Despite a hectic schedule this January, I’m hoping to keep my blog up-to-date with the exciting events in my practice and at The Center for Mind-Body Medicine (CMBM).
A quick look at my schedule/to-do list:
I’ve just finished leading (along with Kathie Swift, MS, RD, LDN, my co-director) The Center for Mind-Body Medicine’s professional training program in nutrition, Food as Medicine, in San Francisco.
We’re also moving forward with our exciting work with the US Military training health and mental health professionals who are working with active-duty military as well as in the Veterans Administration to use mind-body techniques with vets returning from Iraq and Afghanistan with severe depression, PTSD, and traumatic brain injury. Over 100 of these professionals came to the first phase of our professional training program in mind-body medicine in Minnesota in October 2008. Here’s some data on the difference our training made to them. Most of them are returning for our advanced training–where we teach them how to lead the same kind of mind-body skills groups in which they participated in the first training—this weekend, from January 31-February 4th, once again in Minneapolis.
We’re also moving ahead with a research study funded by the Department of Defense on the use of our model with traumatized veterans and their families.
Last but not least, 30 of us–health professionals, policy makers, and just plain folks–gathered together in my home to develop a report to make recommendations for a National Health Plan to the Daschle/Obama Health and Human Services Administration. We’re continuing to explore ways for CMBM to be involved in creating a top-down support for truly universal and integrative health care for all Americans.
In other news, a recent op-ed of mine was published in the Clinical Psychiatry News, entitled “We Must Consider CAM for Depression.” You can read this succinct argument for wider use of integrative therapies, versus drug-centric treatment, here (you will have to create an account on this website to access it if you don’t already subscribe to CPN, though–sorry.) I was also published in the New York Times science section, writing about a friend and colleague of mine in Gaza going through the terrible bombings there. Read that one here.
Let me know your thoughts about what we’re doing, how we’re doing it, and how we’re bringing it out into the world! I’ll be in touch too.
This week’s Journal of the American Medical Association reports on the successful use of Viagra by women whose sexual desire and orgasmic capacity have been diminished by the antidepressant drugs they’ve been taking. The data on the benefits of Viagra (which does not ordinarily enhance desire or improve sexual function in women), when compared to an inert placebo pill, are statistically significant. The article is hopeful. Relief is at hand.
That’s the apparent good news. But so far as I’m concerned, it’s overwhelmed by two large, unanswered bad news issues. Viagra may be significantly better than placebo at dealing with the symptoms of sexual dysfunction, but it’s not at all clear that the antidepressant drugs, whose side effects they’re addressing, are better than placebo for improving the symptoms of depression. Two recent reviews of the literature, including one in the prestigious New England Journal of Medicine, show that when all the studies – the negative ones the drug companies file away, as well as the positive ones they rush to publish – are put together, the drugs are far less useful than physicians and the public have long been led to believe.
A reasonable person has to ask, why then are women (and men) in such large numbers (more than 200 million US prescriptions in 2007) taking drugs to improve their mood which appear not to work very well, and so often (in up to 70% of cases) have negative sexual side effects? And ask as well, why researchers are reporting so cheerfully about the use of Viagra, a drug with its own side effects, to counteract the side effects of antidepressant drugs that may only be marginally helpful?
It’s time to step back from this cycle of promiscuous prescription and unpleasant side effects, to look for better news in an approach that is likely improve mood and perhaps even enhance sexual functioning without the negative consequences – and the expense –the drugs bring. This approach which I describe in my new book, Unstuck: Your Guide to the Seven Stage Journey Out of Depression, details a variety of therapeutic techniques including exercise, meditation, nutrition, and psychotherapy. Each is as likely to improve mood as antidepressants. Used together they may also have positive sexual and emotional “side benefits” – improved energy, greater calm, enhanced body image, self-esteem and self-control, and maybe even more interest in and compassion and love for one’s partner.
Coming up soon: More Responses to A Readers’ Question about Depression and Posttraumatic Stress
My focus for a while is going to be on clinical depression, which affects almost 20 million Americans each year, and the ordinary confusion, unhappiness, and anxiety that is a part of virtually all of our lives. I’m going to be using the blog to give you an absolutely up to date understanding and experience of the comprehensive approach I describe in my new book Unstuck: Your Guide to the Seven Stage Journey Out of Depression. I’m going to share with you what I am, and will be learning, since I wrote Unstuck.
New research on food and mood, on herbal therapies and social support; additional exercises to enhance your ability to deal with the “demons,” the fears and vulnerability that plagues us; new resources for improving mood and enhancing optimism – groups that are effective, books that are inspiring; hints for sorting out confusion as you embrace the spiritual dimension of your life, and much more.
You might want to think of Unstuck as a kind of basic text – a Life 101. It clearly and simply presents my approach to moving through and beyond depression, confusion, and anxiety and will give you a grounding that this blog will build on. You can if you want, order the book at a per-publication discount through The Center for Mind-Body Medicine website (www.cmbm.org/unstuck) or find it, after June 16th, 2008, in your local bookstore.
As time goes on, I’ll respond in my blog to questions that readers like you will ask about depression, anxiety, unhappiness, and confusion, or about any of the places in your life or in “Life” where you find yourself stuck.
As part of my first entry, I’m sharing with you a piece I wrote a couple of months ago on a very important study that appeared in The New England Journal of Medicine (358:252, January 17, 2008 Special Article) The style is a little more formal than I’ll use in the blog because I originally wrote it for a mainstream publication, but I think the main idea comes across pretty well. The best scientific evidence tells us that antidepressant drugs are far less effective than all of us, doctors and patients alike, have been led to believe. Its eye-opening and necessary information. Here it is:
Some months ago, The New England Journal of Medicine review of studies on antidepressant drugs confirmed what some of us who know the literature well have long understood: that a careful review of unpublished research would largely cancel out the drug benefits that have been demonstrated in published positive studies and endlessly trumpeted in drug company propaganda. This definitive examination of studies reviewed by the U.S. Food and Drug Administration (between 1987 and 2004), appearing now in America’s premier medical journal, is both deeply disturbing and surprisingly hopeful.
It’s disturbing because it throws into relief, once again, the way drug companies can suborn science to profit. 37 of 38 positive randomized controlled trials comparing drugs to inert placebos were published, but, according to the NEJM authors’ careful search, only 14 of 36 failed trials that were similarly designed appeared in scientific journals. Moreover, 11 of these latter 14 were presented as having a “positive outcome” even though they actually failed to meet the FDA’s criteria for success. The bottom line is that the published studies on antidepressants are 94% positive, but an examination of unpublished as well as published data reveals positive results in only 51%. This means that antidepressants actually have nowhere near the therapeutic advantage over placebos that the drug companies claim.
Antidepressant drugs are a very big business. In 2005 U.S. physicians wrote 189 million prescriptions for them and individuals, insurers, and the government –that is, all of us – paid some 12 billion dollars for them, and many billions more to the physicians who prescribed them. Though a number of the tens of millions of Americans who have taken antidepressants have experienced symptomatic relief, a significant portion have also suffered their all too common side effects, including disturbances of gastrointestinal and sexual functioning, headaches, weight gain, and the increased agitation and desperate, even suicidal thoughts. Furthermore when these people stop taking the drugs, large numbers experience the highly uncomfortable and depressing withdrawal symptoms, which, not incidentally, are minimized in drug company literature. Even more disturbing, we do not know what the long-term negative consequences of these drugs will be: It took more than twenty years for researchers to document the life threatening heart valve deformities caused by the Fen-Phen diet pill combination which, like the most popular antidepressants, is a serotonin enhancing drug.
The other negative effects of widespread antidepressant use are far less easily quantifiable and speak to a more disturbing cultural issue. We are as a society enamored with instant gratification, with the kind of “quick-fix” that these drugs have promised us. But depressed people who do not get relief from drugs that are supposed to regularly work miracles tend to feel let down, indeed, more depressed, by their failure. And the promiscuous prescription of antidepressants can itself be psychologically disabling: In propagating the belief that a pharmacological quick fix is appropriate, it has turned countless people away from addressing the emotional, attitudinal, societal, and existential causes of their distress.
This leads us to the more hopeful side to the NEJM report, the kind of hope that careful scientific investigation can so often bring. These dramatic findings remind us that the quick fixes – pharmacological and otherwise – that seduce so many of us are likely to be illusory as well as improbable. It encourages those who suffer the very real pain of depression, and those of us who treat them, to refocus our efforts on the causes of this pervasive condition, not simply the symptoms. It also shows us once again that the placebo effect – the faith and hope we invest in our treatment– is just about as powerful as the drugs themselves, without, of course, any of the negative side-effects and dependency drugs produce.
Perhaps these findings will finally encourage us to invest this faith and hope – and our money—into other ways of understanding and treating depression. First and foremost, we have to recover our belief in our capacity to help ourselves. We also need to appreciate the very real power of healing, therapeutic relationships, and non-toxic, non-pharmacologic self-care approaches – including physical exercise, meditation, self expression and improved diet. In recent years all these have been demonstrated to help us to overcome the helplessness and hopelessness that are the hallmarks of depression, even as they enhance our physiological functioning and improve our mood.
2500 years ago Hippocrates admonished his students to “first do no harm.” The NEJM study reminds all of us of the wisdom of this dictum, and its contemporary relevance.