DECREASED CORTISOL FOLLOWING MASSAGE THERAPY
In this article the positive effects of massage therapy on biochemistry are reviewed including decreased levels of cortisol and increased levels of serotonin and dopamine. The research reviewed includes studies on depression (including sex abuse and eating disorder studies), pain syndrome studies, research on auto-immune conditions (including asthma and chronic fatigue), immune studies (including HIV and breast cancer), and studies on the reduction of stress on the job, the stress of aging, and pregnancy stress. In studies in which cortisol was assayed either in saliva or in urine, significant decreases were noted in cortisol levels (averaging decreases 31%). In studies in which the activating neurotransmitters (serotonin and dopamine) were assayed in urine, an average increase of 28% was noted for serotonin and an average increase of 31% was noted for dopamine. These studies combined suggest the stress-alleviating effects (decreased cortisol) and the activating effects (increased serotonin and dopamine) of massage therapy on a variety of medical conditions and stressful experiences.
Massage therapy has been noted to significantly alter the biochemistry of humans both immediately following massage sessions and over the course of massage therapy treatment periods. These studies can be grouped according to the type of condition: depression as a primary diagnosis; depression- related disorders, including sexual abuse and eating disorders (anorexia and bulimia); pain syndromes, including burn trauma, juvenile rheumatoid arthritis and migraine headaches; autoimmune conditions, including asthma and chronic fatigue; immune conditions, including HIV and breast cancer; and normal stress conditions, including job stress, the stress of activity, the stress of aging, and pregnancy stress. Accordingly, these studies are reviewed individually by their grouping. Although each condition may be affected by massage therapy in some unique ways, some effects generalize across these highly variable conditions. Of these, the stress reduction effects (cortisol reduction) of massage therapy and the activation effects (increased serotonin and dopamine) would appear to generalize across conditions.
Cortisol is notably a culprit variable deriving from stressful conditions and ultimately negatively affecting immune function. Cortisol is an end-product of the sympathetic system, the hypothalamic-pituitary-adrenal-cortical axis. Its production reliably increases following experimentally induced stress and reliably decreases following relaxing therapies such as massage therapy. Cortisol has been labeled a culprit variable for killing immune cells, most particularly natural killer cells, those cells in the immune system that kill cancer and viral cells. Thus, it is perhaps not surprising that cortisol reduction following massage therapy has been noted in conditions ranging from job stress to depression to HIV and breast cancer. In most studies cortisol has been sampled before and after the massage therapy session in saliva to document the immediate effects of a massage therapy session. Traditionally, the saliva has been collected using dental swabs (or syringe tubes in the case of infants), although a simpler, less invasive assay has recently been developed that involves a simple litmus paper placed on the tongue. Thus, cortisol is relatively easy to collect in a non-invasive and a cost-effective manner. For an assessment of longer term effects of massage therapy, cortisol has been assayed from urine samples typically collected at the beginning of the month of therapy and at the end of the month. This is the more invasive and more costly assay.
Serotonin is an activating central nervous system neurotransmitter. Serotonin is typically assayed from metabolite derivatives (5HIAA) taken from urine samples. The synthetic counterpart of serotonin can be found in many antidepressant medications including Prozac and in many anti-pain medications. Serotonin is thought to interact with dopamine and cortisol in complex ways, although it can generally be said that serotonin enhances the production of dopamine and hampers the production of cortisol.
Dopamine is also a central nervous system neurotransmitter that has activating properties. Cocaine, for example, is noted to enhance the release of dopamine leading to the active state noted for that drug use. Dopamine, like serotonin, is notably involved in the reduction of depression and its stress effects.
Depression as a Primary Diagnosis
Depression has significant negative effects on preg-nancy including the negative outcomes of prematurity and low birthweight. The incidence of pregnancy depression has been variously estimated at 20 to 40%. In a recent study conducted by Field et al. (2004), 84 depressed pregnant women were recruited during the second trimester of pregnancy and randomly assigned to a massage therapy, progressive muscle relaxation or a control group that received standard prenatal care alone. These groups were compared to each other and to a nondepressed group at the end of pregnancy. The massage therapy group participants received 2 20-min therapy sessions by their significant others each week for 16 weeks of pregnancy starting during the second trimester. The relaxation group engaged in progressive muscle relaxation sessions on the same time schedule. Immediately after the massage therapy sessions on the first and last days of the 16-week period the women reported lower levels of anxiety and depressed mood and less leg and back pain. By the end of the study the massage group had lower levels of saliva cortisol (↓23%) (see Table 1) and higher urine dopamine (↑25%) (see Table 2) and serotonin levels (↑23%) following pregnancy massage (see Table 2). These changes may have contributed to the reduced fetal activity and the better neonatal outcome for the massage group (i.e., lesser incidence of prematurity and low birthweight) as well as their better performance on the Brazelton Neonatal Behavior Assessment Scale. The data suggest that depressed pregnant women and their offspring can benefit from massage therapy.