There has been much written and reported about the positive effects that a simple massage performed by a legitimate massage therapist can have on depression. The benefits of massage on depression have been touted on hourly news programs and television shows, covered by newspapers and magazines, and taught to prospective LMTs in massage school. However, due to the dearth of credible research on the matter, massage therapy as a treatment of depression remains controversial and difficult to quantify. The reasons for this are the placebo effect and the notion that a research trial should be double blind. Recall that a double blind trial is one in which the therapist and the subject are unaware that they are receiving treatment. This is virtually impossible to obtain in massage therapy research. However, according to the Journal of Clinical Psychiatry (March 2010), 17 studies were identified using massage therapy as a treatment of depression and all of the studies, though inconclusive because they lacked “well-designed and longer follow-up studies, including accurate outcome measures”, had “potentially significant effects” on the alleviation of depression Now, without throwing science out the window, answer me these two questions.
2. How many of you felt relaxed and a sense of greater energy afterwards?
That many! That is what I thought? Me too! I have never got off of a massage table feeling worse than I did when I got on it. So… Mr. and Mrs. Scientific research, can we for just a moment drop all pretense of what can “potentially” occur and understand that massage has for centuries made us feel good and been used as a holistic therapy to ease people’s pains whether physical, emotional, or psychological. That perhaps the science of touch itself is enough to warrant that while not being the sole treatment for depressed individuals may be a bona fide benefit to those who are suffering from depression? I agree more research needs to be done, but if it feels good and does not cause harm, then massage therapy is probably a good idea to incorporate into a depressed individual’s treatment strategy.
What is depression? Depression is a group of disorders that causes changes to the emotional state that affects an estimated 20 million Americans that can range from moderate to severe to chronic. There are many causes for depression and colliding factors such as genetics, environmental triggers, chronic pain and illness, and historical or family experiences. According to Ruth Werner (Massage Today October, 2003) different subsets of depression have shared symptoms such as
- Feeling sad or empty
- Experiencing decreased enjoyment of life
- Feelings of guilt or disappointment
- Changes in sleeping habits
It is believed that in depressed individuals, that there is an imbalance of neurotransmitters, serotonin, norepinephrine and dopamine caused by a deficiency or resistance by central nervous system neurons. This can lead to disruptions in hormonal secretions especially progesterone and estrogen as well as our happy hormones, endorphins and our stress hormones, cortisol. The hormone ACTH (adrenocorticotropic hormone) stimulates the release of the stress hormone and it is believed that depressed individuals tend to release more ACTH than individuals with a healthy sympathetic response. Robert Sapolsky, author of Why Zebra’s Don’t Get Ulcer’s explains the difference between a healthy sympathetic response and an unhealthy sympathetic response. On the plains in Africa, a zebra calmly grazes on grass without a worry in the world until a lion jumps out from its hiding place and chases the zebra. The zebra’s sympathetic fight or in his case flight reaction occurs and adrenaline is released, the eyes dilate, digestion ceases, and the heart rate increases, just to escape from impending disaster. After the lion gives up the hunt, the zebra’s parasympathetic rest/digest system kicks back in and the zebra resumes his lunch of grass. Why doesn’t he get an ulcer then like humans may do? Because he does not reflect on what just happened. He does not wonder why that lion always chooses to chase him. He does not worry about the next time he will be chased. Individuals who just escaped being hit by the bus on street have a healthy sympathetic response. Individuals who have the same response to their child spilling milk on the floor have an unhealthy sympathetic response and are typically treated for depression with antidepressants and psychotherapy. Why not massage therapy?
Soothing touch or massage increases the efficiency of our parasympathetic rest/digest system. Since massage is relaxing, it helps the body operate optimally increasing circulation and lymph flow, decreasing cortisol (stress hormone), and increasing serotonin (happy hormone) and the levels of oxytocin, (trust hormone). That is what massage does from a hormonal and neuroscience view. What about physiologically? When thinking of our inherent response to stress think about what you would do if someone was to throw an object at you. In that second of response, you would try to fold in on yourself for protection. That is you would try to roll into a ball- to most of us this is physically not possible –but the body tries anyway. Our abdominals shorten pulling the diaphragm tight, our back hunches, our head projects down and in, our shoulders roll inward, the eyes wince. Now take that quick response and slow it down over time as life beats you down, deadlines loom, bosses breathe down your neck, foreclosure notices come in, etc.; those same physiological traits remain and compound into a structural collapse. One of the goals of massage therapy, according to Don McCann in a February 2009 article in Massage Today, is to release the structural collapse by treating the abdominals, the pectorals, and the muscles of the shoulders and the neck and follow up with lower extremity work to help bring them more under the body resulting in a significant structural change, thereby improving breathing process and promoting increased energy.
As health care practitioners, we understand the need for more scientific research involving states of depression and how it can be alleviated with massage therapy. Please understand, we are NOT advocating massage as a replacement of professional treatments by physicians, psychotherapists and or psycho-pharmaceuticals. Massage Therapy is not a cure for depression. However, based on the present research, we can agree that massage therapy is beneficial to individuals suffering from depression and when carefully administered by legitimate massage therapists is a reasonable additional therapy.
Kip Yates, LMT was trained at the Swedish Institute in New York City and is New York State and Texas State licensed. He is owner and operator of Massage Refresh in New York City where he provides Swedish wellness and recuperative Deep Tissue massage that encompasses myofascial release and trigger point therapy. Kip lives in Brooklyn with his wife and three children and also practices at Physiofitness Physical Therapy in Soho.