Alternative Therapies for Depression

Acupuncture

Acupuncture is an ancient Chinese healing technique that prevents and cures specific diseases and conditions by sticking very fine, solid needles into specific points (called acupuncture points) just below the surface of the skin. There are more than 2,000 acupuncture points on the body connecting with 12 main and eight secondary pathways called meridians, which conduct energy - chi or qi - between the surface of the body and the internal organs. Acupuncture is based on the principle that stimulation of specific areas on the skin affects the functioning of certain organs of the body.

It is believed that acupuncture can help to relieve depression, along with anxiety, nervous tension and stress.

In 1996, the FDA approved acupuncture needles for use by licensed practitioners. Needles are either new or sterilized. Relatively few complications have been reported to the FDA, but bad results can happen from improper sterilization of needles and improper treatment. The needles are hair thin and don't cause the kind of pain associated with hollow hypodermic needles.

Acupuncture is an approved treatment for depression by the United Nations World Health Organization. A small number of studies support the view that acupuncture plays a valuable role in alleviating depression.

Psychologist John Allen, from the University of Arizona in Tucson, and Acupuncturist Rosa Schnyer, conducted the very first pilot controlled study on treating depression symptoms with acupuncture in the Western scientific world. The study findings suggest that using acupuncture alone could be as effective as other types of treatments for relieving depression symptoms typically used in Western medicine, such as psychotherapy and drugs.

In one study in Italy involving 50 patients, auricular acupuncture (acupuncture treatment to the ear) was found to be effective in reducing anxiety and depression levels. In another study at the Wayne County General Hospital in Michigan, USA, acupuncture treatment was given to 85 patients all suffering from psychological disorders (including depression). The treatment was shown to be beneficial in over 78% of the patients. (2) There is therefore little doubt that acupuncture is a prime therapy to consider in helping overcome depression.

Scientific evidence of Acupuncture effectiveness

• 1. Ear acupuncture in psychosomatic medicine: the importance of the Sanjiao (triple heater) area. Romoli M; Giommi A S.I.R.A.A.-Societa Italiana di Riflessoterapia, Agopuntura, Auricoloterapia, Prato, Italy. Acupunct Electrother Res (UNITED STATES) Jul-Dec 1993, 18 (3-4) p185-94
• 2. An introduction to sequential electric acupuncture (SEA) in the treatment of stress related physical and mental disorders. Chen A Department of Anesthesiology, Wayne County General Hospital, Westland, Michigan. Acupunct Electrother Res (ENGLAND) Oct-Dec 1992, 17 (4) p273-83
• 3. Zhou SH, Wu FD. Therapeutic effect of acupuncture on female's climacteric depression and its effects on DA, NE and 5-HIAA contents. Zhongguo Zhen Jiu. 2007 May;27(5):317-21. PubMed
• 4. Leo RJ, Ligot JS Jr. A systematic review of randomized controlled trials of acupuncture in the treatment of depression. J Affect Disord. 2007 Jan;97(1-3):13-22. Epub 2006 Aug 8. PubMed
• 5. MacPherson H, Thorpe L, Thomas K, Geddes D. Acupuncture for depression: first steps toward a clinical evaluation. J Altern Complement Med. 2004 Dec;10(6):1083-91. PubMed
• 6. Manber R, Schnyer RN, Allen JJ, Rush AJ, Blasey CM. Acupuncture: a promising treatment for depression during pregnancy. J Affect Disord. 2004 Nov 15;83(1):89-95. PubMed
• 7. Han C, Li X, Luo H, Zhao X, Li X. Clinical study on electro-acupuncture treatment for 30 cases of mental depression. J Tradit Chin Med. 2004 Sep;24(3):172-6. PubMed
• 8. Eich H, Agelink MW, Lehmann E, Lemmer W, Klieser E. Acupuncture in patients with minor depressive episodes and generalized anxiety. Results of an experimental study. Fortschr Neurol Psychiatr. 2000 Mar;68(3):137-44. PubMed
• 9. Poliakov SE. Acupuncture in the treatment of patients with endogenous depression. Zh Nevropatol Psikhiatr Im S S Korsakova. 1987;87(4):604-8. PubMEd

Cognitive Behavioral Therapy

Many people think that cognitive therapy is a relatively recent development in psychotherapy. However, Albert Ellis published, Reason and Emotion in Psychotherapy in 1962, and Aaron Beck wrote about The Self Concept in Depression with D. Stein in 1960.

Cognitive behavioral therapy (CBT), which is considered to be one of the most effective forms of psychotherapy for treatment of anxiety or depression, is also the most studied psychotherapy. It is the most effective psychological treatment for moderate and severe depression and is as effective as antidepressants for many types of depression. It has been found to be helpful in the following conditions: anxiety, depression, panic disorder, agoraphobia, social phobia, bulimia, obsessive compulsive disorder (OCD), post traumatic stress disorder (PTSD), schizophrenia.

CBT helps patients to change how they think (Cognitive) and what they do (Behaviour). Unlike some of the other talking treatments, it focuses on the "here and now" problems and difficulties. Instead of focussing on the causes of the distress or symptoms in the past, it attempts to focus on current symptoms and current thoughts and behaviors. The therapist helps the patient establish new patterns of thinking by directing attention to both the "wrong" and "right" assumptions they make about themselves and others.

CBT can be done individually or with a group of people. It can also be done from a self-help book or computer programme. A treatment course may last from 6 weeks to 6 months.

Effectiveness.
Numerous clinical studies throughout the world have consistently demonstrated that cognitive behavioral therapy is as effective as antidepressant medication in the treatment of major depression. Within 20 sessions of individual therapy, approximately 75% of patients experience a significant decrease in their symptoms. The combination of cognitive therapy with medication, in some studies, increases the efficacy to 85%. Moreover, most patients in cognitive therapy maintain their improved mood on follow-up two years later. This advantage of "maintaining gains" is due to the fact that in cognitive therapy the patient should not only reduce his symptoms, but he should learn to understand the distortions in thinking and behavior which are associated with the depression and learn self-help rather than dependence.

The National Institute of Mental Health compared the effectiveness of two forms of psychotherapy (interpersonal therapy and CBT) with imipramine (Tofranil) or placebo in the treatment of 250 patients with major depressive disorder. The study found no significant differences between the therapies. However, the two psychotherapies were slightly less effective than imipramine but more effective than placebo. A meta-analysis of four studies showed similar results for tricyclic antidepressants and CBT in the treatment of major depression.

Relapse.
In addition to effectively managing acute episodes of depression, cognitive therapy also can prevent relapse. One study showed that cognitive therapy significantly reduced the risk of relapse compared with discontinuation of medication. Cognitive therapy was similar to maintenance medication in preventing relapse [3]. A meta-analysis [4] that included eight studies showed that 29.5% of patients treated with cognitive therapy relapsed, compared with 60% of those treated with antidepressants. However, the studies were small, used tricyclic antidepressants, and did not specify the duration of therapy.

Combination therapy with antidepressants.
Cognitive therapy seems to add to the effect of pharmacotherapy in patients with residual depression. Large study randomized 158 patients who did not respond to adequate antidepressant therapy to receive cognitive therapy with clinical management or clinical management alone. All patients continued antidepressant therapy. Remission rates of major depression increased, and relapse rates significantly decreased in patients treated with cognitive therapy compared with those who were not (29% versus 47%) [5].

Scientific evidence of Cognitive behavioral therapy effectiveness for headaches

• 1. Elkin I, Shea MT, Watkins JT, Imber SD, Sotsky SM, Collins JF, et al. General effectiveness of treatments. Arch Gen Psychiatry 1989;46:971-82.
• 2. DeRubeis RJ, Gelfand LA, Tang TZ, Simons AD. Medications versus cognitive behavior therapy for severely depressed outpatients: meta-analysis of four randomized comparisons. Am J Psychiatry 1999;156:1007-13.
• 3. Evans MD, Hollon SD, DeRubeis RJ, Piasecki JM, Grove WM, Garvey MJ, et al. Differential relapse following cognitive therapy and pharmacotherapy for depression. Arch Gen Psychiatry 1992;49:802-8.
• 4. Gloaguen V, Cottraux J, Cucherat M, Blackburn IM. A meta-analysis of the effects of cognitive therapy in depressed patients. J Affect Disord 1998;49:59-72.
• 5. Paykel ES, Scott J, Teasdale JD, Johnson AL, Garland A, Moore R, et al. Prevention of relapse in residual depression by cognitive therapy: a controlled trial. Arch Gen Psychiatry 1999;56:829-35.\Kunik ME, Veazey C, Cully JA, Souchek J, Graham DP, Hopko D, 6. Carter R, Sharafkhaneh A, Goepfert EJ, Wray N, Stanley MA. COPD education and cognitive behavioral therapy group treatment for clinically significant symptoms of depression and anxiety in COPD patients: a randomized controlled trial. Psychol Med. 2007 Oct 9;:1-12. PubMed
• 7. Fenton L, Fasula M, Ostroff R, Sanacora G. Can cognitive behavioral therapy reduce relapse rates of depression after ECT? a preliminary study. J ECT. 2006 Sep;22(3):196-8. PubMed
• 8. Hautzinger M, Welz S. Cognitive behavioral therapy for depressed older outpatients--a controlled, randomized trial. Z Gerontol Geriatr. 2004 Dec;37(6):427-35. PubMed
• 9. March J, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, Burns B, Domino M, McNulty S, Vitiello B, Severe J; Treatment for Adolescents With Depression Study (TADS) Team. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. JAMA. 2004 Aug 18;292(7):807-20. PubMed
• 10. Rohan KJ, Lindsey KT, Roecklein KA, Lacy TJ. Cognitive-behavioral therapy, light therapy, and their combination in treating seasonal affective disorder. J Affect Disord. 2004 Jun;80(2-3):273-83. PubMed
• 11. Roy-Byrne PP, Craske MG, Stein MB, Sullivan G, Bystritsky A, Katon W, Golinelli D, Sherbourne CD. A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder. Arch Gen Psychiatry. 2005 Mar;62(3):290-8. PubMed
• 12. Laberge B, Gauthier JG, Co^te' G, Plamondon J, Cormier HJ. Cognitive-behavioral therapy of panic disorder with secondary major depression: a preliminary investigation. J Consult Clin Psychol. 1993 Dec;61(6):1028-37. PubMed

Psychodynamic Therapy

Psychodynamic therapy, based on the theories of psychoanalysis, is a generic term that embraces all those therapies of an analytic nature. It's one of the most common types of psychotherapy. Patient and therapist explore the roots of patient's depression. Psychodynamic therapy is based on the assumption that a person experiences depression as a result of unresolved, generally unconscious conflicts, often stemming from childhood. The goal of this type of therapy is for the patient to understand and cope better with these feelings by re-experiencing them through talking about them. Psychodynamic therapy is administered over a period of three to four months, although it can last longer, even years.

Psychodynamic psychotherapy includes a variety of therapeutic techniques, such as exploring person's past, confronting beliefs and actions, offering support, and interpreting one's thoughts and behavior. That process allows the patient to become aware of and acknowledge the link between a feeling, thought, symptom or behavior and an unconscious meaning or motivator. With that new understanding, patient can modify unwanted behavior or thoughts.

Psychodynamic therapy helps resolve depression caused by: loss (grief), relationship conflicts, role transitions. This therapy tends to work best with those who are curious to learn more about themselves and develop insight into the unconscious factors that contribute to their problems.

Scientific evidence of Psychodynamic therapy effectiveness for headaches

• 1. Reck C, Mundt C. Psychodynamic therapy approaches in depressive disorders. Pathogenesis models and empirical principles. Nervenarzt. 2002 Jul;73(7):613-9. PubMed
• 2. Burnand Y, Andreoli A, Kolatte E, Venturini A, Rosset N. Psychodynamic psychotherapy and clomipramine in the treatment of major depression. Psychiatr Serv. 2002 May;53(5):585-90. PubMed
• 3. Simpson S, Corney R, Fitzgerald P, Beecham J. A randomized controlled trial to evaluate the effectiveness and cost-effectiveness of psychodynamic counselling for general practice patients with chronic depression. Psychol Med. 2003 Feb;33(2):229-39. PubMed
• 4. Abbass AA, Hancock JT, Henderson J, Kisely S. Short-term psychodynamic psychotherapies for common mental disorders. PubMed

Group psychotherapy

Group therapy has many of the same goals as individual therapy but involves meeting with a therapist and a group of other people with depression. Group therapy is a way to get feedback, suggestions and support from people facing similar issues. It can help people improve the way they interact with others and understand more about how other people perceive them. The interaction with other members in the group, as well as with the therapist, is beneficial to some depression sufferers and contributes to the therapeutic effect of this type of therapy.

Scientific evidence of Group psychotherapy effectiveness for headaches

• 1. McRoberts C, Burlingame GM, Hoag MJ. Comparative efficacy of individual and group psychotherapy: a meta-analytic perspective. Group Dynamics 1998;2:101–17.
• 2. Morris JB. Group psychotherapy for prolonged postnatal depression. Br J Med Psychol. 1987 Sep;60 ( Pt 3):279-81. PubMed
• 3. Christensen AM. Group psychotherapy. A prospective study of its effect. Ugeskr Laeger. 1991 Mar 25;153(13):929-32. PubMed
• 4. Bachar E, Kindler S, Schefler G, Lerer B. Reminiscing as a technique in the group psychotherapy of depression: a comparative study. Br J Clin Psychol. 1991 Nov;30 ( Pt 4):375-7. PubMed

Neurofeedback (EEG Biofeedback)

Biofeedback training (also known as neurotherapy) is a systematized approach for learning relaxation. Biofeedback is a type of complementary and alternative medicine called mind-body therapy. This therapy uses the mind to control the body. Using feedback from a variety of monitoring procedures and equipment, a biofeedback specialist will try to teach patient to control certain involuntary body responses, such as: brain activity, blood pressure, muscle tension, heart rate. Once patient learns to recognize and control these responses, he can use biofeedback to help treat a wide range of mental and physical health problems.

Biofeedback reduces the symptoms of depression by making changes in the brainwave (EEG). Drugs are not used in this treatment. The brainwave patterns are changed through training. The training can be performed by a professional neurotherapist.

Scientific evidence of Biofeedback effectiveness

• 1. Karavidas MK, Lehrer PM, Vaschillo E, Vaschillo B, Marin H, Buyske S, Malinovsky I, Radvanski D, Hassett A. Preliminary results of an open label study of heart rate variability biofeedback for the treatment of major depression. Appl Psychophysiol Biofeedback. 2007 Mar;32(1):19-30. Epub 2007 Mar 1. PubMed
• 2. Hickling EJ, Sison GF Jr, Vanderploeg RD. Treatment of posttraumatic stress disorder with relaxation and biofeedback training. Biofeedback Self Regul. 1986 Jun;11(2):125-34. PubMed

Light Therapy

A lack of exposure to sunlight is responsible for the secretion of the hormone melatonin, which could trigger a dispirited mood and a lethargic condition. Melatonin is only produced in the dark. It lowers your body temperature and makes you feel sluggish. If you spend too much time cooped up in your room then you could be setting yourself up for depression. This is the reason why many people are suffering from depression much more often in winter than in the other seasons.

For years, light therapy has been used to treat seasonal affective disorder, a type of depression that afflicts about one in 10 people who live in places with short winter days and extended darkness. In the early eighties, researchers discovered that specialized bright light (20 times brighter than normal indoor light), was the most effective treatment for winter depression. Now, growing evidence indicates that being bathed at least 30 minutes a day in bright artificial light may be as effective as an anti-depressant at any time of the year.

Dozens of clinical, placebo controlled studies have been done using light therapy to treat depression. These studies confirm that light is not only as effective as other methods, but it causes no long-term side effects. Additionally, people responded within a week to light instead of several weeks with medications, and different medication trials were needed before an effective regimen was found.

Scientific evidence of Light Therapy effectiveness

• 1. Desan PH, Weinstein AJ, Michalak EE, Tam EM, Meesters Y, Ruiter MJ, Horn E, Telner J, Iskandar H, Boivin DB, Lam RW. A controlled trial of the Litebook light-emitting diode (LED) light therapy device for treatment of Seasonal Affective Disorder (SAD). BMC Psychiatry. 2007 Aug 7;7:38. PubMed
• 2. Krzystanek M, Krupka-Matuszczyk I. Bright light therapy in pregnant women depression--3 case studies. Psychiatr Pol. 2006 Mar-Apr;40(2):261-7. PubMed
• 3. Volz HP, Mackert A, Stieglitz RD, Mu"ller-Oerlinghausen B. Effect of bright white light therapy on non-seasonal depressive disorder. Preliminary results. J Affect Disord. 1990 May;19(1):15-21. PubMed
• 4. Lam RW, Levitt AJ, Levitan RD, Enns MW, Morehouse R, Michalak EE, Tam EM. The Can-SAD study: a randomized controlled trial of the effectiveness of light therapy and fluoxetine in patients with winter seasonal affective disorder. Am J Psychiatry. 2006 May;163(5):805-12. PubMed
• 5. Benedetti F, Barbini B, Fulgosi MC, Colombo C, Dallaspezia S, Pontiggia A, Smeraldi E. Combined total sleep deprivation and light therapy in the treatment of drug-resistant bipolar depression: acute response and long-term remission rates. J Clin Psychiatry. 2005 Dec;66(12):1535-40. PubMed
• 6. McEnany GW, Lee KA. Effects of light therapy on sleep, mood, and temperature in women with nonseasonal major depression. Issues Ment Health Nurs. 2005 Aug-Sep;26(7):781-94. PubMed
• 7. Epperson CN, Terman M, Terman JS, Hanusa BH, Oren DA, Peindl KS, Wisner KL. Randomized clinical trial of bright light therapy for antepartum depression: preliminary findings. J Clin Psychiatry. 2004 Mar;65(3):421-5. PubMed
• 8. Levitt AJ, Lam RW, Levitan R. A comparison of open treatment of seasonal major and minor depression with light therapy. J Affect Disord. 2002 Sep;71(1-3):243-8. PubMed
• 9. Prasko J, Horacek J, Klaschka J, Kosova J, Ondrackova I, Sipek J. Bright light therapy and/or imipramine for inpatients with recurrent non-seasonal depression. Neuro Endocrinol Lett. 2002 Apr;23(2):109-13. PubMed

Exercise

Apart from its physical benefits, exercise has been shown to have very positive effects upon mental well-being. Some evidence suggests that exercise positively affects the levels of certain mood-enhancing neurotransmitters in the brain. Exercise may also boost feel-good endorphins, release tension in muscles, help you sleep better and reduce levels of the stress hormone cortisol. It also increases body temperature, which may have calming effects. All of these changes in your mind and body can improve such symptoms as sadness, anxiety, irritability, stress, fatigue, anger, self-doubt and hopelessness.

Research suggests that it may take at least 30 minutes of exercise a day for at least three to five days a week to significantly improve symptoms of depression. However, smaller amounts of activity (as little as 10 to 15 minutes at a time) have been shown to improve mood in the short term.

In a recent study (September 2000), researchers have found that exercise works at least as well as antidepressant Zoloft (sertraline) in treating clinical depression and keeping the condition from returning. In this study, 156 patients diagnosed with major depressive disorder were assigned to three groups: exercise, medication, or a combination of medication and exercise. After 16 weeks all three groups showed similar significant improvement in measurements of depression. 60.4% of the patients who only exercised were no longer considered depressed after 16 weeks, compared with 65.5% for the medication group and 68.8% of the combination group. The researchers did note that patients who took the antidepressants saw their symptoms relieved sooner, but by 16 weeks the group differences had disappeared.

Scientific evidence of Physical exercise effectiveness

• 1. Newman CL, Motta RW. The effects of aerobic exercise on childhood PTSD, anxiety, and depression. Int J Emerg Ment Health. 2007 Spring;9(2):133-58. PubMed
• 2. Manger TA, Motta RW. The impact of an exercise program on posttraumatic stress disorder, anxiety, and depression. Int J Emerg Ment Health. 2005 Winter;7(1):49-57. PubMed
• 3. Lindwall M, Rennemark M, Halling A, Berglund J, Hassme'n P. Depression and exercise in elderly men and women: findings from the Swedish national study on aging and care. J Aging Phys Act. 2007 Jan;15(1):41-55. PubMed
• 4. Brenes GA, Williamson JD, Messier SP, Rejeski WJ, Pahor M, Ip E, Penninx BW. Treatment of minor depression in older adults: a pilot study comparing sertraline and exercise. Aging Ment Health. 2007 Jan;11(1):61-8. PubMed
• 5. Daley AJ, Macarthur C, Winter H. The role of exercise in treating postpartum depression: a review of the literature. J Midwifery Womens Health. 2007 Jan-Feb;52(1):56-62. PubMed
• 6. Sjosten N, Kivela SL. The effects of physical exercise on depressive symptoms among the aged: a systematic review. Int J Geriatr Psychiatry. 2006 May;21(5):410-8. PubMed
• 7. De Moor MH, Beem AL, Stubbe JH, Boomsma DI, De Geus EJ. Regular exercise, anxiety, depression and personality: a population-based study. Prev Med. 2006 Apr;42(4):273-9. Epub 2006 Jan 24. PubMed
• 8. Bartholomew JB, Morrison D, Ciccolo JT. Effects of acute exercise on mood and well-being in patients with major depressive disorder. Med Sci Sports Exerc. 2005 Dec;37(12):2032-7. PubMed
• 9. Lane AM, Lovejoy DJ. The effects of exercise on mood changes: the moderating effect of depressed mood. J Sports Med Phys Fitness. 2001 Dec;41(4):539-45. PubMed
• 10. Blumenthal JA, Babyak MA, Doraiswamy PM, Watkins L, Hoffman BM, Barbour KA, Herman S, Craighead WE, Brosse AL, Waugh R, Hinderliter A, Sherwood A. Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosom Med. 2007 Sep-Oct;69(7):587-96. Epub 2007 Sep 10. PubMed
• 11. Babyak M, Blumenthal JA, Herman S, Khatri P, Doraiswamy M, Moore K, Craighead WE, Baldewicz TT, Krishnan KR. Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom Med. 2000 Sep-Oct;62(5):633-8. PubMed
• 12. Blumenthal JA, Babyak MA, Moore KA, Craighead WE, Herman S, Khatri P, Waugh R, Napolitano MA, Forman LM, Appelbaum M, Doraiswamy PM, Krishnan KR. Effects of exercise training on older patients with major depression. Arch Intern Med. 1999 Oct 25;159(19):2349-56. PubMed

Hypnosis (hypnotherapy)

Hypnosis can be quite effective with milder types of depression and anxiety. Hypnosis produces an altered state of consciousness (ASC) in which certain senses are heightened and others seem to fade into the background. While in a hypnotic trance, you become more aware of words and suggested images, and they grow more intense. Bodily sensations and time are often distorted.

Scientific evidence of Hypnosis (hypnotherapy) effectiveness

• 1. Yapko M. Hypnosis in treating symptoms and risk factors of major depression. Am J Clin Hypn. 2001 Oct;44(2):97-108. PubMed
• 2. Alladin A, Alibhai A. Cognitive hypnotherapy for depression: an empirical investigation. Int J Clin Exp Hypn. 2007 Apr;55(2):147-66. PubMed
• 3. Gould RC, Krynicki VE. Comparative effectiveness of hypnotherapy on different psychological symptoms. Am J Clin Hypn. 1989 Oct;32(2):110-7. PubMed

Alexander Technique

The Alexander technique is not a therapy as such, but a process of re-education which aims to teach the person to identify and exercise control over physical habits of excess tension, internal stress, posture, breathing and movement. This is combined with teaching changes in the thinking patterns that interfere with natural ease and flow in everyday activity.

It is now generally accepted that there is a connection between anxiety states and muscle tension. In particular, chronically contracted muscles are associated with mental and emotional imbalances. The Alexander Technique enables a redistribution of muscle tension throughout the body, that can lead to an improvement in mental functioning. It may also teach a person how to react to life's challenges and stresses in a positive way, avoiding overreactions and distress.

Scientific evidence of Alexander technique effectiveness

• No clinical studies on humans have been conducted to prove or disprove Alexander technique effectiveness for depression

Yoga & Meditation

Meditation and yoga are very gentle and powerful techniques to aid rest and relaxation whilst energising the body.

Yoga is an ancient Indian exercise philosophy that provides a gentle form of exercise and stress management. It consists of postures or "asanas" that are held for a short period of time and are often synchronised with the breathing. It is very helpful for reducing stress and anxiety which are often precursors to depression. A number of studies have shown that yoga breathing exercises are beneficial for depression.

Meditation is a form of relaxation that, unlike sleep, is entered into purposely. Meditation is usually practiced regularly, for at least 10 minutes each day. While the body is at rest, the mind is cleared by focusing on one thought, sometimes a word, phrase, or particular scenery.

Meditation is useful in relieving mild episodes of depression. Meditation has a very calming affect. It helps to ease tension, and improves your capacity to concentrate. As you meditate, you also become much more attuned to your inner feelings and sensations, achieving a heightened state of awareness. Rather than dwelling on the negative emotions that are making you feel depressed, you can transcend them through meditation. This kind of personal growth, in which you gain a higher level of consciousness and greater awareness of yourself, can help to bolster your self-confidence, esteem, and peace of mind. Your mind is free to travel beyond the busy chatter of thoughts to a silent, tranquil place. In turn, a positive emotional outlook and sense of well-being can help you maintain good physical and mental health.

Scientific evidence of Meditation effectiveness

• 1. Sharma VK, Das S, Mondal S, Goswami U, Gandhi A. Effect of Sahaj Yoga on neuro-cognitive functions in patients suffering from major depression. Indian J Physiol Pharmacol. 2006 Oct-Dec;50(4):375-83. PubMed
• 2. Vedamurthachar A, Janakiramaiah N, Hegde JM, Shetty TK, Subbakrishna DK, Sureshbabu SV, Gangadhar BN. Antidepressant efficacy and hormonal effects of Sudarshana Kriya Yoga (SKY) in alcohol dependent individuals. J Affect Disord. 2006 Aug;94(1-3):249-53. Epub 2006 Jun 5. PubMed
• 3. Sharma VK, Das S, Mondal S, Goswampi U, Gandhi A. Effect of Sahaj Yoga on depressive disorders. Indian J Physiol Pharmacol. 2005 Oct-Dec;49(4):462-8. PubMed
• 4. Pilkington K, Kirkwood G, Rampes H, Richardson J. Yoga for depression: the research evidence. J Affect Disord. 2005 Dec;89(1-3):13-24. Epub 2005 Sep 26. PubMed
• 5. Woolery A, Myers H, Sternlieb B, Zeltzer L. A yoga intervention for young adults with elevated symptoms of depression. Altern Ther Health Med. 2004 Mar-Apr;10(2):60-3. PubMed
• 6. Janakiramaiah N, Gangadhar BN, Naga Venkatesha Murthy PJ, Harish MG, Subbakrishna DK, Vedamurthachar A. Antidepressant efficacy of Sudarshan Kriya Yoga (SKY) in melancholia: a randomized comparison with electroconvulsive therapy (ECT) and imipramine. J Affect Disord. 2000 Jan-Mar;57(1-3):255-9. PubMed

Massage Therapy

Massage is one of the oldest techniques of treatment, first recorded in China during the second century B.C. Massage produces chemical changes in the brain that result in a feeling of relaxation, calm and well-being. It also reduces levels of stress hormones - such as adrenalin, cortisol and norepinephrine - which in some people can trigger depression.

While there are variations of massage, they all work under the general principle of the connection between body and mind - that when the body is relaxed and at ease, the mind is promoting better health, less depression and overall well-being. Some examples of massage include shiatsu, neuromuscular therapy, spinal release therapy, Swedish, and the sports variation.

In a group of studies which included about 500 men, women, and children with depression or stress problems, researchers measured the stress hormone cortisol in participants before and immediately after massage. Massage therapy lowered levels by up to 53%. Massage also increased serotonin and dopamine, neurotransmitters that help reduce depression.

Research by Tiffany Fields, at the Touch Research Institute at the University of Miami School of Medicine in the USA looked into the therapeutic value of massage in reducing anxiety and depression. The subjects massaged were found to have lower levels of cortisol stress hormone in their saliva and depressed people also had lower levels of urinary cortisol and noradrenaline which increase in times of stress.

Scientific evidence of Massage Therapy effectiveness

• 1. Field T, Grizzle N, Scafidi F, Schanberg S. Massage and relaxation therapies' effects on depressed adolescent mothers. Adolescence. 1996 Winter;31(124):903-11. PubMed
• 2. Field T, Diego MA, Hernandez-Reif M, Schanberg S, Kuhn C. Massage therapy effects on depressed pregnant women. J Psychosom Obstet Gynaecol. 2004 Jun;25(2):115-22. PubMed
• 3. Muller-Oerlinghausen B, Berg C, Scherer P, Mackert A, Moestl HP, Wolf J. Effects of slow-stroke massage as complementary treatment of depressed hospitalized patients. Dtsch Med Wochenschr. 2004 Jun 11;129(24):1363-8. PubMed
• 4. Field T, Grizzle N, Scafidi F, Schanberg S. Massage and relaxation therapies' effects on depressed adolescent mothers. Adolescence. 1996 Winter;31(124):903-11. PubMed
• 5. Field T, Morrow C, Valdeon C, Larson S, Kuhn C, Schanberg S. Massage reduces anxiety in child and adolescent psychiatric patients. J Am Acad Child Adolesc Psychiatry. 1992 Jan;31(1):125-31. PubMed

Reflexology

This is a technique in which a therapist applies pressure to specific points on the hands and feet. Reflexologists believe that the body has the capacity to heal itself. There are nerves in the hands and feet related to various parts of the body, and by manipulating these points through reflexology, it is thought that the healing process is stimulated. Massaging these points, either stroking them or applying pressure, releases tension and blockages that prevent the flow of energy and stimulates the circulation of blood. Reflexology also helps crush small "crystals," or deposits of lactic acid, that settle in your feet. Once they are broken up, they can be reabsorbed into the body and the waste can be eliminated by the lymph system.

Recent studies have shown that reflexology can be helpful in alleviating symptoms of depression.

Scientific evidence of Reflexology effectiveness

• 1. Song RH, Kim DH. The effects of foot reflexion massage on sleep disturbance, depression disorder, and the physiological index of the elderly. Taehan Kanho Hakhoe Chi. 2006 Feb;36(1):15-24. PubMed
• 2. Lee YM. Effect of self-foot reflexology massage on depression, stress responses and immune functions of middle aged women. Taehan Kanho Hakhoe Chi. 2006 Feb;36(1):179-88. PubMed

Aromatherapy

Aromatherapy is an ancient practice that began when people of early civilizations began discovering the healing properties of plants.

The essential oils have a complex action on the body which is still not fully understood. This may be due to the fact that one oil can have hundreds of different compounds. Interestingly, your sense of smell is over 10,000 more sensitive than your sense of taste and researchers have shown how aromas cause a brain reaction, activating the hypothalamus gland, the pituitary gland and the body's hormones as well as stimulating the limbic system (centre for emotion and memory) in the brain.

Aromatherapy can help in mild forms of depression. It may ease mental fatigue and help with sleep. However, in severe depression, additional support and therapy are necessary. Aromatherapy is more effective when used as a complementary therapy, assisting other therapies.

The following essential oils are beneficial in the treatment of depression as they have properties helping to balance and relax the nervous system:

• Chamomile - relaxant and calmative
• Clary Sage - antispasmodic
• Cypress - anti-spasmodic
• Lavender - relaxant and calmative
• Marjoram - emotional balancer
• Rose - anti depressant
• Rosewood - calmative
• Ylang Ylang - sedative and antidepressant

Scientific evidence of Aromatherapy effectiveness

• 1. Soden K, Vincent K, Craske S, Lucas C, Ashley S. A randomized controlled trial of aromatherapy massage in a hospice setting. Palliat Med. 2004 Mar;18(2):87-92. PubMed
• 2. Perry N, Perry E. Aromatherapy in the management of psychiatric disorders: clinical and neuropharmacological perspectives. CNS Drugs. 2006;20(4):257-80. PubMed
• 3. Lee IS, Lee GJ. Effects of lavender aromatherapy on insomnia and depression in women college students. Taehan Kanho Hakhoe Chi. 2006 Feb;36(1):136-43. PubMed
• 4. Kim MJ, Nam ES, Paik SI. The effects of aromatherapy on pain, depression, and life satisfaction of arthritis patients. Taehan Kanho Hakhoe Chi. 2005 Feb;35(1):186-94. PubMed
• 5. Edge J. A pilot study addressing the effect of aromatherapy massage on mood, anxiety and relaxation in adult mental health. Complement Ther Nurs Midwifery. 2003 May;9(2):90-7. PubMed