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rpautrey2 · Guest

Prozac Nation No More?

In a new book, psychiatrist James Gordon explains why he believes
there's a more effective and drug-free way to treat depression and
anxiety.

Anne Underwood
Newsweek Web Exclusive
Updated: 8:56 AM ET Jul 8, 2008

Do we really need Prozac? James Gordon, founder of the Center for Mind-
Body Medicine in Washington, D.C., says there's a better way to treat
depression—through diet, exercise and meditation. Roll your eyes all
you like. He's used the approach for 35 years with a wide range of
patients, from runaway children and middle-class adults in Washington,
D.C., to victims of war in Bosnia, Kosovo, Israel and the Gaza Strip.
This week, Gordon is heading to flood-stricken Iowa to see if he can
be of assistance there. About 10 percent of American women and 4
percent of men now take antidepressants (according to a 2004 CDC
report). Gordon's new book, "Unstuck: Your Guide to the Seven-Stage
Journey Out of Depression," outlines a treatment program he believes
can be an alternative to medication. NEWSWEEK's Anne Underwood spoke
to Gordon about his recommendations and how he's implemented them
around the world. Excerpts:

NEWSWEEK: So many people have been helped by Prozac and other
antidepressant medications. Why do you say these drugs should only be
used as a last resort?
James Gordon: Depression is not the end stage of a disease process but
a wakeup call to examine our lives. There are better ways to do that
than taking drugs, which have side effects and don't address the
underlying message that depression is bringing—that our lives are out
of balance and significant change is necessary. Instead they tell us,
"You have a biochemical disorder, here's a drug."

But people with depression do have imbalances in levels of
neurotransmitters.
Some people do, I wouldn't deny that. What I'm saying is that there
are many ways to address those changes that do less harm and may be
more productive in the long run because they give people the sense of
control that comes from helping themselves.

Do psychiatrists hate your program?
I've heard some do, but I hope that will change as they take a closer
look at the evidence. After all, I'm a psychiatrist myself. I have my
medical degree from Harvard, and I worked for 10 years at the National
Institute of Mental Health. I'm not the only clinician who believes
antidepressant drugs are overused and that we need other ways to treat
depression. A major study that appeared recently in the New England
Journal of Medicine, which reviewed both unpublished and published
studies submitted to the FDA, found that, when the unpublished trials
were included, antidepressants were not nearly as effective as they've
been thought to be. A second study that appeared in February in PLoS
Medicine, the online journal, reviewed similar data and found that
antidepressants were no better than placebos for mild to moderate
depression and only slightly more effective for severe depression.

How did you get interested in alternative treatments in the first
place?
At the National Institute of Mental Health in the 1970s, I worked with
runaway and homeless children on the streets, in runaway houses and
group foster homes. They came from chaotic households. Running away
for some of them was the sanest thing they could have done. I wanted
to develop programs to help them help themselves. Later I ran the
adolescent service at St. Elizabeth Hospital in Washington. Virtually
all the patients were minorities, and many were in trouble with the
law. I created a holistic, or integrative, approach to their
treatment. I brought in a kung fu instructor to work with them. I
started meditating with them. I changed their diets and significantly
increased their amount of exercise—lots of basketball, a running club
and so on. The level of violence went down on the ward.

Describe the program you use with patients.
It's a good deal like what I describe in "Unstuck," but done in a
group setting. Each group opens with quiet meditation. You then
introduce yourself and say what's going on with you, focusing on your
present experience. There is no analyzing, interpreting or
interrupting. You become aware of what's going on inside. In the first
session, we have participants draw three pictures—one of themselves,
then themselves with their biggest problem and finally themselves with
the problem solved. It shows people they can identify their biggest
problem and imagine a solution, a powerful experience when they're
feeling hopeless.

That's it?
The second session, we use a low-tech form of biofeedback to teach
them to relax. In the third session, we do guided imagery, and so on—
one new technique in each session. I also teach several types of
meditation.

How much exercise does it take to deal with depression?
Generally speaking, the more, the better. But the idea is not to feel
guilty if you don't do as much as you think you should. Just starting
with a little bit can make a difference. If all you think you can
manage is 10-15 minutes of walking a day, that's a great place to
begin.

Have you published research showing that this works?
We have one published study with 139 traumatized kids in Kosovo in
2002. After 10 weeks, their post-traumatic stress disorder scores went
down from 88 percent to 38 percent. We have another coming out soon—a
randomized controlled trial with war-traumatized teens. Other
researchers have done many studies on the individual techniques that I
use in "Unstuck." The key is using a variety of techniques that work
together to help people look at the world differently and lower their
levels of stress. Individually, these techniques work at least as well
as antidepressants for people with mild to moderate depression.
Together they are likely to be far more effective.

And for severe depression …?
That's harder to work with. That's where we need studies.

When did you start working with traumatized populations?
Twelve years ago, I wanted to see if this approach could help people
who'd been through horrendous experiences. The first places I went
were Mozambique, where we worked with child soldiers, and South
Africa. But my colleague Dr. Susan Lord and I began in earnest in
Bosnia, after it had been totally decimated by war. Then when the war
in Kosovo began in 1998, we went in there, too. If you wait until
after a war is over, the psychological and physiological patterns of
trauma become fixed. Rates of heart disease, alcoholism, spousal
abuse, child abuse, depression and PTSD go way up. Eventually my
faculty and I trained 600 professionals to teach our program, and our
model became an integral part of the country's mental-health services.

And in a long-term conflict areas like the Gaza Strip?
Almost simultaneously, I received nearly identical emails—one from a
Palestinian psychologist and one from an Israeli psychologist who had
seen what we had done in Kosovo. They were completely overwhelmed by
the situation and asking for help. We've now trained 300 professionals
[to teach our techniques] in Israel, many of whom work along the Gaza
border, in areas where there's shelling. In Gaza, our 90 trainees are
dealing with people who have amputations and chronic illnesses,
children orphaned by the conflict, men who've been in Israeli prisons.
We work with every faction—Hamas, Fatah, Islamic Jihad—and with some
people who aren't part of any group. We've worked with thousands of
kids, and we have detailed data on 490 so far, showing they feel
better, more relaxed, less depressed, more hopeful about the future—
and this is in a situation with ongoing conflict, little electricity
and very few jobs.

What kind of impact does that have on their lives?
Two weeks ago, one of our Gaza leaders told me I had to meet this 16-
year-old boy. I went to talk to him. He had seen his best friend
killed by Israeli gunfire. He would dream about it at night and
couldn't concentrate at school. He started throwing rocks at Israeli
soldiers, hoping they would kill him, too. Our training helped him
talk about those experiences for the first time. Then, during the
guided imagery, when participants imagine having an "inner guide," he
imagined his grandfather bringing what seemed like the wisdom of the
Koran. The boy asked his grandfather what to do about his friend. And
he heard a voice that sounded like his friend, saying, "You will honor
me by living." He doesn't throw stones at the soldiers anymore.

So are you saying that people should throw out their Prozac?
No, the bottom line is that there is another way. Don't quit cold
turkey. Withdrawal symptoms can be very serious, including anxiety and
agitation. Some people get more depressed. They may have headaches,
difficulty sleeping, muscle cramps. You can begin the "Unstuck"
approach while taking the medications. When and if you feel ready to
stop taking the drugs, work with a physician who can help you
gradually taper off.

URL: http://www.newsweek.com/id/144951
© 2008