Massage is an agreeable and pleasant treatment. It comes in various guises and, according to many patients’ experience, it relaxes both the mind and the body. But does it have therapeutic effects which go beyond such alleged benefits?
There is a considerable amount of research to test whether massage is effective for some conditions, including depression. In most instances, the evidence fails to be entirely convincing. Our own systematic review of massage for depression, for instance, concluded that there is currently a lack of evidence.
This was ~5 years ago – but now a new trial has emerged. It was aimed at determining whether massage therapy reduces symptoms of depression in subjects with human immunodeficiency virus (HIV) disease. Subjects were randomized into one of three groups to receive either Swedish massage (the type that is best researched amongst the many massage-variations that exist), or touch, or no such interventions. The treatment period lasted for eight weeks. Patients had to be at least 16 years of age, HIV-positive, suffering from a major depressive disorder, and on a stable neuropsychiatric, analgesic, and antiretroviral regimen for > 30 days with no plans to modify therapy for the duration of the study. Approximately 40% of the subjects were taking antidepressants, and all subjects were judged to be medically stable.
Patients in the Swedish massage and touch groups visited the massage therapist for one hour twice per week. In the touch group, a massage therapist placed both hands on the subject with slight pressure, but no massage, in a uniform distribution in the same pattern used for the massage subjects.
The primary and secondary outcome measures were the Hamilton Rating Scale for Depression score and the Beck Depression Inventory. The results showed that, compared to no intervention and/or touch, massage significantly reduced the severity of depression at week 4, 6 and 8.
The authors’ conclusion is clear: The results indicate that massage therapy can reduce symptoms of depression in subjects with HIV disease. The durability of the response, optimal “dose” of massage, and mechanisms by which massage exerts its antidepressant effects remain to be determined.
Clinical trials of massage therapy encounter formidable problems. No obvious funding source exists, and the expertise to conduct research is minimal within the realm of massage therapy. More importantly, it is difficult to find solutions to the many methodological issues involved in designing rigorous trials of massage therapy.
One such issue is the question of an adequate control intervention which might enable to blind patients and thus account for the effects of placebo, compassion, attention etc. The authors of the present trial have elegantly solved it by creating a type of sham treatment which consisted of mere touch. However, this will only work well, if patients can be made to believe that the sham-intervention was a real treatment, and if somehow the massage therapist is prevented to influence the patients through verbal or non-verbal communications. In the current trial, patients were not blinded, and therefore patients’ expectations may have played a role in influencing the results.
Despite this drawback, the study is one of the more rigorous investigations of massage therapy to date. Its findings offer hope to those patients who suffer from depression and who are desperate for an effective and foremost safe treatment to ease their symptoms.
My conclusion: the question whether massage alleviates depression is intriguing and well worth further study.
4 Responses to Massage might be an option to alleviate depression.
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Why study HIV patients instead of just depressed patients? Is it reasonable to extrapolate that massage may be as effective for depression without HIV?
I really like that they included an arm in the study that received only touch. This is an important attempt to control for the important factor that complicates any evaluation of manual therapy, that of simple touch inducing relief from “skin hunger” .
“Skin hunger” is a term that refers to the very stress-inducing human craving that results from prolonged lack of human touch adn warmth.
Nisse Simonson, a pensioned Swedish surgeon, author, philantropist and humorist tells in his book “Why do we feel so bad when we have it so good?” a story about how he had observed an older family practitioner stroking and caressing an elderly lady in no apparent distress. When asked what in the world he was doing, the older and wiser colleague said: “She is lonely and depressed and suffers from skin hunger, I am only giving her what she really needs” or something to that effect (I am quoting from memory). The lady came frequently and was very happy with the good doctors manual therapy.
It is not unlikely that the authors have read Nisse Simonsons book and taken notice of this important factor.
Massage might be an option to alleviate depression in HIV patients, you have to be specific
Having experienced depression and anxiety to varying degrees throughout my lifetime and finding myself once again totally socially isolated I believe a lot of my problems are due to a lack of on-going physical contact. Massage has always lifted my emotions however as the massage has to be paid for I only seek it out when I reach rock bottom. It’s amazing how we humans don’t seem to have a problem without reservation to touching inanimate objects e.g. television remote, knives and forks, a cup, a steering wheel but when it comes to touching a human within a safe environment we tend not to do this regularly. It may be a case of “what’s in it for me” rather than “what’s in it for them” which has placed limits on human interaction.