Trading Pain for Love, Through Movement: Ending Depression in America
An Integrative Approach to Ending Depression in America
A lingering cloud of heavy darkness follows over 18 million Americans at any given time (NIMH, 2016). This cloud does not blow away in the wind, nor does it dissipate on the sunniest of days. It follows about its victims like the shadow of a lurking stranger. Stalking them like prey, this cloud attacks and kills more than 120 people every day in America and leaves others alive to suffer its wrath more than any other disorder (National Center for Health Statistics. Health, United States 2015). This dark cloud is called Depression. Its victim’s numbers continue growing as more lives and families become destroyed by its wrath each year. Depression is the leading cause of disability worldwide. It accounts for over 10% of our healthcare’s economic burden (Greenberg, Fournier, Sisitsky, Pike, & Kessler, 2015) and the current forms of treatment are simply not doing enough to solve the problem.
In my discussion on taking an integrative approach to the treatment of depression I will be focusing on some key ideas. They are:
· A brief description of the pathology, signs and symptoms of depression
· Current allopathic remedies for depression and their effectiveness
· A brief review of the Insular Cortex (IC) region of the brain and how its activation can be so vital to the treatment of depression
· How specific movement practices can achieve effective results in the treatment of depression
· A suggested protocol in which to integrate specific movement practices to permit lasting change in a Depressed Person (DP)
The many Faces of Depression
Depression is the most complex psychiatric disorder on the planet. It can show up in a multitude of ways for any unknown length of time. It is most commonly seen following adverse or traumatic life events in people suffering from it but can also take over its victims for no comprehensive reason at all. The most notable symptoms of depression, as defined by World Health Organization (WHO, 2017) include: lowered levels of interest and enjoyment, lowered energy, and depressed mood lasting for at least two weeks. Emotional symptoms are further illustrated by Mental Health Specialist Ashley Santangelo as: a “struggle with a relentless sense of hopelessness, prolonged sadness, sudden episodes of panic, recurring flashbacks to a traumatic incident, or intense fear that others might be out to harm you” (Santangelo, 2018). The severity of depression is another factor which must be discussed, as it will be referred to throughout this article. The severity of depression is found using a Beck Depression Inventory (Sellers, n.d.) which ranks symptoms from 0-63, where 0-13 indicates minimal depression, 14- 19 mild depression, 20-28 moderate and 29-63 as severe. While the many faces of depression are given names such as: Post-Pardon Depression, Bipolar Disorder, and Post Traumatic Stress Disorder, there are two common threads which tie each of them together: Depression is miserable. And, there ARE ways of improving.
Current Allopathic Remedies
Over the past ten years suicide rates in the United States have skyrocketed by 21% taking the lives of 35,000 depressed persons per year (NCHS, 2015). Meanwhile, the number of people using depression medications in the United States has nearly doubled. When we take the placebo effect into account, the numbers show that these forms of allopathic treatment are effective in the treatment of the disorder just 30% of the time (NCBI, 2017). These statistics point to one conclusion: the current marketed allopathic remedies are not good enough.
Some of the most commonly prescribed remedies for depression include:
Selective Serotonin Reuptake Inhibitors (SSRI)
Tricyclic Antidepressants (TCA)
Selective Serotonin Noradrenaline Reuptake Inhibitors (SSNRI)
Each remedy uses different methods to increase availability of imbalanced chemicals in the brain of a depressed person. While TCA’s have been around the longest, making way for more cutting-edge treatments such as serotonin-based treatments, each of them scores an F when it comes to level of effectiveness in the treatment of depression as well as curbing the likelihood of a relapse which docks in at just below 30% effectivity in suffering a relapse (NCBI et. al.). Clearly, something needs to change.
The Insular Cortex- The Gateway to an Integrative Approach to the Treatment of Depression
As we have seen in multiple studies, including one of the most notable works on insular cortex function (especially from the right hemisphere of the brain) (Sridharan, Levitin, Menon, 2008) we find that when the right frontal-insula cortex (rFIC) is active it allows for a deactivation in Default-Mode Networking (DMN) in the brain, and switching to an activation in the Central-Executive Network (CEN). What we can immediately draw from this finding is that by stimulating the insular cortex, particularly on the right hemisphere of the brain we begin to tap into functions of the CEN. These functions, as described by Sridharan et.al. as “critical for the active maintenance and manipulation of information in working memory, and for judgment and decision making in the context of goal directed behavior” (2008).
“Goal directed behavior;” an idea not often prioritized by a person suffering from depression. Naturally then, finding ways to stimulate this region of the brain and finding ways to begin marrying it to goals of positivity, growth and love becomes of top priority in any effort to construct an integrative approach to treatment of depression and all of its forms.
Not only does this study show that by activating the rFIC we activate the CEN and promote positive action, but perhaps just as important as this, by activating the rFIC we deactivate the DMN. This is a profound piece of information since we are discussing a disorder that exists deep in the subconscious default of the current wiring of a human brain. In other words; by creating an environment for a depressed person to switch off their default depressed existence, we can make room for a goal-oriented, life of happiness, purpose and love. I again refer to love as a proposed destination of good health for a DP for reasons which we will discuss in sections to come.
In another breakthrough study (Williamson, McColl, Mathews, Ginsburg, & Mitchell, 1999) conducted to test the activation of the insular cortex during different intensities of exercise, 18 participant’s IC activity were tested during three different levels of exercise intensities. What was found by the study concluded that activation in the rFIC was significantly affected by the exercise and intensity of exercise.
Yes. The rFIC. The specific region and hemisphere which was also associated with an activation in CEN and a deactivation in DMN became significantly more active in response to the magnitude of exercise. This then, provides valid reasoning to suggest movement as a key modality of treatment from depression. Simply by moving (exercising), we are able to drop the gates of Default-Depression Networking, while simultaneously activating the autonomic Executive-Goal-Oriented Network. So, now the question is: Which styles of movement will best serve a DP in orienting their goals toward?
The Movement for the Cure
In this section, I discuss an alternative approach to the treatment of depression by way of movement. Although the research shows that nearly all forms of movement can aid in the elevated activity of rFIC and therefore effect positive change in a DP, I will be focusing on three specific types of movement in which I foresee to be the most beneficial in the treatment of a DP. They are:
· Somatic Therapy
· Cardiovascular exercise (preferably outside)
Somatics, as stated by its’ creator, Thomas Hanna “is the soma’s (the body as experienced from within) internal process of self-regulation that guarantees the existence of the external bodily structure. Hence, the dictum that is universally valid in Somatics: function maintains structure” (Hanna, 1998a). Hanna goes on to explain how this law remains true as structure maintaining function, just the same. So, to address one is to address them both. By implementing exercises that serve to pull a DP out of a body which is expressing depression is the key factor in using Somatics as a tool for treatment. By activating weak movement patterns while deactivating overused ones in everything from posture and depth of breathing to pace of movement and body regional muscular tension (or lack thereof) we can truly begin to help a DP in their battle against their disorder. As we find ways of unfolding or unlocking stored energy in the body by reactivating neuro-networks suffering from Sensory Motor Amnesia (SMA) we will find a DP to be more reflective of a happy, healthy individual (Hanna, 1998b). The theories introduced by Hanna will echo into many other modalities of exercise we explore. As we continue contemplating ways in which to activate rFIC by way of movement; most specifically movements which aim to open the body up in order to release whatever it is holding on to. One of the most profound of these methods of movement is yoga.
In a study conducted earlier this year, titled, Treating Major Depression through Yoga, in which 38 participants with a BDI score of 14-28 were placed in an 8-week hatha yoga routine protocol, performing two 90-minute yoga sessions per week for 8 weeks, half of the group was compared to a control group which simply thought about yoga for the same 8-week period. By the end of the 8 weeks it was found that BDI scores in the yogis fell to an average BDI score of <9 as compared to the control group which saw no significant changes after the 8 weeks. On top of that, 9 of the 15 yogis (60%) completed remission and are now free of their disorder (Prathikanti, Rivera, Cochran, Tungol, Fayazmanesh, & Weinmann, 2017).
“Yoga is a way to freedom. By its constant practice we can free ourselves from fear, anguish and loneliness” -Indra Devi (Goldberg, 2015).
When we apply the principle ideas of Somatics in a setting which aims to cultivate love, strength and a commitment to service, it becomes clear why yoga is such a valuable instrument in which to be used for treating a DP. In fact, “Depression consistently ranks among the most common health conditions self-treated with yoga” (Prathikanti et al). One of the other more popular alternative medicines used for the treatment of depression is meditation. In her thorough article: A Blueprint when Feeling Blue, Mental Health Specialist, Ashley Santangelo describes her (and many of her clients’) journey to overcoming depression by empowering herself through self-awareness and tools such as meditation. And, since yoga is so often referred to as a “moving meditation,” it must be given precedence when choosing a method of movement to overcome depression in America.
By now, it is clear that a DP can benefit immensely by committing to a very somatically aligned yoga program. One that focuses on opening up the closed-off body and realigning in a direction which cultivates self-love and positivity. Now, I could rest my case here and leave a DP with a solid foundation to get to work on. But I must include this last component because it has been shown to be so effective and may be more in line with certain personalities (IE: “There’s no way I would be caught dead in a yoga class”). The last form of movement in which I will discuss then, is cardiovascular exercise, particularly when performed outdoors.
The most fundamental way in which to participate in exercise is to open your front door and start running. In our study referred to earlier by Williamson et al which addressed exercise as a means of activating rFIC, the participants who achieved the best results were simply riding a stationary bicycle. Whether a DP is riding a bike, running, hiking, skipping rope or crawling around like an animal; by performing cardiovascular exercises outside they are also receiving the many benefits of moving and thriving in a “green environment.” In a study pulled from the Journal of Integrative Environmental Sciences it was noted that “Feelings of anger, depression, tension and confusion all significantly reduced and vigour increased” after participants completed walks through four different National Trust sites of natural and heritage value (Barton, Hine & Pretty, 2009). So, what can we conclude form this? Get outside and move! By subjecting a DP to movement and activating the rFIC we make pathways that can allow for change. By performing this in a green environment, we can multiply our chances for positive change.
So, what do I suggest as a protocol for affecting lasting change on a Depressed Individual? Let’s review.
A Formula for Change
The formula is quite simple really. Move! In the most fundamental form of alternative treatments to depression the formula for change is just to start moving! Of course, as providers of effective change we must find ways of implementing the best plan possible to treat the imposed issue at hand. In the discussion on treating a depressed person and allowing for liberation from their disorder I recommend the following. It is proposed for an otherwise healthy individual who is between the ages of 18 and 60.
Somatic therapy exercises: 5-7 days a week. These exercises are rarely very taxing, but as I have shown in this paper, they are very effective in remedying a person of their depression.
Outdoor cardiovascular exercise: such as running, hiking, biking, surfing or paddle boarding 2-5 days a week. This frequency and activity type varies greatly due to the broad spectrum of age groups and unaccounted-for fitness levels between the data. I also suggest as many different forms of movement which can be completed by the individual with enjoyment.
Yoga practice: 3-6 days a week from a studio, private yoga teacher or noteworthy online platform such as Devata Active. If one decides to integrate their somatic exercises along with their yoga, this is a viable option as well. Reach out to learn about studios near you that specialize in somatic-forward yoga, or find out if I am currently taking new clients.
So, in summary: an ideal week for an otherwise healthy person suffering from depression, who is in their 30’s would look something like this: 5 days of somatic therapy in the morning, some outside cardiovascular training 2 days a week, and yoga practice 3 days a week. Of course, every individual is unique and would require their own specific formula for success with the absolute most important factor being adherence. So, when we aim to design a program for a person suffering from depression it is of utmost importance that we maintain a positive, open space for communication in order to find an honest response from the person suffering as to what we can hold them accountable for. This communication channel should be open across all modalities of help in which the person suffering is using. This means that the doctor, the personal trainer, the health coach, and the yoga teacher or therapist would all have constant dialogue about the person’s progress, adherence and effectiveness.
In the beginning of a new alternative health program such as the one suggested, an effective program for this person may look extremely different from the proposed ideal week, and perhaps the celebration of consistency in getting out for a walk in the park 1 day a week is all we can achieve for now, and that’s okay. No matter what the case, we as the integrative wellness providers must cultivate an environment and a message that indicates simply, only and fully: love, patience and trust; for, no matter what type of integrative approach a depressed person seeks out, we, as the wellness providers can just serve as the bridge to help bring them there. Back to freedom, peace and love.
· NIMH. (2016). Major Depression Among Adults. Retrieved September 15, 2017, from https://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml
· National Center for Health Statistics. Health, United States, 2015: With Special Feature on Racial and Ethnic Health Disparities. Hyattsville, MD. 2016, from https://www.cdc.gov/nchs/data/hus/hus15.pdf
· Greenberg, P. E., Fournier, A. A., Sisitsky, T., Pike, C. T., & Kessler, R. C. (2015). The economic burden of adults with major depressive disorder in the United States (2005 and 2010). The Journal of clinical psychiatry, 76(2), 155-162.
· WHO. (2017, February). Depression. Retrieved September 17, 2017, from http://www.who.int/mediacentre/factsheets/fs369/en/
· Santangelo, A. (2018, September 15). A Blueprint When Feeling Blue: How A Mental Health Diagnosis Can Be Empowering. Retrieved from https://www.jenreviews.com/mental-health-diagnosis/
· Sellers, A. H., Ph.D. (n.d.). Beck Depression Inventory 2nd Ediion. Retrieved September 15, 2017, from http://www.cps.nova.edu/~cpphelp/BDI2.html
· NCBI. (2017, January 12). Depression: How effective are antidepressants? Retrieved September 15, 2017, from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0087089/
· Sridharan, D., Levitin, D. J., & Menon, V. (2008). A critical role for the right fronto-insular cortex in switching between central-executive and default-mode networks. Proceedings of the National Academy of Sciences, 105(34), 12569-12574.
· Williamson, J. W., McColl, R., Mathews, D., Ginsburg, M., & Mitchell, J. H. (1999). Activation of the insular cortex is affected by the intensity of exercise. Journal of Applied Physiology, 87(3), 1213-1219.
· Hanna, Thomas. "What is somatics." (1988). Journal of Behavioral Optometry, 2-2. Retrieved from http://www.drupal.oepf.org/sites/default/files/journals/jbo-volume-2-issue-2/2-2%20Hanna.pdf
· Hanna, Thomas. (1988). Somatics: Reawakening the mind's control of movement, flexibility, and health. Reading, MA: Addison-Wesley.
· Prathikanti, S., Rivera, R., Cochran, A., Tungol, J. G., Fayazmanesh, N., & Weinmann, E. (2017). Treating major depression with yoga: A prospective, randomized, controlled pilot trial. PloS one, 12(3), e0173869.
· Goldberg, M. (2015). The Goddess Pose: The Audacious Life of Indra Devi, the Woman who Helped Bring Yoga to the West. Vintage.
· Barton, J., Hine, R., & Pretty, J. (2009). The health benefits of walking in greenspaces of high natural and heritage value. Journal of Integrative Environmental Sciences, 6(4), 261-278.