During the summer of 2020, I experienced the most stressful but provoking two weeks of my life. I worked at a mental hospital specifically with children. My mentors are psychiatrists who have been working there for at least ten years. The first time we met, I listened to them introduce themselves and the whole system in the department. They spoke in a flat but mild tone and had distant but friendly temperaments. I started to realize that psychiatrists need to separate work and life. During the first week of doing rounds, I was terrified by every patient I saw. They were all beautiful teenagers, even children, but their mental conditions were seriously concerning. For example, one boy told me about some eyes on the wall. I knew his illness and medications, but at that moment, I was frightened. I did not know what to say to help him. As time passed, I got used to my work. I developed distant but friendly relationships with patients and families. All of my experience in the hospital has been valuable and inspiring. It led me to become interested in psychiatry and left me with burning questions about treatment and interventions.

Depression has gradually become a major mental illness, and society’s attention is steadily turning towards it. According to the World Health Organization, 3.8% of the world population, including 1.9 million children, are diagnosed with depression (Depression). Treating depression relies on many practical applications and clinical experience because it is often unclear why some people experience depression, even though there are explanations in neuroscience and Eastern medicine. Currently, many hospitals all over the world apply treatments for depression derived from both Western medicine and Eastern medicine, such as acupuncture, herbal medicine, chemical medicine, and electroconvulsive therapy. Hence, new research on combining these two perspectives is explored to study safer and more effective treatments for patients with depression.

This research paper will present information from both Eastern and Western medicine perspectives and explore how they can co-exist in treating psychiatric disorders. Even though psychotherapy has been a significant development in treating mental illness, this paper will focus on physical and medical treatments to discuss every detail. For example, selective serotonin reuptake inhibitors are major treatments from the Western perspective, while Danzhi Xiaoyao Powder is one of the most traditional prescriptions from the Eastern perspective. The diagnosis of depression will be examined through cultural and medical lenses from each perspective to explain how depression is viewed and how treatments are developed. Then, the passage will point out some advantages of combining Western medicine and Eastern medicine. Finally, the last section will provide predictions of some future developments in treating depression. Based on the local cultures, different extents of combination occur. The article will indicate several relative issues about treating depression as well.

Western medicine sets the background for analyzing mental illness from a scientific perspective. Its development presents a gradual understanding of the human brain and chemical substances. Even though the mechanism behind depression is unclear, researchers conduct studies, clinical trials, etc. Currently, there are various hypotheses and theories for depression. According to each hypothesis, treatments are designed and approved to treat the illness.

1.1 Monoamine hypothesis

The Monoamine hypothesis, a major theory for depression, proposes that patients with depression have depleted concentrations of serotonin, norepinephrine, and dopamine. Many medications were developed based on this hypothesis which explains the theories of depression. Currently, more recent clinical studies have provided evidence showing that the hypothesis for depression needs to be revised. The theory of depression is not as simple as the hypothesis suggests. There are more and deeper reasons that cause depression. The revised monoamine hypothesis has several suggestions. Monoamine depletion may function as a modulator that influences other neurobiological systems, such as intracellular signaling and other neurotransmitter and neuropeptide systems. Besides, monoamine depletion may cause depression under pressure. After the basic introduction of the monoamine hypothesis, various types of medications are the essential parts of psychopharmacology.

1.1.1 Monoamine Oxidase Inhibitors (MAOIs)

In the 1950s, the first invented medication for depression was Monoamine Oxidase Inhibitors, MAOIs. It is an effective inhibitor for monoamine oxidase. On the other hand, it has severe side effects, including dizziness, insomnia, and somatic disabilities. MAO is an enzyme that generates oxidative dissemination of biogenic amines and sympathomimetic amines. Iproniazid was the first successful MAO inhibitor treatment for depression. However, it is a non-selective irreversible MAO inhibitor that might lead to safety concerns, including hypertensive crises, so it was eventually removed from the US market (Shen, 877). In order to improve the safety of MAO inhibitors, researchers focused on reversible and selective MAOs inhibitors, such as moclobemide and brofaromine.

1.1.2 Tricyclic antidepressants (TCAs)

Moving on to the 1980s, Tricyclic antidepressants, TCAs, replaced MAOIs. In 1898, iminodibenzyl was synthesized as an antipsychotic drug, but then scientists realized that it could elevate mood rather than treat schizophrenia. It was considered the most effective antidepressant until more medications were discovered in the 90s. However, TCAs have many severe side effects, so they are currently not the first choice of antidepressants. A commonly used TCA called Amitriptyline is used for major depressive disorder and is a highly effective mood stabilizer. Based on different conditions of people, amitriptyline brings various side effects. In severe situations, patients will experience dizziness, body ache, illusion, seizure, etc.

1.1.3 Selective serotonin reuptake inhibitors (SSRIs)

In 1948, when 5-hydroxytryptamine, 5-HT, was first separated and synthesized, scientists discovered that this neurotransmitter has multiple functions, such as regulating pain, sleep, and mood. Currently, many medicines that target 5-HT to treat depression are considered to be the most effective treatments. Selective serotonin reuptake inhibitors (SSRIs) are used in 50% of depression treatments. SSRIs can be absorbed well orally, and there is no specific impact on diet. In addition, it can function for a relatively long time compared to other medications. On the other hand, some side effects may impact certain individuals to varying degrees. Usually, the side effects occur in the first week of treatment, and ideally, they will disappear after three or four weeks. Nausea and headache are common symptoms that are associated with doses of medicine. Side effects have different mechanisms: nervous system, gastrointestinal symptoms, sexual dysfunction, allergies, 5-HT syndromes, withdrawal reaction, and others. Among these, gastrointestinal symptoms are prevalent, given that almost 90% of the body’s serotonin supply is found in the intestinal system. Fluoxetine, for example, was approved by FDA in 1987. It is comparably safe and effective, especially for the elderly and pregnant women. In addition, it does not increase the risk of suicide in the overall evaluation of controlled clinical trials. Fluoxetine has been used to treat various mental illnesses, such as bulimia nervosa, depression, and Obsessive Compulsive Disorder known as OCD. It acts on the same neurochemical pathways as those previously mentioned and has little effect on other neurotransmitters. In a journal article called Fluoxetine: A Review on Evidence Based Medicine, Andrea and colleagues gather many experiments and studies for a review of Fluoxetine. The authors aim to understand if Fluoxetine is safe and effective compared to previously used drugs and point out Fluoxetine’s role in treating diseases. After selecting some studies and experiments that match the authors’ research, they analyze the data from the studies. Significantly fewer patients discontinued treatments due to any adverse event compared with TCAs. Also, using a small dose, 20 mg/day, has improved safety and tolerability compared with using higher doses of Fluoxetine. Last but not least, this medication works quickly. Its most common side effects include the central nervous system, gastrointestinal symptoms, and sexual dysfunction (Rossi).

Take Citalopram as another example. In 1998, FDA approved it as a medication for major depression. It is the most potent specific serotonin reuptake inhibitor. Like other SSRIs, most patients who orally take Citalopram will not experience difficulties in eating or changes in appetite. Its major side effects occur in the central nervous system. For example, the most common side effect is sleep disturbance, such as insomnia, drowsiness, and vivid nightmares. In addition, the interaction between citalopram and other medications is serious, which influences the effectiveness of treatments. Similar to Fluoxetine and Citalopram, Paroxetine, Sertraline, and Fluvoxamine are commonly used medications for depression. Even though their chemical structures are different, they all work as specific serotonin reuptake inhibitors by improving the function of serotonin receptors (Shen, 896).

1.1.4 Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Another big category of antidepressants is Serotonin-norepinephrine reuptake inhibitors (SNRIs). Venlafaxine, a medication introduced to the United States in 1993, belongs to this group (Shen 898). As its name suggests, this drug targets the serotonin and norepinephrine transporters. Some studies indicate that SNRIs are more effective than SSRIs, but the differences are not very explicit. In addition, the side effects of SNRIs, such as sexual dysfunction, are similar to those of other antidepressants.

1.2 Glutamatergic system hypothesis

Even though there are various types of antidepressants, they all function by producing an immediate increase in monoamine neurotransmitter concentrations. In order to help the patients who do not respond to these medicines, researchers are focusing their attention on further study and the development of new medications that function differently. Recently, the glutamatergic system has been a major topic for this development. Glutamate is the primary excitatory neurotransmitter in the brain. Based on the studies, both indirect and direct measures indicate glutamatergic dysfunction in depression. Major Depressive Disorder, MDD, and chronic stress exposure cause atrophy of neurons in cortical and limbic brain regions and alter connectivity and network function in the brains of depressed patients.

1.2.1 N-methyl-D-aspartate (NMDA) receptor antagonist

If patients receive chemical substances that reduce the inhibition of glutamate, they may notice positive changes in mood. A great example of a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist is Ketamine. It has been used for nearly 50 years as an anesthetic, and it has been abused to uplift mood significantly. In 2000, it was first used to treat depression. Compared to SSRIs, Ketamine can effectively and rapidly help depressed patients who have no response to other antidepressants. The treatments need to be precisely utilized, or patients can become addicted and have other serious side effects. In most situations, the safest starting dose is usually 0.5mg/kg. Based on the bioavailabilities of different methods to take Ketamine, intravenous injection has been shown to be the most effective and comfortable way. In 2019, the FDA approved a nasal spray of Ketamine. Even though there are possible side effects, Ketamine does not damage the cardiovascular system and respiratory system, so it is considered a safe treatment. In addition to Ketamine, another noncompetitive NMDA receptor antagonist is Memantine. Though Ketamine and Memantine have approximately the same binding affinity for the NMDA receptors, they do not show similar antidepressant effects. Memantine is effective as antimanic and mood-stabilizing medicine. Also, it has an excellent safety and tolerability profile based on clinical practices. Moving forward, scientists have developed many options for antidepressants. Currently, there are low trapping NMDA receptor channel blockers, NR2B subunit selective NMDA receptor antagonists, partial agonists at the glycine binding site of NMDA receptors, excitatory amino acid transporter two enhancers, and many others.

1.3 Inflammation & depression

According to a book called The Inflamed Mind: A Radical New Approach to Depression by Edward Bullmore, depression is linked to inflammation. Bullmore indicates that the mind and body are not distinct systems. When he first became a doctor, one of his patients with rheumatoid arthritis, Mrs. P, suffered from chronically inflamed hands and chronic depression, which led him to think about the link between physical ailments and mental states. Inflammation is a protective mechanism of the body by the immune system. However, the blood-brain barrier is less impenetrable than previously assumed. So, the inflammatory proteins and cells in the body can directly change the brain’s functions, which can lead to changes in behaviors and thoughts. According to the data, 25% of inflamed patients have depression, and one-third of depressed people suffer from inflammation (Bullmore). The treatments based on this hypothesis are using anti-inflammatory drugs, such as Remicade. These drugs will reduce the levels of cytokines, a protein that communicates inflammatory signals throughout the body and circulation, so they can stop the communication between the brain and inflammation in the body, blocking the influences of inflammation on mood and behavior.

1.4 Electroconvulsive therapy

Evil spirits have always been considered a reason for mental illnesses, so people would use all kinds of exorcism in the early stages of treating the illnesses. In the earliest records of the study of medicine, healers and priests utilized herbs and other medicinal plants to induce convulsion to cast out evil spirits. Moving on to the 17th and 18th centuries, attention shifted to electricity and its ability to induce convulsions stronger and more effective than herbal remedies. In 1932, three Italian therapists noticed that many of their depressed patients also had epilepsy. If the patients’ epileptic seizure was treated, their depression would be largely alleviated or even cured. Hence, they tried electroconvulsive therapy on a homeless man with schizophrenia. As a result, the man was treated well. From then on, many psychologists started to use electroconvulsive therapy for schizophrenia or severe depression. In the 1930s, ECT was very popular for depressed patients since there were no effective medications for depression then.

During the development of ECT, doctors would anesthetize patients, but they had difficulties paralyzing muscles, so some patients would experience severe seizures and fractures. Then, in the late 1950s, muscle relaxers were developed, which supported the development of non-convulsive electroconvulsive therapy (Nuland). Before the treatment, doctors used muscle relaxants and intravenous anesthetics to induce patients into general anesthesia. Then, they pasted electrodes on both sides of the patients’ temporal region. According to the patients’ situation, the current stimulation intensity varied. There will not be seizures and fractures, and the body still experiences changes in the brain. In a study conducted in 2021, Wang, Bai, and Liang explored the efficacy of non-convulsive electroconvulsive therapy in patients with treatment-resistant depression. They found that the treatment acts fast and effectively. It reduces the cortisol level in the blood and triggers physical changes in several brain cells linked with depression. Based on the conditions of different patients, non-convulsive ECT is combined with other treatments. Their data also points out that non-convulsive electroconvulsive therapy can effectively alleviate patients’ suicidal ideation. Although ECT has been a controversial treatment, it is an effective treatment for severe depression because about 10% of patients show no response to medications (Wang, Bai, and Liang).

1.5 Discussion

From the Western perspective, depression is a disorder that can be explained by chemical substances and neurons. In order to develop better recognition of our physical conditions and mental states, people keep exploring innovative paths to treat depression. Since the mechanisms under mental illnesses are not clear, neither monoamine deficiency nor glutamate receptors can be the complete explanation for depression. Hence, improving hypotheses and testifying theories with scientific attitudes support people with depression to have more available treatments.

Eastern medicine emphasizes the integrity of the body and environmental influences on internal homeostasis. So, in the comprehension of mental illnesses, Eastern medicine supports the indistinct relationships between human and nature, objectivity and subjectivity, and mentality and physicality. As this perspective has been developed for thousands of years, it has a complete and unique worldview for diagnosis and treatments. According to the documented ancient knowledge, depression is induced by physical problems, such as dysfunction of organs and yang-qi deficiency. All mental activities are based on the body, so repairing physical conditions is essential to treat illnesses.

2.1 Fundamental theories

Based on the Eastern medical perspective, depression can be categorized into positive syndromes and deficiency syndromes, including Qi stagnation, fire stagnation, phlegm stagnation, blood stagnation, heart and spirit loss nourish, deficiency of both heart and spleen, Yin deficiency, and fire excess. Emotion is a major indicator of people’s mental conditions. When people are depressed, they have little euphoria and much sadness or fear. Meanwhile, the ultimate reasons are physical illnesses, such as disordered qi, an imbalance between yin and yang, and dysfunction of organs.

First, in Eastern medicine, euphoria, anger, worry, thought, fright, fear, and sadness are the seven emotions that impact qi’s movement, which further influences organs and human health. Each of the emotions corresponds to a specific somatic symptom and an organ. The heart is related to euphoria and fright; the liver is related to anger; the lung connects with worry and sadness; the spleen relates to thought, and the liver relates with fright. Either feeling too much emotion or lacking it will cause illnesses (Rossi, Emotions and the Movement of Qi). For example, if you overthink, your spleen is harmed, and your sleeping quality decreases. However, if you don’t think, you lose control of qi in the body. Hence, the stability of organs and emotions strongly depend on each other. Moreover, the relationships between yin yang and emotions can be the causes of depression. The disorders in organs are shown through the imbalanced flow of yin and yang. For example, dysfunction of the kidney, lung, spleen, and other viscera might induce deficiency of yin, which in turn damages people’s sleeping quality and diet.

During different periods, philosophers held on to various theories about depression, which led to multiple treatments. In Huangdi Neijing, “愁忧者，气闭塞，而不行” (本神). It says that if the patient feels sad and inactive, the flow of qi will be stagnant, causing illnesses. In addition, Zhang Shi Medical Guidance, published in the Qing dynasty, points out that deficient blood in the heart and lung might induce depression (Lin and Wang). Until 2000, Qu, a researcher, pointed out that depression is considered a deficiency syndrome because of its typical symptoms, including lacking interest, feeling pessimistic, a decrease in memories, and others. Eventually, after doing clinical practices data analysis, depression is further classified into six types: kidney deficiency with liver stagnation, liver stagnation with spleen deficiency, damp-heat liver and gallbladder, heart-kidney imbalance, deficiency of heart and spleen, and qi deficiency in heart and gallbladder.

2.2 Herbology

2.1.1 Yangyu

Jia is a famous doctor for treating depression with traditional Chinese medicine. He indicates that Yangqi stagnation is the ultimate reason for depression. There are several essential concepts of this theory. Yangqi is generated in the kidney, and its flowing in the body is fundamental for active and optimistic thinking. If the patient has kidney deficiency, either inborn or acquired, the person’s Yangqi will not be sufficient to flow up and nourish the brain, which causes low spirits, loss of memories, sleeping problems, and others. Despite Yangqi in the kidney, other organs need a stable flow of Yangqi to play vital roles in sustaining normal thinking processes and movements (Jia).

Jia indicates that doctors should individualize treatments for depression based on each patient’s condition. The variation of medicines should be based on warming yang and avoiding strengthening fire in the body. In order to have a systematic approach, he developed a dialectical method for guidance.

• External causes

If patients have stagnant Yangqi because of external impacts—suffering from bad emotions—they have drained livers. In order to repair the organ and flow of Yangqi, Jia recommends Xiaoyao powder or Chaihu Shugan powder. Xiaoyao powder is a traditional medicine documented in the Song dynasty as an effective treatment for depression and anxiety. It contains eight herbs: Bupleuri radix (柴胡), Angelicae radix (当归), Paeoniae radix alba (白芍), Atractylodis rhizome macrocephalus (白术), Poria cocos (茯苓), Zingiberis siccatum rhizome (生姜), Menthae haplocalycis (薄荷), and Glyrrhizae radix (甘草). Currently, different versions of this medicine are being developed to treat specific symptoms. For example, Danzhi Xiaoyao powder is designed to manage sleeping quality and mood. Cortex moutan (牡丹皮) and Fructus gardenia (栀子) are added to it. Even though doctors cannot clearly explain the mechanisms of the medication, according to the scientific research on these medications, they found that Danzhi Xiaoyao Powder can increase the expression of the brain-derived neurotrophic factor, protecting hippocampal neurons, which is effective in treating depression (Jia).

Moreover, Chaihu Shugan powder is another traditional medicine to treat the stagnation of qi. It consists of Bupleurum chinese(柴胡), Cyperus rotundus (香附子), and Ligusticum chuanxiong (川芎). Based on the clinical practices, Chaihu Shugan powder can shorten the incubation period of auditory evoked potential and visual evoked potential in the brainstem, which alleviates the symptoms of depressed patients (Jia).

• Internal causes

There are three conditions for internal causes. If patients suffer from depression due to weak spleens, Jia supports Guipi Soup. According to both ancient documents and modern studies, this medicine effectively treats depression. Chemically, it works by enhancing triiodothyronine and thyroxine, regulating hypothalamus glandular thyroid, and increasing 5-hydroxytryptamine’s level. From the Eastern medicine perspective, on the other hand, low spirits can be explained by a deficient spleen, so appropriately adjusting the conditions of the spleen and stomach is necessary to treat the illnesses.

Another internal reason for depression is stagnation of phlegm and blood. The patients’ bodies cannot circulate the dampness, causing Yangqi deficiency. To facilitate the flow of phlegm and blood, Jia recommends Yueju pill. According to Dan Xi Xin Fa, this medicine can repair patients’ emotions and alleviate depression (Jia).

2.2.2 Fire-heat

Ye Tianshi was a famous doctor in the Qing dynasty. In the book called Clinical Guidance with Medical Cases that he published, depression is caused by the stagnation of liver-qi, which accumulates into the fire that damages body liquid. Then, the body's cycle is imbalanced, and the blood is damaged. After a long time, the illness becomes treatment-resistant. Corresponding to his diagnosis, the medication design is based on clearing heat and detoxifying. For example, Danzhi Xiaoyao Powder is an effective medicine that relieves the liver and clears heat. They help patients to release fire, recover the body cycle, and calm the Shen. In a case study, a 56-year-old man was diagnosed with treatment-resistant depression for a year. The patient showed intense unhappiness, lack of motivation, and unwillingness to communicate. In addition, his sleep quality was low. He tried maprotiline, citalopram, venlafaxine, and other medications, but there was no change. According to the Eastern medical diagnosis, the man had depression caused by weak yin and strong fire. He had herbal medications for 20 days and claimed that his sleep had improved. After having medicine for half a year, the man could communicate with people and go outside for activities. A year later, the patient had no relapse. According to Ye, the body cycle for qi, liquid, and blood can impact people’s health severely. In addition, each organ’s functions are related. It is vital to comprehend the connections (Jia).

2.3 Acupuncture

Acupuncture works by stimulating specific spots on nerves with needles. It can reregulate the automatic functions in the body, such as mood, organs, and Shen. Since the 1980s, acupuncture has been utilized as a clinical treatment for depression. With the development of TCM brain theories based on the etiology and the pathology of depression, including the channel of the brain, scalp acupuncture, and other theories, acupuncture shows great potential in treating depression (Shen, 940). The brain is the central location of the illness, so the treatment will be more based on regulating Dumai and rebalancing the brain. Since depression is categorized into several types due to different causes, acupuncture provides different approaches, mostly Dumai Daoqi technique and scalp acupuncture.

2.3.1 Diagnosis with corresponding treatments

• Liver Qi stagnation

Common symptoms are fullness in the chest, the rib area, and the stomach. They have dry mouths with red tongues, headaches, red eyes, and tinnitus. They might taste bitterness. The skin is light and yellow. Also, patients are easily irritable and impatient. They suffer from irregular periods and show a wiry pulse. The recommended treatment is to soothe the liver and reduce the fire. The specific points are LV-3 Taichung, LI-4 Hegu, LV-13 Qimen, GB-34 Yanglingquan, SJ-6 Zhigou, and DU-20 Baihui (Wang, 15.3.1).

• Spleen Qi deficiency

Common symptoms are feeling suspicious, fatigue, cold, and weak. Patients have poor appetites, light and white tongues, and thin, weak, and slippery pulses. To treat this condition, it is essential to nourish the spleen Qi. The specific points are REN-12 Zhongwan, REN-10 Xiawan, REN-6 Qihai, SP-15 Daheng, SP-9 Yinlingquan, SP-6 Sanyinjiao, and BL-20 Pishu (Wang, 15.3.2).

• Heart and Gallbladder Qi Deficiency

Common symptoms are low sleeping quality, thin and weak pulse, and thin and white skin. Patients experience emotional restlessness, fear, despair, and inferiority. The treatments need to nourish the heart and the gallbladder Qi, and soothe the mind. The specific points are HT-7 Shenmen, REN-6 Qihai, GB-34 Yanglingqun, GB-40 Qiuxu, BL-15 Xinshu, BL-19 Danshu (Wang, 15.3.3).

• Both Spleen and Heart Deficiency

Common symptoms are light-colored tongue, thin and white skin, and thin and slow pulse. The patients usually feel worried, dizzy, tired, and forgetful. They might also experience poor appetites and fatigue. The treatments will be focused on nourishing the heart and the spleen, which can replenish Qi and the blood. The specific points are DU-20 Baihui, HT-7 Shenmen, HT-3 Shaohai, SP-9 Yinglingquan, REN-6 Qihai, REN-12 Zhongwan, BL-15 Xinshu, BL-20 Pishu (Wang, 15.3.4).

• Both Kidney and Liver Deficiency

Common symptoms are back pain, knee pain, light tongue, and deep and weak pulse. The patients show poor concentration, frequent worries, a decrease in memories, and irritability. Treatments need to re-regulate the kidney Qi and the liver. The specific points are KI-10 Yingu, KI-3 Taixi, SP-6 Sanyinjiao, LV-3 Taichong, REN-4 Guanyuan, BL-15 Xinshu, BL-18 Gansu (Wang, 15.3.5).

2.4 Moxibustion

Moxibustion is a traditional TCM treatment that has the effect of tonification and purgation. Moxa and fire are two essential factors that impact the meridian system. A moxa will be placed on the acupoints where the patients need it, and depending on the situation, doctors will place various vegetables with the moxa. The ingredients of moxa are complicated. There are more than sixty kinds of components with different volatile oils. The combustion can re-regulate Qi and blood in the spot to prevent or treat illnesses. According to scientific experiments, moxibustion has thermal stimulation on both shallow and deep tissues of the skin.

A famous historical document, Zuo Zhuang, in the Qin dynasty, recorded the earliest case that was treated with moxibustion. Moving along the history, researchers discovered more and more documents of moxibustion. At around 168 B.C., moxibustion was used to treat many complex illnesses, including somatic and mental illnesses.

2.5 Discussion

In Eastern medicine, mental illnesses are representations of physical disorders. Since the body and the mind are indistinct systems, realizing the relationships of organs, emotions, Qi, and other elements is essential for treating illnesses effectively. Also, each individual is unique based on experience and background, so the diagnosis needs to be specific. Even though there is less scientific evidence for Eastern medicine's efficacy compared to the number of experiments and studies done on Western medicine, Eastern medicine’s history cannot be ignored. Since ancient people kept improving the techniques and studying herbs, current researchers can develop systematic and reliable treatments for depression. Eastern medicine is not only about science but also represents a complete worldview for humans and nature.

Nowadays, scientists and doctors are developing innovative intervention strategies for depression based on combinations of Western and Eastern medicine. Comprehending the illnesses from various perspectives is essential to discovering new treatments. In the Handbook of Depression, the concepts of depression are different based on culture. First of all, people pay attention to various critical symptoms of depression. For example, the Diagnostic and Statistical Manual of Mental Disorders (DSM) used in the United States emphasizes the uniqueness and autonomy of each person and the importance of personal experiences, goals, values, and others. Intrapersonal ideas are noted more than interpersonal symptoms. Moreover, ethnographic methods are crucial to understanding that culture shapes how people experience and express distress, which causes the difference between prevalence rates of major depression across cultural contexts. Therefore, before diagnosing and treating depression, learning local norms for thoughts, emotions, and behaviors is crucial (Cycleback).

In terms of the treatments, there are apparent differences between these two perspectives, but there are also overlaps. Western medicine focuses on symptoms and specific parts. It has abundant scientific evidence to support its development. On the other hand, Eastern medicine emphasizes the whole body and the relationships between each part. Similarly, both perspectives provide patients with methods to treat illnesses instead of cures, which is the basis of integrating them. In addition, as mentioned in the Western medicine section, a newly developed hypothesis is the connections between inflammation and depression. It presents a scientifically testified connection between body system and mind, which coincides with Eastern medicine’s theories over Qi and blood.

To design effective and safe treatments, researchers retain each approach's benefits and remove the drawbacks. For example, Prozac might cause severe side effects in patients, such as sleeping and eating problems. If the patients also do acupuncture and moxibustion, the side effects might be alleviated. While Western medicine treats the clinical symptoms of low spirits, Eastern medicine re-regulates the functions of organs that support Qi and blood. Even though there are not sufficient scientific theories to explain the mechanisms behind integrating the two perspectives, clinical practices and trials are essential resources for innovative treatments to be improved.

3.1 Examples of experiments and studies

In 2019, Krta and other colleagues did a literature review of the efficacy comparison between acupuncture and Western medicine. According to the result, acupuncture is very effective in treating; however, it is not widely practiced. Acupuncture is a complementary therapy to treat depression. Acupuncture relieves people’s stress and improves their sleeping quality. In addition, there is no side-effect, so even pregnant women can do acupuncture. In addition, acupuncture can alleviate side effects caused by antidepressants (krta, et al.). Even though integrating the two treatment methods needs further research for their effectiveness, it can be a potential option for treating depression.

From 2020 to 2021, Li, Song, and He did a clinical experiment on 83 depressed patients about the efficacy of combining acupuncture and SSRIs. The participants are divided into two groups to receive a control assignment—only SSRIs—or an experimental assignment—-SSRIs and acupuncture. Then, the researchers compare the results of efficacy through patients’ data from Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale (HAMD) before and after treatments. As a result, the clinical efficacy of patients who receive combined treatment is significantly higher than the other group, so the authors conclude that acupuncture combined with SSRIs in the treatment of depression can significantly improve the patients’ condition and reduce the patients’ anxiety and depression (Li, Song, and He).

In 2019, Xu did a clinical experiment on 86 depressed patients on the efficacy of combing Danzhi Xiaoyao powder and fluoxetine hydrochloride capsules. The participants were divided into two groups to either receive only fluoxetine hydrochloride capsules or a combination of two medicines. The results are shown through the patients’ scores of HAMD, cognitive abilities, GDNF, levels of VEGF, and probabilities of side effects. After comparing data from each set, the author concludes that combining two medicines to treat depression has fewer side effects and better clinical results (Xu).

3.2 Discussion and implications for future development

Despite the scientific development of innovative treatments, social attitudes are critical factors as well. Politically, governments all over the world might publish policies to encourage new intervention strategies and preserve traditional knowledge. Economically, the price of medicine will vary along with the marketing situation, and issuance companies will provide different services. In terms of education, people will learn more about science and medicine from various perspectives based on cultures. In order to collect thoughts from a general perspective, I interviewed four people with diverse backgrounds. However, their statements do not represent all people who have the same occupations or any population with similar experiences.

Doctor Jia focuses on researching clinical practices of Eastern medicine’s fundamental theories in treating mental illnesses. He also studies neuroscience in terms of understanding mental disorders. With his abundant working experience, he indicates that treating with the two medical perspectives is only effective in certain conditions. For severe depression, patients need to be treated for both clinical symptoms and internal body conditions. Therefore, fixing details with chemical substances and supporting body circulation with natural substances should be supported. He states that if there are effective and sustainable treatments for patients, he will support cooperating Western medicine and Eastern medicine.

From Professor Szumlinski’s perspective, the development of medicine still has a long way to go. Western medicine will experience reformations to provide patients with more effective and economical treatments. Changing medications’ names to their specific functions might be one of the steps. She points out that patients diagnosed with mental illnesses do not only suffer from an imbalance of one chemical substance, which means one type of medication is not sufficient to treat the patients. It is very likely that a depressed patient is well-treated by an antipsychotic because the patient has a dysfunctional dopamine system. In addition, the insurance company would only pay for antidepressants even though the patient also needs antipsychotics for complications. For Eastern medicine, the comprehension and utilization depend on regions greatly. In big cities with a larger population, people are more likely to know and try these approaches than people in rural areas or small towns. The combination of the two perspectives in treatment will also be a future step. In the university she works at, there are programs and annual conferences supporting the communication between countries about science and medicine. Lastly, she states that therapy is an essential part of both Western and Eastern medicine.

Lian is a graduate student who studied Eastern medicine and applied psychology. She supports the combination of Western and Eastern medicine in treating depression. She also has heard a lot of researchers doing clinical studies about it. Many developments are limited by scientific methods, whereas Eastern medicine points out that various paths lead to science. There might be no clear, specified theories for acupuncture, but it works as a treatment. Also, no scientific evidence proves the existence of Qi and Shen, but that does not mean they don’t function in the body. However, there are some difficulties that she mentions. Lian points out that Eastern medicine is still in a developing stage where it is used to assist Western medicine treatments. For example, some doctors might suggest patients do acupuncture periodically while taking medications. She thinks that the current medical environment underestimates the value of Eastern medicine. Hence, there should be more policies to support the implementation of Eastern medicine so that doctors can be exposed to this perspective, either in studies or clinical treatments. Patients will gradually learn that there are more treatment options through education.

Tan is a high school teacher who teaches psychology. She studied basic knowledge of Western medicine and decided to devote herself to education. She indicates that based on the information she knows, she cannot make clear statements on the combination of Western and Eastern medicine. However, Tan has some friends and diverse practical experience with Eastern medicine. She thinks people need more research to explore the common areas between these two perspectives. For example, many doctors would prefer treating illness from only one perspective to avoid potential adverse reactions between the two approaches. Moreover, people need to learn more about medicine from both perspectives, especially its efficacy. Higher levels of education and supportive policies from governments are eligible solutions.

After learning about others’ opinions on the development of approaches for depression, I realized that this new path is considered differently based on people’s standpoints. As a high school student, I think combining Western and Eastern medicine to treat depression will be implicated in the future. There are limiting factors but also encouragements. With the huge differences between the two medical theories, people need time to learn and digest new information. For example, due to regional differences, relatively few herbs in Eastern medicine are introduced to psychiatrists studying psychotherapy. Moreover, historically and philosophically, doing brain surgeries might not be accepted because they change the original structures and functions of the brain from the TCM perspective. However, these differences can be advantageous in treating illnesses with integration approaches. While Western medicine treats the chemical imbalance in the brain, Eastern medicine can adjust a patient’s emotions and body cycles. Similarly, both Eastern and Western medicine aims to treat depression. In addition, some of the theories and hypotheses show overlap. The newly studied idea of the relationship between physical inflammation and depression is similar to the Qi theory. The identical goal of supporting health is the link between them, and their diverse health standards are the formula for combining their approaches. In the future, there will be research and studies that to solve the problems we have now. It is critical to make the first step, so I support new developments in treating depression and all other illnesses.

This research paper demonstrates treatments for depression from Western and Eastern medicine. There are various theories and hypotheses in each perspective, which lead to diverse approaches. Some traditional treatments are listed to present more detailed information. The main purpose of this paper is to introduce a new path to treating depression: combining Western and Eastern medicine. There are significant differences between these perspectives, which means there is potential to design effective and safe intervention strategies for depression by integrating the strength and avoiding the weakness. Plus, there are also similarities. No matter with perspective is supported, the ultimate goal of developing innovative treatments is for people’s health. This is also the original aspiration for all doctors. While we preserve the traditional knowledge and approaches that have contributed to many patients and families, researchers will keep studying so patients can have better options in the future.

My interest in psychiatry is inspired and reinforced by my experience in the hospital internship. As I dive deeper into this topic through this Global Scholarship Diplomat program, many people give me the most significant support. Doctor Jia, Professor Szumlinski, Lian, and Tan are the interviewees. I am grateful for their efforts and encouragement. They show me an overview of the medical environment that I hope to explore, which is essential information for this paper and a critical guide for my future career. In addition, Ms. Kirchoff and Mr. Haupt are my mentors in this program. They are the lights when I am struggling and in despair. I learn not only the knowledge but also studying technics. This valuable experience will guide me in the future when I face greater challenges.

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