Is Drug-Free Depression Treatment More Effective?

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 A major study that appeared recently in the New England Journal of Medicine, which reviewed both unpublished and published studies submitted to the FDA, found that, when the unpublished trials were included, antidepressants were not nearly as effective as they've been thought to be.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.