Depression in Traditional Chinese Medicine and Modern Medicine - Essay Example

Depression in Traditional Chinese Medicine and Modern Medicine Introduction As medical science and technology developed through the course of human history, so did the definition of what constitutes a healthy individual. Health is defined by the World Health Organization (WHO) as “not an absence of illness, but a state of complete mental and physical wellbeing”, which clearly encompasses the mental health of an individual. This makes depression, as one of the most widespread mental disorders, one of the more prominent focuses of medical science. However, as it will be stated further, depression was considered a serious illness in the traditional medicine of many cultures and in particular the Chinese, pointing that happiness and the elements that negatively influence it are a timeless focus of man’s pursuit for the same. WHO defines depression as “a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration” and it currently affects 121 million people worldwide (WHO). While depression is defined as a mental illness, there are many psychosomatic reactions that affect a person’s general health and wellbeing. These somatic symptoms include headaches, aches and pains throughout the body without any conclusive medical testing, as well as constipation, decreased appetite and loss of weight, and even disturbed menstrual cycle. Decreased libido, as well as one of the most obvious symptoms of depression, excessive sleep are also evident, and patients generally present with slowness in movement and action when completing even the most menial of tasks (WHO). Depression can have, however, even far more reaching consequences, as its chronic form significantly increases the chances of a might to a disastrous outcome in the form of suicide, of which 850 000 people lose their lives (WHO). The latest statistics show that depression is already the second cause of global contributor to disease in the 15-44 years category for both sexes, and represents the leading cause of disability worldwide (WHO). It affects mostly the previously mentioned age group, and it is more prevalent in women than in men. It is also important to mention that there is a certain genetic component, as people with family history of depression are 10-15% more likely to develop depression than in the 1-2% in the normal population. One should also consider the daunting fact that children whose parents are depressed are 50-70% more likely to develop depression, when considering the realistic genetic component behind depression (WHO). To truly understand the effect of depression, however, one must consider the treatments and their availability to the population. While psychological treatment, coupled with antidepressants and other medications is effective 60-80% (WHO), one should also consider that less than 25% of depressive patients receive the appropriate treatments, mainly because of the lack of the appropriate medications, or social status and stigma (WHO). Depression as a psychological illness in modern medicine In 1980, the cluster of symptoms including depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration were named as major depressive disorder by the American Psychological Association in their Diagnostic and Statistical Manual of Mental Disorders. Depression is usually diagnosed through careful examination of the patient and the presented symptoms. In order to have a successful diagnosis of depression, the physician, generally a psychiatrist or psychologist, or even a general practitioner, must consider whether or not there are certain elements in the patient’s life that may cause symptoms of depression, but not the mood disorder itself. A history of drug and alcohol abuse should always be taken into regard, but there are other diseases that may present the psychological effects of depression. The most marked condition is hypothyroidism, which can present not only the mental aspects of depression, but also many of the physical aspects, such as low energy, poor concentration and disturbed and prolonged sleep. Therefore a test to determine the level of TSH and thyroxine should be performed. Latest research has also shown the impact of the lack of testosterone on the mental health of patients, as such patients, typically men, frequently experienced depression. This requires testing for hypogonadism, or certain tumors such as a seminoma (Orengo et al., 2004). When depressive symptoms are found in older patients, Alzheimer’s disease and dementia should be considered, as depressive symptoms may appear in the beginning stages of these diseases (Reid and Maclullich, 2006). There are also many different types of depressive disorders. The most prevalent is the atypical depression, which affects 42% of depressed patients. It is characterized with more pronounced symptoms of depression with a significant difference in reversed vegetative symptoms, as it is characterized with significant weight can, compared to the lack of appetite in major depressive disorder. Another major subtype of depressive disorder is postpartum depression, which affects mothers that have recently experienced childbirth. Studies have shown that 15.7% of women that have given birth experience postpartum depression (Segre et al., 2008). Patients usually experience the same symptoms as in major depressive disorder, with several noticeable differences, such as fits of aggression, as well as lack of bonding to the newborn, with feelings of inability to care for the same. It is this latter symptom that bears the weight of this type of depressive disorder, prompting more focus on treatment and care in recent years. Seasonal affective disorder is another kind of depressive disorder that occurs in particular populations and in particular periods of time. This type of depression appears during the winter periods and mainly in population living in the cold climate of the north, such as Alaska and Norway, and usually it is experienced with less pronounced symptoms, and sometimes appearing in subclinical form. Its treatments involve a variety of medications and procedure, most notably the use of light therapy with light ranging from 2500 to 10 000 lux (Avery et al. 2001). Melancholic depression affects 10% of the population and it falls typically within the generally accepted symptoms of depression, and it is amongst the first types of depression that was analyzed by early psychiatrists. Modern medical science has provided many explanations as to the causes of depression, and 3 theories are most prominent: genetics, the monoamine- deficiency hypothesis and the hypothalamic-pituitary-adrenal axis. Experiments performed with monozygotic and dizygothic twins showed that there is heritability of 37% (Belmaker and Agam, 2008). It is considered that depression has complex genetic origin, and linkage was discovered on choromosome 15q-25-q26, but without significant risk to the genetics to the population (Holmans et al, 2007). While currently there is no known molecular risk factor, there is a common polymorphic variant of serotonin-transporter–linked polymorphic region (5-HTTLPR) which reduces the re-uptake of serotonin in the presynaptic membrane, and therefore predisposes certain people to depression, although a certain link has not been established (Lesch KP et al, 1996). One of the more controversial theories is the monoamine-deficiency theory, which states that the lack of any of the multiple neurotransmitters located in the nervous system is responsible for depressive symptoms. Experiments have shown that when certain neurotransmitters are absent they cause symptoms of anxiety or loss of energy, such as in the case of norepinephrine, or obsessive compulsive disorder in the case of serotonin. Even though this theory has been heavily supported by treatments with antidepressants, yet it is known that 2/3 of the patients respond to the medications, while 1/3 respond to the placebo, which shows that at the very least, the monoamine-deficiency theory is incomplete (Belmaker and Agam, 2008). The hypothalamic-pituitary-cortisol hypothesis states that depression is based on the abnormal responses of the brain to stress. As stress is affects the brain cortex and the amygdala, and therefore the hypothalamus, corticotrophin-releasing hormone (CHR) is released, and corticotrophin is released by the pituitary gland which causes an increased level of cortisol in the blood. The theory states that in depression, there is an increase in cortisol level, which instead of reducing the level of CHR through the negative feedback, it allows for higher levels of CRH, which in turn affects the limbic region of the brain. Despite such a variety of theories, it is considered that depression has a multifactorial origin, both genetic and environmental in nature (Belmaker and Agam, 2008). Depression in Traditional Chinese Medicine History has shown that depression as a diagnosis is not limited to modern medicine. Referred to as Yu Zheng, depression involved the lack balance between several organs, as the entire Chinese medicine is based on duality and maintaining the balance of duality. The main concept on which Chinese medicine is based is the concept of Yin Yang, or in essence the duality within a greater whole. It is this duality that is the basis not only of Chinese medicine, but the entire Chinese philosophy, and it is on this duality the key elements are combined in order to explain both health and sickness. These elements are the vital substances, the internal organs and the meridians (Holland and Lanphear, 2000, p.10). There are 5 vital substances in Chinese medicine: the Qi, Jin Ye (body fluids), Shen, Jing and the Xue (blood). Qi is most prominent, appearing not only in traditional medical texts but also in many aspects of Chinese philosophy. It is defined as an energy flow, or a life force that is present in the body, and the uninterrupted and balanced movement of this energy is what provides health and essentially, life (Holland and Lanphear, 2000, p.22). It is also the stem point for the materialization and more importantly providing energy to the other vital substances. Xue can be most accurately translated as blood, although it substantially differs from the modern idea of blood. It is essential to provide vitality, giving the ability of the organs to function, as well as to provide nourishment. It is created by the foods and fluids in the body, named Gu Qi, and Yuan Qi, which is an energy flow (Qi) derived from the Jing (Holland and Lanphear, 2000, p.25). It is also essential in the creation of the organs. The Jin Ye, or the body fluids are essential in moistening and maintaining the body in a functioning condition. The name itself is a composite of two terms, each signifying the type of body fluids, namely Jin meaning light, such as tears and sweat and Ye meaning heavy, representing fluids such as spinal fluid, or the fluids that provide lubrication of the joints (Holland and Lanphear, 2000, p.26). Jing, meaning essence, or life force, is the basic and strongest physical matter of the body, and believed to be the carrier of traits form one generation to another. Togerther with the Shen and Qi, they form the so-called Three Treasures, essentially forming the Shen (Spirit), Qi (energy) and Jing (physical) (Gander, 2009). Depression, on the other hand is related to the functioning of the organs, even though organs in Chinese medicine has different meaning than in Western medicine. The organs in Chinese medicine are viewed like materialization of the five primal powers of Wood, Fire, Earth, Metal and Water into the two types of organs, solid organs or Zang or hollow organs or Fu. Depression was considered to be dysfunction of the Zang organs such as the liver, heart, spleen, lungs and the kidney. The dysfunction can arise from disturbances of any of the vital elements, for example the flow of Qi, or the deficiency of Xue (Holland and Lanphear, 2000, p.27-30). Usually depression is associated with several conditions, and in certain aspects, can be related to some of the subtypes of major depressive disorder that can be identified in modern times. Liver Qi stagnation can be most easily related with atypical depression, while yin and blood deficiency can be correlated with melancholic depression. Lung Qi deficiency can be related to postpartum depression (although it can affect men), while phlegm and Qi and phlegm clasing can be correlated to seasonal depressive disorder. References: 1. Avery, D. H.; Kizer D, Bolte MA, Hellekson C (2001). Bright light therapy of subsyndromal seasonal affective disorder in the workplace: morning vs. afternoon exposure. Acta Psychiatrica Scandinavica 103 (4): 267–274. 2. Belmaker, R. H and Agam, G. (2008). Major depresive disorder. New England Journal of Medicine, vol. 358: 55-68. 3. Conquering Depression: What is depression?. 2006. World Health Organization. Retrieved on January 09, 2010. http://www.searo.who.int/en/Section1174/Section1199/Section1567/Section1826_8098.htm 4. Conquering Depression: Some Facts and Figures. 2006. World Health Organization. Retrieved on January 09, 2010. http://www.searo.who.int/en/Section1174/Section1199/Section1567/Section1826_8101.htm 5. Depression. 2010. World Health Organization. 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