THE WORLD HEALTH Organization estimates that major depression is now the fourth most important cause worldwide of loss in disability-adjusted life-years and will be the second most important cause by 2020 (World Health Organization, 2004). Depression is a frequently occurring psychiatric disorder with a prevalence of approximately 5% in the general population (Bebbington et al 1981 and Weissman et al 1988). It is estimated that at least one-third of all individuals are likely to experience an episode of depression during their lifetime (Rorsman, Grasbeck, Hagnell, Lanke, Ohman, Ojesjo, & Otterbeck, 1990). In Taiwan the lifetime rates for major depression was 1.5 cases per 100 adults (Weissman, Bland, Canino, Glorisa, Faravelli, Greenwald, Hwu, Joyce, Karam, Lee, Lellouch, Lepine, Newman, Rubio-Stipec, Wells, Wickramaratne, Wittchen, & Yeh, 1996). Depressive disorders are persistent, recurring illnesses that cause great suffering for patients and their families (Williams, Mulrow, Chiquette, Elaine, Noël, Aguilar, Christine, & Cornell, 2000).

Depression results in high personal, social, and economic costs through suffering, disability, deliberate self-harm, and health care provision. The personal burden of depression includes higher mortality and impairment in multiple areas of functioning. The attendant economic costs to society and personal burden to patients and families are enormous. In the United States, the estimated costs of treating depression and the costs incurred by lost productivity exceeded $44 billion in 1990 (Greenberg, Stiglin, Finkelstein, & Berndt, 1993). Despite the availability of drug and psychotherapeutic treatments, much depression remains undiagnosed or inadequately treated (Freeling, Rao, Paykel, Sireling, & Burton, 1985). Although there is much research about depression, few studies have focused on the effects of music in improving depression (Aldridge, 1993), particularly in psychiatric inpatient.

Three types of therapy for major depressive disorder (MDD) have proven efficacy: pharmacotherapy, psychotherapy, and electroconvulsive therapy (Thase, Greenhouse, Frank, Reynolds, Pilkonis, Hurley, Grochocinski, & Kupfer, 1997). The most frequently used treatment for major depression is antidepressant medication (Depression Guideline Panel, 1983). As many as 30% to 35% of patients do not respond to treatment although the development of new and effective medications for depression (Baldessarini 1985; Baldessarini 1989 and Silver & Yudofsky 1988). Furthermore, medications also may induce unwanted side effects that can impair patients’ quality of life and reduce compliance (Silver & Yudofsky, 1988). Even among patients who show improvement with short-term antidepressant use, there is a significant risk for relapse within 1 year after treatment termination (Craighead et al 1998 and Keller, M.B., 1988. Diagnostic issues and clinical course of unipolar illness. In: Francis, A.J. and Hales, R.E., Editors, 1988. Review of Psychiatry, American Psychiatric Press, Washington, DC, pp. 188–212.Keller 1988). Therefore, nonpharmacological methods that promote a mind-body interaction without side effects should be tested to reduce depression in MDD patients.

Depression is one of the most common reasons for using complementary and alternative therapies (Ernst, Rand, & Stevinson, 1998). In 1991, 40% of the US adult population used at least one such therapy for 1 year (Astin, 1998). It is estimated that about 20% of those who suffering from depression had used an unconventional therapy within the past year (Eisenberg, Kessler, Foster, Norlock, Calkins, & Delbanco, 1993). Depression is among the 10 most frequent indications for using alternative therapies, and music is one of the remedies for this condition (Astin, 1998). Complementary and alternative therapies are popular in Taiwan. A survey revealed that 90% of Taiwanese families frequently combined a variety of approaches in treating illnesses (Wu & Hu, 1980).

Only three researchers have examined the therapeutic effect of music on depression. Each found that music had beneficial effects (Chung 1992; Hanser & Thompson 1994 and Lai 1999), but there were methodological problems of small sample size and lack of consideration of confounding factors. Moreover, none studied the effects of music on major depression in psychiatric inpatients.

Music is known to effect the individual by sympathetic resonance. Based on a psychophysiological theory synthesized from the literature, certain type of music induces relaxation and please responses (Lai & Good, 2002), which reduce activity in the neuroendocrine and sympathetic nervous systems, resulting in decreased anxiety, heart rate, respiratory rate, and blood pressure (Good et al 1999; Standley 1986 and Zimmerman et al 1988). Music has been found to increase circulating endorphin (Mockel, Rocker, Stork, Vollert, Danne, Eichstadt, Muller, & Hochrein, 1994), which is associated with moods (Gerra, Zaimovic, Franchini, Palladino, Guicastro, Reali, Maestri, Caccavari, Delsignore, & Brambilla, 1998). Thus, a music intervention was expected to improve depression. Addressing music selection is important when conducting music intervention. Music preference plays a large role because people generally like what they know and dislike the unfamiliar (Lai & Good, 2002). However, little is know about the effects of music on depression in psychiatric patients. Thus, the aim of the study was to test the hypotheses that, while controlling for identified covariates, subjects who used music as therapy at 6pm each day for 2 weeks would have (1) better depression scores and (2) better individual subscores of depression over time than those who did not use music.

Methods

Subjects

Patients with major depressive disorder diagnosed by a psychiatrist according to the Diagnostic and Statistical Manual of Mental disorder 4th edition (DSM-IV) in a psychiatric ward of a psychiatric hospital in southern Taiwan were included in the study. Exclusion were current alcohol or substance abuse, primary psychiatric diagnosis other than MDD, ongoing participation any other alternative or complementary therapies, and were those who with suicidal ideation.

A total of 54 subjects were expected to achieve a power of .8 at ALPHA = .05, one-tailed, with a medium effect size, a medium correlation (r = .50) among three repeated measures, and using repeated measures analysis of covariance on depressive scores, the size of each group was computed to be 27 (Stevens, 1996). The subjects in both groups received either Efexor (venlafaxine HCl) 75 mg/#1 twice daily or Prozac (fluoxetine HCl) 20 mg/#1 daily during time the study was conducted.