Adapted cold shower as a potential treatment for depression

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Summary

Depression is a debilitating mood disorder that is among the top causes of disability worldwide. It can be characterized by a set of somatic, emotional, and behavioral symptoms, one of which is a high risk of suicide. This work presents a hypothesis that depression may be caused by the convergence of two factors: (A) A lifestyle that lacks certain physiological stressors that have been experienced by primates through millions of years of evolution, such as brief changes in body temperature (e.g. cold swim), and this lack of “thermal exercise” may cause inadequate functioning of the brain. (B) Genetic makeup that predisposes an individual to be affected by the above condition more seriously than other people.

To test the hypothesis, an approach to treating depression is proposed that consists of adapted cold showers (20 °C, 2–3 min, preceded by a 5-min gradual adaptation to make the procedure less shocking) performed once or twice daily. The proposed duration of treatment is several weeks to several months.

The following evidence appears to support the hypothesis: Exposure to cold is known to activate the sympathetic nervous system and increase the blood level of beta-endorphin and noradrenaline and to increase synaptic release of noradrenaline in the brain as well. Additionally, due to the high density of cold receptors in the skin, a cold shower is expected to send an overwhelming amount of electrical impulses from peripheral nerve endings to the brain, which could result in an anti-depressive effect. Practical testing by a statistically insignificant number of people, who did not have sufficient symptoms to be diagnosed with depression, showed that the cold hydrotherapy can relieve depressive symptoms rather effectively. The therapy was also found to have a significant analgesic effect and it does not appear to have noticeable side effects or cause dependence. In conclusion, wider and more rigorous studies would be needed to test the validity of the hypothesis.

Introduction

Depression is a common term for a group of depressive mood disorders, which includes major depressive disorder (the most severe form of depression), dysthymia, and bipolar depression among others [1]. It is estimated that depression is one of the leading causes of disability worldwide [2] and approximately 10% of the adult population suffer from a depressive illness in the United States [3]. Symptoms of depression affect body, mood and behavior and may include some or most of the following: persistent sad or empty mood; feelings of guilt, hopelessness, or helplessness; loss of interest in activities that were previously enjoyed; fatigue or being “slowed down”; thoughts or attempts of suicide (Table 1). The combination, severity and duration of symptoms vary among different depressive disorders and can vary within a given disorder as well [1]. Depression is considered to be a disorder of the brain and people suffering from depression cannot will their way out of this negative state or simply “pull themselves together” [3]. Depression affects productivity, school performance, relationships of the patient with other people and is among the top causes of suicide [1].

Many researchers in the field admit that our current understanding of etiology of depression is rudimentary [1], [2]. No single gene has been shown to cause depression so far, although the existence of families with an extended history of depression suggests that a gene or a group of genes may be involved [1], [2], [4]. On the other hand, many cases of depression cannot be traced to a family history of the illness [1], [2]. The fact that depressive disorders are usually not congenital, but rather develop at some point in adolescence or much later, suggests that environmental and biomedical factors may play a role, and, indeed, some risk factors associated with occurrence of depressive symptoms have been reported (this association may not always be causal): cigarette smoking [5], medical causes such as a somatic illness (e.g. diabetes, cancer, endocrinopathies, anemia) [6] or use of certain medications (e.g. isotretinoin) [7], vitamin deficiencies (e.g. folic acid) [6], and stressful life events [8]. In most cases of diagnosed depressive disorders however, no clear causal factor can be identified [2], [8] and this work is an attempt to explore contributing factors of depression that, to my knowledge, have not been considered in the field to date.

One such contributing factor could be a lifestyle that lacks most of the physiological stressors that have been present throughout evolution of mammals and primates. These stressors include frequent acute physical activity as well as frequent (temporary) changes in body temperature, for example, occasional forced swimming in cold water or hunting in very hot weather. A number of studies have shown beneficial effects of small amounts of otherwise stressful or harmful treatments on the lifespan of animals, for example: hypergravity, small amounts of toxic substances, heat shock and cold shock among others [9]. Closer to psychiatry, moderate amounts of electric shock have long been used to treat drug-resistant forms of depression (a procedure called electroconvulsive therapy or ECT [10]). This work examines hypothetical benefits of a stressor that may be related to ECT in its mechanism, but not necessarily in its effects, namely, brief whole-body exposure to cold water (cold shower). Since the density of cold receptors in the skin is thought to be 3–10 times higher than that of warm receptors [11], [12], simultaneous firing of all cutaneous cold receptors could be quite overwhelming and shocking for the brain, which may result in a positive therapeutic effect. In addition, exposure to cold has been shown: (i) to activate the sympathetic nervous system [13]; (ii) to increase the blood level as well as cerebral synaptic release of noradrenaline [14], [15], one of the key excitatory neurotransmitters in the brain [16]; and (iii) to increase production of beta-endorphin [17], which is known to produce the sense of well-being [18], [19].

Section snippets

The hypothesis

In view of the above, the hypothesis is that some depressive disorders may be caused by the convergence of two factors:

  • (A)

    A lifestyle that lacks sufficient physiological stressors, such as brief changes in body temperature, resulting in inadequate functioning of the central nervous system.

  • (B)

    Genetic makeup that predisposes an individual to be affected by the above condition more severely than other people.

Evaluation of the hypothesis

To test the hypothesis, an approach to treating depression is proposed that consists of adapted cold showers performed once or twice daily. A volunteer study among patients diagnosed with a depressive illness would be needed with a significant number of volunteers (30–100) plus a control group of patients who undergo a different kind of therapy. The effectiveness of cold hydrotherapy would be assessed by comparing the symptoms of the experimental group with symptoms of the control group after

Empirical data

The proposed method of cold hydrotherapy appears to be effective at alleviating depressive symptoms in approximately two years of experience of the author and two people that he knows (longer experience for them). This is a statistically insignificant sample given that there was no questionnaires, no systematic records, no consistent methodology, and this was not a volunteer study per se because those people were using cold hydrotherapy for their own reasons and were kind enough to share their

Consequences of the hypothesis and discussion

As mentioned above, rigorous, statistically significant volunteer studies would be needed to test the validity of the present hypothesis. If the therapy is proven to be effective and safe, it could become a viable treatment option for some depressive disorders, especially for childhood and adolescent depressive disorders where therapeutic options are rather limited [1]. Psychological counseling and/or cognitive behavioral therapy most likely would be beneficial in combination with the proposed

Acknowledgments

The author thanks Stephan Ladisch for providing critical comments about cold hydrotherapy, and Yevgeniya A. Nusinovich for critical comments about the manuscript.

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    Funding for this work was in part derived from the Children’s National Medical Center Fellowship at the George Washington University, Washington, DC, USA.

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