Teodor Huzij DO FACN

Mood Disorders 

and OMM 

Teodor Huzij DO FACN 

Medical Director, Trinity Institute 

1

Objectives 

1. Review literature for manual medicine 

and mood disorders 

2. Review Anatomy and Physiology related 

to current evidence for mood disorders 

3. Discuss proposed osteopathic 

manipulative medicine (OMM) interventions 

based on objectives 1 and 2. 

2

Outline 

Literature Review: Manual medicine & Mood 

Anatomy/Physiology Review: Mood related 

Proposed OMM for Mood Disorders 

3

Literature Review: 

Manual Medicine 

4

Overall 

Search terms included: “depression”, “major 

depressive disorder”, “dysthymic disorder”, 

“dysthymia”, “bipolar”, “manic depression”, 

“mood disorder”, “manual medicine”, 

“osteopathic”, “osteopathy”, “osteopathic 

manipulative treatment”, “osteopathic 

manipulative medicine”, “OMT”, “OMM”, 

“manual medicine”, “chiropractic”, 

“massage”, “manipulation” and “spinal 

manipulation” 

5

Citations Found 

Massage and Depression: 13 

OMT and Depression: 2 

Spinal manipulation and Depression: 1 

Massage and Bipolar: 1 

6

Massage - Depression 

4 studies: Patient’s with co-morbid condition 

(OA, CA, HIV, ESRD)- Decreased Depression 

2 studies: Pregnant women - Mixed results 

1992 Pilot Study: Inpt Psych C&A- Decreased 

Depression 

Choi 2006, Wilkinson 2007, Fulk 2004, McDougall 2005, Field 2004, 

Dimidjian 2009, Field 1992 

7

Massage - Depression 

Critical Reviews 

2002 - Immediate +, Long term No evidence 

2004 - Improvement = to psychotherapy 

2008 - RCTs did not support efficacy 

Manber 2002, Moyer 2004, Coelho 2008 

8

OMT - Depression 

Pilot Study: Adjunctive OMT with Paxil for 

Depressed Women 

20-50 y.o. Women, 8wks (weekly sessions) 

Control (9): Cognitive therapy, 

Neurolinguistic programming, Paxil, OSE 

Treatment (8): Same as control + OMT 

OMS administered, Physician supervised 

No specific OMT protocol (20 min limit) 

Plotkin. JAOA. Sep 2001 

OMT provided: low-impact tech-niques, such as soft tissue and facial release techniques 

performed on a find- and-fix basis. 

9


Pilot Study: Adjunctive OMT with Paxil for 

Depressed Women 

Zung Depression Scale 

Both groups significantly better 

Control: 30% reached normal range 

OMT: 100% reached normal range 

Plotkin. JAOA. Sep 2001 

10


Quality of life for OMT referrals 

SF-36 only admistered 

Lower quality of life vs controls 

Undetermined impact of OMT on QOL 

Licciardone. JAOA. Mar 2002 

11

Spinal Manipulation - 

Depression 

Systematic review of RCT for spinal 

manipulation and psychological outcomes 

Included osteopathic (2) and others 

Small significant benefit in first 5 mo 

Williams. Comp Therapies in Med. 2007 

12


Depression 

N.H. Willi 

Comparilon: 

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-- • 

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., frrhmbslo2003 (a

yslotherapist. 4O 

One triaL from the USA for subacute low back 

n did not find a statistically Significant differ- 


Depression 

a cervicaL collar. 39 ALthough no baselin 

were reported and it was not possible to 

change scores, it was assumed that both g 

Cotnp,8rison: 

Ou\oom ..: 

Maniptllatioo V8r$U. phy...lttaatme:nt 

any plI'yt:hoIoglcal 

Spinal manipulation 

Physical erutmenl 

Ii Mo_.(SO) N "",_,,(SO) 

SMO{ftxed) 

95'4Cl 

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95%CI 

Triano 1995 (sham) 4iJ 1.SOi7.00i 

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Giebel 1997{oorviClicoHar) 4" 1.24!1tO.7S) SO 1.09(6.75; 11.2;: (-0.17, O.1!i;1j 

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(95.,. CI) , 5" 0,13 {O.U. 0 • .:.!'1 

Toatlot hoIerogeneitj: ""3,87. df. T (P -0.19). I' 21 0% 

Test for ovet':8!ll 6ffttet: Z. 2.15(P" 0,(3) 

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T..t r... o_,.1fec;I; l = 0.09) 

1.67 (P = 

-, 

11.11 0.25) 

Figure 3 Meta-analysis of trials of spinal manipulation compared with other physical treatments 

Williams. Comp Therapies in Med. 2007 

14

Massage - Bipolar 

Review of complimentary and alternative 

treatment for Bipolar 

Aromatherapy massage & Massage Therapy 

“almost entirely lacking” evidence 

Andreescu. Jrnl Aff Dis. 2008. 

15

Literature Summary 

Most Evidence: Massage Therapy for 

Depression but mixed 

OMT: Depression Pilot study is the best 

evidence 

16

Literature Review: 

Neuro - A&P 

17

MDD: Findings Vary 

Reduced Frontal Lobe 

volume 

Reduced Caudate 

Reduced Putamen 

Reduced CBF Anterior 

Cingulate Gyrus 

Increased CBF Medial 

Orbital Cortex 

Increased CBF Left 

Amygdala & Medial 

Thalamus 

Increased CBF 

Cerebellar Vermis 

Amygdala-Medial- 

Thalamus-Ventral- 

Prefrontal Cortex 

Limbic-Striatal- 

Pallidal-Thalamic 

Ebert 1996, Soares 1997, Drevets 1998, Daroff 2012 

18

MDD: Most Evidence 

Hypoperfusion Dorsolateral/Dorsomedial 


Increased CBF Medial Thalamus 

Hypoperfusion of Anterior Cingulate Gyrus 

Reduced Frontal Lobe volume 

Coffey 1993, Ito 1996, Ebert 1996, Soares 1997, Drevets 1998, Daroff 2012 

19

Bipolar: Findings Vary 

Bilateral anterior 

frontal 

Anterior cingulate 

gyrus 

Left superior 

temporal 

Bilateral anterior 

insular 

Cerebellar vermis 

Inferior prefrontal 

Amygdala 

Striatum 

Hippocampus 

Third ventricle 

Ito 1996, Soares 1997, Strakowski 2004, DelBello 2004, Lyoo 2006, 

William 2007, Ellison-Wright 2010 

21

Bipolar: Most Evidence 

Reduced Cerebellar Vermis Volume 

Right Anterior Cingulate Gyrus 

Left Superior Temporal Cortex 

Bilateral Insular Cortex 

Increased Striatum Volume 

Ito 1996, Soares 1997, Strakowski 2004, DelBello 2004, Lyoo 2006, 

William 2007, Ellison-Wright 2010 

Caudate and putamen make up the striatum and are a sub part of the basal ganglia 

22

Proposed OMM 

24

Not The Goal 

25

Osteopathic Philosophy 

1. Body is a Unit - Body, Mind, Spirit 

2. Structure and Function are Interrelated 

3. Self-healing Self-regulating Systems 

4. Rationale treatment includes prior 3 

Glossary of Osteopathic Terminology 2009, p33 

Interpersonal conflict is a manifestation of inflammation occurring between 2 structures 

(people) and their dyfunctional operation (conflict) 

26

Osteopathic Approach 

An osteopath reasons from his knowledge 

of anatomy - Still 

Principles of osteopathy follow the logic 

of an applied knowledge of anatomy-the 

science of structure, physiology-the 

science of function, and pathology-the 

science of disease - Webster 

Life is not a composite of the functions of 

the viscera - Korr 

Still-Research & Practice, Webster-Sage Sayings, Korr-Physiological basis 

27

General 

Biomechanical Goals 

Optimize Structure and Function 

Whole Body Assessment 

Sympathetic Nervous System 

Vascular System 

Lymphatic System 

Primary & Secondary Respiration 

Parasympathetic has no direct innervation of the brain. 

Cerebral arteries lose their peripheral nerve supply upon entry into the brain parenchyma. 

From then on they are under control of the “intrinsic innervation” as they receive neural input 

from neurons located within the brain itself. 

28

Common Treatments 

Sympathetic Nervous 

System 

T1-6 

Any modality 

29


Vascular 

Arterial 

Vertebrobasilar system, Post Comm 

Anterior Cerebral 

Middle Cerebral 

Venous 

Dural Sinuses and Jugular Vein 

Avoid treatment if a recent vascular event 

30

Vertebrobasilar system: C1-C2, OA, Suboccipital triangle, Foramen magnum 

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Internal carotid to circle of willis: Temporal bone (cervical, petrous parts), Sphenoid 

(cavernous part), Circle of Willis (Located approximately at the juncture of lateral frontomaxillary 

and maxillo-zygomatic suture lines) 

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Anterior cerebral artery: Metopic suture to coronal suture 

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Middle cerebral artery: From Circle of Willis along superior temporal lobe 

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Lymphatic System 

Open Thoracic Inlet 

36


Secondary Respiration 

Re-dome Abdominal Diaphragm 

38

Treating Cortical 

Tissue 

Avoid if recent vascular event 

Balanced Membranous Tension 

Assess 

Tension, Restriction 

Laxity, void 

Seek balance 

39 

Biomechanical anatomic connections: Scalp, cranial bones, dura, arachnoid, pia, extracellular 

matrix, neuronal cell wall, intracellular contents

Major Depressive D/O 

Hypoperfusion Dorsolateral/Dorsomedial 


Vascular: Anterior & Middle Cerebral 

Arteries 

1° Respiration: 

40

Hold: DMPFC- Fingers along metopic suture from nasion to coronal suture (bregma). DLPFC- 

Structures: DMPFC-Anterior falx cerebri (crista gali, metopic suture to coronal suture: 

ethmoid, frontals, anterior dural girdle). DLPFC- Ipsilateral frontal bone. 

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Increased CBF Medial Thalamus 

Vascular: Vertebrobasilar, Post Comm Art 


42

Hold: Glabella to Lambda make ring with finger contacts and hand (modified fronto-occipital 

Structures: Tour of the minnow- 3rd ventricle lateral walls made up by the thalamus. 

Attending to fluid dynamics can be the most approximate handle on the thalamus. 

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Hypoperfusion of Anterior Cingulate Gyrus 

Vascular: Anterior Cerebral Artery 


44

Hold: Bilateral: fingers of both hands on both sides of metopic suture to coronal suture with 

Structures: Anterior falx cerebri (crista gali, metopic suture to coronal suture: ethmoid, 

frontals, anterior dural girdle). 

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Reduced Frontal Lobe volume 



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Structures: Sphenoid. Frontal bones. 

47 

Hold: Fingers lay on full frontal bone area bilaterally.


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Bipolar D/O 

Reduced Cerebellar Vermis Volume 

Vascular: Vertebral and Basilar arteries 


48

Hold: Bilateral fingertips at inferior nuchal line toward the foramen magnum with PIP/MCP 

joints at the superior nuchal line/inion 

Structures: Tentorium cerebelli, occiput. 

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Bipolar D/O 

Right Anterior Cingulate Gyrus 



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Hold: Unilateral: Right hand fingers along metopic suture and thumb at mid lateral edge of 



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Bipolar D/O 

Left Superior Temporal Cortex 

Vascular: Middle Cerebral Artery 


52

Hold: Medial hand- Fingers along line from greater wing of sphenoid to above the mastoid 

process on the parietal. Lateral hand ipsilateral temporal hold 

Structures: sphenoid, temporal and parietal 

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Bipolar D/O 

Bilateral Insular Cortex 

Vascular: Middle Cerebral Artery 


54

Hold: Bilateral fingers along straight line from zygomatic process of frontal to apex of 

squamous temporal juncture with parietal. Unilateral- medial hand along line from zygomatic 

Structures: Frontal, sphenoid, parietal, temporal bones. 

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Bipolar D/O 

Increased Striatum Volume 

Vascular: Vertebral and Basilar 


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squamous temporal juncture with parietal. Unilateral: Lateral hand along straight line from 


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Other Options? 

Cranial Vertebrae 

Charlotte Weaver DO 

Biodynamics 

James Jealous DO 

Brain Curriculum 

Bruno Chikly MD DO 

58

SUMMARY 

Limited Evidence for OMM in Mood d/o 

Limited Evidence of anatomical/ 

physiological correlates in Mood d/o 

Rationale Approach utilizing OMM in Mood 

d/o 

59

QUESTIONS? 

60

Teodor Huzij DO FACN

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