It is estimated that in the United States, 1 in 10 people are depressed. There are myriad of reasons for it, as well as more treatment options than ever.

In this month’s feature, “Massage Strategy For Depressed Clients,” author Pamela Fitch reveals how massage therapy can have a positive impact on clients who are being treated with depression. It also includes a list of massage techniques that have proven effective in this area.

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By Pamela Fitch

Until recently, depression carried an unfortunate social stigma: Admitting any sort of psychological condition could open a person to negative perceptions and discrimination. Much has changed in the last decade, however, and depression no longer has the stigma that this disorder once carried.

People often are astonished when a health professional suggests that their constellation of strange and seemingly unrelated symptoms might be occurring as a result of depression, but depression can complicate and color the simplest of conditions. If clients are unable to resolve their illnesses or mend their injuries, there is a good chance that depression may be contributing to the problem.

This article explores the nature of depression, and how it may complicate the lives and health of people. It also looks at how massage therapy may help manage the overwhelming symptoms of this psychological disorder.

Depression describes an inner state of being fraught with despair and blocked with feeling. There are few major illnesses that do not carry the potential for depression.

Andrew Solomon, author of The Noonday Demon, suggests that depression can only be described in allegory and metaphor because it is wholly personal and exquisitely painful to the individual. Its symptoms are vast and varied. Its effects range from annoying to life-threatening. “Perhaps depression can best be described as emotional pain that forces itself on us against our will, and then breaks free of its externals … Grief is depression in proportion to circumstance; depression is grief out of proportion to circumstance … Grief is a humble angel who leaves you with strong, clear thoughts and a sense of your own depth. Depression is a demon who leaves you appalled.”

Who Is Depressed?

Dr.Virginia Edwards, a psychiatrist, suggests that one in five people will experience a depressive episode at least once in his or her life. According to the National Institutes of Health (NIH), a Public Health Services agency under the U.S. Department of Health and Human Services: “In the United States about 19 million people, or one in 10 adults, experience depression each year, and nearly two-thirds do not get the help they need. Treatment can alleviate the symptoms in over 80 percent of the cases. Yet because it often goes unrecognized, depression continues to cause unnecessary suffering.

Getty Images In the United States, 19 million people suffer from depression. Though it affects both sexes, women experience it at twice the rate of men.

“Depression is a pervasive and impairing illness that affects both women and men, but women experience depression at roughly twice the rate of men. Researchers continue to explore how special issues unique to women—biological, life cycle and psychosocial factors—may be associated with women’s higher rate of depression” (NIH Publication No. 00-4779, August 2000).

The reasons for women’s depression are complex and interwoven among social, psychological, economic and biological strata. Pregnancy and postpartum depression are very common. Edwards suggests that nearly 50 percent of women experience some degree of depression during pregnancy, although only half of them receive treatment. Hormonal fluctuations during adolescence and menopause also may contribute to women’s depression.

Depression in women is diagnosed and reported more frequently than in men, but Terrence Real, author of I Don’t Want To Talk About It, suggests that men and women respond differently to depression. He believes that depression is far more common in men than is currently thought. According to Real, men are conditioned to be self-reliant, and to not share their feelings. To acknowledge emotions in men is considered risky at best, or unmanly at worst. Men who bury themselves in their work, simmer chronically in anger, or numb their unhappiness or discontent with alcohol may not even be aware that they are depressed.

What Is Depression?

Overwhelming sadness, guilt or sense of worthlessness are common reactions of a person who is depressed. It is sometimes difficult for depressed people to identify feeling states for themselves, and they may more frequently describe physical conditions, since these are often easier to describe. Physical manifestations of depression may include migrating chronic pain, fibromyalgia, headaches, migraines, clenching or grinding of teeth, muscle tension, stiffness, inflexibility, no desire to move or exercise, brain “fog,” and the inability to concentrate or carry out tasks to completion.

Feeling down and sad as a result of a difficult or painful event in life is normal. But if the feelings persist over a period of time, especially if the event has long since resolved, then a person may be diagnosed with depression. Edwards suggests that depressed people cannot allow themselves to express sadness because it’s too painful. They are afraid of being destroyed by the intensity of their feelings.

What Causes Depression?

There are numerous factors in the development of depression, and they range from the neurochemical to environmental, nutritional, hereditary, social and financial. When a person experiences a severe degree of stress—be it physical, emotional, social or nutritional—he or she may react by feeling overwhelmed to a point of complete incapacity, despair, anger, sadness or disconnection. There are a number of conditions that either cause or are closely related to depression: chronic pain, irritable bowel syndrome, insomnia, migraines, fibromyalgia, side effects of medications, among other things.

In addition, a person's temperament may predispose him or her to depression. If a person has low self-esteem, and little or no secure bonds or sense of community, then depression may occur. Those who have witnessed or experienced any types of abuse, or who have been traumatized psychologically, will be predisposed to depression. When a poor social support network exists, then the person is at risk.

How Massage Therapy Can Help Depression

Massage offers a unique way of accomplishing deep relaxation. How extraordinary to be able to sit quietly with another person, to ease his or her tension and to massage away the pain. Massage may not be a long-lasting cure for depression, but there is significant evidence that the “touching cure” has much to offer in the management of chronic depression in a number of age groups.

According to Dr. Tiffany Field, who has devoted almost 20 years to touch research, massage therapy is an effective way to reduce the stress hormones in the body. By soothing and calming a client, he or she may “turn down the volume” of the stressors, and more easily access a relaxed state of being. There is significant research from the Miami-based Touch Research Institutes—the facility at which Field is the director—which suggests that massage reduces cortisol levels and promotes a parasympathetic response. A study on depressed adolescents showed a significant and long-lasting reduction in urine cortisol and norepinephrine levels. The subjects in this study who were depressed reported feeling less anxiety and depression for up to five days following the massage session. They also were less wakeful and experienced better quality sleep following a massage.

Another important healing dimension that massage therapy offers is the opportunity to feel emotions that may be overwhelming, while at the same time being touched. Massage therapists do not try to elicit emotional responses in their clients, but occasionally clients are overcome with sadness, and sometimes cry while lying on the massage table. To be able to cry in the presence of someone who is comfortable with displays of emotion can be exceptionally healing. The client learns that it is all right to feel such pain, and perhaps more importantly, that those overwhelming feelings do indeed pass.

Desired Massage Therapy Outcomes For A Depressed Client

Theoretical or documented evidence for how massage therapy may affect a client is difficult to find. Clinical experience indicates, however, that short-term desired outcomes include a slowing and deepening of the breath, such as is found in sleep. Enhanced body awareness of just how the client holds tension is often instructive. The client may unclench muscles that have been tense for a long time, giving the muscles a rest and reducing the body’s overall tension. In addition, there is at least a temporary or momentary letting go of the concerns and issues that trouble the client.

Getty Images Therapy is  an important part for chronic depression treatment.  However, there is evidence massage also can help manage the condition.

A few minutes or hours after the massage, clients commonly report feeling more alert, less anxious and less inclined to the “brain fog” that causes difficulty in concentrating. Some clients have expressed a sense of wonder over being able to let go and relax, to still feel safe on the massage table, to feel unhurried, accepted, nurtured and grounded.

Gently stroking or kneading tight and sore muscles helps a client to transition from the hyperaware state or sympathetic response, to the relaxation response in which tissues are repaired, the immune system is rejuvenated and the body rests. Much of what massage therapists offer is unconditional acceptance of what is. Spending time in the present moment and feeling one’s body being touched, massaged, stroked and kneaded can ground a person, and help to reestablish a sense of balance and homeostasis.

The long-term outcomes may range from better quality sleep and better immunity and health, to a more positive body image, enhanced concentration, less chronic muscle tension and less chronic pain.

Considerations, Cautions And Contraindications

Depression is a complex condition that may be a factor in dozens of pathologies. It may be a stand-alone problem, or be accompanied by other puzzling symptoms or conditions. It is important for any massage therapist working with depressed clients to be aware of his or her limitations and abilities. If a client’s problems appear insurmountable, or if a therapist feels sad and overwhelmed after working with a depressed client, then it may be time to either seek supervision from a more seasoned therapist or to refer the client to another therapist who has experience with such conditions.

Depression can be a chronic or long-term problem. The symptoms may only be alleviated temporarily with massage therapy, giving a client much relief. But in order for the depression to be fully eradicated—if that is possible—drug
therapy in combination with psychotherapy and/or nutritional education may be necessary.

Consequently, working with a depressed client should be considered similar to working with a client who has chronic pain. It is not impossible that the pain may be cured, but it more than likely will be lessened.

Conclusions

In her book, Pain: The Fifth Vital Sign, Marni Jackson exposes the crucible of our society’s dual attitudes toward body and mind: “Why do we still distinguish between mental pain and physical pain when pain is always an emotional experience?”

Depression is pain, and is as deserving of our profession’s awareness and respect as any myofascial restrictions, neural tension, migraine or low-back injury.

Jackson writes: “Pain is not always conquerable, but it is adaptable. Fight nature, and you risk ending up like the explorer Sir John Franklin, frozen in the ice of Hudson Bay, with the rictus of victory on his face. People may remember you as very brave, but it will do you no good. Work against pain, and you lose. Work with pain, and the struggle lightens. The body is not the enemy.”

Depression causes its sufferers to feel overwhelmed by life to a point of serious or complete incapacity. Massage therapy offers grounded nurturing touch and a release from longstanding tension. It provides a kinesthetic means for reconnecting the somatic experiences of the body with the emotional and cognitive processes of mind and spirit. As massage therapists, we shouldn’t ignore the signs and symptoms of depression. Instead, by considering a client’s emotional condition when planning a session, we may support the client’s healing body and mind: “Why do we still distinguish between mental pain and physical pain when pain is always an emotional experience?”

~ Pamela Fitch, RMT, is a professor in massage therapy at Algonquin College and maintains a small private practice in Ottawa, Ontario. Her areas of interest and expertise include women’s health issues, trauma and body image. She may be contacted via E-mail at: p.fitch@sympatico.ca

Q: My company recently started offering on-site massage for its employees. What can I expect if I take advantage of this benefit?

A: More companies are realizing the value of offering massage as an employee benefit. On-site massage, (also known as chair massage or corporate massage)—is administered while the client is clothed and seated in a specially designed chair. These chairs most often slope forward allowing access to the large muscles of the back. On-site massage usually lasts between 15 and 30 minutes, and is intended to relax and improve circulation.