Chapter 1:

Many Paths to Healing Depression

James Strohecker and Nancy Shaw Strohecker



"It's supposed to be a professional secret, but I'll tell you anyway. We doctors do nothing. We only help and encourage the doctor within."

                                                                              - Albert Schweitzer


There is no shortage today of media stories on depression. Newspaper headlines from this year cover a wide range of issues surrounding depression: "Herb is Found to Aid Mild Depression," "Researchers Probe Heart Disease-Depression Link," "Millions of American Teenagers Suffer from Depression," "A Hidden Epidemic of Male Depression," "Feeling Blue? Check your Thyroid," "Medicating Kids: A Pacifier for Depression," and of course, "Prozac Keeps Drug maker Feeling Good After 10 Years." Why this sudden fascination with depression? Is it because depression is rapidly becoming recognized as the one of the biggest health problems facing our society, not only affecting adults, but teens and children?

This current climate is a far cry from the amount of public interest and media coverage of depression just four years ago in 1994 when we produced a conference called "Healing Depression" in Santa Monica, California that inspired this book. At that time, depression was still a taboo subject socially, a frightening and mysterious condition that was treated medically with powerful psychotropic antidepressants which had disturbing side effects. The controversial antidepressant drug, Prozac, had been on the market for several years and was just penetrating the public consciousness and beginning to make headlines. There was little or no interest in, nor knowledge of natural alternatives to treating depression.

Today, thanks to the barrage of media stories and a number of well known public figures who have disclosed their battles with depression, including television journalist Mike Wallace, actor Rod Steiger and novelist William Styron, much of the social stigma surrounding depression has been removed. Discussion of depression in our culture has become more commonplace, and it can now be mentioned in the same breath as being "anxious" or "stressed out." Concurrently, there is an increasing public interest in natural approaches to dealing with this health condition. Even conventional medical doctors who have historically been known to only prescribe antidepressants, are now responding to the public demand and are beginning to recommend natural remedies like St. John's wort for mild to moderate depression.

A National Health Problem
One in four Americans will experience some degree of clinical depression or mood disorder during their lifetime, and each year over twenty- five million people will be diagnosed with a depressive illness. Two-thirds of those suffering from depression are women. However, the recent focus upon a "silent epidemic" of depression among men indicates that these figures are in need of adjustment.1

All told, it is estimated that depression will cost our economy more than forty-four billion dollars, and an annual loss of two hundred million work hours. These numbers may be deceiving, however, given people's reticence in the past to talk to their physician about depression. Today over 17 million people, including teens and children, are currently on Prozac, the second most commonly prescribed drug in America. Pharmaceutical giant Eli Lilly, the maker of Prozac, is now engaged in a major media campaign to raise public awareness about depression and Prozac. With the rising tide of awareness of depression, many who would have never considered themselves depressed will be taking Prozac, or some other antidote, pushing the statistics even higher.

And it appears we are bringing our children along for the ride. It is estimated that close to 13% of teenagers and approximately 3% of children under thirteen suffer from depression according to the Center for Mental Health Services. Until recently, no one has wanted to recognize that teens and children suffer from depression. To make matters more difficult, childhood depression is hard to identify and diagnose because it is so easily confused with other health conditions, and because children lack the verbal skills to explain what they are experiencing. As a result they act out their depression in the only way they know how--what we commonly describe as moodiness irritability, anger and even rage.

Are we becoming a "Prozac nation?" Prozac, despite its ability to transform personality, appears to be a short-term solution to a long-term problem. FDA statistics reveal unsettling reports of adverse side-effects ranging from loss of sexual appetite to suicide and death. These serious shortcomings, the rising incidence of depression, and the growing popularity of natural health care, clearly demonstrates the need for safe and reliable drug-free treatments. It is no surprise then that the antidepressant herb St. John's wort, despite having been successfully used for centuries, was barely on the radar screen in the United States four years ago, but is now the number four-selling herb in the U.S. and is outselling Prozac in Germany.

Where Does the Answer Lie?
We have spoken with an endless succession of people whose psychiatrist or psychologist reflexively prescribed antidepressant medication for their depression as the only available option. Modern medicine, with its focus on treating disease with a single "standard of practice" has created a serious situation for those being treated for depression in the class of psychotropic antidepressant drugs. Many complain they have been on a treatment merry-go-round for years, going from one antidepressant to another, and are still seeking help. They report that they have had some relief but at the cost of unpleasant and grave side-effects. Others, however, have received virtually little or no relief, or have actually gotten worse, and are becoming increasingly desperate.

Two things are clear. The human suffering resulting from depression is real and impacts every aspect of one's life--family, work, and relationships. Secondly, depression is not an illness that can be reduced to a single cause or a single cure, as demonstrated by the problems associated with the succession of antidepressant drugs produced over the years. There are no magic bullets for depression.

Where then does the answer lie to relieving the toll of human suffering brought on by depression? We have discovered that there are many answers to solving this complex malady. The key is in understanding the many underlying causes of depression, and becoming aware of the variety of natural approaches to its treatment.

Many of the solutions come from the world's great systems of traditional health care. Some have ancient roots such as herbal medicine, the oldest form of health care on the planet, and the Greek medicine of Hippocrates. Chinese medicine and Ayurveda, both of which have both been practiced continuously for five thousand years, can rightly be called the original systems of holistic medicine.

Other systems of traditional health care have more modern origins, such as homeopathy and naturopathic medicine, each of which originated in early- to mid-19th century Germany before taking root in the U.S. After having fallen into obscurity for most of the 20th century due to the advent of miracle drugs, both are now enjoying a major renaissance.

What all of these systems of traditional health care have in common is a focus on health maintenance, prevention, treating the whole person, reliance on natural therapies, and taking a more integrative, multi-disciplinary approach to treatment in order to restore health and internal balance. These systems also share another commonality--for most of this century, each has remained outside the accepted standards of conventional Western medicine, but are now becoming increasingly in demand by people like yourself in search of solutions to their health problems.

In order to prevent illness and achieve optimum level of personal health, it is important to be familiar with the tools that can help build a wellness-based lifestyle, and become aware of all of your treatment options. The approaches in this book represent the collective wisdom of thousands of years of the great healing traditions as well as the best of the emerging field of integrative medicine--nutrition, healthy lifestyles, mind/body therapies, and spiritual practices.

We have brought together a team of nine leading experts from each of these fields to present, for the first time, a comprehensive and integrated picture of depression, including an understanding of its many causes, prevention and time-tested natural approaches to its treatment. This team of health professionals will provide an in-depth understanding of the following primary systems of natural medicine:

  • Ayurveda: The traditional system of medicine in India, the practice of Ayurveda extends to 3500 BC. The term Ayurveda means "Science of Life," and it has a long history working with rejuvenation, longevity, and mental health through diet, lifestyle, herbs, massage, yoga, and meditation.
  • Chinese Medicine: Practiced for over 5,000 years, Chinese medicine includes the use of herbs, acupuncture, dietary therapy, massage, lifestyle as well as qigong, a system that uses movement, energy and breath. This medicine is based on balancing the flow of qi or life force through the body's meridian system or energy pathways.
  • Herbal medicine: The therapeutic use of herbs to alter physiology and mental/ emotional states. Both western and Chinese herbs are explored here in the treatment of depression, and an emphasis on St. John's wort as the most highly researched and publicized herb for treating depression today.
  • Homeopathy: Homeopathic remedies are designed to stimulate the body's own natural powers of recovery to aid in overcoming the disease rather than simply suppressing symptoms. Homeopathy aims to treat the patient rather than the disease and has effective treatments for mental/emotional disorders.
  • Mind/Body Medicine: The use of stress-reduction techniques, guided imagery, biofeedback, meditation and other modalities to achieve higher levels of mind/body integration, greater capacities for self-regulation and inner peace in order to better control anxiety and mood swings.
  • Naturopathic Medicine: A comprehensive and natural approach to medicine which looks at all of the factors needed to help move a person towards health. This medicine looks to understand the underlying causes of illness, and then addresses these causes with natural therapies such as diet, lifestyle, herbs, homeopathy, nutritional supplements, hydrotherapy and acupuncture.
  • Nutritional Medicine: This approach involves the use of diet and nutritional supplements to correct nutritional deficiencies that may contribute to biochemical imbalances in the brain resulting in depression. Nutritional medicine also utilizes nutrients in higher, pharmacological doses in order to push biochemical reactions in the desired direction to bring about a return to balance and health..
  • Qigong: The Chinese art and science of gathering, circulating and storing body/mind energy (qi) through breath and energy work. These are techniques that involve movements and visualizations while standing, sitting and moving.
  • Spiritual Medicine: An emerging field that explores the spiritual dimension of health and psychology, utilizing psychospiritual disciplines such as meditation, yoga, breathwork, self-inquiry and other spiritual disciplines. In the more ancient systems of traditional health care, the spiritual dimension of health was an integral part of a comprehensive, holistic approach to health and well-being.
  • Yoga: A spiritual discipline practiced in India for many thousands of years, employing diet, lifestyle, relaxation, physical postures, breathing practices, meditation, and awareness to promote physical, mental, and spiritual health.

    (For a complete list of therapies covered in this book see Appendix B: "Quick Reference to Therapies" in Natural Healing for Depression.)

    Many Perspectives on the Causes of Depression
    There are many underlying causes of depression beyond the conventional biomedical perspective that focuses solely on imbalances in brain chemistry. We now know that numerous biochemical and physiological factors can induce depression. Many physical illnesses can be the cause and, conversely, depression can lead to physical illnesses. Depression may be caused by emotional, psychological factors or life's circumstances. On an energetic level depression can be viewed as an imbalance of vital energy, and on a spiritual level it can be seen as stemming from spiritual disconnection or lack of soul awareness.

    From an overall systems perspective, depression can be viewed as a "warning sign" that the body-mind is off-course in some manner--whether it be biochemical, physiological, psychological, energetic or spiritual--and is signaling that there is a need to make some change in your life.

    Psychological/Emotional Causes of Depression
    Depression often has emotional or psychological roots in the experience of loss, which may involve the loss of a loved one, a job, a change of circumstances, or divorce. Depression that accompanies the grieving process following a significant loss is a natural phenomenon that we all experience at one time or another in our lives. In many cases, depression can run its course without professional intervention, and in these cases it is not appropriate to "medicalize," the experience and classify it as "mental illness." On the other hand, more severe and enduring forms of emotional and psychological depression due to preocuppation with a loss, long-term disappointments in life, or chronic pain and physical trauma may require psychological intervention or counseling to help guide one through the often dark and difficult process of emotional healing.

    Biochemical/Physiological Causes of Depression
    Contrary to conventional wisdom, there are numerous biochemical and physiological factors that can induce depression. These elements include diet, stress, sleep, exercise, environmental toxins, nutritional deficiencies, or hormonal imbalances. Similarly, depression may be a symptom of other underlying health conditions such as candidiasis, hypothyroidism, hypoglycemia, or hormonal imbalance. Cases of chronic, psychologically-based depression may eventually result in altered biochemistry, which in turn, may reinforce depression as a psychological state, making it even more difficult to alleviate. In these cases, it may be beneficial to deal with the biochemical factors while simultaneously addressing the psychological level. The contributing health professionals in this book will cover the following underlying factors that can cause or contribute to depression:

  • Alcoholism: Depletes levels of many essential nutrients and amino acids which are necessary for proper brain physiology.
  • Candidiasis: Chronic overgrowth of yeast in the gut
  • Chronic pain: The experience of ongoing physical or emotional pain
  • Dietary Imbalances: Excess sugar and caffeine consumption
  • Environmental factors: Toxic reactions to neurotoxins such as solvents and heavy metals--aluminum, cadmium and lead.
  • Food and chemical sensitivities: Allergies to foods such as dairy and wheat as well as to chemicals such as aspartame
  • Hormonal imbalance: When the endocrine glands (thyroid, ovaries, testes, pituitary, and adrenal) are under stress or not functioning properly, hormone levels may fluctuate and profoundly effect mood.
  • Hypoglycemia: This condition of low blood sugar can lead to chronic mood swings and depression.
  • Hypothyroidism: Low levels of thyroid hormone can lead to exhaustion and depression.
  • Infectious Diseases: Such as strep throat, especially in children, affects the auto immune system
  • Intestinal parasites: Symptoms of parasitic infection include brain fog, depression and feelings of doom.
  • Lack of exercise: Non-exercisers are three times more likely to have depression as exercisers.
  • Leaky Gut Syndrome: Caused by candidiasis and intestinal parasites can lead to allergic reactions, poor absorption of food, and malnourishment.
  • Lifestyle: High stress levels, smoking and lack of exercise can lead to depression.
  • Low levels of neurotransmitters: Low levels of serotonin and nor epinephrine
  • Malabsorption: Inability to properly absorb nutrients due to deficiency in stomach HCL, pancreatic enzymes or bile acids.
  • Nutritional deficiencies: Deficiencies in vitamin B Complex, vitamin C, iron, calcium, magnesium, potassium
  • Pharmaceutical Drugs: Anti-psychotics, barbiturates, benzodiazepines, beta-blockers, cholinergics, corticosteroids, estrogens (including contraceptives, levodopa, reserpine.
  • PMS/Menopause: Often accompanied by mood swings, anxiety and depression.
  • Seasonal Affective Disorder (SAD): Caused by lack of exposure to sunlight.

    Energetic Basis of Depression: According to Traditional Chinese Medicine (TCM) illness results from an energetic imbalance of qi or life force in the body's meridians and internal organs. TCM views depression as resulting from a blockage or stagnation of emotional qi. Similarly, the Chinese system of energy training known as qigong and the Indian system of yoga, both recognize the link between the mind and life force (qi or prana), while utilizing breathing and awareness practices to help regulate the flow of life energy in the body/mind.

    Spiritual Basis of Depression: According to the "perennial philosophy" found in the world's great spiritual traditions, we have essentially forgotten who we are--our true nature and divine heritage--and feel disconnected from our spiritual source. This disconnectedness or separation is viewed as the primary source of unhappiness. Many sacred traditions view mental illness and conditions such as depression not as a disease of the mind, but as a lack of connection to and awareness of soul. It is when we lose touch with our essential spiritual nature, and forget our true purpose in life that we become subject to depression and other illnesses.


    Is Depression Preventable?

    "The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease."

                                                                                                         Thomas Edison

    When looking at the many faces of depression, the logical question arises: is depression preventable? In many cases the answer is, "yes" if we can learn to minimize or avoid the previously mentioned causes by living a balanced, wellness-based lifestyle, and maintaining a healthy psychological and spiritual perspective. Until recently, however, prevention has been a hard sell in America, as our system of health care has actually been a "sickcare" system focused on treating disease, not in preventing illness and maintaining health. In this book, each of the health traditions discussed by our team of health experts offer secrets to not just treating, but preventing depression through a healthy lifestyle and having tools and resources at hand to help deal with depression at its onset.

    What Do the World's Systems of Traditional Health Care Offer?
    Throughout history, the world's great systems of traditional medicine have provided a more balanced approach to health care, echoed in the World Health Organization's classic definition of health:

    "Health is a state of complete physical, mental and social well-being,
    and not merely the absence of disease or infirmity."

    The World Health Organization (WHO) uses the term "traditional medicine" to describe established systems of health care worldwide considered "unconventional" by modern, standardized western medicine. Most people are surprised to learn that according to the WHO, 80% of the world's population receives their health care from the various forms of traditional medicine considered to be "alternative" or "unconventional" in the U.S. These systems include Ayurveda, Chinese medicine, herbal medicine, unani (Graeco-Arab medicine), native American medicine, traditional African medicine, naturopathic medicine, homeopathy, chiropractic and osteopathy, among others.

    The maintenance of health and the prevention of disease form the basis of Ayurveda, Chinese medicine, naturopathic medicine and other forms of traditional health care. The therapeutic protocols in these systems are intended to restore balance to the body systems in order to reestablish health. Samuel Hahnemann, the late 18th/early 19th century founder of homeopathy wrote volumes on hygiene, health maintenance, mental health, as well as the prevention of disease. These systems all understood the connection between diet and mental health, the influence of lifestyle factors, the strong connection of mind and body, and finally the importance of the spiritual dimension in physical and mental health.

    Yoga and qigong are psychospiritual practices aimed at integrating body, mind and spirit. Meditation, now regularly prescribed by many physicians, is one of the eight limbs of classical yoga. In fact, the basis of much of today's mind/body medicine, including guided imagery, biofeedback and other relaxation techniques, have strong ties to the practices of yoga and meditation.

    The following poetic passage written thousands of years ago in the Yoga Vasistha, a Sanskrit text of yoga and spiritual philosophy, demonstrates a profound and time-less understanding of how illness can originate in the mind--an understanding that is now weaving itself into the fabric of today's medicine:

    "When the mind is agitated, then the body also follows in its wake. And when the body is agitated, then there is no proper perception of the things that are in one's way and prana (vital force) flies from its even path onto the bad road, staggering like an animal wounded by an arrow. Through such agitation's, prana, instead of pervading the whole body steadily and equally, vibrates everywhere at an unequal rate. Therefore, the nadis (subtle channels for circulation of prana) do not maintain a steady position, but quiver. Then to the body, which is the receptacle of partially or completely digested food, the nadis are simply death, because of the fluctuations of the pranas. The food which settles down in this body amidst such commotion is transformed into incurable diseases. Thus through the primary cause (of the mind) the disease of the body is generated. If this primary cause be annihilated at its root, then all diseases will be destroyed."4

    The formation of a truly global medicine in the spirit of the World Health Organization's vision of integrating modern western medicine with the world's traditional medicines, is more and more becoming a reality. This process involves a revitalization of medicine, inspiring the evolution of even greater numbers of safe and effective forms of naturally-based approaches to health care, side by side with the cutting edge developments in the field of mind/body medicine and energy medicine.


    Alternative, Complementary or Integrative Medicine? What's in a Name?
    Alternative medicine is a relative term that refers in large part to the systems of traditional medicine that until recently were considered to be outside of the mainstream of western medicine. Today, courses on many of these systems are now being taught in over fifty U.S. medical schools, including Chinese medicine, acupuncture and qigong, Ayurveda, herbal medicine, mind/body medicine, nutritional medicine, homeopathy, naturopathy and chiropractic. There is a growing number of traditional patient-care organizations who now offer alternative medicine services in their clinics as well as insurance reimbursements.

    Many in conventional medical circles, however, still refer to "alternative" as unproven therapies which purport to replace or act as alternatives to conventional medical treatment. The issue as to what constitutes proof, conventional double-blind studies as opposed to hundreds or even thousands of years of favorable or successful outcomes, remains a contentious issue in conventional medicine.

    We often see conventional medical experts erroneously stating that there is no research on herbal or nutritional medicine. The German Commission E Reports, probably the single most important collection of botanical research in the world, have been publicly available in Germany for over ten years. Few in this country were aware of its existence and many who were, discounted it significance as it was not "American" research. However, the German Commission E Reports2 have now been translated into English (1998) in a project spearheaded by the American Botanical Council, and beginning to gain its due respect. Similarly, Dr. Melvin Werbach's classic book, Nutritional Influences on Illness3, now a CD Rom containing over four thousand pages of nutritional research on over one hundred health conditions, was until recently little known outside of alternative medicine circles.

    Two other terms coming into greater use are "complementary" medicine and "integrative" medicine. Complementary medicine means that it complements, but does not replace conventional health care, such as the use of acupuncture for pain control in the treatment of diabetic neuropathy. The Office of Alternative Medicine (OAM) at the National Institutes of Health now promotes the use of the term Complementary and Alternative Medicine (CAM). Integrative medicine refers to a form of health care that integrates both alternative/traditional and conventional medicine.

    Whatever name you choose, the strengths of this approach to health care are in maintaining a high level of health and well-being, treating the whole person, preventing illness, and offering safe and non-toxic natural therapies for treating illness, particularly chronic illness.

    The public demand for alternative medicine is very strong. A national survey conducted in1998 by Stanford Center for Research in Disease Prevention showed that the public does not differentiate between alternative and conventional medicines. Those polled wanted the options of going to both conventional and alternative health practitioners, and using those medicines and services that proved most effective without being restricted by arbitrary definitions. Over 69% of the respondents had used some form of complementary and alternative medicine in the past year. Clearly, consumers want choice in the forms of treatments they pursue --they want the best of both worlds.


    How to Get the Most Out of This Book
    The information and resources in this book will empower you to be more proactive and self-reliant in dealing with cases of mild or transient depression, showing you how it can be managed through the appropriate self-care and wellness-based lifestyle practices. It will also show you how to work in partnership with a health professional in more moderate or serious cases of depression to create an effective treatment program that incorporates the leading-edge natural approaches.

    Choosing a specific program or approach for any health condition can be a very personal process. For healing depression, some of you may choose to work primarily with an acupuncturist or Doctor of Oriental Medicine, while others may prefer to work with a homeopathic or naturopathic physician. Still others will choose a psychiatrist or a physician who is knowledgeable of both alternative and conventional therapies. Some of you may find that taking a more multi-dimensional approach in designing a program that utilizes several different health practitioners and forms of therapy including exercise, massage, meditation, a healthy diet, nutritional supplements and herbs, is the right solution for your condition.

    Look over each chapter and see if the approach is relevant to your situation, and whether or not its basic principles resonate with your own philosophy and belief system. Each of these approaches has been effectively used for treating depression, and can work if it is the appropriate approach for you. With the broader acceptance of alternative/ complementary therapies we are no longer restricted to standardized, conventional medicine which looks for one solution to each health problem as if physicians were treating "disease units" rather than a whole person with both biochemical and psychological individuality.

    As the various systems of traditional medicine and the more modern systems of alternative medicine share a common perspective--a holistic focus on prevention, health maintenance, the use of natural therapies, and a comprehensive treatment plan--you will find throughout the various chapters some of the same therapies as part of an overall treatment plan. For example, St. John's wort is included in the chapters on herbal medicine, naturopathic medicine as well as an integrated approach to women's depression. This overlapping is not only because of this herb's high success rate with depression, but because the description of each approach would be incomplete without a discussion of this herb.

    Finally, you can use this book to help increase your general level of health and well-being by incorporating the dietary, lifestyle, and stress management guidelines.

    Every chapter provides tools to help you develop a wellness-based lifestyle and to address imbalances that may occur in your physical and mental health. We have provided additional resources in the appendices for each specific therapy included in the book: recommended reading, national organizations and educational institutes, professional referral sources, as well as Internet resources. The Internet has played a strong role in disseminating information and resources about alternative medicine to consumers, health professionals and health care organization. More importantly, as a global delivery system it supports the formation of an integrated global system of health care which can utilize the best of traditional and modern medicine.


    The Need for Self-Managed Care

    "The next major advance in the health of the American people will be determined by what the individual is willing to do for himself."

    - John Knowles, Former President of the Rockefeller Foundation

    With the current direction of managed care, it is vital for the individual to take more control over their own health care. The abundance of information about medical options and alternatives necessitates that we become educated brokers of our own health care. Consumers are doing much of their own medical research today and assessing alternative treatments before conferring with their health professional. The accessibility and wealth of information on the Internet, has only accelerated thisprocess.

    The philosophy of Self-Managed Care emphasizes maintaining health and well-being, consumer empowerment, partnership with one's health care provider, and increased utilization of natural remedies and alternative medicine services. The demanding baby-boomer population, many of whom are now managing their own health as well as that of their children and aging parents, are opting for less-invasive and more cost-effective natural approaches as their primary strategy, tending to avoid the medical system when possible in non-emergent cases. Savvy health consumers today want a full range of treatment options from both conventional and alternative medicine. More than ever the key word is choice.

    Many Paths to Healing Depression
    This book presents contributions from nine nationally recognized experts in the major fields of alternative/complementary (traditional) medicine, which as a whole, presents a comprehensive and holistic vision of depression. Five of the contributors are experts in the major systems of traditional medicine: Ayurveda, Chinese medicine and qigong, herbal medicine, homeopathy and naturopathic medicine. Three contributors are experts in mind/body medicine, nutritional medicine and spiritual medicine. The final contributor, a psychiatrist and expert in women's mood disorders, represents the true integrative approach by blending western medicine with nutritional medicine, herbs, and leading-edge psychotherapy.

    In reading this book you will witness the true art of medicine as you are intelligently and compassionately guided by dedicated health professionals who look beyond the apparent symptoms to address the deeper, underlying causes of depression through natural and humane approaches. Reading each chapter will take you on a journey of hope and discovery. You will be exposed to healing secrets, both ancient and modern, that will expand your view of the nature of depression and illness as well as educate you in the many paths to healing this condition.

    The following summaries of the nine chapters of this book will give you a sense for each healing system or approach, and help you or your loved one begin developing the options for an effective treatment plan.

    Depression as Emotional Pain: A Mind/Body Approach -- David Bresler, Ph.D., L.Ac.
    Depression is a part of the natural healing process and does not always require therapeutic intervention, says clinical psychologist and mind/body pioneer Dr. David Bresler, who is an Associate Clinical Professor at the UCLA School of Medicine and co-founder of the Academy for Guided Imagery. In this compelling and human picture of the psychological dimension of depression, he explains how our real concern should not be with people who experience depression, but with those who have become stuck in the healing process. From this perspective, we can view depression as a form of chronic emotional pain or an emotional habit which results in one becoming "stuck" in a depressed state of consciousness. In order to break the habit of depressed thinking, we can employ mind/body approaches such as interactive guided imagery which can have powerful physiological and psychological effects, and put us in touch with our own inner resources.

    Guided imagery can help us learn to "focus attention on the part of the nervous system that may have answers to our questions and solutions to our problems," according to Dr. Bresler. Most of us are unaware of the powerful inner resources we have at our disposal, and guided imagery techniques can help us to discover these resources and use them to provide new insights and creative solutions to our problems. The reader is guided through an evocative imagery experience which is designed to identify the particular qualities that are needed right now to help get one through a current challenge or difficulty. Additional imagery tools are given for dealing with depression: exploring the origin and meaning of symptoms, encountering the Inner Critic, and accessing yourInner Intelligence or Inner Advisor. According to Bresler, of vital importance in healing depression is keeping the human spirit alive through hope and faith. "When we lose hope, we lose the very thing that offers the greatest help in healing our problem."

    Natural Medicine and Depression: A Naturopathic Approach -- Joseph Pizzorno, N.D.
    The true role of a naturopathic physician is not in treating disease but helping people to re-establish health, says Dr. Pizzorno, President and co-founder of Bastyr University and an internationally recognized expert in natural medicine and author of the acclaimed book, Total Wellness: Improve Your Health by Understanding the Body's Healing Systems. Identifying a disease is a useful label to help people understand their health problems, however, the naturopathic approach looks beyond the label of "depression." It looks at the whole person and identifies the underlying causative factors to determine what steps are needed to eliminate those causes and help a person move towards a balanced state of health.

    This approach has many advantages. Stressing prevention and honoring the healing power of nature, Naturopathic medicine relies upon natural therapies including diet, nutritional medicine, herbs, homeopathy, acupuncture, massage and bodywork as well as psychological and lifestyle counseling. The patient is able to utilize a combination of therapies determined by the naturopath at very safe dosages, rather than a using a single therapy at a higher, toxic dosage. Naturopathy also views the role of the physician to be an educator, teaching and motivating people to take more personal responsibility in maintaining good health and a state of wellness. All of these factors allow the patient to be highly involved in the treatment process. Dr. Pizzorno's naturopathic approach to treating depression identifies five primary determinants of mood: physical factors; social factors (family and social patterns), mental factors (a person's thinking patterns), emotional factors and spiritual factors. For example, on the physical level we may need to eliminate toxins, normalize endocrine function and neurotransmitter metabolism, increase exercise and light exposure, and utilize natural mood elevators. On the mental and emotional levels we may need to deal with family of origin issues, employ psychodynamic approaches when necessary, or even follow a prescription for having fun if we are in need of lightening up our lives.

    Dr. Pizzorno offers a fascinating case study to illustrate naturopathic medicine's comprehensive and effective approach to dealing with depression that first provides the necessary and immediate symptomatic relief while treating the primary causes.

    Women's Depression: An Integrative Approach -- Hyla Cass, M.D.
    Psychiatrist and author Hyla Cass, an expert in integrating leading-edge natural medicine with innovative psychotherapy, and Assistant Clinical Professor at the UCLA School of Medicine, encounters many women in her private practice with typical psychiatric complaints: depression, addiction, impaired concentration, eating disorders, weight gain, insomnia, anxiety, fatigue, and sexual dysfunction. Rather than approaching her patients from a standard psychiatric, drug-prescribing perspective, Dr. Cass examines other possible underlying causes for their depression and related symptoms: genetic predisposition, hormonal imbalances, food and chemical sensitivities, chronic fatigue syndrome, candidiasis, toxic reactions, and nutritional deficiencies.

    Her integrative approach to treating depression and mood disorders in women utilizes a wide range of therapies depending upon the specific history and biochemistry of the patient as determined by laboratory tests. These therapies include dietary therapy and nutritional medicine, amino acid therapy, herbal medicine, and natural hormone therapy, as well as mind/body therapies, leading-edge forms of psychotherapy including Voice Dialogue, and when necessary, conventional antidepressant medications. Dr. Cass' integrative approach to treating depression and its underlying metabolic causes is also relevant to men, with the exception of the specific hormonal imbalances.

    A Comprehensive Approach to Depression: Nutritional Medicine and Biofeedback -- Melvyn Werbach, M.D.
    Psychiatrist Melvyn Werbach presents a "new" model for looking at depression based on the natural and holistic principles of Hippocrates, the ancient Greek physician/healer recognized as the father of Western medicine. Depression can be viewed in three different ways according to Dr. Werbach: as a failure of a body system, a psychological defense, and a physical or psychological warning of the imbalance between mind and body. Optimal treatment involves a holistic approach which integrates the best of psychiatry, nutritional medicine and mind/body therapies.

    Dr. Werbach, an internationally recognized authority in nutritional medicine, an early pioneer in biofeedback research at UCLA, and Assistant Clinical Professor at the UCLA School of Medicine, provides a clear and in-depth explanation of the nutritional treatment of depression through diet and nutritional supplementation, based on solid scientific research. Dietary factors and common foods associated with depression are examined such as caffeine, sugar and alcohol, as well as specific nutrient deficiencies including vitamin B-Complex, folic acid, vitamin B6, vitamin B12, and vitamin C, as is neurotransmitter precursor therapy to raise serotonin levels. A case study emphasizes the importance of integrating therapies such as biofeedback and relaxation response training into a more comprehensive model of treating depression.

    The Natural Pharmacy: Herbal Medicine and Depression -- Janet Zand, O.M.D., L.Ac.
    Depression is an enigmatic and complex phenomenon according to Dr. Janet Zand, a Doctor of Oriental Medicine, author, and a nationally known expert in herbal medicine. In fact, many of the numerous symptoms of depression--chronic fatigue, insomnia, loss of appetite, headaches, backaches, bowel disorders, and feelings of worthlessness and inadequacy--can, in other circumstances, be the cause of depression. Herbal medicine has a long and respected history, and holds a valuable place in the treatment of mental/emotional disorders such as anxiety and depression as well as the vast majority of health problems. The proper use of herbs not only helps to alleviate symptoms, but also helps to treat the underlying problem and strengthen the overall functioning of a particular organ or body system.

    Dr. Zand profiles the Western and Chinese herbs herbs that have proven effective in treating depression, anxiety and mood disorders, including St. John's wort, kava, Siberian ginseng, Ginkgo biloba, astragalus, Dong quai, bupleurum, milk thistle, ginger root, and valerian. She also provides a list of essential oils that are helpful in alleviating depression as well as a useful herbal chart for quick reference. This chart lists the herbs and the corresponding symptoms of depression that it addresses, along with how the herb is taken, plus any possible side effects.

    Homeopathy and Depression -- Jacquelyn Wilson, M.D.
    Homeopathic remedies use minute doses of a medicinal agent that stimulate the body's own natural powers of recovery to restore balance and health rather than to simply suppress symptoms. Dr. Wilson, a nationally recognized authority in homeopathy and past President of the American Institute of Homeopathy, has found this system of natural medicine to be consistently effective in treating mental and emotional problems, as a method of individual self-care, and in more serious cases, when administered under the care of a health professional. In classical homeopathy, however, there are numerous forms of depression, as depression is not considered to be a single disease but a specific symptom-picture. Classical homeopathic prescribing matches a single remedy with a patient's detailed symptom profile. The keyto the homeopathic approach to treating depression, therefore, is to find the medicine that corresponds or is similar to the depressed person's mind and body traits, and complaints.

    The most important homeopathic remedies for depression are described in this chapter, along with the appropriate Bach Flower remedies and cell salts, including each remedy's matching symptom profile. Dr. Wilson also distinguishes between the advantages and disadvantages of the two primary forms of homeopathy--classical single remedy prescribing, and complex homeopathy which uses combination remedies. She provides a fascinating account of a serious depressed woman who did not respond to antidepresssants and conventional medicine, but significantly benefited from a specific homeopathic remedy.

    Qigong, Chinese Medicine and Depression: Roger Hirsh, O.M.D.
    Chinese medicine as well as the many Chinese healing arts and martial arts are based on the concept of Qi or vital force. Chinese philosophy believes that the free and unobstructed flow of qi throughout the organ meridian system of the body brings radiant health, whereas its blockage or stagnation results in reduced energy that can lead to health problems. There is a strong recognition in Chinese Medicine of the role of the emotions in health and illness. When the body and mind move in harmony, positive emotions prevail. Depression, however, is due to a stagnation of emotional Qi within an individual's internal organs, especially the liver, kidneys and lungs. If the Qi is deeply stagnated for a period of time it can affect every organ meridian system and cause severe depression.

    Dr. Hirsh, a respected doctor of Chinese herbal medicine, acupuncture, and a longtime teacher of Qigong and taiji (tai chi), leads the reader in a journey into the secrets of Qigong, an ancient Chinese art of energy training and rejuvenation. Qigong is increasingly utilized in health care settings worldwide, and is used in both the prevention and treatment of depression. For those experiencing either acute or deep-seated depression, Hirsh provides some simple Qigong exercises which involves breathing, visualization and movement to stimulate and energize. The first set of Qigong exercises are warm-ups that can be performed either individually or as a group to help deal with mild to moderate depression. The second group, "The Eight Silken Brocades" is a set of ancient exercises that help to stimulate and tonify the whole biomechanical system of the body in order to relieve stress, maintain youthfulness, and promote general well-being.

    Ayurveda for Depression and Mental Health -- Shri Kant Mishra, M.D., M.S., Doctor of Ayurveda
    Ayurveda, the traditional system of medicine in India practiced continuously for over 5,000 years, literally means the "Science of Life." The principal goal of Ayurveda is the preservation and promotion of health with special emphasis on preventing illness. The secondary goal of this form of medicine is the treatment of physical, mental and spiritual illness, according to Dr. Shri Kant Mishra, an internationally renowned neurologist, and the only western-trained M.D. working in the U.S. with a formal degree in Ayurveda from Benares University in India. In addressing one's overall heath, Ayurveda embraces a holistic perspective, integrating all aspects of life--nutrition, hygiene, sleep, seasonal changes, lifestyle, and physical, mental and sexual activities. Diagnosis and treatment in Ayurvedic medicine revolves around determining the individual's constitutional profile, which is based upon the unique combination of the three doshas or humors (vata, pitta and kapha). Illness and depression results when there is a dosha imbalance.

    This ancient system of natural medicine has a long history in the areas of mental health, rejuvenation, and longevity through the use of diet and lifestyle practices, herbs, massage, yoga, and meditation. Dr. Mishra explores the Ayurvedic approach to attaining a balanced state of mental health and focuses on specific approaches to treating vata, pitta and kapha forms of depression. He also provides yogic practices such as pranayama (breathing practices) and meditation to help promote optimal health and mental clarity and balance.

    The Spiritual Dimension of Depression -- Carlos Warter, M.D., Ph.D.
    The great spiritual traditions of the world tell us that pain and suffering are rooted in the forgetfulness of our true divine nature-- our separation from the universal source. Psychiatrist Carlos Warter, M.D., Ph.D., a pioneer in spiritual psychology and psychospiritual integration, shows us how depression can manifest through ignoring or forgetting our true identity as spiritual beings. In treating hundreds of individuals with symptoms of depression, Dr. Warter recognizes the validity of each treatment modality, and the importance of looking at the physical, biochemical, mental and emotional causes of depression. To be really effective, however, he has discovered that one must cross into the realm of the spiritual to create a truly comprehensive treatment approach. "In the majority of depression cases that I have treated," says Warter, "the essential problem is that the individual's identity is firmly established in the smaller story of the personality and their larger, divine identity has been 'forgotten.' "

    The solution, according to Warter, is to help the individual to move from the small, contracted story where depression is able to develop, to the awareness of a larger dimension of one's being, the large or big story of human life. This elevation in awareness entails a fundamental shift in the very notion of who one is, thereby undercutting very basis of the existing depression. In this final chapter, Dr. Warter charts out the spiritual terrain of healing, by combining both eastern and western spiritual traditions, and providing many practical tools and exercises to help us reclaim our wholeness and spiritual birthright.

    Where Do I Go From Here?
    The final chapter gives you important tips to further educate yourself about the therapies in this book, and the criteria for selecting the most appropriate one for a specific condition. This includes referrals to the various appendices of the book, that provide resources on alternative and complementary health care, recommended reading and Internet resources. The chapter also provides guidelines for finding the most suitable professional services, including health professionals, diagnostic laboratories and compounding pharmacies.

    Treat this book like a treasure chest of healing approaches to depression and mood disorders. Open and examine its unique and valuable contents. Discover and take with you the map to healthier living.