Anyone who has ever put on a favourite CD at the end of a hard day knows that music can improve a bad mood. Now, it turns out that, with the help of a trained professional, music may be a valuable tool in treating clinical depression.
"We all use music to make ourselves feel better, to feel more in touch with our emotions," says Anna Maratos, a music therapist in London. "Music therapy works on the basis that listening to music can provide a bridge to other things, like self-reflection, relaxation, or cognitive techniques."
Ms. Maratos and her colleagues reviewed all of the published studies they could find for a journal called the Cochrane Library. They found only five studies of high enough quality to be included in the article, but four of those five suggested that music therapy does work.
But the treatment is not as simple as throwing on some earphones and listening to happy music. The successful studies all used music as a way to make people aware of their mood, which could then lead to a discussion of how they could act to change it.
One of the studies worked with nursing-home residents and used oldies, hymns, country music and semi-classical piano music. It's not clear what types of music the other studies used. But, in general, music therapists use music from many different genres, sometimes including blues, heavy metal and hip hop, depending on the individual patient and the treatment goals.
Although upbeat music might be used to try to improve mood, a sad or angry piece may also help depressed people to express or reflect on their feelings, Ms. Maratos says.
One of the most encouraging thing about the studies, she says, was that they had very low dropout rates - people tended to stick around for the full course of treatment.
That could make music therapy a good treatment for people who are reluctant to use drugs or who have a hard time with other forms of psychotherapy, she says. "Lots of people don't benefit from other forms of therapy. Music therapy might be an alternative for those for whom talking therapy wasn't effective."
Doctors have been interested in using music to treat patients since at least the Middle Ages. By 1621, Robert Burton had published the famous Anatomy of Melancholy, a study of what we would now call depression. In it, he wrote that music "is a sovereign remedy against despair and melancholy, and will drive away the devil himself."
Modern music therapy began after the Second World War and was often used to treat soldiers returning from battle. In Canada, music therapists receive accreditation through the Canadian Association of Music Therapists.
Music therapy is often used to treat people who have difficulty communicating verbally, such as children, the elderly or people with developmental disabilities. But it isn't a common treatment for stand-alone depression.
However, Ms. Maratos says, working music therapists often notice improved mood in their subjects. She and her colleagues wanted to know what the scientific evidence was.
The five studies included in the paper were done over the past 15 years.
In one, participants played music along with a therapist. In the others, they listened to music. In all of the successful studies, participants either discussed their emotions with the therapist, or were instructed on how to use the music to help them focus on and change their feelings.
All of the studies compared the music therapy to some other form of therapy for depression, including drugs and talk therapy.
In the one study that showed no improvement, the music therapy simply consisted of listening to music for an hour in a group, the authors say.
(The researchers who conducted that study were actually more interested in cognitive behavioural therapy and included the music-therapy component as a control.)
Canadian music therapists are encouraged by the growing body of evidence that validates their work.
Colin Lee, the head of the music-therapy program at Wilfrid Laurier University, has worked a lot with people with HIV/AIDS. "The clients I worked with were for the main part depressed. The thing with music is that it's a creative phenomenon. You have to take the idea that being creative is being well. So to be creative when you're not well, when you're depressed, is going to affect your mental state," he says.
"I think it's great that the Cochrane Library has done a meta-analysis," says Sandra Curtis, co-ordinator of the music therapy program at the University of Windsor. "We have a rich history of research, but it's not always been up to standard of the Cochrane Library. In the future, we'll see more studies up to their level."
Ms. Maratos and her colleagues did included some caveats. All of the studies were fairly small, with at most 68 people participating. All of them took different approaches to music therapy, making them hard to compare with each other. And all had technical flaws in the way they were conducted or reported, which meant that they were not as strong as the best scientific studies.
However, Ms. Maratos says the results were strong enough to suggest that music therapy is effective. She says she hopes that her review will persuade researchers to conduct bigger and more definitive studies.
Kurt Kleiner lives in Toronto and writes frequently about science.
