Why massage might be one of the better ways to care for seasonal depression
Did you know that the skin is the largest organ in the human body?
Not only does the skin act as a protective barrier between us and the outer world, but it is also packed with touch receptors. Each fingertip has 3,000 touch receptors! Each hand has approximately 100,000 nerves. While areas like the back are less sensitive than the hands, every square inch of our skin has the capacity to convey information about the outside world to the brain1.
Made up of billions of cells, our sense of touch forms a crucial element of the human "somatosensory" system. This system is the collection of receptors and neural pathways that respond to changes at the surface of the body (the skin) as well as to the body's position in space 2. Without touch, our brains would lose an enormous amount of information about the physical world and our ability to navigate it would be greatly reduced - both physically and socially.
The importance of touch is difficult to overstate, yet it's the least understood of the five senses. Many of us have contemplated what it would be like to live without vision or the ability to hear, but can you imagine an existence without touch or feeling?
It's been found that infants born without other senses who retain a sense of touch fare much better than children born able to see or hear but without the ability to feel 3. Our sense of touch is our first language and it is a very beautiful language. While all our senses help us navigate the world, there is clearly something about touch that makes it critical to our development and survival 4.
So what is it about touch that makes it such a powerful sensory tool? The answer to that question might lie in our evolutionary history. Over millions of years, our dependence on visual cues has increased, since behaviour guided by vision has conferred evolutionary advantages in finding food, shelter, and mates (basic needs) as well as higher-order needs involving child-rearing and the establishment of social hierarchies 5. In other words, because certain sensory inputs allowed our ancestors to survive and thrive, the modern human brain now devotes more space and processing power to those inputs than our ancestor's brains did.
While our sense of touch has also been refined through millions of years of evolution as a means of navigating the world, manipulating tools, forming social bonds and protecting us from harm and we are shifting our technologies for greater tactile integration; We seem, however, to spend a lot less time touching each other lately than our primate ancestors did! Studies of non-human primates have shown that primates are spending up to 15% of their waking life touching and grooming each other 6. That equates to about 4 hours of physical touch each and every day. And while the goal of this grooming behaviour is assumed to be related to the removal of nits or parasites, it's actually more closely related to the formation of alliances and social bonds (ibid)! I am willing to bet it's been a while since someone hugged you or held your hand.
Our primate ancestors (and current relatives) appear to recognize that touch is important to the health and strength of our social relationships. For those of us who work with touch (physiotherapy, osteopathy, bodywork, massage, medicine) where it is not unheard of to engage in some form of therapeutic touch for several hours in a given day, we know the power and importance of touch to human well-being.
But for most living in urban centers, especially in this era of social-distancing and isolation, the amount of physical touch given and received is much, much lower now. While it's important to acknowledge that our other means of forming social bonds (such as through speech) are now more highly developed, we've also had to acknowledge the emergence of phenomena such as "touch starvation" and "skin hunger" which occur when we are unable to meet our deep need for the satisfaction and security that comes with the touch of another human being 7.
While it's valuable to explore the physiological or evolutionary significance of touch, when it comes to physical or intimate touch there is clearly more to the story than sensory input and neural pathways. There is a deeply emotional component to touch that seems especially relevant not only because of COVID-19's social impact physically but because many of us are also in the midst of some of the coldest, and most isolating months of the year.
Winters in the northern hemisphere are known for contributing to "Seasonal Affective
Disorder" or SAD. The Mayo Clinic describes SAD as "a type of depression that's related to changes in seasons" which begins most often in the fall and continues through the winter months 8. SAD can bring about feelings of low energy, guilt, or hopelessness, and can result in loss of interest in everyday activities, changes important to keep in mind is that SAD is a diagnosable form of depression that can have serious consequences for our mood, behaviour, and relationships - including increased social isolation (and who needs more of that now), problems at school or work, substance abuse, and even suicidal thoughts.
If you feel like you might be experiencing symptoms of SAD, don't brush these off! Talk to your support system and health practitioners to ensure that you get proper care - don't suffer needlessly trying to "tough it out". The bottom line is that SAD is more than just the "winter blues". Treatment for the disorder is multifaceted and involves both medical and physical interventions - including medication, psychotherapy, or lightbox (phototherapy) devices.
There is also a significant body of research supporting therapeutic touch and massage in effectively relieving the symptoms of mood disorders, including SAD, and show that many sufferers of mood disorder seek out massage therapy as part of their treatment 9. Moreover, despite how far our understanding of depression has come, its continued prevalence demonstrates that a holistic and complementary approach to mood disorder treatment should be available to all those who suffer from them.
I am interested in exploring how therapeutic touch can form part of a care plan for those suffering from seasonal changes in mood in an evidence-based way. Findings from even the most conventional sources have demonstrated that touch can not only convey but change emotional states 10. In one clinical trial, it was found that Swedish massage decreased average levels of anger, anxiety, and depression versus a control group who did not receive massage 11. Another study found that seriously ill patients who received aroma hand massage showed a statistically significant reduction in both depression and pain symptoms 12. Other major meta-analyses (a statistical technique that combines the results of multiple scientific studies) have suggested that, overall, massage is beneficial for depressed patients, especially when patients have an interest in this type of therapy, to begin with 9.
So why is massage helpful when it comes to combating depression or SAD? For one thing, neural imaging and EEG (brain wave studies) have shown that massage is effective in changing the patterns of neural activity in our brain 9. The changes observed were consistent with higher levels of relaxation but also with increased alertness, meaning that for the patients in these studies massage relaxed them while also improving mental sharpness. This finding is supported by the fact that after the massage, these patients showed better accuracy on mathematical calculations! Other neuroimaging studies have found that massage is associated with patterns of activation in the brain that reflect positive affect (mood) and an increase in parasympathetic activity 9. The parasympathetic nervous system, known as the "rest and digest" system helps us relax and conserve energy by slowing the heart rate and other bodily processes associated with the fight-or-flight response.
Massage seems to play a positive role in our hormonal and immune systems. Research shows that even a single session of massage can lower levels of stress hormones like cortisol and vasopressin. Cortisol, your body's primary stress hormone, plays a major part in the "fight-or-flight" response to stress and also affects how our bodies process nutrients, our sleep-wake cycle, and our ability to restore balance after difficult life events 13. Decreases in salivary cortisol levels following massage were associated with reduced anxiety and depression and an increase in the sense of psychological well-being 9.
Even better! Massage was also associated with increases in oxytocin (the "love hormone") which can promote a sense of bonding and reduce feelings of anxiety and stress - with twice-weekly massages showing an even larger increase in oxytocin than a once-per-week massage! But that's not all, massage has also been found to increase natural killer (NK) cell activity in the body. These cells act as first responders to virus cells and play a role in supporting the body's adaptive immune response to new viruses or infections 14.
I hope you found this overview of the potential benefits of massage in the care of Seasonal Affective Disorder illuminating! Take every opportunity you can to get outside and get some sunshine! *Sunlight is also crucial for the synthesis of Vitamin D (a key vitamin in bolstering an immune response, should you encounter covid-19 but that's another post for another time).
As always, I'm available for your questions and will gladly help you navigate the care options available if you feel you may be suffering the effects of SAD. Congrats on making it through this anatomy, physiology and science-heavy post! As I wrote earlier, I find it best to draw on and share the evidence and research available. If you are intrigued, definitely check out the references and further reading!
Much warmth and solidarity in the healing of our world, sincerely be well.
Raven Taylor is a licensed massage therapist and instructor; applying her other skills to the social health challenges of our times. Raven's knowledge of health, wellness and trauma come mainly from massage therapy and bodywork, as well as her studies in Communications and Sociology with a public health focus at Simon Fraser University. This article was written and edited in collaboration with E. Baker.
References & Further Reading:
The Neuroscience of Touch series
The science of touch: why physical contact can make you happier and more successful: Touch can deactivate stress regions and was used by primates to form alliances
"Cellular liaisons of natural killer lymphocytes in immunology and immunotherapy of cancer". Expert Opinion on Biological Therapy. Arina A, Murillo O, Dubrot J, Azpilikueta A, Alfaro C, Pérez-Gracia JL, Bendandi M, Palencia B, Hervás-Stubbs S, Melero I (May 2007).