Depression, Anxiety, and Stress
Acupuncture is beneficial in the treatment of Depression, Anxiety, and Stress
Sadness and joy are part of our everyday lives. Like the ebb and flow of Yin and Yang. The moving of the planets around the sun or the rise and fall of the sun and moon are natural phenomenon just as our emotions are, they change.
Sadness or transient depression is a normal healthy response to defeat, disappointment, and other adverse situations.
Transient depression or the “blues” may occur as a reaction to certain events in our lives such as significant anniversaries, birthdays, holidays, premenstrual syndrome, or in the first 2 weeks postpartum.
Reactive depression is archetypal of grief or normal bereavement, death of a loved one, marital separation, marital disharmony, and romantic disappointments, or loss of a job; or leaving a familiar environment.
Depression is a serious medical illness; it’s not something that you have made up in your head. It’s more than just feeling “down in the dumps” or “blue” for a few days. Feeling “down” and “low” and “hopeless” for weeks at a time. People with depression do not all experience the same symptoms. The severity, frequency and duration of symptoms will vary depending on the individual and his or her particular depression.
The symptoms of emotional stress mimic symptoms of other health problems.
Signs & Symptoms:
- Persistent sad, anxious or “empty” feelings
- Feelings of hopelessness and/or pessimism
- Feelings of guilt, worthlessness and/or helplessness
- Irritability, restlessness
- Loss of interest in activities or hobbies once pleasurable, including sex
- Fatigue and decreased energy
- Difficulty concentrating, remembering details and making decisions
- Insomnia, early–morning wakefulness, or excessive sleeping
- Overeating, or appetite loss
- Thoughts of suicide, suicide attempts
- Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment
The Yellow Emperor’s Classic of Medicine (Huang Di Nei Jing Suwen) is the oldest medical reference still in use today in Traditional Modern Chinese Medicine. The emotions come from the qi of the five zang (solid) organs. This qi manifests as the spirit of the five zang organs. Over indulgence in the five emotions can create imbalances of the workings of the body and mind.
Chinese medicine integrates the mind and body and attributes emotional imbalances to disharmonies of the flow of Qi. Shen resides in the heart and it is the mind and all of its activities. Here is an example of how the emotions and the body are integrated.
- Resides in the heart. Integrates mind-body mental-emotional is injured by excesses, overindulgence, joy
- Resides in the liver. Integrates the Ethereal soul, balances excitation and restraint, helps to prevent excesses in emotions to prevent disease, is injured by anger
- Resides in the spleen. Integrates the intellect. The Yi is responsible for thinking, learning, memory, focus, concentration, and ideas. It is injured by pensiveness, mental rumination, over thinking
- Resides in the kidneys. Integrates will-power or personal drive. The Zhi is responsible for Storing memories, drive, determination, the origination of an idea and the acting out on the idea. It is injured by fear & worry
- Resides in the lungs, it represents the physical body aka corporeal soul or the spirit of the body. The Po is responsible for giving the body agility, movement, balance and coordination, hearing and sight. It is injured by great sadness, loss, despair.
It has been said that “Unfulfilled desires, goals, or expectations lead to the condition known as liver depression qi stagnation.” Simply the liver is responsible for the free flow of qi, this free flow is disturbed by the liver being constrained by a stagnation of qi, the liver activity becomes depressed, and this affects the heart qi which leads to a disturbed Shen or consciousness.
This is a cyclical process, meaning it will go around and around building more and more stagnation which leads to heat buildup (heat rises) and it is the liver heat (yang) rising that clouds the Shen leading to depression and anxiety.
The stagnation of qi, blood, food, and phlegm all block the free flow of qi. Stagnation of qi refers to the liver qi, and blood stagnation occurs because the liver qi stagnates (no free flow).
Food stagnation is an excess accumulation due to a spleen stomach disharmony (process of proper digestion) leading to stagnation of qi, and phlegm stagnation a thick form of viscous qi. These stagnations all block the free flow of yang qi to the head. This leads to depression, anxiety, and stress.
Treatment typically uses Chinese herbs, Physiological Regulating Medicine, acupuncture, exercise, psychotherapy talk or body centered or both, and the use of prescribed antidepressants by your medical doctor where necessary.
Treatment goals are to increase energy levels and lift depression. Please let your medical doctors know if you are currently taking any prescribed depression medication or if you are self medicating with herbs or other drugs there can be serious side effects if taken with Chinese Herbs.
Acupuncture May Help Symptoms of Posttraumatic Stress Disorder
A pilot study shows that acupuncture may help people with post traumatic stress disorder. Posttraumatic stress disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat.
Michael Hollifield, M.D., and colleagues conducted a clinical trial examining the effect of acupuncture on the symptoms of PTSD. The researchers analyzed depression, anxiety, and impairment in 73 people with a diagnosis of PTSD.
The participants were assigned to receive either acupuncture or group cognitive-behavioral therapy over 12 weeks, or were assigned to a wait-list as part of the control group. The people in the control group were offered treatment or referral for treatment at the end of their participation.
The researchers found that acupuncture provided treatment effects similar to group cognitive-behavioral therapy; both interventions were superior to the control group. Additionally, treatment effects of both the acupuncture and the group therapy were maintained for 3 months after the end of treatment.
The limitations of the study are consistent with preliminary research. For example, this study had a small group of participants that lacked diversity, and the results do not account for outside factors that may have affected the treatments’ results.
Stress: Everything you wanted to know about STRESS and its effects
The following information is from the National Institutes of Health National Institute of Child Health and Human Development. This article outlines the biological reasons behind stress and the bodily response to it.
Stress System Malfunction Could Lead to Serious, Life Threatening Disease
Whether from a charging lion, or a pending deadline, the body’s response to stress can be both helpful and harmful. The stress response gives us the strength and speed to ward off or flee from an impending threat. But when it persists, stress can put us at risk for obesity, heart disease, cancer, and a variety of other illnesses.
Perhaps the greatest understanding of stress and its effects has resulted from a theory by George Chrousos, M.D., Chief of the Pediatric and Reproductive Endocrinology Branch at the National Institute of Child Health and Human Development (NICHD), and Philip Gold, MD, of the Clinical Neuroendocrinology Branch at the National Institute of Mental Health (NIMH).
A threat to your life or safety triggers a primal physical response from the body, leaving you breathless, heart pounding, and mind racing. From deep within your brain, a chemical signal speeds stress hormones through the bloodstream, priming your body to be alert and ready to escape danger.
Concentration becomes more focused, reaction time faster, and strength and agility increase. When the stressful situation ends, hormonal signals switch off the stress response and the body returns to normal.
But in our modern society, stress doesn’t always let up. Many of us now harbor anxiety and worry about daily events and relationships.
Stress hormones continue to wash through the system in high levels, never leaving the blood and tissues. And so, the stress response that once gave ancient people the speed and endurance to escape life-threatening dangers runs constantly in many modern people and never shuts down.
Research now shows that such long-term activation of the stress system can have a hazardous, even lethal effect on the body, increasing risk of obesity, heart disease, depression, and a variety of other illnesses.
Much of the current understanding of stress and its effects has resulted from the theory by Drs. Chrousos and Gold. Their theory explains the complex interplay between the nervous system and stress hormones – the hormonal system known as the hypothalamic-pituitary-adrenal (HPA) axis.
Over the past 20 years, Dr. Chrousos and his colleagues have employed the theory to understand a variety of stress-related conditions, including depression, Cushing’s syndrome, anorexia nervosa, and chronic fatigue syndrome.
The Stress Circuit:
The HPA axis is a feedback loop by which signals from the brain trigger the release of hormones needed to respond to stress. Because of its function, the HPA axis is also sometimes called the “stress circuit.”
Briefly, in response to a stress, the brain region known as the hypothalamus releases corticotropin-releasing hormone (CRH). In turn, CRH acts on the pituitary gland, just beneath the brain, triggering the release of another hormone, adrenocorticotropin (ACTH) into the bloodstream. Next, ACTH signals the adrenal glands, which sit atop the kidneys, to release a number of hormonal compounds.
These compounds include epinephrine (formerly known as adrenaline), Norepinephrine (formerly known as noradrenaline) and cortisol. All three hormones enable the body to respond to a threat. Epinephrine increases blood pressure and heart rate, diverts blood to the muscles, and speeds reaction time.
Cortisol, also known as glucocorticoid, releases sugar (in the form of glucose) from the body reserves so that this essential fuel can be used to power the muscles and the brain.
Normally, cortisol also exerts a feedback effect to shut down the stress response after the threat has passed, acting upon the hypothalamus and causing it to stop producing CRH.
This stress circuit affects systems throughout the body. The hormones of the HPA axis exert their effect on the autonomic nervous system, which controls such vital functions as heart rate, blood pressure, and digestion.
The HPA axis also communicates with several regions of the brain, including the limbic system, which controls motivation and mood, with the amygdala, which generates fear in response to danger, and with the hippocampus, which plays an important part in memory formation as well as in mood and motivation.
In addition, the HPA axis is also connected with brain regions that control body temperature, suppress appetite, and control pain.
Similarly, the HPA axis also interacts with various other glandular systems, among them those producing reproductive hormones, growth hormones, and thyroid hormones. Once activated, the stress response switches off the hormonal systems regulating growth, reproduction, metabolism, and immunity. Short term, the response is helpful, allowing us to divert biochemical resources to dealing with the threat.
Stress, heredity, and the environment:
According to Dr. Chrousos, this stress response varies from person to person. Presumably, it is partially influenced by heredity. For example, in most people the HPA axis probably functions appropriately enough, allowing the body to respond to a threat, and switching off when the threat has passed.
Due to differences in the genes that control the HPA axis, however, other people may fail to have a strong enough response to a threat, while still others may over respond to even minor threats. Beyond biological differences, the HPA axis also can alter its functioning in response to environmental influences.
The HPA axis may permanently be altered as a result of extreme stress at any time during the life cycle – during adulthood, adolescence, early childhood, or even in the womb.
If there are major stresses in early childhood, the HPA feedback loop becomes stronger and stronger with each new stressful experience. This results in an individual who, by adulthood, has an extremely sensitive stress circuit in place.
In life threatening situations – such as life in an area torn by war – this exaggerated response would help an individual to survive. In contemporary society, however, it usually causes the individual to overreact hormonally to comparatively minor situations.
Stress and the Reproductive system:
Stress suppresses the reproductive system at various levels, says Dr. Chrousos. First, CRH prevents the release of gonadotropin releasing hormone (GnRH), the “master” hormone that signals a cascade of hormones that direct reproduction and sexual behavior.
Similarly, cortisol and related glucocorticoid hormones not only inhibit the release of GnRH, but also the release of luteinizing hormone, which prompts ovulation and sperm release. Glucocorticoids also inhibit the testes and ovaries directly, hindering production of the male and female sex hormones testosterone, estrogen, and progesterone.
The HPA over activity that results from chronic stress has been shown to inhibit reproductive functioning in anorexia nervosa and in starvation, as well as in highly trained ballet dancers and runners. For example, in one study, Chrousos found that men who ran more than 45 miles per week produced high levels of ACTH and cortisol in response to the stress of extreme exercise.
These male runners had low LH and testosterone levels. Other studies have shown that women undertaking extreme exercise regimens had ceased ovulating and menstruating.
However, the interaction between the HPA axis and the reproductive system is also a two way street. The female hormone estrogen exerts partial control of the gene that stimulates CRH production. This may explain, why, on average, women have slightly elevated cortisol levels.
In turn, higher cortisol levels, in combination with other, as yet unknown, factors, may be the reason why women are more vulnerable than men to depression, anorexia nervosa, panic disorder, obsessive compulsive disorder, and autoimmune diseases like lupus and rheumatoid arthritis.
Growth and stress:
The hormones of the HPA axis also influence hormones needed for growth. Prolonged HPA activation will hinder the release of growth hormone and insulin-like growth factor 1 (IGF-1), both of which are essential for normal growth. Glucocorticoids released during prolonged stress also cause tissues to be less likely to respond to IGF-1. Children with Cushing’s syndrome – which results in high glucocorticoid levels – lose about 7.5 to 8.0 centimeters from their adult height.
Similarly, premature infants are at an increased risk for growth retardation. The stress of surviving in an environment, for which they are not yet suited, combined with the prolonged stress of hospitalization in the intensive care unit, presumably activates the HPA axis.
Growth retarded fetuses also have higher levels of CRH, ACTH, and cortisol, probably resulting from stress in the womb or exposure to maternal stress hormones. Old research has also shown that the stress from emotional deprivation or psychological harassment may result in the short stature and delayed physical maturity of the condition known as psychosocial short stature (PSS).
PSS was first discovered in orphanages, in infants who failed to thrive and grow. When these children were placed in caring environments in which they received sufficient attention, their growth resumed.
The children’s cortisol levels were abnormally low, a seeming contradiction, which Chrousos investigated by studying a small, non-human primate, the common marmoset. These monkeys live in small family groups in which infants are cared for by both parents. As in human society, the infants are sometimes well cared for, but sometimes abused. Like humans, the abused monkeys showed evidence of PSS.
The researchers determined that the stressed and abused monkeys appeared to respond normally to stress, but seemed unable to “switch off” the stress response by secreting appropriate cortisol levels, thereby remaining in a state of prolonged stress arousal as compared to their peers.
The gastrointestinal tract and stress:
As many of us know, stress can also result in digestive problems. The stress circuit influences the stomach and intestines in several ways. First, CRH directly hinders the release of stomach acid and emptying of the stomach. Moreover, CRH also directly stimulates the colon, speeding up the emptying of its contents.
In addition to the effects of CRH alone on the stomach, the entire HPA axis, through the autonomic nervous system, also hinders stomach acid secretion and emptying, as well as increasing the movement of the colon.
Also, continual, high levels of cortisol – as occur in some forms of depression, or during chronic psychological stress -can increase appetite and lead to weight gain. Rats given high doses of cortisol for long periods had increased appetites and had larger stores of abdominal fat. The rats also ate heavily when they would normally have been inactive. Overeating at night is also common among people who are under stress.
The immune system and stress:
The HPA axis also interacts with the immune system, making you more vulnerable to colds and flu, fatigue and infections. In response to an infection, or an inflammatory disorder like rheumatoid arthritis, cells of the immune system produce three substances that cause inflammation: interleukin 1 (IL-1), interleukin 6 (IL-6), and tumor necrosis factor (TNF).
These substances, working either singly or in combination with each other, cause the release of CRH. IL-6 also promotes the release of ACTH and cortisol. Cortisol and other compounds then suppress the release of IL-1, IL-6, and TNF, in the process switching off the inflammatory response.
Ideally, stress hormones damp down an immune response that has run its course. When the HPA axis is continually running at a high level, however, that damping down can have a down side, leading to decreased ability to release the interleukins and fight infection.
In addition, the high cortisol levels resulting from prolonged stress could serve to make the body more susceptible to disease, by switching off disease-fighting white blood cells. Although the necessary studies have not yet been conducted, Dr. Chrousos considers it possible that this same deactivation of white blood cells might also increase the risk for certain types of cancer.
Conversely, there is evidence that a depressed HPA Axis, resulting in too little corticosteroid, can lead to a hyperactive immune system and increased risk of developing autoimmune diseases – diseases in which the immune system attacks the body’s own cells. Over activation of the antibody-producing B cells may aggravate conditions like lupus, which result from an antibody attack on the body’s own tissues.
One of the major disorders characteristic of an overactive HPA axis is melancholic depression. Chrousos’ research has shown that people with depression have a blunted ability to “counter regulate,” or adapt to the negative feedback of increases in cortisol.
The body turns on the “fight or flight” response, but is prevented from turning it off again. This produces constant anxiety and overreaction to stimulation, followed by the paradoxical response called “learned helplessness,” in which victims apparently lose all motivation.
Hallmarks of this form of depression are anxiety, loss of appetite, loss of sex drive, rapid heartbeat, high blood pressure, and high cholesterol and triglyceride levels. People with this condition tend to produce higher-than-normal levels of CRH.
The high levels of CRH are probably due to a combination of environmental and hereditary causes, depending on the person affected. However, rather than producing higher amounts of ACTH in response to CRH, depressed people produce smaller amounts of this substance, presumably because their hippocampuses have become less sensitive to the higher amounts of CRH.
In an apparent attempt to switch off excess CRH production, the systems of people with melancholic depression also produce high levels of cortisol. However, by-products of cortisol, produced in response to high levels of the substance, also depress brain cell activity. These by-products serve as sedatives, and perhaps contribute to the overall feeling of depression.
Other conditions are also associated with high levels of CRH and cortisol. These include anorexia nervosa, malnutrition, obsessive-compulsive disorder, anxiety disorder, alcoholism, alcohol and narcotic withdrawal, poorly controlled diabetes, childhood sexual abuse, and hyperthyroidism. The excessive amount of the stress hormone cortisol produced in patients with any of these conditions is responsible for many of the observed symptoms.
Most of these patients share psychological symptoms including sleep disturbances, loss of libido, and loss of appetite as well as physical problems such as an increased risk for accumulating abdominal fat and hardening of the arteries and other forms of cardiovascular disease.
These patients may also experience suppression of thyroid hormones, and of the immune system. Because they are at higher risk for these health problems, such patients are likely to have their life spans shortened by 15 to 20 years if they remain untreated.
Although many disorders result from an overactive stress system, some result from an under active stress system. For example, in the case of Addison’s disease, lack of cortisol causes an increase of pigment in the skin, making the patient appear to have a tan.
Other symptoms include fatigue, loss of appetite, weight loss, weakness, loss of body hair, nausea, vomiting, and an intense craving for salt. Lack of the hormone CRH also results in the feelings of extreme tiredness common to people suffering from chronic fatigue syndrome. Lack of CRH is also central to seasonal affective disorder (SAD), the feelings of fatigue and depression that plague some patients during winter months.
Chrousos and his team, showed that sudden cessation of CRH production may also result in the depressive symptoms of postpartum depression. In response to CRH produced by the placenta, the mother’s system stops manufacturing its own CRH. When the baby is born, the sudden loss of CRH may result in feelings of sadness or even severe depression for some women.
Recently, Dr. Chrousos and his coworkers uncovered evidence that frequent insomnia is more than just having difficulty falling asleep. The researchers found that, when compared to a group of people who did not have difficulty falling asleep, the insomniacs had higher ACTH and cortisol levels, both in the evening and in the first half of the night. Moreover, the insomniacs with the highest cortisol levels tended to have the greatest difficulty falling asleep.
The researchers theorized that, in many cases, persistent insomnia may be a disorder of the stress system. From their ACTH and cortisol levels, it appears that the insomniacs have nervous systems that are on overdrive, alert and ready to deal with a threat, when they should otherwise be quieting down.
Rather than prescribing drugs known as hypnotics to regulate the sleep system, the researchers suggested that physicians might have more success prescribing antidepressants, to help calm an overactive stress system. Behavior therapy, to help insomniacs relax in the evening, might also be useful.
After conducting many years of research into the functioning of the HPA axis, Dr. Chrousos concluded that chronic stress should not be taken lightly or accepted as a fact of life.
“Persistent, unremitting stress leads to a variety of serious health problems,” Dr. Chrousos said. “Anyone who suffers from chronic stress needs to take steps to alleviate it, either by learning simple techniques to relax and calm down, or with the help of qualified therapists. I will add here that acupuncture and Oriental medicine can be of great help as well.
Michael Hollifield, Nityamo Sinclair-Lian, Teddy D. Warner, and Richard Hammerschlag, “Acupuncture for Posttraumatic Stress Disorder: A Randomized Controlled Pilot Trial.” The Journal of Nervous and Mental Disease, June 2007.
A new translation of the Neijing Suwen with commentary. Maoshing Ni, Ph.D. Shambhala Press, ©1995 ISBN 1-57062-080-6
Giovanni Maciocia lecture series on the Psyche in Chinese medicine and the treatment of mental-emotional disorders. Presented by Options for Wellness February 7 and 8, 2009 Miami, FL
National Institutes of Mental Health: What are the signs and symptoms of depression?
Merck Manual Online Edition: Depression
Lotus Institute of Integrative Medicine Clinical Manual of Oriental Medicine 2nd Edition, Dr. John Chen PharmD
Jeffrey Grossman Acupuncture Media Works Education Card on Depression
Bob Flaws Blue Poppy Press, Many excellent lectures and classes
NCCAM National Institutes of Health: Acupuncture May Help Symptoms of Posttraumatic Stress Disorder
MayoClinic.com: Stress symptoms: Effects on your body, feelings and behavior