentially tragic consequences can occur if done inappropriately.
When working with depressed clients, you must remember that safety is paramount. Although the communication between you and your client is confidential, there is one exception. If a client ever mentions thoughts about suicide, a therapist is obligated to note it in his/her chart and report the situation to the client’s therapist.
Depression often accompanies complex emotional issues that a client may bring into your session. The therapeutic relationship between client and practitioner is in danger of being compromised if boundaries are not carefully respected. If working with a depressed client who is not getting adequate support by the medical community, a referral is necessary. This keeps bodyworkers from becoming responsible for their clients’ lives, prevents the blurring of professional relationship boundaries, and allows clients to get the help they need.
Although considered an adjunct therapy for depression, massage is known to improve its symptoms. Research demonstrates ample physiological reasons for the mechanisms behind massage’s therapeutic value in treating depression. While practitioners should keep in mind the warnings of working with this population, the rewards that come from helping clients ease their depression are well worthwhile.
Ethics: Therapeutic Relationships
Depression: Massage Benefits and Precautions
Werner, LMP, NCTMB, Depression and the Stress Response System: Part I of III, Massage Today, August 2003.
Werner, Ruth, LMP, NCTMB, Depression and the Stress Response System: Part III, Massage Today, December 2003.
Werner, Ruth, LMP, NCTMB, Depression and the Stress Response System: Part II, Massage Today, October 2003.
www.depression.com, Depression Basics, GlaxoSmithKline, 2006.
www.nimh.nih.gov, Depression, National Institute of Mental Health.