Welcome back to our year’s end series on mental health. Today I again welcome back Suzanne Campbell, who has contributed significantly to the writing below. Suzanne is a mental health counselor and one of my students. I am thankful to have her expertise and input as we tackle these complex topics in mental health.
To finish out our work, today’s post will focus on depression. Anxiety and Depression are like yin and yang, although anxiety if left untreated and unmanaged for long enough often results in depression. If anxiety is a state of hyperactivity, depression is one of hypoactivity. It is “lowness” that manifests not only in the mind but in the body and spirit as well. Folks who have experienced any sort of depression know how truly painful and debilitating it can be, and most of our discussion today will be about the complicated relationships between depression, pain and stagnation in the body.
Depression is one of many mood disorders and within this area of mood disorders there are many characteristics that are both similar and unique. For the purpose of this post, we are just summarizing some of the more generalized and applicable information for symptoms of depression. Please feel free to research up on variations if interested.
Symptoms of depression may include:
*changes in appetite, sleep, weight, grooming, mood or libido
*lack of energy or fatigue
*disinterest and withdrawal from people/places/things
*self-harm, including the use of alcohol and other drugs and suicidal thoughts
Depression like other mental health diagnoses can have both genetic and environmental factors. Factors contributing to an increase in risk of depression include:
*Mental health conditions and/or substance use can be present in generations of the family.
*Managing other physical or mental health conditions especially if chronic increases comorbidity of diagnoses.
*History of trauma/abuse (early onset)
*Several major adjustments to life (loss)
*Changes in brain chemistry/imbalances and those of a hormonal nature. Ex post-partum
*Personality traits (pessimism, low self-worth)
*Lack of meaningful interpersonal relationships
*Side effects of medications
In herbal energetics, we use the term “depression” to refer to a state of lowness. There is a
low level of activity, a hypofunction or an underperformance. The vital force is in “underdrive”, so to speak. If we think about this in terms of the six tissue states, we find ourselves in the realm of cold. This makes sense – if excessive heat is related to hyperactivity (as we saw with anxiety), then excessive cold naturally correlates to a slowdown in vitality. It is important to note that in the world of energetics, “depression” and “cold” are so closely correlated that the two terms are used interchangeably and, for our purposes, have the same meaning. Therefore, for us herbalists, “depression” is not just a mental health concern: it is a description of any imbalance where the underlying cause is slow & stagnant hypofunction.
If we are talking elemental constitutions, the depression or cold state most strongly correlates with earth. Earth folks tend to be physically or emotionally heavy, slow in movement and prone to physical pathologies where the underlying cause is hypoactivity, such as hypothyroidism, venous stasis and constipation. These are all depressed, cold states. Furthermore, earth folks are prone to mental & emotional depression, as well as prone to many of the depression-like symptoms listed above. Whether depression is physical, mental, emotional or spiritual, vitality is low, the system is cold and the will is weak.
Gut Health and Depression
Before we start talking about ways we can help support folks with depression, I think now is a good time to discuss the relationship between GI health and mental health. While this link is becoming more and more recognized in medicine, it is still commonly overlooked. There are a few crucial pieces of information here, which I will list below and then will circle back to later on:
1. 95% of your serotonin is produced by the good bacteria in your gut.
2. The enteric nervous system (gut nerves) functions independently of the central nervous system, and is the only major part of the nervous system to do so.
3. The largest concentration of immune cells in the body lies in the gut-associated lymphatic tissue (GALT), which is located right outside the intestinal walls.
4. Hypofunction in the gut (cold, again) is directly linked to intestinal pathologies affecting all of three things listed above, all of which have an impact on mental health.
Here again, it should not surprise us that folks prone to any sort of cold hypofunction are also prone to chronic depression. We will take a closer look at these connections when we discuss herbs and protocols for support in the next section.
Depression and Chronic Pain
Another factor to consider in our conversation is the role of chronic pain in mental health. Pain can take many forms, of course: it could be physical debility, history of trauma or abuse, loss of a loved one or related to a chronic disease. It could also be many other things as well. Whatever the underlying cause, and whether the pain is emotional or physical, pain hurts. When hurt happens over long periods of time, or even if it occurs acutely in the case of a massive loss or grief, it is common for that hurt to intertwine with the development of depression. Sometimes this depression is situational, just as stress can be situational – it hangs around for a while but when the pain resolves, so does depression. However, when the hurt becomes chronic or digs deep enough, it can become its own entity, affecting brain chemistry and functional status in the long term.
In our discussion of protocols below we will discuss the importance of treating pain when it is present, understanding that not all pain is created equal and there is no “one size fits all” remedy for it. Upcoming articles and writings will address pain treatment more completely, with this post offering some fundamental concepts.
With any sort of depression or stagnation, our primary energetic goals are to gently warm and gently stimulate, with an emphasis on gentle. We can approach this not just with herbs, but also with food. Below are some fundamental nutritional suggestions for folks struggling with depression:
1. Food should be cooked and warm, not raw and not cold.
2. Encourage the use of warming & stimulating foods such as ginger, garlic, onion in tolerable and pleasurable amounts.
3. Add warming culinary herbs such as rosemary, thyme, oregano & sage. More on these as medicines later 😊
4. Do not force spicy foods, but a little cayenne doesn’t hurt if spicy foods are enjoyed
5. Limit the intake of pro-inflammatory foods that can cause GI dysfunction such as artificial sweeteners and additives, trans fats, saturated fats, processed foods and simple/processed carbs. Whole grains are ok as long as there is no suspicion for gluten intolerance.
6. For folks with known insulin resistance, overweight folks or those with metabolic syndrome, carbohydrates should be limited in general.
Similar to anxiety and chronic stress, it should be remembered that depression hits everyone’s appetite differently. Folks may want to eat a lot, or not much at all. If there is underlying gut dysfunction or chronic pain, these may affect appetite as well. Furthermore, many people who are struggling with mental health are in crisis, and may not be able to make drastic dietary changes since the removal of certain foods would equate to the removal of a coping mechanism. Attempts should not be made to undermine a coping mechanism until someone is emotionally ready to do so and has a coping plan for after such a change is made. Be patient with people, and regardless of the situation, be prepared to meet them where they are.
The brush border of the intestines is a delicate thing. It is easily permeated when there are imbalances in gut bacteria, when there is overuse of antibiotics or NSAIDs, when there are foods present that the immune system thinks are hostile invaders or when hypofunction of the GI tract leads to low digestion. When the intestinal border becomes “leaky”, the GALT stationed outside of the intestines becomes activated leading to low-grade inflammation. This inflammation has been tied not only to obesity, insulin resistance and other physical maladies intertwined with depression, but actually to depression itself. This is one of the ways that our gut health interacts with out mental health – studies have shown time and again that low grade inflammation is a causative factor in the development of chronic depression due to the effects of immune system upregulation on brain chemistry.
For that reason, it is important to treat the GI organs as part of our mental health solutions. Since low stomach acid, low enzyme secretion and low movement of food through the stomach and intestines are all possible underlying causes of intestinal permeability, these should be addressed. They are also all “cold” conditions of low function that are often found in the same groups of folks at risk for chronic depression. Foods that assist with increasing what we call “digestive fire” and good forward movement of foods are similar to the ones listed above. It is also important to minimize inflammatory foods in the diet to decrease the chances of immune system activation if permeability is present.
Supplements and Such
Our gut bacteria are largely responsible not just for serotonin production but for how well our intestinal wall works. Seratonin is the neurotransmitter most directly linked with “happy”, although this is an admittedly reductionist way of looking at things. It is also the neurotransmitter targeted by most long-term medications used to treat depression.
So when our gut bacteria are also on the list of things that are cold and hypofunctioning, we definitely have some good reasons to care. For that reason, adding daily probiotics is always a good idea. Add:
*One cup of good quality fermented foods daily (sauerkraut, yogurt, kimchi, kombucha) or:
*a good quality daily probiotic supplement: it should be refrigerated, and should contain at least three strains of bacteria
Adding the following daily supplements can also enhance mental clarity, boost mood and improve nerve function, the last of which is important for both mental health and GI health. Since the nerves in our gut are able to function largely independently, the health of our nervous system affects not just our brain chemistry, but our belly chemistry as well. And as we’ve seen, they are quite intertwined:
*Omega 3 Fatty Acids (EPA & DHA)
Flower essences are also a great intervention to consider in any and all mental health concerns. Furthermore, pharmaceutical medications are necessary and life-saving for many, and folks should never be shamed or discouraged from seeking medical treatment when needed.
Our herbal interventions with depression focus on three primary areas:
1. Lifting the nervous system and the metabolism
2. Supporting the GI tract
3. Addressing pain
Herbs for Lifting
Lucky for us, the herbs that gently stimulate both the nervous system and the metabolism through a depressed state are largely the same, and with a few notable exceptions which we will discuss, when we stimulate one, we stimulate the other. Metabolic support through depression is important, since everything slows when the mind & heart slow. Here we look to aromatic nervines, largely in the form of the more warming members of the mint family:
*Mugwort (not a mint)
In addition to these, we add to the list the “brightening flowers” of the Western apothecary:
*St. John’s Wort
These happy little plants pair well with the warming mints to uplift the spirit and support the nerves as well as the immune system. St. John’s Wort is also an excellent remedy for chronic nerve pain and enteric nervous system support. It pairs especially well with lemonbalm. It should not be used with folks who take antidepressant medications from the SSRI, MAOI or SNRI families.
All of these herbs are well prepared as both tea and tincture, and decisions about which preparation to use should be based on personal preference. Keep in mind that multiple cups of tea daily can seem like heaven to one person and also feel completely overwhelming to someone else
Milky oats is a gentle, well-tolerated herb good for all folks struggling with mental health, and a daily tincture dose of 40-60 drops is great fundamental medicine.
Moderate Depression Triplet:
* St Johns Wort, Milky Oats, Mugwort
Classic Balanced Hypnotic Triplet (for depression with insomnia):
*Skullcap, Passion Flower, Valerian
Supporting the GI Tract
Herbs to heal the intestinal wall:
These should be taken together as a daily infusion in large doses to “coat” the mucus membranes that line the intestinal wall. Patients can sip on a water bottle full throughout the day.
Herbs to increase digestive fire, acid and enzyme secretion:
With cold folks, start with warming aromatic carminatives -
As long as some of the above herbs are also being given, its ok to give bitters. Bitters are lovely, but they are also quite cold. When the person is very cold already, be mindful of this, and make sure to give plenty of warming herbs in addition:
*dandelion (added liver support)
*burdock (highly nutritive to the gut)
*yellow dock (added support for constipation)
Carminatives are best taken as tea. Bitters can be taken as tea or tincture, but the bitter taste must be present – it cannot be covered up by honey or sugar.
Herbs for Chronic Pain
This remains a tricky topic because there are so many underlying causes for pain. For now, I will post several resourced for further reading on herbal management of chronic pain, and we will circle back to the topic in future writings:
Dr. Jill Stansbury. Herbal Formularies for Health Professionals Vol 4: Neurology, Psychiatry and Pain Management. Book.
Reflections on Depression Management:
1. Manage expectations. Let go of “shoulding” yourself. Depression can really rule our feelings while “in the thick of it.” It is difficult to be objective and know that this feeling is not permanent. For these reasons take self-care and stress management back to square one. Think simple acts, like grooming, eating, sleeping. These are typically disrupted for several reasons when depressed. So instead of doing something 100%, congratulate yourself for 20%, whatever you can muster. It does not have to be all or nothing, black or white thinking, the grey is really important during these days.
2. Self Compassion. Boundaries are important, protecting your energy is important. This means being kind to ourselves as we distance ourselves from the figurative and literal Negative Nancy’s in ourselves and in our lives. We may not have total control over this depending on certain circumstances, but we can minimize influences that deplete us and our energy. This is where our power resides within our response.
3. Authenticity. Often what we are showing to the world is not what it is we are experiencing internally when we are going down the landslide of depression. Often withdrawal begins, we lose interest in things we typically enjoy, and we start to pull away from others as well. We struggle to reach out and ask for help for fear of being a burden or others not understanding what we are going through, feeling alone and lonely is common. Having a plan for what red flags to notice, go-to self care and whom to reach out to before an episode arrives can be helpful. This can be named a safety plan but really it would not hurt for anyone to do this exercise. Know your needs.
4. Attune to the body. Another way to get out of the mind and into the body, which can be often disconnected due to fatigue at this point. Practicing joyful movement and expression whether that is stretching, walking, dancing, singing, being playful can help to release endorphins and come alive. Doing this even 10 minutes a day can have benefits. Bonus points if it is in nature!
5. Feel and Express. Feel what you need to feel. Your emotions are valid and should not be minimized and you do not have to explain why you are feeling this way, sometimes it just is. It can be troubling sitting with feelings and quite uncomfortable. Remember this is a practice, seek healthy and helpful outlets.
6. Belonging. Whether it is family, friends, a community meeting, or book club, having places where you can feel a part of something larger than yourself is a protective factor against depression and when in depression, being able to honestly share how you are doing among real supports who love and care for you unconditionally is crucial.
7. Resources and tools. Being preventative, it would be ideal to have professionals like a general doctor, counselor, that you have established relationships with so that these conditions can be managed via a variety of interventions. However, not everyone has the privilege of health insurance. If you are someone who has lived with depression, you may know suicidal thoughts are a symptom. So, knowing the free and available resources like the suicide hotline and/or text line can be lifesaving. The National Suicide Prevention hotline is 800-273-8255 it is available 24/7 free and confidential. You can also visit suicidepreventionlifeline.org and do web chat if this is more comfortable and/or accessible. Lastly a crisis text line that is local to us is texting home to 741741.