CORTISOL DECREASES AND SEROTONIN AND DOPAMINE INCREASE FOLLOWING MASSAGE THERAPY.
- markacolwill
- May 12
- 11 min read
The full pdf version of the paper can be found via this link
This article reviews the positive effects of massage therapy on biochemistry, including decreased levels of cortisol and increased levels of serotonin and dopamine. The research reviewed includes studies on depression, pain syndromes, autoimmune conditions, immune conditions, stress reduction on the job, the stress of aging, and pregnancy stress. In studies where cortisol was assayed either in saliva or urine, significant decreases were noted in cortisol levels (averaging decreases 31%). In studies where 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, 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 generalise across conditions.
Cortisol is notably a culprit variable deriving from stressful conditions and ultimately negatively affecting immune function. It 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 labelled 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 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. The massage therapy group participants received two 20-minute therapy sessions by their significant others each week for 16 weeks of pregnancy starting during the second trimester. By the end of the study, the massage group had lower levels of saliva cortisol (↓23%) and higher urine dopamine (↑25%) and serotonin levels (↑23%) following pregnancy massage. These changes may have contributed to the reduced fetal activity and 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 Behaviour Assessment Scale.
Postpartum depression is a common issue among mothers, with depression affecting the relationship between mother and child. Massage and relaxation therapy have been suggested to help reduce these symptoms. A study on postpartum depression found that 32 depressed adolescent mothers received 10 30-minute sessions of massage or relaxation therapy over a 5-week period. The women reported lower anxiety following their first and last therapy sessions, but only the massage therapy group showed behavioural and stress hormone changes, including a decrease in anxious behaviour and salivary cortisol levels (↓28%).
Infants of depressed mothers also experience depression symptoms similar to their mothers, including elevated cortisol and low levels of serotonin and dopamine. In an attempt to modify the depressed profile of infants of depressed mothers, a massage therapy study was conducted with 40 full-term 1- to 3-month-old infants born to depressed adolescent mothers. The infants who experienced massage therapy spent more time in active alert and active awake states, cried less, and had lower salivary cortisol levels (↓33%), suggesting lower stress. After the massage versus the rocking sessions, the infants spent less time in an active awake state, suggesting that massage may be more effective than rocking for inducing sleep. Over the 6-week period, the massage therapy infants gained more weight, showed greater improvement on emotionality, sociability, and soothability temperament dimensions, and had greater decreases in urinary cortisol (↓53%) and increased serotonin (↑34%).
Depressed children and adolescents, particularly those hospitalised for their depression, are noted to have elevated stress hormones, including elevated cortisol and norepinephrine. In an attempt to lower the depression and cortisol levels of these children and adolescents, a 30-min back massage was given daily for a 5-day period to 52 hospitalized depressed children and adolescents. Compared with a control group who viewed relaxing videotapes, the massaged subjects were less depressed and anxious and had lower saliva cortisol levels after the massage.
Posttraumatic stress disorder is frequently noted in children following natural disasters such as hurricanes. Symptoms commonly described by the children include depressed affect, numbing of responses, and conduct problems. Following Hurricane Andrew, teachers in the affected school suggested that people in these children's lives, namely their parents, were experiencing posttraumatic stress symptoms themselves, which may have been a reason for their initiating less physical contact with their children at this time. The massage therapy study showed that the children who received massage therapy reported being happier and less anxious, had lower salivary cortisol levels (↓11%) and urinary cortisol levels (↓30%) after the therapy, and were observed to be more relaxed. These positive effects were promising given the persistence of PTSD symptoms noted for children who have not received intervention following disasters such as hurricanes.
This section reviews studies on depression-related disorders or disorders that are typically accompanied by depression, including sex abuse, eating disorders, anorexia, and bulimia. Sex abuse is a relatively common event, with some suggesting that more than 50% of women are sexually abused by the age of 18. Massage was thought to be an effective therapy for women who had experienced sexual abuse because the positive touch could help them feel less negative about touch. In the present study, women who had experienced sexual abuse were given a 30-min massage twice a week for one month. Immediately after the massage, the women reported being less depressed and less anxious, and their salivary cortisol levels decreased following the session (↓25%). Over the one-month treatment period, the massage therapy group experienced a decrease in depression amid in life event stress and in urine cortisol levels (↓31%). Although the relaxation therapy control group also reported a decrease in anxiety and depression, their stress hormones did not change, and they reported an increasingly negative attitude toward touch.
Eating disorders include anorexia, which features (1) a refusal to maintain normal body weight, (2) a fearful and irrational preoccupation of weight gain, body size, and body image despite being underweight, and (3) in females, the disturbance of the menstrual cycle resulting in amenorrhea. The American Psychiatric Association (1996) diagnosed anorexia as a separate disorder, which includes symptoms such as depression and anxiety, higher cortisol levels, and increased stress hormones. Massage therapy has been shown to reduce the levels of depression and cortisol in women experiencing anorexia.
Bulimia is a separate disorder, with symptoms including curb binge eating, regular self-induced vomiting, strict dieting or fasting, and rigorous exercise to prevent weight gain. A study conducted on massage therapy with bulimia showed immediate reductions in anxiety and depression, lower depression scores, lower urine cortisol levels, and lower saliva cortisol levels. These findings suggest that massage therapy is effective as an adjunct treatment for bulimia.
Pain syndromes include burn injuries, where patients with depression and anxiety may affect their perception of pain. In a study conducted on burn injuries, it was expected that massage therapy may increase pain threshold and be of help through the debridement session. In this study, 28 adult patients with burns were randomly assigned before debridement to either a massage therapy group or a standard treatment control group. State anxiety and saliva cortisol levels decreased (↓20%), and behaviour ratings of state, activity, vocalisations, and anxiety improved after the massage therapy sessions on the first and last days of treatment. Longer-term changes were also significantly better for the massage therapy group, including decreases in depression and anger and decreased pain on the McGill Pain, Present Pain Intensity, and Visual Analogue Scales.
Juvenile rheumatoid arthritis is based on persistent arthritis for six or more weeks in one or more joints. Several alternative therapies have been explored due to the limited effects of anti-inflammatory drugs and the undesirability of using narcotics for pain reduction in children with arthritis. The use of massage therapy with this group of children was investigated, with children with mild to moderate juvenile rheumatoid arthritis experiencing decreased anxiety and saliva cortisol levels, decreased urine cortisol levels, and decreased pain on self-reports, parent reports, and physician assessments of pain (both the incidence and severity) and pain-limiting activities.
Stress can lead to the dilation of blood vessels in the brain, which can trigger migraines. Massage therapy has been shown to have positive effects on reducing headaches, such as fewer distress symptoms, less pain, more headache-free days, and fewer sleep disturbances. In a study conducted by the authors, 26 adults with migraine headaches were randomly assigned to a massage therapy group who received two 30-minute massages per week for 5 consecutive weeks. The massage therapy participants reported fewer distress symptoms, less pain, more headache-free days, and fewer sleep disturbances, and they showed an increase in serotonin levels (↑13%). Synthetic serotonin medications have been effective for treating headaches, and the natural production of serotonin can be used potentially to decrease the intensity and frequency of headaches.
In the case of migraine headaches, the decrease in cortisol levels and, in the case of migraine headaches, the increase in serotonin levels, the reduction of pain along with improved sleep suggests reduced stress. It is not clear whether the change in stress led to the change in biochemistry or vice versa. Self-reports of improved mood and decreased anxiety might relate to enhanced sleep, reduced pain, and/or a change in the biochemical profile.
Autoimmune conditions such as asthma, chronic fatigue syndrome, and fibromyalgia have been associated with stress including elevated depression, anxiety, and cortisol. Very little is known about the etiology of autoimmune conditions, and it is not clear the degree to which stress and stress hormones contribute to the autoimmune conditions. Although the symptoms that are altered by massage therapy are unique to each condition, these conditions have in common the reduction in cortisol levels.
Children with asthma are noted to experience high anxiety levels, and because of the chronicity of asthma and because it was expected that parents would experience lower anxiety levels if they were to massage their children, parents were used as massage therapists in a study of children with asthma. The children who received massage therapy showed an immediate decrease in anxiety and saliva cortisol levels (↓37%) after massage. Additionally, their attitude toward asthma and peak air flow and other pulmonary functions improved over the course of the study.
Chronic fatigue syndrome is clinically defined as (1) the new onset of chronic, debilitating fatigue that does not disappear with bedrest and (2) the exclusion of other conditions that could produce the same symptoms as determined by medical history, clinical exam, or laboratory test. Other symptoms that have been associated with chronic fatigue syndrome include depression, with as many as 58% of this population experiencing depression. In a study on chronic fatigue, 20 subjects with chronic fatigue were recruited from local physicians and randomly assigned either to massage therapy or to a sham (transcutaneous electrical stimulation) group used as a control group. Characteristic of the incidence of chronic fatigue at large, the sample was primarily women (80%). The massage therapy group reported fewer depressive symptoms following the massage therapy sessions and by the end of the massage therapy period. They also reported lower anxiety levels and less pain. They had fewer fatigue symptoms and somatic symptoms, and they experienced less pain by the end of the study. Their saliva cortisol levels decreased (32%) after the first session and the last session, and their urine cortisol levels decreased (↓41%) across the course of the study, although their urine dopamine levels increased (↑2l%).
Immune disorders are likely to be most affected by elevated cortisol, as cortisol has been noted to kill immune cells, specifically natural killer cells. The reduction in cortisol would be expected to lead to an increase in natural killer cells that, in turn, would be expected to improve conditions like HIV and cancer. In the case of two studies reviewed here, one on HIV and one on breast cancer, both decreases in cortisol and increases in natural killer cells were noted.
Breast cancer is the leading cause of cancer death in women aged 15 to 54 in the United States. It is associated with psychological distress, including depression and anxiety, which are correlated with lower natural killer cells and natural killer cell activity. Lower levels of natural killer cells present a problem as they have an important role in cancer defense by fighting tumor and virus-infected cells. Massage therapy has been effective in increasing serotonin and dopamine levels, which are noted to decrease cortisol levels, thereby increasing natural killer cell number.
In a study on breast cancer, 34 women diagnosed with stage 1 or 2 breast cancer were randomly assigned post-surgery to a massage therapy group (30-min massages 3 times per week for 5 weeks) or a control group. The massage consisted of stroking, squeezing, and stretching the head, arms, legs/feet, and back. Results showed that massage therapy had immediate effects, including reduced anxiety, depressed mood, and anger. Longer term massage effects included reduced depression and hostility and increased urinary dopamine (↑26%), serotonin (↑38%), and natural killer cell number and lymphocytes. Although the direction of effects has not been assessed because the samples are too small for conducting path analyses, the expected pathway would involve increased serotonin and dopamine contributing to lower cortisol levels, in turn contributing to elevated natural killer cell levels and natural killer cell activity.
Stress conditions, such as job stress, physical activity stress, hypertension, pregnancy stress, and ageing stress, might contribute to elevated cortisol and compromised immune function. Healthcare workers are prime candidates for high stress levels. In a study on healthcare workers, results showed decreases in job stress, anxiety, and depression. In addition, EEG patterns changed in the direction of heightened alertness and math computations were performed faster and with fewer errors. Finally, urine cortisol levels decreased (↓24%).
Activity stress, such as dance, can be stressful for the body as muscles are shortened or stretched. Various forms of therapies, including massage therapy, have been used for injury prevention, treating muscle soreness, and improving range of motion. In a study on pregnancy stress, 26 pregnant women were assigned to a massage therapy or relaxation therapy group for 5 weeks. Both groups reported feeling less anxious after the first session and less leg pain after the first and last sessions. Only the massage therapy group reported reduced anxiety, improved mood, better sleep, and less back pain by the last day of the study. In addition, urine dopamine levels increased (↑25%) for the massage therapy group, and the women had fewer complications during labour and their infants had fewer postnatal complications, including a lower incidence of prematurity.
Aging stress, research shows that elderly people are prone to feelings of loneliness, depression, and decreased immune function, possibly because they receive less touch. In a study on elderly retired individuals who were volunteering at a home for children, the effects of the elderly retired volunteers giving a massage to infants were compared with their receiving massage themselves. Immediately after the first- and last-day sessions of giving massages, the elder retired volunteers had less anxiety and depression and lower saliva cortisol levels (4.28%). Their lifestyle and health also improved, possibly because their lower cortisol levels led to improved immune function. These effects were not as strong for the 3-week period when they received massage versus when they gave massage, possibly because the elder retired volunteers initially felt anxious about being massaged and because they derived more satisfaction massaging the infants.
SUMMARY
Thus, positive changes have been noted in biochemistry following massage
therapy including reduced cortisol and increased serotonin and dopamine.
Many conditions were positively affected by massage therapy including de-
pression and depression-related conditions, pain syndromes, autoimmune and
immune chronic illnesses, and stress conditions. The underlying mechanisms
for their effects remain to be understood.