Can St. John's Wort replace Prozac for Depression Treatment?

The extract from St. John's wort (Hypericum perforatum), a bushy, wild-growing plant with yellow flowers, has been used for centuries in many folk and herbal remedies. Today in Europe, it is used extensively to treat mild to moderate depression. In the United States, it is one of the top–selling botanical products.

Historical St. John's Wort Applications

The historical use of medical St. John's wort is well documented. Commencing 2400 years ago St. John's wort was used as a nerve tonic, a painkiller for arthritis, menstrual cramping, gastrointestinal problems (such as diarrhea and nausea) as well as ulcers.



The ancient Greeks and Romans used to treat many ailments, including sciatica and poisonous reptile bites as well as to ward against evil spirits, placing sprigs of the plant on statues of their Gods. In fact, the genus name Hypericum is from Greek and means "over an apparition" as the herb was once considered odiferous enough to cause evil spirits to depart.



In the first century St. John’s wort was referred to in Pliny the Elders famous book on natural history for its bracing quality in treating diarrhea and promoting urine flow and bladder troubles.



Dioscorides, a Roman army surgeon, recommended drinking St Johns wort in his medical text, “For it expels choleric excrements…” He also recommended rubbing it on burns. Paracelsus, a medical authority of the Renaissance also wrote of using St. John’s wort to treat wounds. He was also the first to mention using it for psychotic symptoms which he called “phatasmata”.



During medieval times, the Europeans used the plant to treat all forms of madness (They thought St. Johns wort had magical properties) as it blooms near the Summer Solstice. The Saltenitan drug list of the thirteenth century also referred to St. John’s wort as herba demonis fuga--an herb to chase away the devil.



Sixteenth century medical books refer to the plant as Fuga demonum, or devil’s scourge, a term that was repeated frequently in the literature of the next several hundred years.



The oil made from the flowers was listed in the first Pharmacopoeia Londinensis (1618). 1630 Angelo Sala stated that St. John’s wort treated illnesses of the imagination, melancholia, anxiety and disturbances of understanding. He wrote, “St. John’s wort cures these disorders as quick as lightening.” Gerard wrote that its use as a balm for wounds, burns, ulcers and bites was without equal (Gerard 1633).



There is even evidence that the American Indians used St. John's wort used it in the treatment of Tuberculosis and other breathing ailments.



Civil War soldiers collected St. John's wort to use on battle wounds. A prolific and hardy plant that threatened grazing land, a beetle was introduced into the Pacific Northwest in the early 1900's to keep St. John's wort under control.



19th century literature incorporated the use of hypericum to treat melancholia. 19th century British and American literature stressed the superficial use of the herb for the treatment of burns and wounds. A powerful antibacterial, St. John’s wort has been used through the centuries as an analgesic (pain reliever) to treat saddle sores and in poultices for certain lameness's in horses.



More contemporary St. Johns Wort applications

• Over time, and the advent of modern pharmaceutical science, St. John's Wort was nearly forgotten as a medicinal herb. Only recently has St. John's Wort gained a renewed reputation as an effective treatment for all manner of infirmities most notably depression. Its complex and diverse chemical makeup has also shown to support depression related infirmities such as chronic fatigue syndrome, and pms.


• St. John's Wort's antibacterial / antiviral properties render it very useful adjunctive treatment for bacterial and viral infections.


• St. Johns Wort has also been shown to be useful in treating pulmonary complaints, bladder trouble, suppression of urine, dysentery, worms and nervous depression.


• St. Johns Wort can act to dissolve and remove bacterially based tumors and boils. It calms the nerves and increase the flow of urine.


• St. John's Wort is an excellent blood cleanser and blood purifier.


• For Tourette's syndrome - used with Wormseed


• Bells' Palsy (apply directly on face)


• St. Johns Wort antibacterial/viral properties have been shown useful in relieve phlegm obstructions in the chest and lungs. It can be beneficial in addressing bronchitis as well.


• Like Horsechestnut, St. Johns Wort may be valuable for treating internal bleeding.


• St. Johns Wort is used to treat chronic uterine problems and will correct irregular and painful menstruation.


• St. Johns Wort contains an alkaloid that is a heart and artery stimulant


• Is useful for low back pain


• Mattioli wrote of its use as an emmenagogue and antimalarial (Bombardelli and Morazzoni 1995).


• Most recent research at two of the world's leading medical institutions, New York University and the Weizman Institute of Science in Israel ,found that 2 of the main constituents of St. John's Wort namely hypercin and pseudohypericin were found to inhibit the growth of retroviruses( including HIV, the AIDS virus) in animals. Although the results of these studies are promising, more work needs to be done. The mechanism is thought to involve the production of oxygen free radicals which can damage the viral envelope. 

Why people use St. John's Wort as an alternative therapy for depression

Some patients who take antidepressant drugs do not experience relief from their depression. Other patients have reported unpleasant side effects from their prescription medication, such as a dry mouth, nausea, headache, or effects on sexual function or sleep.



Sometimes people turn to herbal preparations like St. John's wort because they believe "natural" products are better for them than prescription medications, or that natural products are always safe. Neither of these statements is true (this is discussed further below).



Finally, cost can be a reason. St. John's wort costs less than many antidepressant medications, and it is sold without a prescription (over the counter).

How is St. John's wort sold?

St. John's wort products are sold in the following forms:

• Capsules


• Teas--the dried herb is added to boiling water and steeped for a period of time.


• Extracts--specific types of chemicals are removed from the herb, leaving the desired chemicals in a concentrated form.

Does St. John's wort work as a treatment for depression?

There has been scientific research to try to answer this question.



In Europe, results from a number of scientific studies have supported the effectiveness of certain St. John's wort extracts for depression. An overview of 23 clinical studies, published in the British Medical Journal in 1996, found that the herb might be useful in cases of mild to moderate depression. The studies, which included 1,757 outpatients, reported that St. John's wort was more effective than a placebo (a "dummy" pill designed to have no effect) and appeared to produce fewer side effects than some standard antidepressants.



Other studies conducted recently have found no benefit from the use of St. John's wort for certain types of depression. For example, the results of a study funded by Pfizer Inc., a pharmaceutical company, found that St. John's wort, when compared with placebo, was not effective for treating major depression.



In addition, several components of the National Institutes of Health--NCCAM, the Office of Dietary Supplements, and the National Institute of Mental Health--funded a large, carefully designed research study to find out whether St. John's wort extract benefits people with major depression of moderate severity. This trial found that St. John's wort was no more effective for treating major depression of moderate severity than placebo.

Are there any risks to taking St. John's wort for depression?

Yes, there are risks in taking St. John's wort for depression.



Many so-called "natural" substances can have harmful effects--especially if they are taken in too large a quantity or if they interact with something else the person is taking.



Research from the NIH has shown that St. John’s wort interacts with some drugs--including certain drugs used to control HIV infection (such as indinavir). Other research shows that St. John’s wort can interact with anticancer, or chemotherapeutic, drugs (such as irinotecan). The herb may also interact with drugs that help prevent the body from rejecting transplanted organs (such as cyclosporine). Using St. John’s wort limits these drugs’ effectiveness.



Also, St. John's wort is not a proven therapy for depression. If depression is not adequately treated, it can become severe and, in some cases, may be associated with suicide. Consult a health care practitioner if you or someone you care about may be experiencing depression.



People can experience side effects from taking St. John's wort. The most common side effects include dry mouth, dizziness, gastrointestinal symptoms, increased sensitivity to sunlight, and fatigue.

To address increasing American interests in St. John's wort, the National Institutes of Health conducted a clinical trial to determine the effectiveness of the herb in treating adults who have major depression. Involving 340 patients diagnosed with major depression, the eight–week trial randomly assigned one-third of them to a uniform dose of St. John's wort, one–third to a commonly prescribed SSRI, and one–third to a placebo. The trial found that St. John's wort was no more effective than the placebo in treating major depression. Another study is looking at the effectiveness of St. John's wort for treating mild or minor depression.



Other research has shown that St. John's wort can interact unfavorably with other medications, including those used to control HIV infection. On February 10, 2000, the FDA issued a Public Health Advisory letter stating that the herb appears to interfere with certain medications used to treat heart disease, depression, seizures, certain cancers, and organ transplant rejection. The herb also may interfere with the effectiveness of oral contraceptives. Because of these potential interactions, patients should always consult with their doctors before taking any herbal supplement.

In general, you should be alert for any of the following effects if you are taking St. John's Wort:

• allergic reactions


• fatigue and restlessness with long-term use


• increased blood pressure


• increased sensitivity to the sun -- especially if you are fair-skinned and taking large doses


• stomach upsets

Sources and Additional Information:

http://www.depressiontreatment.com/articles/146/Depression-Treatment

http://www.hypericum.com/

http://www.mamashealth.com/mental/johndep.asp

http://altmedicine.about.com/cs/anxietydepression/a/SJW.htm

http://www.webmd.com/depression/guide/st-johns-wort?page=2

http://nccam.nih.gov/health/stjohnswort/sjw-and-depression.htm

The Center for Epidemiologic Studies Depression Scale (CES-D)

The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of depression.

The CES-D was developed in the 1970s by Lenore Radloff while she was a researcher at the National Institute of Mental Health. Almost 85% of those found to have depression after an in-depth structured interview with a psychiatrist will have a high score on the CESD. However, about 20% of those who score high on the CESD will have rapid resolution of their symptoms and not meet full criteria for major or clinical depression.

For the 20 items below, circle the number next to each item that best reflects how frequently the indicated event was experienced in the past 7 days.

Rarely or none of the time (less than 1 day)	Some or a little of the time (1-2 days)	Occasionally or a moderate amount of time (3-4 days)	Most or all of the time (5-7 days)
DURING THE PAST WEEK:
1. I was bothered by things that usually don’t bother me.	0	1	2	3
2. I did not feel like eating; my appetite was poor.	0	1	2	3
3. I felt that I could not shake off the blues even with help from my family or friends.	0	1	2	3
4. I felt that I was just as good as other people.	3	2	1	0
5. I had trouble keeping my mind on what I was doing.	0	1	2	3
6. I felt depressed.	0	1	2	3
7. I felt that everything I did was an effort.	0	1	2	3
8. I felt hopeful about the future.	3	2	1	0
9. I thought my life had been a failure.	0	1	2	3
10. I felt fearful.	0	1	2	3
11. My sleep was restless.	0	1	2	3
12. I was happy.	3	2	1	0
13. I talked less than usual.	0	1	2	3
14. I felt lonely.	0	1	2	3
15. People were unfriendly.	0	1	2	3
16. I enjoyed life.	3	2	1	0
17. I had crying spells.	0	1	2	3
18. I felt sad.	0	1	2	3
19. I felt that people disliked me.	0	1	2	3
20. I could not get "going."	0	1	2	3

Scoring: Since items 4, 8, 12, and 16 reflect positive experiences rather than negative ones, the scale should be reversed on these items so that 0 = 3, 1 = 2, 2 = 1, and 3 = 0. To determine the "depression score," add together the numbers for each answer. The score will be somewhere in the range of 0 to 60. A score of 16 or greater indicates that some depression may have been experienced in the past week.

Scoring and Assessment

Less than 16 Depression is not indicated

Consult a social worker to address any concerns you may have. People with scores in this range usually do not have clinical depression. However, emotional distress can be common in people with cancer. You are encouraged to get assistance from friends, family, clergy, social worker or your primary health care team.

16 - 20 Mild depression indicated

Seek assistance from mental health professional and/or a physician. People with scores in this range usually have a mild clinical depression that should be addressed. Getting help is not a sign of weakness; depression is a medical illness that can commonly affect people with cancer.

21-25 Moderate depression indicated

Seek assistance from mental health professional and/or a physician. People with scores in this range usually have a moderate clinical depression that should be addressed. Getting help is not a sign of weakness; depression is a medical illness that can commonly affect people with cancer.

26 or higher Severe depression indicated

It is important that you get assistance as soon as possible from your physician or mental health professional. People with scores in this range usually have a severe clinical depression. Getting help is not a sign of weakness; depression is a medical illness that can commonly affect people with cancer.

Sources and Additional Information:

http://pathwayscourses.samhsa.gov/aaap/aaap_4_supps_pg8.htm

http://www.cancerquest.org/index.cfm?page=4003

http://www.friendsnrc.org/download/outcomeresources/toolkit/annot/cesd.pdf

http://www.bmedreport.com/archives/7139

Acupuncture Depression Treatment

Acupuncture is a centuries (if not millennia) old practice of Chinese medicine. It is truly an art form and an incredible way to heal just about everything that ails you. There is research going on into the effectiveness of acupuncture on depressed patients as a way to augment or replace chemical therapies.

It is believed that acupuncture can be at least as good as and maybe better than drug therapies and even psychotherapy regimens. The studies that are surfacing are properly and scientifically controlled studies that use placebo, drug and talk therapy treatments in comparison to people with similar types of depression. The researchers are finding that the acupuncture depression treatment is so effective that doctors are beginning to recommend their patients consider this as an alternative depression therapy.

How Chinese Medicine Views Depression

In contrast, Traditional Chinese Medicine (TCM) does not recognize depression as a particular illness per se, but it aims to treat the specific symptoms that are unique to the individual using a variety of techniques such as acupuncture, Chinese herbs, tui-na massage, and energetic exercises to restore imbalances found in the body.



Based on a holistic approach, acupuncture consists of fine needles inserted along various points in the body, with the purpose of stimulating the body's flow of energy and functionality, known as Qi. Though acupuncture has been traditionally taught as a preventive form of health care, it has also been proven effective in the treatment of pain and chronic conditions.

Acupuncture Depression Treatment

As with other types of acupuncture treatments, acupuncture depression treatment rebalances the life forces in the body using ancient Chinese medical techniques. These types of therapies have been employed in eastern medicine for many, many years so it is a wonder they took so long to find their way to the west.

Acupuncture depression treatment addresses the many problems that come along with depression and works to eliminate the symptoms of depression as well as the illness itself. Many depressed people suffer from chronic pain, fatigue, insomnia, mood disorders and emotional upheaval; acupuncture depression treatment treats all of these problems at the same time as treating the overall depression.

Understanding Acupuncture Depression Treatment

The treatment works because it releases endorphins in to the central nervous system which are ‘feel good’ hormones which increase energy and rebalance the emotional imbalances that lead to mental imbalances which result in depression. It kick starts the process of realigning the mental processes and begins a positive cycle to combat the negative, depressive cycle.

Initially, acupuncture depression treatment is not enough to treat depression on its own, it is a catalyst. It helps other treatments take hold easily and work better on the depression. Eventually, you are able to decrease any medication or other therapy and use acupuncture as your primary depression treatment.

How That Works

Unlike allopathic treatment where each condition or organ system is treated separately, acupuncture considers the entire human body system and its alignment or balance with the environment in examining and treating various conditions. Acupuncture engages a similar methodology in diagnosis, treating, and healing depression.

Acupuncture establishes a concrete link or association between the mind and the body while treating depression; hence this form of treatment becomes much more effective and holistic in treating depression.

Most physical problems have a corresponding mental or physical cause or imbalance and the opposite is also true, mental problems and complaints do have physical causes and reasons. Therefore, acupuncture is one of the best forms of treatments to employ in diagnosing and treating depression.

The premise on which acupuncture and depression treatment works is to bring about a balance in energy flow with no disruptions or blockages and to bring about a harmonious relationship between the mind, body, intellect, and environment.

Depression, according to Traditional Chinese Medicine (TCM) and acupuncture, is a representation of blocked energy or imbalance between the yin and yang poles of energy. This is something which is made used of in acupuncture and depression treatment.

Imbalance in the yin and yang energy can manifest in different forms and by examining the physical body, posture, gait, texture of the skin, vision, voice, tongue, pulse etc., an astute and well-experienced acupuncturist will be able to make an accurate assessment of the problem and extent of depression.

Acupuncturists will also record a detailed history of the patient and his or her symptoms from the patient. This will be followed by evaluating the extent of imbalance present in the fortitude, mettle, energy, blood, fluids, and organs of the patient.

Acupuncture describes the presence of 14 main channels in the human body through which the life force or qi (chi) flows. These channels run through all parts of the body and are interconnected. Externally there are close to 400 acupoints or key points that can provide access to these channels of energy. Each key point is associated with one or more functions hence by inserting needles into these key points, the acupuncturist is releasing energies that are stagnating or blocked and helping it to move freely.

Energy that is blocked at a particular point will result in depriving a certain organ or channel of energy thereby starving it of the vital force. By releasing energy that is blocked, these organs or channels will be flush with fresh energy and will no longer be deficient of energy.

During acupuncture and depression treatment, people suffering from depression often claim that their experience of acupuncture treatment was soothing, relaxing, and energizing. Needles employed in treatment are extremely fine, thin, and sterile making it a safe and painless procedure. Any experience of soreness or stretching sensation during acupuncture for depression treatment is a strong indication of the needle connecting with the qi or energy. During the procedure, patients are made to feel relaxed and comfortable and draped appropriately.

Patients often describe the acupuncture and depression treatment experience as coming out of deep meditation. The precise acupuncture treatment for depression could include a history and physical examination, followed by vital statistics, and acupuncture treatment. Patient is generally requested to lie on his or her stomach followed by a brief acupuncture session to key points on the back.

These points could include the lung point to release any sorrow that the patient is withholding and not letting go. The heart point to heal the lack of happiness, liver points to cure anger or depression, and kidney points to heal fear or distress, and the treatment to the back is completed.

For the next part of acupuncture and depression treatment, the patient is then asked to lie on his or her back for treatment of points that enhance the energy flow and balance the spirit. This involves inserting needles in the lower arms, legs, stomach, and head.

Acupuncturists select these points are selected because they are associated with the seven chakras as described in ancient Indian science of yoga.

In addition to this acupuncture needles could be inserted on the exteriors of the ears in an attempt to harmonize the neurotransmitters released by the brain and establish a sense of wellness. Most often times, magnets are placed behind the ears or in the auricular points to extend the treatment.

Thus, acupuncture and depression treatment involves releasing the blocked energies that are stagnating at certain points and depriving other channels and organs from the free flowing life force. Balancing the energy and brining about harmony within the body by accessing the energy channels with the help of needles is the treatment modality employed by acupuncture in treating depression.

Studies of Acupuncture for Depression

Since the early nineties, studies around the globe have suggested that treating depression with acupuncture has a positive and holistic effect on depressed patients, particularly when used in combination with psychotherapy and herbal treatments.

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. In a double blind randomized study, 34 depressed female patients who met the DSM-IV diagnostic criteria were assigned to one of three treatment groups for eight weeks.

The first group received acupuncture treatment specifically tailored to their depression symptoms. The second group received a general acupuncture treatment not specific to depression, and the third group was placed on a waiting list for acupuncture treatment, but received no treatment. The study found that those in the tailored acupuncture treatment experienced a significant reduction in symptoms, compared to those in the non-specific treatment. Moreover, over 50% of the participants no longer met the DSM-IV diagnostic criteria for depression after the study.

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. While these results are promising and the United Nations World Health Organization has approved acupuncture as a treatment for depression, further clinical trials with larger samples are deemed necessary to endorse this new hope for relief.

Disadvantages and Side Effects

None known, apart from discomfort from the acupuncture needles. Single-use needles are required.

Insurance Coverage

Depression is now considered an illness like any other that you would receive treatment for from a health practitioner and is covered by medical insurance. Most insurance companies accept acupuncture depression therapy as a normal type of treatment for depression and will cover the expense. Even if your insurance company does not cover acupuncture depression therapy, the cost of treatment is usually quite low and affordable.

Different Patients, Different Results

Just as with any other form of medicine or therapy, acupuncture depression treatment will not work for absolutely everyone. No one understands how or why acupuncture works, but they know that it does.

There is no known physical science explanation behind the treatment but it does work better than most other treatments available. Some people blame it on the placebo effect and others say it is simply ancient medicine that works for a forgotten reason. Simple fact is, it works. This treatment works in people of all ages, from childhood to old age and even works on animals. It is necessary to use any type of therapy for depression under the supervision of a trained professional and not try any form of self treatment.



Many people are incapable of using traditional drug treatments and even herbal depression treatments for a variety of reasons. When people find a treatment that is effective they tend to stick with it, especially if it has few or no ill side effects. Acupuncture depression treatment is one of those few therapies that is easy to stick to because it works and you feel great afterward.

Sources and Additional Information:

http://www.survivingdepression.net/living/acupuncturetreatment.html

http://www.acufinder.com/Acupuncture+Information/Detail/Depression+and+Acupuncture+-+A+new+hope+for+relief

http://www.acupuncture-online.com/depression.html

http://www.all4naturalhealth.com/acupuncture-and-depression.html

http://www.survivingdepression.net/copying/acupuncture.html

Mindfulness Based Cognitive Therapy (MBCT) in clinical depression treatment

Clinical Research

The research, just published in the Journal of Consulting and Clinical Psychology, found that the group-based psychological treatment called Mindfulness Based Cognitive Therapy (MBCT) was as good or better as treatment with anti-depressants like Prozac in preventing a relapse of serious depression -- and the non-drug therapy was more effective in enhancing quality of life. What's more, the study concluded MBCT is cost-effective in helping people with a history of depression stay well for the long term.

The research team, which included British investigators from the Mood Disorders Center at the University of Exeter and the Center for Economics of Mental Health (CEMH) at the Institute of Psychiatry at King's College in London, looked at 123 people who had suffered repeated episodes of clinical depression. In a randomized control trial, the research subjects were assigned to one of two groups. Half continued their on-going drug treatment with anti-depressants and the rest participated in an MBCT course and were also given the option of stopping their anti-depressant medications.



MBCT focuses on targeting negative thinking and helps people who are at risk for recurring depression to stop their depressed moods from spiraling out of control into a full episode of depression. During the eight-week trial, groups of between eight and fifteen people attended meetings with a therapist who taught them a range of meditation exercises that they could continue to practice on their own once the course ended. The MBCT exercises were primarily based on Buddhist meditation techniques and helped the study participants learn to focus on the present, rather than dwelling on the past or worrying about future tasks.



Although the meditation exercises worked in a different way for each person, many reported more control over their negative thoughts and depressed feelings. Over the 15 months after the trial ended, about 47% of the group following the MBCT course experienced a relapse -- but those who continued normal treatment with anti-depressant drugs experienced a much higher, 60 percent relapse rate. In addition, the group practicing the mindfulness meditation techniques learned in the MBCT program reported a far better quality of life, more overall enjoyment and better physical well-being.



In a statement to the media, Professor Willem Kuyken of the University of Exeter, who headed the research, explained that people treated with anti-depressants are highly vulnerable to relapse when they stop their prescription drug therapy. "MBCT takes a different approach – it teaches people skills for life. What we have shown is that when people work at it, these skills for life help keep people well. Our results suggest MBCT may be a viable alternative for some of the 3.5 million people in the UK known to be suffering from this debilitating condition. People who suffer depression have long asked for psychological approaches to help them recover in the long-term and MBCT is a very promising approach. I think we have the basis for offering patients and GPs an alternative to long-term anti-depressant medication. We are planning to conduct a larger trial to put these results to the test and to examine how MBCT works," Kuvken said.

About MBCT

Mindfulness-Based Cognitive Therapy (MBCT) is designed to help people who suffer repeated bouts of depression and chronic unhappiness. It combines the ideas of cognitive therapy with meditative practices and attitudes based on the cultivation of mindfulness. The heart of this work lies in becoming acquainted with the modes of mind that often characterize mood disorders while simultaneously learning to develop a new relationship to them. MBCT was developed by Zindel Segal, Mark Williams and John Teasdale, based on Jon Kabat-Zinn's Mindfulness-Based Stress Reduction program at the University of Massachusetts. Kabat - Zinn's work shows that for these people who have had little success with conventional pain management, the internal work of mindfulness practice substantially helped in dealing with pain.



So the authors of MBCT worked with Kabat - Zinn in specifying the MBSR for training chronic sufferers of depression in skills that prevent relapse. Their own research shows in people with 3 or more episodes, MBCT cut the relapse rate in half (over the 60 week follow-up period).



MBCT consists of a mix of mindfulness practice, of practicing a mere noticing of sensation (vipassana practice), as well as certain thought-tracking techniques from cognitive therapy. It is taught as an 8 week class that focuses on skill acquisition, rather than on psychotherapy per se. Groups are from 8-12 people, a size that tends to pull away from the tendency for it to become group therapy. It's really about learning and practicing skills.

MBCT addresses unwanted beliefs, feelings and body sensations. People are then taught to change the way their mind normally responds to negative events and thoughts. This helps to create a more positive outlook. The goal is to provide skills for life to help prevent chronic depression.

How does MBCT help?

MBCT works by keeping the mind from being caught in old habits that can create a downward spiral of negative thinking. The therapy is based on concepts that teach you to:

• Get to know the workings of your mind


• Notice small beauties and pleasures around you instead of living in your head


• Not drive yourself to meet impossible goals


• Accept yourself as you are, without judgment


• Recognize unhelpful thoughts and how they affect your mood


• Break the link between negative mood and the negative thinking that could lead to a relapse


• Learn to stay in touch with the present moment, and not obsess about the past or future

MBCT helps you to see more clearly the patterns of your mind; and to learn how to recognize when your mood is beginning to go down. It helps break the link between negative mood and the negative thinking that might normally have escalated into a relapse. You develop the capacity to mindfully disengage from distressing mood, and negative thoughts. You find that you can learn to stay in touch with the present moment, without having to ruminate about the past, or agonize about the future.

MBCT can be used on its own. It may also be combined with antidepressants or other types of therapy. Studies are looking into whether MBCT can reduce or eliminate the need for antidepressant medication in some people.

What to expect

MBCT is used by health care professionals who have had specific training in this approach. It is usually taught in a group with eight weekly classes. Each person is also asked to do "homework," using CDs with guided meditations that support what they learn in class.

The exercises work in a different way for each person. But many report greater acceptance of - and more control over - negative thoughts and feelings.

Most sessions involve:

• Simple breathing techniques, meditations and yoga stretches to increase awareness of the present moment. This includes getting in touch with moment-to-moment changes in the mind and the body.


• Education about depression and anxiety.


• Group discussion about using these practices at home.


• Advice on how to deal with any problems that came up.

MBCT can be cost-efficient, as group sessions cost less than individual therapy. Also, some people may be able to reduce their medication in lieu of therapy.

Case studies

Case study 1: Di

Di Cowan of Sampford Peverell, East Devon, has suffered from depression since he was in his late teens, though it was not diagnosed until much later. Now 53, he has been taking anti-depressant drugs for more than 15 years and has had no previous psychological treatment.

It is now two years since he completed the eight-week MBCT trial and Di practices the meditation techniques learned during the trial four or five times a week, for up to an hour each time. He plans to continue doing this for the rest of his life.

Di explains how the techniques learned on the trial have helped him in his daily life: "It's helped me immensely. It's given me the ability to come up against something that would have previously thrown me, think it through, come up with a solution and then move on. It's helped me deal with recurrent thoughts."

Shortly after completing the trial, Di was diagnosed with bone cancer and had to undergo treatment, including a major spinal operation, which has left him less mobile than he was before. Despite this set-back, he feels he is managing his depression using the techniques learned on the MBCT trial.

He says: "My view of the world has changed and I look at life in a new light. I'm much more cheerful and positive. Other people noticed a change. My friends and family were very quick to comment that I was showing an improvement."

Di concludes: "It was very worthwhile and I would highly recommend it to anyone who has similar problems. It's a very sound way of combating mental illness and promoting mental health."

Originally from Manchester, Di has lived in Devon for 28 years. He is a retired Math teacher and is married with two boys, aged 19 and 11.

Case study 2: Stephen

Stephen hopes that MBCT will be "the final piece in the jig-saw" in learning to cope with a tendency towards severe depression that he has suffered since his teens. Now 56, he experienced severe episodes between 2000 and 2002, involving hospitalization. Having already tried a number of alternative therapies, and talking cures, as well as anti-depressant drugs, he finally agreed to try the mood-stabilizer, Lithium.

Soon afterwards, he embarked on a course of cognitive behavioral therapy, and it was via this route that he heard of MBCT. "It was the right thing at the right time", he says. Sufficiently "stabilized" by Lithium, he was able to benefit fully from the techniques taught, which he now practices on a daily basis, some six years later.

The group context of MBCT was important for him. Not only did participants share their individual experiences of depression, and find common ground in symptoms suffered and warning signs to heed, they also helped keep each other "on track" with the practical homework involved. Stephen believes that, in addition to the group's support, self-discipline helped him complete the eight week course and has been essential for him to continue regular practice at home. He says: "Persistence and determination are necessary during the course and become even more vital when you're on your own."

Stephen, who lives in Exeter, is realistic enough to suspect that, without Lithium he could not have reaped the benefits of MBCT. However, he says: "Mindfulness gave me added insight into the way I function and respond to people, and helped me become more accepting. Along the way I have gained an understanding that, much of the time, life may not be as I would like it, but an awareness – particularly a body awareness – of such situations can lead to easier acceptance of them, and sometimes to beneficial change. Maybe, one day, I'll have gained sufficient insight not to need the Lithium any more".

Sources and Additional Information:

http://www.naturalnews.com/024986_meditation_depression_health.html

http://www.sciencedaily.com/releases/2009/04/090423210055.htm

http://www.myoptumhealth.com/portal/Information/item/Suffering+from+Depression%3F+Mindfulness+

http://www.sciencedaily.com/releases/2008/11/081130201928.htm

http://www.wellsphere.com/depression-article/review-of-mbct-mindfulness-based-cognitive-therapy-for-depression/404596

Therapeutic Gardening against Clinical Depression

Getting dirty might help lift our spirits, according to a new study which reveals that common soil bacteria could act like antidepressant drugs.



Mycobacterium vaccae, a harmless bacteria normally found in dirt, has been found to stimulate the immune system of mice and boost the production of serotonin, a mood-regulating brain chemical.

The bacterium has already been successfully used in people as a vaccine against tuberculosis. It is also being tested as a treatment for cancer patients and in asthma sufferers, as a way to control the allergic reaction and help 'rebalance' the immune system.



Now, studies on mice led by neuroscientist Christopher Lowry at the University of Bristol in England, suggests that the bacteria may have other applications as a treatment for mood disorders like depression.



"These studies help us understand how the body communicates with the brain and why a healthy immune system is important for maintaining mental health. They also leave us wondering if we shouldn't all spend more time playing in the dirt," said Lowry.



Interest in the unusual antidepressant properties of M.vaccae arose by accident following an experimental treatment for human lung cancer led by cancer researcher Mary O'Brien at the Royal Marsden Hospital in London, England. Under that treatment, patients received heat-killed inoculations of the bacteria.



Following the tests, O'Brien's team observed not only fewer symptoms of cancer, but also improvements in their patients' vitality, emotional health and mental abilities.



Lowry and his colleagues speculated that the bacteria in these earlier experiments might have activated brain cells to release mood-lifting chemicals. To investigate the idea further, they injected heat-killed bacteria into a group of mice and found that they initiated an immune response, which activated serotonin-producing neurons in the brain.



Low levels of serotonin cause depression – an illness which afflicts around 1.3 million Australians. The most commonly prescribed antidepressant medications help treat depression by delaying the re-uptake of serotonin, thus raising levels in the brain.



According to Lowry, the strange effect of the bacteria may work by prompting the body's immune cells to release cytokines, chemicals known to activate sensory nerves that stimulate the brain. The findings are published in the journal Neuroscience.



"We believe that the brain then responds by activating serotonin neurons," he said. "These studies help us understand how the body communicates with the brain and why a healthy immune system is important for maintaining mental health."



They also raise the question of whether exposure to common bacteria from a young age, could make us less vulnerable to disease. "We believe that prolonged exposure to [M.vaccae] from childhood could have a beneficial effect," said Lowry.

Further studies are required to confirm the effect in people and to see if other types of bacteria might have a similar effect, he said.



The study lends further support the 'hygiene hypothesis' whereby exposure to bacteria and pathogens from an early age helps balance the immune system. The idea is that some experience of disease early in life prevents our immune systems from attacking our own bodies - leading to allergies, asthma and other so-called auto-immune diseases.



Gardening benefits in combating depression are not limited exclusively to the bacteria related weaponry. Dr Cosmo Hallstrom, a psychiatrist in Chelsea and member of the Royal College of Psychiatrists, said gardening provides also a distraction therapy, vital in helping deal with depression.



"If I was seeing you in cognitive behavior therapy (CBT) I might say, 'Let's look at three things you enjoy doing,' and let's say you say one of them is gardening, I would then say, 'OK let's do one hour's gardening,' he said. "CBT is a modern form of psychological therapy dealing with the here and now as opposed to your past experiences looking at thinking and behavior and can include all manner of techniques.



"When you get depressed you stop doing things and get isolated which makes you more depressed. The theory is that if you do pleasurable things you will in time get better



"Gardening is a pleasurable activity and it focuses you away from thinking about your health problems.

"Why gardening and not running? Well I think at first it is a bit much doing things that are too physical. It is important to find something you enjoy."







Sources and Additional Information:

http://www.cosmosmagazine.com/news/1154/how-gardening-could-cure-depression

http://news.bbc.co.uk/2/hi/health/8027335.stm

http://www.epinions.com/content_3461390468

Types of the Depression-Related Mood Disorders

Depression is a form of what is known as a mood or affective, disorder, because it is primarily concerned with a change in mood.

Depression is a very complex illness. No-one really knows for certain what causes depression, and everyone's experience of depression is different.

Depressive disorders come in different types, just as is the case with other illnesses such as heart disease. When a psychiatrist makes a diagnosis of a patient's depressive illness, he or she may use a number of terms--such as bipolar, clinical, endogenous, major, melancholic, seasonal affective or unipolar--to describe it. These labels confuse many people who don't understand that they can overlap. People with depressive illness may also receive more than one diagnosis since the illness is often linked with other problems, such as alcoholism or other substance abuses, eating disorders, or anxiety disorders.

Depression can also categorize in the following manner - (1) - Depression that is originating from a bad or disturbing event in your life and (2) - Depression which appears without apparent cause - the most common. The first type of depression is easier for you to tackle because the cause is known. The first step is to deal with the event that triggered your depression. It may have started as a result of a death, an accident, a divorce or any other type of setback. The second type of depression is more difficult to deal with as the source is unknown. It is the most common form of depression.

Getting proper help for different types of depression begins with a proper diagnosis. There are several different diagnoses for depression, mostly determined by the intensity of the symptoms, the duration of the symptoms, and the specific cause of the symptoms, if that is known.

For 20 percent to 35 percent of depressed people, a normal routine is all but impossible. Others have episodes of depression followed by feelings of well-being. Still others have episodes of terrible lows that alternate with inappropriate "highs." Here are some descriptions of the most common forms of depression.

Major Depression : Major depression is probably one of the most common forms of depression. You probably know a handful of people who suffer from it. The sufferer seems to walk around with the weight of the world on his or her shoulders. He or she seems disinterested in becoming involved in regular activities and seems convinced that he or she will always be in this hopeless state. There is a lack of interest in sexual activity and in appetite and a weight loss.

Atypical Depression : Atypical depression is a variation of depression that is slightly different from major depression. The sufferer is sometimes able to experience happiness and moments of elation. Symptoms of atypical depression include fatigue, oversleeping, overeating and weight gain. People who suffer from atypical depression believe that outside events control their mood (i.e. success, attention and praise). Episodes of atypical depression can last for months or a sufferer may live with it forever.

Psychotic Depression: Sufferers of psychotic depression begin to hear and see imaginary things - - sounds, voices and visuals that do not exist. These are referred to as hallucinations, which are generally more common with someone suffering from schizophrenia. The hallucinations are not "positive" like they are with a manic depressive. The sufferer of psychotic depression imagines frightening and negative sounds and images.

Dysthymia: Many people just walk around seeming depressed - - simply sad, blue or melancholic. They have been this way all of their lives. This is dysthymia - - a condition that people are not even aware of but just live with daily. They go through life feeling unimportant, dissatisfied, frightened and simply don't enjoy their lives. Medication is beneficial for this type of depression.

Manic Depression (also known as Bipolar Disorder): Manic depression can be defined as an emotional disorder characterized by changing mood shifts from depression to mania which can sometimes be quite rapid. People who suffer from manic depression have an extremely high rate of suicide.

Cyclothymic Disorder: Cyclothymia is a milder form of manic depression, characterized by hypomania (a mild form of mania) alternating with mild bouts of depression.

Unipolar Depression: This lowered mood may vary slightly throughout the day but the sufferer cannot usually be cheered up, and this is the major distinction between simply being unhappy and being clinically depressed. Unipolar depression is another name for the major depressive disorder. This term is used to distinguish it from depression which occurs within the context of of bipolar disorder, a disorder in which a person experiences alternating periods of depression and mania.

Post Partum Depression: Major depressive episode that occurs after having a baby. Depressive symptoms usually begin within four weeks of giving birth and can vary in intensity and duration.

Seasonal Affective Disorder (SAD): A type of depressive disorder which is characterized by episodes of major depression which reoccur at a specific time of the year (e.g. fall, winter). In the past two years, depressive periods occur at least two times without any episodes that occur at a different time.

Anxiety Depression: Not an official depression type (as defined by the DSM). However, anxiety often also occurs with depression. In this case, a depressed individual may also experience anxiety symptoms (e.g. panic attacks) or an anxiety disorder (e.g. PTSD, panic disorder, social phobia, generalized anxiety disorder).

Chronic Depression: Major depressive episode that lasts for at least two years.

Double Depression: Someone who has Dysthymia (chronic mild depression) and also experiences a major depressive episode (more severe depressive symptoms lasting at least two weeks). See above for definitions of these two categories of depression.

Endogenous Depression: Endogenous means from within the body. This type of depression is defined as feeling depressed for no apparent reason.

Situational Depression or Reactive Depression (also known as Adjustment Disorder with Depressed Mood): Depressive symptoms developing in response to a specific stressful situation or event (e.g. job loss, relationship ending). These symptoms occur within 3 months of the stressor and lasts no longer than 6 months after the stressor (or its consequences) has ended. Depression symptoms cause significant distress or impairs usual functioning (e.g. relationships, work, school) and do not meet the criteria for major depressive disorder.

Agitated Depression: Kind of major depressive disorder which is characterized by agitation such as physical and emotional restlessness, irritability and insomnia, which is the opposite of many depressed individuals who have low energy and feel slowed down physically and mentally.

Psychotic Depression: Major depressive episode with psychotic symptoms such as hallucinations (e.g. hearing voices), delusions (false beliefs).

Melancholic Depression (Sub-type of Major Depressive Disorder): Main features of this kind of depression include either a loss of pleasure in virtually all activities or mood does not temporarily improve in response to a positive event.

Catatonic Depression (Sub-type of Major Depressive Disorder): This type of depression is characterized by at least two of the following: Loss of voluntary movement and inability to react to one's environment; Excessive movement (purposeless and not in response to one's environment); Extreme resistance to instructions/suggestions or unable/unwilling to speak; Odd or inappropriate voluntary movements or postures (e.g. repetitive movements, bizarre mannerisms or facial expressions); Involuntarily repeating someone’s words or movements in a meaningless way.

Sources and Additional Information:

http://www.depression-guide.com/types-of-depression.htm

http://depression.about.com/od/mooddisordertypes/p/depressiontypes.htm

http://www.psychologyinfo.com/depression/depression_types.html

http://www.depression-help-resource.com/types-of-depression.htm