Ask the Doctor
by Jake Paul Fratkin, OMD, LAc

Q. My teenager suffers from bouts of depression that sometimes last more than a week. We’ve tried Paxil and Wellbutrin, which seemed to work for a while, but I’m concerned about long-term side effects. Can you offer any suggestions?

A. Teenage depression can be a very serious matter and can lead to self-mutilation, drug or alcohol abuse, attempted suicide, or even suicide. As such, it needs to be addressed quickly. The use of Western pharmaceutical medicine can help in a short amount of time, especially under the guidance of an experienced medical psychiatrist. In situations where a pattern of low self-esteem or a troubled family environment exists, psychotherapy can serve as a useful adjunct to Western medicine as well.

Often, however, the problem lies not just with the teenager’s environment or self-esteem but, instead, with neurotransmitter deficiencies aggravated by hormonal changes during puberty. In these cases, one should recognize Western prescription medicines as a reshuffling of neurotransmitters—they increase one by decreasing another, sort of a “robbing Peter to pay Paul�?approach. Natural medicine offers a deeper method that aims to boost neurotransmitter levels. You can do this with nutritional medicines, including certain amino acids, vitamins, enzyme cofactors, and Western herbs. I would look for holistic practitioners who work with this approach. They can include medical doctors, psychotherapists, doctors of naturopathic medicine, chiropractors, or practitioners of Oriental medicine.

Within TCM, we work to boost neurotransmitters back to natural levels. Instead of using nutritional components directly, our approach relies on a mixture of different Chinese herbs to regulate underlying organs and functional systems. The type of depression most prevalent in teenagers involves the liver. It occurs because of stagnant qi (energy) and blood in the liver. That stagnation inhibits the free movement of qi and blood in the body. Consequently, a sort of paralysis of intention, effort, and hope results, leaving the person feeling that things will never change. Liver stagnation can occur from the release of hormones during teen maturation and can be compounded by environmental chemicals, prescription drugs such as birth control, and over-stimulation of the nervous system.

The Chinese herbal approach uses herbs that move and regulate liver qi and blood. Acupuncture can accomplish the same effect if done on a weekly basis, and practitioners often combine the two approaches. Some teenagers have bipolar-2 syndrome, a mixed pattern exhibiting both anxiety and depression. In these cases, we regulate both the liver for depression and the heart/shen for anxiety. This approach can be quite effective for the long term but may require months of treatment to achieve relief of depressive symptoms.

Another type of depression within Chinese medicine—lung-type depression—results from grief or a shock due to loss and can actually damage the lungs and heart. It requires different herbal formulas decided by an experienced practitioner as well. For all of these types of depression, the TCM approach is certainly effective, but it’s not as quick an intervention as Western prescription medicine. In my practice, I often see teenagers who are taking certain prescriptions when they start TCM therapy. Gradually, as they boost their overall neurotransmitter levels, they can reduce their medication.

Jake Paul Fratkin, OMD, LAc, is a practitioner and teacher of Traditional Chinese Medicine who has practiced since 1978. He is the author of Chinese Herbal Patent Medicines, The Clinical Desk Reference (Shya Pub, 2001).
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