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Is Depression a Disease or an Opportunity?

Is Depression a Disease or an Opportunity?

A depression diagnosis does not have to be a life sentence. Often, it is a sign that our lives are out of balance and that we’re stuck. It is a wake-up call and, potentially, the start of a journey that can help us become whole and happy, a journey that can change and transform our lives.

When a physician observes the signs and symptoms of “major depressive disorder” in someone—the difficulty sleeping and eating, the weight loss, the absence of interest in a world which once pleased her, the feelings of helplessness and hopelessness—he is likely to prescribe anti-depressant drugs. When a patient asks questions about the need for drugs, she (I use the feminine to remind us that more than twice as many women as men are diagnosed with depression) is often told, “Depression is a biochemical disorder like insulin-dependent diabetes. Diabetics need insulin because their pancreas doesn’t work properly. And you need the drugs, the selective serotonin reuptake inhibitors (SSRIs), like Paxil and Prozac, to raise your levels of serotonin.”

It sounds authoritative, appropriate, and effective. Unfortunately it’s inaccurate.

First of all, the biochemical disorder has never been demonstrated. Some people with depression may have lower levels of serotonin, a neurotransmitter which helps to calm the brain and balance many body functions. But it seems that they are a minority. Doctors often don’t even measure the level of serotonin before prescribing drugs to affect it.

Second, the SSRIs are not, in fact, selective. Serotonin producing cells are distributed widely through the brain and body—the small intestine has the largest number—and altering serotonin inevitably alters the level and action and many functions of other neurotransmitters, including dopamine, which mediates pleasure. A cascade of uncomfortable and sometimes dangerous side effects result, including gastro-intestinal upset, neurological problems like headaches, muscle stiffness and tremors, weight gain, and sexual dysfunction—in up to 70 percent of all those who take the SSRIs. Indeed, in the early weeks of taking the drugs, a number of people, mostly young adults and adolescents, become more depressed and more suicidal.

In fact, neither the SSRIs, nor the serotonin–norepinephrine (norepinephrine is a neurotransmitter that may affect mood and activity level) reuptake inhibitors (SNRIs), which are increasingly prescribed, do a very good job. Doctors have prescribed these and other anti-depressants with great enthusiasm for more than twenty years—some thirty million Americans are currently using them for premenstrual syndrome, chronic pain, and anxiety, as well depression—because they believed the published studies which showed that the drugs were 60 to 70 percent more effective for depression than the placebos, the sugar pills, to which they were compared. These numbers were seriously misleading.

The drug companies, which profit hugely from SSRIs and other antidepressants, had, for the most part, only published the positive studies. When researchers went to the United States Food and Drug Administration and recovered the unpublished negative studies, the results were quite different. Reviews of the literature, which were published in our most prestigious medical journals—including The New England Journal of Medicine and The Journal of the American Medical Association—revealed that antidepressants were little, if any, better than placebos—except for a small minority of the most seriously depressed people.

All this doesn’t mean that antidepressants aren’t sometimes helpful. They can be, even with their limitations and side effects. What it does mean is that they should not be regarded as the “treatment of choice” as most physicians believe them to be, but instead as a last resort.

My treatment of choice is what many call “integrative.” I think of it as a way to get Unstuck, to help us move through and beyond the depression and the other difficulties that our lives may bring us. I describe this integrative, comprehensive approach in some detail in my book, Unstuck: Your Guide to the Seven Stage Journey out of Depression. It combines the best of conventional treatments, including various forms of psychotherapy, with a variety of other techniques that enhance each person’s emotional life and cognitive abilities as well as her physical health. Medication should be used only when this approach doesn’t work. “In extreme situations” Hippocrates said 2500 years ago “extreme remedies.”

The foundation for this Unstuck approach is a meditative or mindful one—which simply means that it is designed to help people to be relaxed, aware and self-aware, and firmly grounded in the present moment. The Unstuck approach includes specific meditation techniques like slow, deep “soft belly” breathing and mindful walking and eating, which have been shown to decrease levels of anxiety and stress, enhance mood and optimism, and promote greater emotional stability and more reliable judgment. Both focused and mindful meditation raise the levels of the same neurotransmitters at which SSRIs and SNRIs are aimed.

Movement and exercise, which have been repeatedly shown to at least equal anti-depressants in relieving symptoms of depression, and also to raise neurotransmitter levels, are central. It looks like about 30 minutes of daily exercise is optimal, but all of us should start with what we can do–walking a couple of blocks is a great beginning—and be sure to do something we hope to enjoy.

Nutrition may also be crucial in preventing, as well as treating, depression. People who are depressed may be deficient in B vitamins, Vitamin D3, Selenium, Magnesium, and the Omega 3 fatty acids that are present in fish oil. Others are sensitive to gluten and other food substances which may cause inflammation, which has been implicated in depression.

It is important to stimulate imagination and intuition as well as nourish the body. I teach techniques like guided imagery, drawings, and written dialogues to help depressed and anxious people to access more easily their imagination and to use their intuition and creativity to find answers to previously insoluble problems.

Work with a skilled therapist can be important, even crucial, but it is exponentially enhanced by what we can do for ourselves. Because they are grounded in self-awareness and self-care, each and every one of these techniques carries with it a general as well as a specific benefit. In acting to understand and help ourselves, we overcome the feelings of helplessness and hopelessness that are the hallmarks of depression.

Many people find they can multiply the effectiveness of self-care by being part of a group in which they learn together and share their experiences and themselves with one another. In the Mind-Body Skills Groups which The Center for Mind-Body Medicine has developed, participants feel less like damaged or ill patients, more like pilgrims together on a journey toward greater understanding, health, and wholeness.

Finally, symptom relief, the treatment of depression, and spiritual practice can be intimately connected. Using self-care techniques and living more meditatively often paves the way for us to connect with something—god, nature, a higher power—great than ourselves and to find meaning and purpose in our lives. And spiritual connection, meaning, and purpose are among the most powerful proven antidotes to depression.

James S. Gordon, M.D., a psychiatrist, is the author of Unstuck: Your Guide to the Seven-Stage Journey Out of Depression, from which part of this article was excerpted. He is the Founder and Director of The Center for Mind-Body Medicine, a Clinical Professor at Georgetown Medical School, and former Chair of the White House Commission on Complementary and Alternative Medicine Policy.

 

Read more: Diet & Nutrition, Health,

By James S. Gordon, MD

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6:59AM PDT on Aug 28, 2013

Thank you Care2 Healthy Living Guest Blogger, for Sharing this!

12:10PM PDT on Aug 18, 2013

I like your idea of doing what you can for yourself. Empowerment might boost your self-esteem and help alleviate depression. If you are at the mercy of others' treatments exclusively, especially if they aren't working, that sounds like a recipe for discouragement to me.

6:40PM PDT on Jul 25, 2013

Nutrition is not a fix but it does make a huge difference and water. When I am miserable I drink water. I just do.It may not help at that moment but we need at least 8-12 glasses of water a day.

I'm diabetic and i have been thirsty since so little. Love my water. NO tap water -sorry.

6:36PM PDT on Jul 25, 2013

Nutrition is always a priority. I have learned that.
I didn't feel comfortable with this article. i think it was all over the place and actually complicated thi9ngs .

I have issues due to medical situations that we all know the body and mind go together so never had any depression but things can cause it now.

I fully refuse and always would refuse antidepressants for anything. They are handed out like candy for everything. Menopause, Neuropathy, fibro, the list goes on....

There truly are people that do benefit from antidepressants but It's a very low count of people compared to what they hand out and say you need them for. I took them for neuropathy and felt like I was speeding and also wanted to kill myself with the first dose. I also have this problem with Kyrica and Neurontin (anti Seizure meds). I had this problem before the commercials were on TV mentioning it could cause suicidal thoughts /feelings.... Way before it was on TVC as commercials. NOT for me and i don't believe for most people. **Not against them for certain people that really need them.

The article was all over the place and made me upset even. Annoyed.
Thanks....

10:26AM PDT on Jul 21, 2013

Dear Lauren, thank you for your caring, emphatetic and understanding post. Depression is VERY REAL to those who are dealing with this illness. We must support each other and not judge. By the way calling depression an illness is very appropo, it is neurons in our brain misfiring, like the body not producing enough or too much insulin. It is also configured by the fact that some people deal with depression in many different ways. Alcohol, drugs, destructive behavior and the list goes on and on. Winston Churchill suffered with depression for most of his life and called his depression his little black dog that accompanied him everywhere.

10:24AM PDT on Jul 21, 2013

Big pharma certainly has much power in this society and big medicine way too exalted. Hooking children on these drugs is an insidious trend. I don't believe in an organic cause for depression in the majority of cases; not saying that anti-depressants don't ever help anybody. Who wouldn't get depressed at times in a world fraught with war, disease and rampant social problems? However, it's not so much what happens in our lives but how we relate and handle it that causes us the problems. Alternatives to prescription drugs can be anything positive that would help to release that negative energy: spirituality, exercise, hobbies, keeping company with positive people. What will change the mindset is different for everyone. Thoughts are just that - thoughts. Like the clouds, they come and go. Just a thought ! :)

"The secret of being miserable is to have the leisure to bother about whether you are happy or not." ~ George Bernard Shaw

10:02AM PDT on Jul 21, 2013

Wow, what a diverse group of comments. Can we agree that there are "levels" of depression?
I had situational depressive episodes lasting 4-6 months almost yearly for 15 years. I used most of the items in the article above, including immersing myself in art work. I did not take medication, by my choice. Apparently what I did worked for me, yet would it work for someone else? I believe that is actually what is being debated by the folks who've commented and spoken up as having depression of whatever "level."

If readers could look at this comment section as a FORUM to air their ideas, questions, problems, possibilities, solutions, and comments then perhaps there would not be such an adversarial tone which I detect now.

Folks- we all want to have a good life. We read Care2 because it "speaks" to us. Why not share rather than attack?

7:37AM PDT on Jul 21, 2013

Ooopppsss I left out something important in my post, sorry. The lower doses of SSRI's (5 - 10mg) are as effective in treating depression without many of the negative side effects of the much higher dosages. I do know as I have worked with my doctor and for me 5mg is working very well and none of the negative side effects I had with the same medicine at 40mg. Will it work for all? I do not know but it is worth trying.

7:02AM PDT on Jul 21, 2013

Mental illness and major depression are very real, yet as a society we shun the whole matter. as if somehow the person suffering from this malady should pull themselves out of it. There is a need for SSRI's in many cases but the major challenge is that the dosage for SSRI's are grossly over prescribed. The FDA has known that the ideal dosage for SSRI's should be 5 to 10 mg yet due to big pharma's intentional misleading physician's, most people are given 20mg and upped to 40mg within a few months. There are many ways of working thru depression, but it is work! En corporo santo, en corporo mente. The food we are now eating does not always have the necessary nutrients the body needs, do foregoing fast food helps, doing even moderate physical work helps, having a pet is also of great help, meditating, yoga and last but not least friends can be of great importance. SSRI's and therapy are also important. As I said it is HARD WORK! And unfortunately I all too well know what depression is, have been dealing with it since age 15 and am now 63 but I still keep on and there are days when things are great and others that I struggle getting out of bed. The important thing is to be gentle with yourself and seek help and support wherever you can. Just do not give up.

2:36AM PDT on Jun 8, 2013

ty

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Disclaimer: The views expressed above are solely those of the author and may not reflect those of
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