Most clients dealing with depression can reap several benefits from massage. Nurturing, non-sexual therapeutic touch is one of the most important ways we humans have of maintaining a healthy stress response.
What is Depression?
The term “depression” is used to describe a large number of mood disorders that often result in persistent feelings of sadness, guilt, or hopelessness. Depression is much more than a temporary “case of the blues.” It can be a chronic, self-perpetuating, and debilitating disease.
It’s hard to say how many people are affected by depression, as many people who suffer never seek help. Some studies have suggested that up to 20% of women and 12% of men develop depression in their lifetime. These numbers mean that in a one year period, nearly 21 million people in the US have some form of depression.
It has been observed in people of all ages, from children to seniors, and it frequently accompanies other diseases.
Causes of Depression
The exact causes of depression are unknown, as nearly every case is different. In some clients, physical changes in the brain have been noted. In others, chemical imbalances are a likely cause.
- Hormonal Imbalance – A disruption in hormonal secretions, including, estrogen, progesterone, endorphins, and the so-called “stress hormone,” cortisol.
- Neurotransmitter Imbalance – Three main neurotransmitters, serotonin, norepinephrine, and dopamine are closely associated with depression. Whether these chemicals are in short supply, or an overabundance causes your body to resist the effects is a matter of debate in scientific circles.
- Atrophy of the Hippocampus – An area of the brain involved with learning and memory, the hippocampus, in persons with major depressive disorder is often smaller than normal. This could be caused by the overactive secretion of cortisol, often seen in patients with anxiety disorders.
- The Hypothalamus-Pituitary-Adrenal (HPA) Axis – The pituitary gland, controlled by the hypothalamus, in turn controls the adrenal glands. The adrenal glands secrete hormones that increase stress responses. When something disrupts any one of these systems, it affects the body’s ability to appropriately deal with physical and emotional stress.
Other Factors
Some causes of depression are controllable, but many are not. Whether a person becomes depressed or not depends on personal chemistry, genetics, and even their individual personality.
- Genetics – Many genetic abnormalities may be responsible for the higher than normal incidence of depression among family members.
- Environmental Triggers – Most depressive episodes can be related to specific life events. Sometimes the triggers are clear, the death of a loved one, financial strain, or trauma; others are less obvious.
- Personality Traits – Some people are just more prone to depression than others. Pessimistic or passive personalities tend to be more likely to develop depression at some point in their life.
- Chronic Illness – Depression occurs in patients with a chronic illness at a much higher rate than healthy people. Chronic pain, disability, and the financial, emotional, and physical strain can obviously lead a person to feelings of hopelessness and a loss of investment in their life. Additionally, some diseases, such as fibromyalgia, are linked to the production (or lack thereof) of the neurotransmitters noted above.
- Other External Factors – There are several other problems that can lead to a higher incidence of depression, including, smoking, drug and/or alcohol abuse, side effects of medication, and nutritional deficiencies.
Signs and Symptoms
The signs and symptoms depend partly on what type of depression is present. However, there are a few common symptoms:
- Persistent feelings of sadness
- Decrease in enjoyment of usual activities, like sex or hobbies
- Sense of guilt or disappointment in yourself
- Irritability
- Changes in sleep patterns
- Inability to concentrate
- Weight fluctuations (marked increase or decrease in appetite)
- Fatigue
- Physical pain that does not respond to treatment, especially:
- headaches
- backaches
- digestive discomfort
- Suicidal thoughts, plans, or attempts
Types of Depression
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) recognizes several distinct types of depression, including:
- Major Depressive Disorder – The classic clinical depression, recognized as lasting for periods longer than two weeks. Episodes may last anywhere from six to 18 months and recurs from four to six times in a lifetime. This means someone who doesn’t seek treatment can expect to spend up to 10 years of their life feeling hopeless, helpless, and worthless.
- Adjustment Disorder – This type is related to a specific event that triggers an emotional response that lasts significantly longer than what is considered normal. Adjustment disorder is often the result of profound grief.
- Bipolar Disease – Also called “manic depression,” this type results in often wild mood swings from crushing sadness to elation.
- Seasonal Affective Disorder – This type is related to the lack of sunlight and may be related to low levels of melatonin. It occurs more frequently with distance from Earth’s equator and in the winter months.
- Postpartum Depression – Affecting new mothers, it is thought to be the result of a combination of fluctuating hormone levels, sleep deprivation, and the life changes associated with bringing home a new baby.
How is Depression Diagnosed?
A combination of physical tests to rule out underlying diseases, plus psychological tests are used by your physician to make a depression diagnosis. Many patients never seek treatment and others are misdiagnosed if the symptoms suggest another disorder or disease.
Young children and seniors usually present physical symptoms of depression, such as headaches, backaches, sleep disruption, and digestive discomfort that are often mistaken for other diseases.
The Dangers of Depression
There are serious complications associated with depressive episodes. A history of depression is a risk factor for several other conditions.
Suicide
Each year in the United States around 200,000 people attempt suicide. About 30,000 succeed.
It is estimated that about half of all suicide attempts are the result of depressive episodes. Suicide is responsible for the deaths of about 15% of patients with major depressive disorder. Men have depression about half as often as women, but they are four times more likely to commit suicide.
Cardiovascular Disease
A history of depression is a risk factor for strokes, heart attacks, and other cardiovascular disease. The severity of your depression can predict how well you recover from a heart attack or stroke.
Comorbity
The symptoms of depression can make the consequences of other conditions worse.
If you are depressed, you are less likely to take care of yourself by maintaining social interactions with friends and family, eating a proper diet, exercising, complying with prescription schedules, and seeking treatment for other medical conditions.
Depression often accompanies other serious medical diagnoses, such as ALS, Multiple Sclerosis, Traumatic Brain Injury, or other conditions that require hospice care.
Depression Treatments
Most types of depression are treatable, though it may require several combinations of therapies to find one that is most effective. The process of finding the correct path to wellness can be frustrating, expensive, and can often temporarily make your depression worse. Patience is key.
Anti-Depressant Medications
There are several types of medications that have been developed to combat depression. Since depression can be caused by any number of different hormone and chemical imbalances, finding the right medication and dosage can take some time.
There are four main categories of antidepressants:
- Selective Serotonin Reuptake Inhibitors (SSRI) work by allowing the brain to hold onto serotonin for longer periods of time.
- Prozac
- Zoloft
- Serotonin Norepinephrine Reuptake Inhibitors (SNRI) work by retaining higher levels of both serotonin and norepinephrine.
- Effexor
- Cymbalta
- Monoamine Oxidase Inhibitors (MAOI) work by limiting an enzyme that breaks down neurotransmitters.
- Nardil
- Parate
- and Tricyclic Antidepressants (TCA) work similar to SNRI’s but doesn’t focus on just serotonin and norepinephrine.
- Elavil
These medications are effective for most patients, but may take several weeks to affect noticeable mood changes. They can also have serious side effects that generally go away after a few weeks.
Psychotherapy
Talk therapy can help you improve your coping skills and reduce the effects of depressive episodes. Cognitive-behavioral, interpersonal, and psychodynamic therapies are often used in addition to antidepressants.
Other Therapies
- Light Therapy to treat Seasonal Affective Disorder
- Electroconvulsive Therapy (ECT), also known as “shock therapy”
- Magnetic Stimulation
- Vagus Nerve Stimulation
- Supplements
Massage Therapy for Depression
Most people with depression receive several benefits from regular massage therapy including:
- Healing touch can improve the efficiency of the HPA axis.
- Massage moves the body from the sympathetic (fight or flight) response system into the parasympathetic (relaxed) system.
- Massage affects mood by shifting brain activity from the right frontal lobe associated with sad feelings to the left frontal lobe associated with feelings of happiness.
- Simply scheduling a massage is a small, low-risk, step towards self-care that can prompt you to take other, larger steps.
- A reduction in the body’s cortisol level is a known benefit of massage.
- Massage provides a safe and nurturing place for individuals to relax, refocus, and find clarity.
- It can increase awareness of the mind-body connection.
- Massage can generate confidence and enhance self-image and self-worth.
Depression Massage Cautions
There are few risks in seeking a massage therapist along with your regular doctor to help manage your depression.
You should be careful to continue taking your medication and attending therapy sessions, even after your symptoms decrease.
Client-therapist relationships run the risk of becoming distorted when boundaries are not carefully respected. Establishing a clear treatment plan and keeping an appropriate emotional distance from your therapist will reduce this risk.
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