(Part 1 of a Series on Depression and Anxiety)
Unstuck: Your Guide to the Seven Stage Journey Out of Depression
Book by James S. Gordon, MD
We're in the Depression Era … And It's Getting Worse
According to the World Health Organization (WHO), major depression is the leading cause of disease burden in North America and high-income countries. It is the fourth leading cause worldwide; by 2030, it is expected to be the second leading cause of disease burden worldwide. (1)
"Depression" generally refers to chronic or severe levels of sadness, anxiety, perceived helplessness, insomnia and disinterest, among other related feelings. Depression can be moderate to severe. "Dysthymia" involves long-term symptoms that keep one from feeling good or functioning well, but will not disable the person affected by the condition. "Major Depression" interferes with a person's ability to function normally and enjoy life; this includes the ability to sleep, work, eat, and socialize. "Bipolar disorder," also known as manic-depressive illness, is marked by wide mood changes, including severe highs (mania) and lows (severe depression). Bipolar disorder is not as common as other forms of depression.
Antidepressants have become the most commonly prescribed drugs in the United States, prescribed more often than drugs for high cholesterol, high blood pressure, asthma, or headaches. (2) The US Centers for Disease Control and Prevention (CDC) reviewed 2.4 billion drugs prescribed in visits to doctors and hospitals in 2005. 118 million were for antidepressants (high blood pressure drugs were the second most common, with 113 million prescriptions). Almost 232 million prescriptions for antidepressants were written last year, a large increase. (3) Approximately 30 million patients in the US spent $ 12 billion on antidepressants in 2007. (4) The average time a general practitioner (MD) will spend with each patient to determine the best approach to treat a patient for the condition at issue during a visit? About 15 minutes. (5)
The use of antidepressants and other related drugs have ballooned over the last decade and that trend is projected to continue. Are more people receiving previously unaddressed yet needed treatment for depression? Are more people becoming depressed and require treatment? Are more people being treated for symptoms that reflect depressive symptoms, such as general unhappiness, with prescription drugs?
These are crucial questions regarding our healthcare system's approach to depression, particularly considering new research addressing the effectiveness of prescription drugs.
New Medical Studies Raise a Lot of Eyebrows, and Even More Questions
The prestigious New England Journal of Medicine (NEJM) recently published a study that questioned both the selective publication of (positive) medical studies on antidepressants and therefore whether we have an accurate, unbiased perspective on their effectiveness and risk-benefit ratio. Instead of only considering published studies on the effectiveness of antidepressants, the authors evaluated all studies registered with the Food and Drug Administration (FDA), both published and unpublished. According to publishes studies, it appeared that 94% of the trials conducted showed positive results. However, when the unpublished studies were included, only about half (51%) of the studies demonstrated positive outcomes, suggesting a bias in the publication of positive studies, significantly questioning their efficacy. The authors concluded that they could not determine, however, the cause of the publication bias, but stated, "[s] elective reporting of clinical trial results may have adverse consequences for researchers, study participants, health care professionals, and patients." 7)
As a group of researchers wrote in a letter to the NEJM as a follow up to the study, "[t] he most serious implication of this study is that guidelines for the treatment of depression may be inaccurate, since they are often based on meta -analyses of published data alone.
This current system makes it impossible for scientific journals to provide a valid picture of the efficacy of antidepressants. "
Additionally, a recent study publushed in PloS Medicine concludes that new antidepressant medications, such as SSRIs, benefit only the most severe patients and, "[a] lthough patients get better when they take antidepressants, they also get better when they take a placebo [ such as a sugar pill], and the difference in improvement is not very great. This means that depressed people can improve without chemical treatments. " (8)
An Explosion of the Use of Antidepressants Combined with the Recent Research Questioning Their Effectiveness
Dr. Ronald Dworkin has a clear opinion regarding the current state of depression treatment, which, as already stated, includes $ 12 billion spent on antidepressants in the US alone. Dworkin, a senior fellow at Washington's Hudson Institute, is the author of "Artificial Unhappiness: The Dark Side of the New Happy Class." "Doctors are now medicating unhappiness," said Dworkin. "Too many people take drugs when they really need to be making changes in their lives." (9)
Unstuck – A New Book That Challenges $ 20 billion in Drug Company Advertising and the Mainstream Treatment of Depression
Pharmaceutical companies spent almost $ 20 billion in advertising in 2001; the largest amount was spent to promote antidepressant drugs. A new book by integrative medicine pioneer James S. Gordon, MD criticizes our current system of treating depression so extensively and quickly with antidepressants and offers a comprehensive and largely self-directed program for those afflicted by depression. "Unstuck: Your Guide to the Seven Stage Journey Out of Depression" is Gordon's first effort to write about the program he has developed and used for thirty five years to treat depression, extreme stress, and anxiety.
Gordon, the Founder and Director of the non-profit Center for Mind-Body Medicine (CMBM) in Washington, DC, developed the foundation of the program over forty years ago and has been using it with patients and teaching it to health professionals during that period. He also served as the Chairman of the White House Commission on Complementary and Alternative Medicine Policy under President Bill Clinton.
Gordon believes that depression is not a disease, but a sign that one's life is out of balance, or "stuck". He asserts that, while there are biological changes associated with depression, they are inconsistent among patients and are more likely to be the result of feelings of hopelessness, loss and helplessness than their cause. A core aspect of Gordon's approach is that antidepressants are significantly over-prescribed and they are less effective than other less-toxic approaches. According to Gordon, writing prescriptions for antidepressants has become a well-intentioned, but ill-informed and quick option for doctors, who have little time to spend with patients due to our current medical reimbursement system that encourages short patient visits. Their use has ballooned as a result. Gordon's comprehensive approach which emphasizes self-care techniques, including dietary change, nutritional supplements, meditation and exercise, represents a significant – and controversial – departure from typical modern medical approaches to depression treatment, which are based primarily on prescription drugs and only secondarily on the use of supportive and cognitive therapy.
Seven Stages of the Program
Gordon's Unstuck Program consists of seven stages and a variety of self-care techniques to treat depression. He tells patients to stay on antidepressants initially and work with their doctors and other health professionals with the program. The seven stages, as Gordon has titled them, include:
The Call. Gordon notes that one has to become aware that he or she is depressed and decide that change is necessary.
Guides on the Journey. The Unstuck Program suggests finding people, such as health professionals, who can help the patient through the process.
Surrender to Change. This stage involves letting go of those issues that may constrain us, and move into the current of life.
Dealing with Demons. Gordon discusses facing the challenges to the process, such as procrastination, pride, resentment, and fear, among others.
Dark Night of the Soul. This stage involves allowing freedom to emerge as participants move through despair along the process.
Spirituality: the Blessing. The Program discusses connecting with something or someone larger than ourselves.
The Return. This stage involves learning to live every day joyously, deeply and consciously in the light of what participants have experienced.
Treatments, Exercises and Techniques Used in Unstuck
Gordon includes a variety of forms of psychological guidance and instruction in various wellness approaches, included below. Ironically, some of these techniques have existed for thousands of years. Though they empower a patient to take control over the treatment process, Gordon also strongly recommends that each patient find a skilled "Guide" or therapist for support.
* Self-expression through words, drawings, and movement
* Nutrition and Supplements
* Acupuncture and Herbal Therapies
* A Variety of Spiritual Practices
* Psychological guidance
Scientific Basis for Program
Gordon has developed and used the Unstuck Program for 40 years. The Program is taught by Dr. Gordon and the faculty of the "Mind-Body Medicine Professional Training Program" held by the Center for Mind-Body Medicine, based in Washington, DC. The Center has taught the program and approach to thousands of medical schools, health professionals and individuals around the world since 1994. Currently, the program is being used in New Orleans, throughout the Middle East, with returning veterans from Iraq, and others around the world to help alleviate the symptoms of stress, trauma, and post-traumatic stress disorder (PTSD).
There are thousands of peer-reviewed scientific studies on the individual techniques included in the program that Gordon cites in Unstuck. In addition, several published studies have demonstrated the effectiveness of Gordon's approach. (10)
Inevitable Controversy and Some Challenges
Gordon's Unstuck approach will inevitably face criticism from those in the mental health field who have seen the clear benefits of antidepressants for their patients and from some of those patients themselves. Gordon acknowledges that many people have, in fact, benefited from prescription medications. His program, however, offers a proven, natural alternative for the many who suffer from depression, but have not gotten relief from the typical treatments. It also offers a way for those who continue on medication to obtain significant benefits as well as take control over their treatment program. This active involvement addresses feelings of helplessness and hopelessness that are hallmarks of depression. The techniques are so simple, in fact, that patients can integrate them into their current mainstream treatment.
If there is one challenge to the program, it is the same one faced by countless dieters, people who exercise, and others who generally attempt to integrate healthy changes in their lives – sticking to the program and practicing the recommended exercises regularly, especially when hit with the "blues" of depression and lethargy. In "Unstuck," Gordon is there every step of the way, encouraging and helping readers to start from where they are, experimenting with different approaches, gradually building up the momentum for change and healing. To help with this process, we have created a web-based webinar with Dr. Gordon on treating depression.
(1) Mathers CD, Loncar D (November 2006). "Projections of global mortality and burden of disease from 2002 to 2030". PLoS Med. 3 (11): e442. doi: 10.1371 / journal.pmed.0030442. PMID 17132052. (3) Source: IMS Health. ww.imshealth.com/portal/site/imshealth (4) Id. (5) Ann Fam Med. 2005 Nov-Dec; 3 (6): 494-9. (6) N Engl J Med. 2008 Jan 17; 358 (3): 252-60. (7) Id. (8) N Engl J Med 2008; 358: 2180-2182, May 15, 2008. Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, et al. (2008) Initial severity and antidepressant benefits: A metaanalysis of data submitted to the Food and Drug Administration. PLoS Med 5 (2): e45. (9) (8) Gordon, James S. Staples Julie K, Blyta Afrim, Bytyqi Murat, Wilson Amy T. Treatment of Posttraumatic Stress Disorder in Postwar Kosovar Adolescents Using Mind-Body Skills Groups: A Randomized Controlled Trial. Journal of Clinical Psychiatry, 2008; Staples, Julie K. & Gordon, James S. "Effectiveness of a Mind-Body Skills Training Program for Healthcare Professionals." Alternative Therapies in Health and Medicine, 2004, 11 (4): 36-41. Gordon, James S., Julie K. Staples, Afrim Blyta, and Murat Bytyqi. "Treatment of Posttraumatic Stress Disorder in Postwar Kosovo High School Students Using Mind-Body Skills Groups: A Pilot Study." Journal of Traumatic Stress, 2004, 17: 143-147.