Conscious Choice Seattle: Natural High

“I’m feeling happier and more positive,” says Breanna Reinna
about art therapy sessions for her depression symptoms. “The art
helps me understand the feelings
that I’m feeling.”
Photo by Richard A. Huston

January 2005

Natural High

Depression affects millions of us — and makes billions of dollars for pharmaceutical companies. Here’s how local patients and practitioners are taking a holistic and decidedly anti-drug approach to the illness

by Joe Follansbee

The diagnosis of her mother’s terminal illness last spring led Cathy Hendrickson of Seattle into what she calls “dark spaces.” Her stress level spiked, she lost her sense of control, her mood oscillated like a metronome. The former singer felt out of tune with the world, and she tumbled into depression.

“I thought, ‘This can’t continue; I’ve got to do something,’ “ she says.

She had experienced depression before; it’s part of her family medical history. The illness has taken her to the brink of suicide. But she rejected prescription antidepressants for her latest bout.

“They brought me up, but I didn’t feel authentic,” says Hendrickson.

She tried homeopathy, chair massage and talk therapy. Then she remembered an experience in 1991 while living in San Francisco. Allergies had taken over her life; she used an inhaler twice a day. She sought out an acupuncturist, and after a series of treatments, she got off her medications.

“I loved acupuncture before,” she thought. “Let’s try it again.”

Last August, a friend referred Hendrickson to Nancy Ishii, a Seattle acupuncturist who continues to work with Hendrickson on her depression. Ishii customizes her treatment to Hendrickson’s particular needs, unlike pharmaceuticals, which tend toward “one size fits all.”

“I get to be tuned to my own note,” Hendrickson says.

Depression is the most common mental illness in the United States. Nearly 10 percent of the population, or 18.8 million adults, suffers some form of the illness, according to the National Institutes of Mental Health. Women experience depression twice as often as men do, although men are less likely to admit feeling down. Medical professionals have only recently recognized depression in children, who may pretend to be sick, refuse to go to school, cling to a parent or worry that a parent may die.

The pervasiveness of depression has encouraged pharmaceutical companies to develop and market ever more powerful drugs. Prozac, Paxil, Celexa, Zoloft, Lexapro and others work by directly modifying brain chemistry. The drugs help millions of people, but patients risk serious side effects.

For example, researchers found that teenagers taking Prozac have a 50 percent higher risk of suicidal thoughts and suicide attempts. And some medical professionals question the widespread use of the drugs. In 2002, Dr. Giovanni Fava, a professor of clinical psychology at the University of Bologna in Italy and State University of New York at Buffalo and editor of the journal Psychotherapy and Psychosomatics, argued the popularity of the drugs has more to do with industry marketing than effectiveness.

Other medical professionals argue drug therapies make more sense than alternative treatments. Dr. David Dunner is director of the Center for Anxiety and Depression at the University of Washington Medical Center, and he teaches in the UW medical school’s psychiatry department. He believes antidepressants and other pharmaceuticals may be under-prescribed, because depression may go undiagnosed or misdiagnosed in as many as half of people who suffer it. He says controlled studies show the drugs work, unlike alternative treatments for depression, which he says don’t stand up to scientific scrutiny.

“I don’t recommend treatments when I don’t have data about their efficacy,” Dunner says.

But doubts about the safety and effectiveness of pharmaceuticals and resentment over aggressive marketing practices have fueled a growing interest in complementary or alternative therapies for depression. There is heightened concern that the government has streamlined its regulatory process for monitoring unsafe drugs and turned over such work to labs that somehow link back to the pharmaceutical industry itself.

That’s one reason it is possible to list up to 30 alternative-treatment approaches for depression, ranging from reading self-help books to wholesale lifestyle changes. Alternative approaches work best on acute, mild episodes of depression.

Serious problems, such as talk of suicide, withdrawal from friends and family and self-destructive behavior, should be treated by a medical doctor or a licensed psychologist. Here are some of the more common integrative medicine approaches for depression:

Herbal Therapies

People looking for alternatives to drug therapy pay close attention to herbal substitutes. Dr. Alicia Gonzalez, a faculty member at Bastyr University in Kenmore, witnessed the short-term benefits of pharmaceuticals when she worked at an acute-care psychiatric hospital in Pennsylvania.

“But I’d hear over and over again [from patients] that ‘I’d rather be crazy than live with the long-term effects of those medications,’ “ she says. “It’s been my life’s passion to show how naturopathic treatments can be applied to psychiatric disorders.”

One of those treatments is St. John’s wort, which came under scrutiny when a recent National Institute of Mental Health study questioned its effectiveness for severe depression, while leaving open the issue of its use for mild cases. An FDA advisory also cautioned against the use of St. John’s wort when patients take standard antidepressants because of negative drug interactions. Gonzalez says naturopaths have traditionally prescribed St. John’s wort for mild to moderate cases only. Patients, medical doctors and alternative therapists should keep each other fully informed about medications to avoid the danger of mixing incompatible treatments, she says.

Patients in her private practice at Tashi Delek Health and Wellness clinic in Seattle are asking Gonzales about “5-HTP,” a chemical precursor to serotonin, a brain chemical linked to mood. 5-HTP is available in supplement form (one website touts the supplement as “nature’s answer to Prozac”), but Gonzales urges caution.

“I just want to make sure that people aren’t relying on a pill to make them feel better,” she says.

Nutrition and Lifestyle Changes

Gonzales says credible alternative medicine practitioners recommend herbal treatments only after evaluating the patient’s entire medical history and status. Are your relationships healthy? Are you getting enough sleep? What about your eating habits?

“I get so many people who come in and tell me that they have a cup of coffee in the morning, skip lunch, and have dinner out of a box, like macaroni and cheese,” she says, “and I tell them, ‘Well, no wonder you’re depressed!’ “

Exercise, stress reduction and a better diet can lift your mood. Exercise, in particular, is a remedy with solid research behind it from powerhouse medical schools such as Duke University. Seeking out relaxation techniques (deep breathing) can change your life consistently for the better, while depression-lifting diets include foods rich in omega-3 fats, such as salmon and other cold-weather fish, nuts and olive oil.

One caution: Some foods can directly affect a depressive state, Gonzalez says. Fermented foods such as wine or beer, meats such as pork or salmon, and even spinach and bananas can exacerbate the mood of a person already prone to feeling low. She adds that your grandmother’s old standby, cod liver oil, may improve your overall neurological health.

Counseling

Sometimes just talking to a friend over a cup of coffee can lift you out of the doldrums (maybe it’s the coffee). But research has shown that talk therapy, such as counseling with a licensed therapist, can steer a person out of a longer-term, persistent, mild depression. Many counselors encourage their clients to find appropriate ways to express feelings they have trouble articulating. One method is art therapy.

Vanessa Stewart of Tulalip picked art therapy when she felt a frustrating “stuckness” in life, spinning her wheels, so to speak, although she prefers not to call it depression. With her therapist, Sue Ellen Longwell of Everett, Stewart tried “veil painting,” a slow, quiet process of applying watercolors in layers on paper. In some sessions, Stewart chose red when she was in an angry mood, blues and greens on calmer days, and she picked bright yellows over several sessions.

“It’s so revealing,” she says. “The art helped me move forward in life.” Stewart says the sessions helped her choose a career path practicing feng shui.

Sixteen-year-old Breanna Reina of Snohomish, another one of Longwell’s clients, has experienced depression since childhood.

“All the time, even when I was really little, I would be really sad and angry at the same time,” she says.

A medical doctor diagnosed bipolar disorder and prescribed drugs, but the side effects overwhelmed improvements in her mood. She’s visited several mainstream doctors and therapists in recent years, but she felt as if they treated her like a small child rather than a young adult. Her only alternative was complementary therapies, and she thought art therapy might work because she likes to paint. She made an appointment with Longwell.

Reina saw a plaster mask at Longwell’s office and asked to try mask making, even though she’d never sculpted a mask before. The warm, secure atmosphere of Longwell’s environment contrasted sharply with the cool, clinical air of Reina’s doctors’ offices. Reina says Longwell talked with her as if she were a person rather than a case, and the artwork gave her insight into her depression.

“I’m feeling happier and more positive,” she says. “The art helps me understand the feelings that I’m feeling.”

Longwell herself first experienced art therapy in 1988 after a serious head injury interrupted a painting career. Now a registered counselor and practicing artist, she has practiced art therapy since 1992. Longwell says the art is a nonverbal, visual reflection of an inner state.

“So by putting it on paper and looking at it, you may not understand it, but it gives you food for thought,” she says. “It’s not an intellectual, left-brain process. It’s an intuitive, right-brain activity.”

Massage and Aromatherapy

Massage therapists have long recognized the value of touch in raising the spirit.

“We know that touching with a compassionate quality has the ability to activate all kinds of positive energy,” says Dawn Schmidt, a licensed massage therapist who teaches at Brenneke School of Massage in Seattle. “As massage therapists, we’re there to touch the places in the body that hold the emotions.”

Massage is used most often to treat physical injuries; relieving the pain may also relieve the anger, frustration and sometimes depression that accompany a damaged joint or muscle. But massage can also relieve psychological pain.

Schmidt recalled a recent three-way session with a counselor, the counselor’s client and herself. As the counselor talked with the client, Schmidt applied massage, increasing or decreasing pressure as needed. The activity let some of the client’s memories and emotions surface, where they could be examined.

Similarly, Schmidt has known some clients who come to her after years of therapy. Though they are seemingly healthy, a massage brings forth all the trauma again. “They go through a ‘wave’ experience, and it’s all gone,” she says.

Many massage therapists combine treatment methods. Seattle-based Ingrid Martin practices massage with aromatherapy, which uses essential plant oils to stimulate the brain via the sense of smell. She says fragrance has a strong impact on the limbic system, the part of the brain that controls appetite, emotions and the instinct for survival.

In her work, Martin pays close attention to emotions that accompany a client’s depression. For example, she may use lavender in cases of depression combined with anxiety. The scent of ginger, a stimulant, could help a depressed client also suffering from low energy.

The main problem for aromatherapy, Martin says, is credibility. There are no licensing standards for aromatherapists; some people give themselves the title after a weekend workshop, while others train for years.

“It’s basically seen as a relaxation technique,” she says. “But it has a lot more applications than that.”

Acupuncture

Acupuncture is one of the most accepted alternative treatment methods for physical pain, though its use in mental health is less well known. The Chinese-medicine concept of “chi,” a type of psychic energy, doesn’t have an anatomical analog. Same goes for the acupuncturist’s notion of meridians, or lines of energy flow in the body, likes the lines of force around a magnet. But the mindful insertion of needles into the skin works for Cathy Hendrickson. Her acupuncturist, Nancy Ishii, says depression is often expressed as feelings of loneliness, isolation, or helplessness. These can indicate a course of action.

“We’re trying to figure out which of your systems and meridians are imbalanced,” she says.

Hendrickson says whatever alternative treatment method you choose, it’s important to choose something, lest the depression feed on itself and bring you down further and further. Keep trying until something works. “If somebody is in a real depressed state,” she says, “start with something that will help break that cycle.”

Joe Follansbee is a contributing writer for Evergreen Monthly. He wrote the November 2004 EM cover story on sustainable and safe seafood.

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