Dr. Robert F. Kidd    

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See also: Applied Psychoneurobiology

Depression is a state of mind that almost everyone has experienced at some point in life. Most people recognize it as a feeling of sadness, of emptiness, or lack of enjoyment of life. It may also be associated with other emotions such as irritability, anxiety or apathy. Or it may manifest with "physical" symptoms such as fatigue, insomnia or pain.

Much confusion revolves around the word however, even amongst physicians. One of the reasons is that the term depression is both a symptom (or a collection of symptoms), and also a diagnosis. When it is a symptom, it might be a normal reaction to misfortune, or it might be an indication that something is medically wrong. When it is a diagnosis however, the implication is that it is a disease, and it should be treated in a direct way (usually with medication).

Another reason for confusion is that it is hard to draw a line between depression as a normal life experience and depression as a medical condition. Physicians sometimes yield to social and economic pressures, prescribing medication for depression when it is in fact a normal response to some sort of loss - or a by-product of boredom, in a life lacking a sense of meaning (an existential or spiritual depression). If the patient is already somewhat depressed for medical reasons, the decision on whether to treat becomes doubly difficult.

Dr. Kidd's approach is to always consider depression a symptom. A cause, or a combination of causes, is to be sought at all times. Only if no cause can be found, or if the need is urgent, should depression be treated medically. And even then, it should be recognized that the inability to find a cause simply indicates a limitation of medical knowledge and skill.

What then are the causes of depression? Certainly there seems to be an innate tendency in some people, often running in families. However a genetic tendency does not mean that those affected should always be depressed. Causes should still be searched for.

In recent years, researchers have learned much about the biochemistry of depression.

A brain hormone, serotonin, has been discovered to be a key factor in maintaining mood and drugs have been designed to optimize serotonin levels. Less attention has been directed at why the serotonin levels are low in the first place. Tracing backward through the biochemical pathways shows many possibilities exist.

One example is the role of cholesterol. Cholesterol has been receiving bad press because of its relationship with coronary disease in some people. Less known is the fact that cholesterol is an essential part of body chemistry. Serotonin, in fact, is made from cholesterol, and if cholesterol levels are low, depression is a distinct possibility. People on low fat diets are at risk of developing depression.

Nutrition is important in other ways. Deficiencies of certain vitamins can result in depression, viatmin B12 and folic acid for example. In fact anything that slows the body's metabolism, - a "slow thyroid", mineral deficiencies, or chronic low grade poisoning from environmental toxins can create depression.

Another area in which to look for causes of depression is the area of "energetics", or the flow of "chi" through the body. A close correlation exists between chi and autonomic nervous system activity. Chinese medicine has noted an association between depression and liver function - which in turn probably affects the autonomic nervous system. When there is overt liver disease, as in alcoholism, the connection is obvious, but depression can occur with even quite mild stresses on liver function. Solvent exposure for example, at times "overloads" the liver's ability to detoxify and depression results. Factory workers and cleaners are especially at risk, but solvent off-gassing from new carpets, paints and other household materials may affect some people.

The liver's detoxifying ability can also be overtaxed by certain medications and other environmental poisons such as mercury (amalgam fillings may be a source). A pre-existing liver weakness may be present with a history of hepatitis, infectious mononucleosis or drug overdose (especially acetaminophen or Tylenol). All these stresses, past and present, may leave a neurophysiological "imprint" on the liver and a tendency towards depression.

Chinese medicine's understanding of a depression-liver connection works in two directions. Not only can liver stress provoke depression, but also an unresolved depressive experience (see Applied Psychoneurobiology) can express itself through the liver. This insight has a practical application in the understanding and treatment of some forms of depression. Techniques exist, centering on the liver, that treat depression by altering the flow of chi, or by changing the autonomic nervous system's control of the liver.