The Treatment of Depression in Clinical Arom

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The Treatment of Depression in Clinical Aromatherapy

Depression is a symptom more than a disease, and is increasingly common along with the rise of stress and subsequent endocrine and metabolic disturbances seen in human physiopathology. Almost everyone in today's urban society complains of suffering from mild depression from time to time as a functional disorder -- witness the stellar rise in prescription drugs such as Zoloft and Prozac, and now their "green" counterparts, St. John's wort and Kava. This highlights the importance of approaching the evaluation and treatment of depression as a symptom rather than a Western medical disease. Likewise, depression is found as a symptom among many in numerous actual Western diseases and syndromes, including malabsorption syndrome, liver disease, allergies, food allergies, intestinal dysbiosis, heavy metal and chemical toxicosis, chronic fatigue syndrome (CFS), hyperactivity (ADHD), viral infections, functional hypothryoidism, adrenal collapse, hypoglycemia and various nutritional deficiencies. These conditions can be compounded by various psychological and social factors, which in themselves are also point predisposers and triggers to depression.

It is only by accepting depression as a symptom rather than as a disease that the holistic practitioner can make a radical assessment of the particular condition presenting, and then work out an appropriate systemic treatment strategy. Another way of saying that is that depression is manifested by an individual, not by a disease. People have depression, not diseases. This is why ultimately every case of depression is unique, and requires the individually-tailored approach of holistic medicine, regardless of the particular modality employed. Making a differential diagnosis of the symptom, depression, is the specific and key method for achieving definition of the whole condition rather than acquiescing in mere symptom relief. For this, the particular quality as well as intensity of the depression needs to be evaluated and seen as a beacon to the clarify the larger contextual imbalance or disorder presenting. This underlying imbalance is usually just functional and preclinical by nature, and doesn't usually invoke organic disease. Through dose questioning of signs and symptoms it requires assessment as such.

The current orthodox medical approach to depression is severely reductionistic, often reducing as it does this condition to an imbalance of brain chemistry. While this may be an accurate description of the physiological dynamics invoked in a few types of depression, it is insufficient in explaining the many kinds of depression actually encountered in clinical practice, not to say inadequate in setting up treatment plans to manage these. Nor do alterations in brain chemistry explain the various syndrome, or typical symptom patterns, seen associated with depression. This is because the origins of depression must be sought in various other factors, nutritional, psychological, social and environmental. It is these that must ultimately be addressed to achieve a cure.

If a permanent cure for depression is sought, treatment usually entails a multifaceted approach -- although there will always be exceptions to this rule. The nutritional, psychological, social and environmental factors must be evaluated as potential causes and advised in whatever way is appropriate. Treatment strategies then may include dietary management, nutritional supplementation, herbal medication, counseling and psychotherapy (including hypnosis) in addition to aromatherapy. It's not that aromatherapy would be ineffective on its own or that good short-term results may not be achieved with it -- especially for relief of symptoms. Depression is simply a condition where one treatment modality on its own is often inadequate for comprehensive treatment and long-term cure. It's a perfect example of a condition where we need to explore the body/mind interface in the individual in order to really understand its primary origins. We should certainly be cautious never to fall into the trap of labeling all cases of depression as primarily psychological in nature, as much as primarily physiological in nature.

Clinical aromatherapy is in an excellent position to address depression because of the olfactory absorption pathway of essential oils. Based on the known neuroendocrine dynamics of essential oils, aromatherapy can help alter and regulate the neurological and hormonal functions of several cerebral centers. By stimulation of usually several of these endocrine pivots, an essential oil will promote the production and release of specific neurotransmitters and/or hormones that will counteract the loss of neurooendocrine homeostasis that is so often invoked in depression.

Still, aromatherapy treatment will only act systemically and deeply in treating depression when the originating factors are mainly psychological by nature, and when other signs and symptoms of a mental or emotional nature are present. In most other cases, aromatherapy will act on a symptom relief level, regardless of the causal context and nature of the depression. However, it's also important to realize two things in this connection. First, symptom relief in itself is not equateable with bad therapy: it simply doesn't go as deep, that's all, and treatment may take longer. In the case of depression we all agree that symptom relief is always desirable, whatever its nature or cause. Second, aromatherapy has an as yet unknown potential for addressing those case of depression involving actual biochemical imbalance. The main condition currently discussed involves an imbalance of amino acids and their biogenic amines, such as seratonin, melatonin, dopamine and adrenaline. On the face of it seems fat essential oil administration through the olfactory route would be somewhat, if not highly, influential in correcting these biochemical imbalances. But as always we have the placebo effect to consider, which may be as high as 30% in the case of depression. The fact is that we simply don't know enough about the scientific aromapharmacology of essential oils to make definitive statements about their actions in specific biochemical imbalances such as this one. In summary, we can say that aromatherapy has the potential for working most deeply and curatively in depression involving psychological factors, and to some unknown extent when biochemical imbalance is involved.

In addition, we should remember that the physiological absorption of essential oils via the respiratory membranes also contributes significantly to their overall therapeutic effect. Essential oils impact brain chemistry and therefore neuroendocrine functions not through neural stimulation of the limbic system alone. They also exert a physiological effect by their substantial molecular absorption through the cerebral circulation. This would help explain their therapeutic value in depression involving biogenic amine imbalance.

From the clinical perspective, the more commonly seen forms of depression are the following five types: liver congestion, sympathetic nervous hyperfunctioning, neuroendocrine deficiency, thyroid and adrenocortical deficiency, and pancreatic deficiency. Each type of depression has its own particular set of predisposing and triggering causative factors, and its specific syndrome (or symptom picture). Each depression type is then treated with certain types of essential oils, based on their neuroendocrine action, fragrance category and chemical components.

For example, the liver congestion type of depression is often seen with nutritional disorders present, especially nutrient deficiency such as folic acid, B12, thiamine, niacin and pyridoxine deficiency, as well as with general poor food combining, low quality food intake and/or high fat and protein intake present. Here the depression often alternates with or is accompanied by feelings of anxiety or guilt. This syndrome usually includes other possible symptoms such as mood swings, general lack of enthusiasm, chronic headaches, menstrual cycle problems, low energy and difficulty getting going in the morning, somnolence after meals (especially lunch), cold hands and feet and general improvement with regular exercise. Liver congestion may also be associated with specific conditions like immediate allergies, intestinal dysbiosis, food allergies, estrogen accumulation, estrogen deficiency, liver disease and several forms of toxicosis. The appropriate essential oil category for this liver congestion type of depression is the regulating one, which includes oils such as Bergamot, Mandarin, Grapefruit, Geranium, Rose, Palmarosa, Frankincense, Marjoram and Vetiver. These oils exhibit primarily sweet, lemony and green fragrance qualities, and often contain sesquiterpenes and sesquiterpene alcohols. They work by targeting the hypothalamus and balancing hormonal homeostasis in general, possibly through selective stimulation and inhibition of certain endocrine glands. While all these oils are regulating by nature, they each possess other particular neuroendocrine effects in addition. This should be considered in essential oil selection, and ideally we want to find the best match between the type of depression and the types of oils, each with thor usually multifaceted nature.

There is one generally recognized category of essential oils that deserves particular attention in the treatment of depression. This is the euphoric, or uplifting, category of oils, whose dynamic is stimulation of enkephalins by the thalamus. Although every oil category addresses a specific type of depressive syndrome in terms of systemic treatment, the euphoric oils can generally be used with impunity for most types of depression. This is because they work on a symptom relief level as well as on a systemic level. On a systemic level the euphoric oils address depression arising from sympathetic nervous hyperfunctioning from sensory, emotional or mental overstimulation (including grief, fear and shock). On a focal level, however, they also work symptomatically to help relieve any kind of depression. As such, they may be used short-term until systemic treatment is available or begun, and regardless of whether the more long-term treatment involves aromatherapy alone or also includes counseling, nutrition, herbal medicine, nutritional supplementation or any other form of natural therapy. In some cases, as in depression with chronic low self-esteem and insecurity, euphoric oils should not be used continuously on their own. At the very least, they should combined with one or two other oil types that address the systemic condition presenting. The main euphoric oils include Jasmine, Ylang-ylang, Neroli, Rose, Champaca, Tuberose, Clary sage, Nutmeg, Patchouli, Vetiver, Atlas cedarwood, Sandalwood and Myrrh. From the fragrance energetics point of view these oils are predominantly floral-sweet, woody and rooty.

In terms of the systemic treatment of depressive conditions, and for the purpose of this short presentation, we may conveniently divide the more commonly used essential oils into the following four groups. Note that several oils appear in more than one group, which is a typical phenomenon when we try to order complex, polyvalent oils into neat categories.

Finally, it should be emphasized that this grouping is essentially a clinical model more than a theoretically watertight construct. Also, it is a working model based on the current stow of the art, and further research and clinical experience will undoubtedly modify, reflow or refine the information presented here.

Group One

ROSE, SANDALWOOD, GRAPEFRUIT, VETIVER

The predominant neuroendocrine action of this group is both regulating and euphoric, working mainly through the hypothalamus and thalamus (respectively) to release various hormones, including enkephalins for the euphoric action. Oils that are both regulating and euphoric simultaneously are predominantly sweet in fragrance quality.

Oils in this group are ideal for depression involving liver congestion, dietary imbalances and nutritional disorders of many kinds, as well as hormonal imbalance in general. This results in an imbalance in the flow and cycles of emotions. This condition can then typically manifest as an anxiety or guilt-laden type of depression, often alternating with other distressed feelings and moods such as anger and frustration. Other symptoms often seen in individuals with this condition include mood swings, low self-esteem, low energy in the morning, loss of enthusiasm, weight problems and various premenstrual and postmenstrual symptoms in general.

Group Two

FIR, TEA TREE, NIAOULI, CYPRESS, LEMON, ROSEMARY, HOLY BASIL

The predominant neuroendocrine action of this group is systemically and mentally restoring and stimulating, working mainly through noradrenaline, dopamine and other hormonal release by various cerebral centers such as the locus ceruleus, hippocampus and amygdala. These physically and mentally stimulant oil are mainly spicy or lemony in fragrance quality.

Oils in this group address depression involving physiological deficiencies such as cerebral, systemic nervous, adrenal, thyroidal, rent, hepatic, etc. deficiencies. This typically results in understimulation of the body and mind, and often manifests as a low energy, cold type of depression. Other possible symptoms seen in individuals with this condition include fatigue, poor stamina, cold extremities, somnolence, concentration and memory difficulties, loss of motivation, feelings of grief, despondency or despair, and general low self-confidence.

Group Three

ROSE, YLANG YLANG, NEROLI, CLARY SAGE, ATLAS CEDARWOOD, SANDALWOOD, MYRRH, VALERIAN

The predominant neuroendocrine action of this group is both sedating and euphoric, working mainly through the raphe nucleus and thalamus (respectively) to release serotonin and GABA, and enkephalins (respectively). Most oils that are both sedative and euphoric exhibit mainly the sweet-floral or woody fragrance qualities.

This group of oils addresses depression involving physiological hyperfunctioning such as nervous hyperactivity, adrenal hyperfunctioning, thyroid hyperfunctioning and low thyroxine quality. This creates concomitant overstimulation (overintensity) of the emotions, senses and mind, and in turn usually results in a tense, restless type of depression. Other typical symptoms often seen in individuals with this condition include feelings of fearlessness, overconfidence, mental hyperactivity, restlessness and insomnia.

Group Four

JASMINE, TUBEROSE, PATCHOULI, SANDALWOOD, YLANG YLANG

The predominant neuroendocrine action of this group is both sensualising and euphoric, working mainly through the pituitary and thalamus (respectively) to release endorphins and enkephalins (respectively). Most oils that are both sensualisers, or aphrodisiacs, and euphoric at the same time show predominantly sweet-floral and sweet-woody fragrance qualities.

This group of oils is best suited for depression involving nervous system or selective organ deficiencies (e.g., from acute or chronic emotional or sensory trauma), sometimes with tension or congestion present This often produces an inhibition (reduction) of the emotions and the senses, which results in a lifeless, stagnant, heavy type of depression. Other possible symptoms often seen in individuals with this condition include feelings of fearfulness, timidity, low self-confidence, low sex drive and general low vitality.

The National Association for Holistic Aromatherapy (NAHA).

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By Peter Holmes

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