It is really difficult to write a comprehensive paper on depression, it is a vast subject and can be approached from so many different perspectives. So please take into consideration that this is but a brief treatment of a complex topic.
Clearly there are a range of both situational and organic causes of depression. Genetics can play a role in depression and new studies in something called epigenetics have proven that it only takes one generation of mice to pass down a fear of something that parental mice had a bad experience with. It is extremely important to note that the theory which drives much of present day pharmaceutical intervention espousing that low serotonin is a cause of many depressive states has not been proven. What we do know is that making serotonin more available in the brain can shift the depressive symptoms. However, it is now becoming clear that people who take antidepressants (most common are serotonin re-uptake inhibitors) are more susceptible to recurrences of depression throughout their life cycle than people who do not use these medications; I am concerned that this approach may be prescribing a life sentence of an ongoing struggle between depression and medication for people who take antidepressants rather than allowing a natural state to facilitate change and growth. Also of grave concern to me is the way that we have forever shifted culture by trying to rid ourselves of uncomfortable symptoms while perpetuating a belief system that only “positive” feelings are acceptable. This is not in synch with the cycles of nature in any way. Yet we forget we are of the natural world. This approach does not understand that symptoms are only a small part of the what really needs our attention. Our culture's classic symptom oriented response leads to exactly what the word depression describes: a condition of “pressed down energy”. Stuck energy that may be very important to look at, exploring the meaning of the situation and allowing it to influence our life choices, leading eventually to change that will re-establish and support the life flow.
Regarding current chemical trends in treatment, let's look briefly at what we actually do know about serotonin: it (along with melatonin and other chemicals) is a neurotransmitter and neural protector that is incorporated into every neural network on the planet as well as within the human body. Serotonin acts as an information transmitter (neurotransmitter), a hormone transmitter and a modulator of various tissues. It regulates neural networks that refine the communication between the brain and the heart allowing them to work as a cohesive system. Neuroplasticity (growing new neural networks in the brain) is necessary for any living adaptive system and serotonin plays a huge role in this. It helps to unify the entire brain into a cohesive biological system by modulating the brain and central nervous system, and continually altering the chemistry of target neurons. It influences form (the morphology- note current trends of obesity), influences sensory and motor neurons in order to track the source of stimuli from outside the system, and regulates the information that comes to us through our senses.
Serotonin neurons are in our heart, brain, digestive and immune systems and are activated by stimuli outside of the body. Serotonin exists (in the body) in any place we touch the outside world and the outside world touches us; it is the interface. As information touches the neural network the serotonin neurons coordinate our physiological response. Serotonin is highly reactive to any kind of change in the environment. It modulates the information received through our senses, the sensory gating channels. As sensory inflows occur it narrows or opens the gates to what becomes our awareness. In depression it would appear that these gating channels are narrowed and do not allow the sufferer to have a complete picture of his here and now situation.
Over 70% of the serotonin in our body is manufactured in the gut, so I would assume this would be a good place to begin the exploration of dealing with depression, looking at the condition of the gut flora, the diet, and the overall physical health of the sufferer. Some depressions are simply caused by poor physical health which needs to be remedied. For others that are situational I think it is important to not seek to suppress the experience but to facilitate the cycle that one is in so that the meaning of the mood disorder can be perceived and lead to a new way of being rather than be pushed back to status quo. Herbs that can support this process as well as other etiology will be listed later in this paper.
Now-a-days it is rare to find a person whose depression hasn't been perceived from the perspective that to be “down” is an illness rather than a part of the rhythm of life. And while I understand the extremely high severity and difficulty in some cases, I repeat that I think that we have exacerbated depression through suppression of a natural cycle. Situational depression happens for more reasons that we can count and many that we don't understand. Some causes are that a person might be recovering from loss or trauma, or dealing with unmet needs from another stage of life. Especially potent are the unmet needs of childhood that leaves some aspect of of the person stuck in an earlier stage of development despite the progression of the body through time. This is seen as soul loss in some cultures. Depression is often related to the feeling of helplessness that leads to a state of despair and of giving up. It is extremely important for the person to explore and acknowledge the meaning of the depression and take the difficult steps to remedy their situation, whether it be that something is not working in their present day reality or there is unprocessed stimuli from a past experience as is seen in PTSD or soul loss. Often it may be a combination of the 2, the present day situation triggering the old issue and making it difficult to perceive the present accurately. When we look at the role of serotonin and how it modulates information from outside it is easy to see how, if we ignore either the difficult life situation or the old material, we can upset the inherent regulatory balance of the chemicals involved.
My main orientation to mental health and depression grows from a Reichian perspective that anything that is suppressed will come out sideways because energy needs to move, it is just information, something that comes to do the work of informing us of something, similar to the way electric currents run through a wire or water through a hose. It's nature is to move. In my work at Body-Psychotherapy of Seattle, I look to open the compromised system and restore the flow of life on the 5 levels of existence: the body, emotions, thinking mind (thoughts), actions (will/ behavior) and the Big Mind (spiritual/ etheric influence of a person). I have written many papers on the subject if anyone is interested, suffice it to say it is too large of topic to do it justice here. However, the point is to create an integration of a person's life experience between these 5 realms so they work in coherence with one another rather than, for example, over-using the thoughts to justify one's actions or to deny one's difficult emotions. Working physically with the body is important to me because whatever physiological and muscular reaction we have to the external environment become involuntary reaction patterns wired into the nervous and muscular systems. These responses are set into motion when the body senses something that remotely resembles a past compromising situation, even if that is not happening in the present. Over time chemical reactions and the associated muscle memory create strong overused muscles that become an actual physical armoring that keeps us stuck reliving our early life experiences over and over again.
One of the major challenges of depression in our culture is the necessity to be high functioning all of the time. I would approach depression very differently if we had a society that had built in flexibility to allow people to adjust to these natural cycles when they beckon. Chronic stress as well as lack of meaning in life contribute to if not, at times, cause depression. This creates a real dilemma in finding healthy responses.
Herbs can play a major role in supporting a person's entire system to meet the demands placed on it while undergoing a difficult change process. It is important that an herbalist not try to be the sole health care provider for someone with a serious depression. It is important to have a guide, or several guides working together, that can negotiate all 5 levels (body, emotions, thinking, behavior etc.) into synchrony. I am less and less comfortable giving out lists of herbs for certain conditions. I think that an herbalist must have her own allies to call on in order to promote health in another. It is our relationship and our experience with the plants that that charge the treatment. But I can suggest some approaches to choosing herbs.
Firstly, be sure to think about the person's constitution, matching herbs to the unique disposition. For example, do not give a drying herb to someone with an agravated dry (Vatta) state; This is a person who might have dry mucous membranes, an airy personality and is easily distracted. Nor should you give sweet herbs to a Kapha, a person who is overly earthy, lacks expression and is slow moving. They would do better with spicy or bitter remedies, those that might confuse and exacerbate the symptoms of a Vatta person. As you can see, the symptoms of depression will manifest differently in different constitutions; basically each constitution will be exaggerated in it's imbalanced state, a Pitta person may be agonizingly irritable and restless, a Vata will demonstrate confusion and lack of concentration and a Kapha will cover all of the windows and stay in bed for months. All of these are common symptoms and may co-occur in one person, but look closely to see the subtleties and with practice you will be guided in choosing appropriate herbs. Overall, herbal remedies for depression need to be stimulating (to get things moving) as well as nourishing to the body and soothing to the nervous system.
In any depression avoid as many environmental toxins as possible; eat organic foods and avoid caffeine, sugar and processed foods. Encourage the client to surround themselves with a natural non-stimulating environment. Promote healthy gut flora through the use of probiotics and regular elimination practices. If one's feces smell strongly be sure to take this as a warning sign from the gut. For a period of time promote good elimination through the use of such herbs as Aloe, Rhubarb or Licorice and Pasqueflower; or use bitters such as Dandelion or Gentian root. This is going to be especially important in working with people with the cold damp constitution as they will tend toward a slower metabolism. But the Pitta and Vatta may also have absorption problems for different reasons.
After creating a well functioning environment in the gut use alteratives to support the liver in removing toxins from the body. Dandelion and Pasqueflower mentioned above are also categorized as alteratives. Many good blends are available. One I make for myself includes Ashwaganda, Burdock, Red Clover (for the blood) and Yellow Dock.
Extremely important is the use of nervines throughout the treatment course to soothe the nervous system and calm anxiety. I list many herbs for this in my paper on Treating the Blues. Some of my favorites: Lemon Balm, Scullcap (especially helpful for racing or obsessive thought patterns typical of a Vatta or Pitta person), Rosemary, Passion Flower, and Milky Oats (which would be good for a Pitta person as it is so cooling and damp). And of course the use of Saint John's Wort should also be considered in depressive states although studies suggest it works best in moderate cases. The sun herbs like SJW, Hawthorne, Rosemary and Frankincense (as aromatherapy) are especially good in seasonal related depressive states. All depression treatments must include getting out into natural light on a regular basis, even if it is dark and cloudy this will have a positive effect. Moving the body through walking or exercise is also crucial and especially hard to facilitate in the person with a Kapha constitution.
After supporting the liver and the nervous system look to adaptogens to put some zing back in the kidney and adrenal systems as these are heavily taxed in depression. There are SO many wonderful adaptogens, I vary my blends regularly to get a sense how the different herbs work and work together. Always use herbs you are familiar with so you can sense into how they are affecting your client. I love Shizandra, Ahswaganda, Polygonum, Gota Kola, Astragalus, Rhodiola, Don Quai, Ginseng and Motherwort. A good friend of mine has a company called Organic Unity. His adaptogen blend “Stressed to Blessed” includes a nice mixture of nervines and adaptogens including Devil’s Club root bark, Schizandra berry, Wood Betony leaf, Milky Oat tops, and Blue Vervain leaf.
And finally, for me the most important treatment guidance is taken from the practices of other cultures. In South America and Africa Shamans travel between the worlds to resolve soul loss, some of which is described above. Much of the work I do involves treating soul loss of several types, but, different from the indigenous practices, I like to make sure that I have fully prepared all aspects of a person's system so that they can retain the results long after the treatment ends. I do the scouting and the guiding but my style also puts the onus of the work on the client; with my help they bring awareness to their old patterns and interrupt them via interventions (for example by thought-stopping, a CBT intervention). I teach them how meet the old underlying need, building relationship and nurturing the young parts of themselves from within. Over time and with vigilance the information that once ran through neural network systems in predictable, outdated and problematic patterns can begin to pool as if in a dam, and finally overflow to form new neural networks that better fit the current reality.
Another great model that I always have in mind when working with depression is that found in ancient mythology involving the underworld. Persephone is one such Goddess who was abducted to the underworld by Hades. She faced many challenges there. But up above her mother Demeter searched and searched and held ground for her until she was returned. Innana of the Sumerians traveled the same journey, having to face the fierce Goddess Ereshkigal in the underworld until her time came (with the help of some tricky mud-men) to be released. This is this same journey that one takes through the belly of depression. An herbalist working on these levels might consider using Spagyric Essences, alchemically prepared herbal remedies which can positively affect depressive states. They are prepared by first distilling the essential oil, the Soul, out of the plant; then leaving the hydrosol and plant matter to ferment and distilling the alcohol from that. This is the Spirit level of the plant. The remaining plant matter is purified through fire until it is reduced to white ash from which the mineral salts, the Body of the plant, is extracted. These are put back together to form a remedy that works on the etheric levels to create change beyond the body. That change trickles down to the body and facilitates health. Organic Unity carries a line of Spagyric Essences that are made from wildcrafted plants, prepared according to corresponding astrological influences and infused with healing prayers and love. In my experience this care makes a huge difference in the potency of the remedy and it's impact on the client. I highly recommend them.
Finally, I think that the most important thing to keep in mind when working with a severely depressed person is that they must not be left on their own. Like Demeter, someone must hold space for them and watch for them from above, creating an anchor to the larger world. This space must be held by someone who is not afraid of the dark. Someone who is patient and kind, wise and strong. A practitioner with knowledge of the territory, a big loving heart and good boundaries!