The Center for Mind-Body Medicine

We Must Consider CAM for Depression

Dear Readers,

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.

Jim

The UltraMind Solution: Fix Your Broken Brain by Healing Your Body First by Mark Hyman, MD Review by James S. Gordon, MD

The UltraMind Solution: Fix Your Broken Brain by Healing Your Body First
by Mark Hyman, MD, Scribner’s: New York: 2009

Review by James S. Gordon, MD

I just finished The UltraMind Solution, a wonderful, ground breaking book that gives new and eminently practical insight into the causes and treatment of mood, behavior, and cognitive disorders. It’s a book I recommend to all of you without reservation.

The UltraMind Solution is by Mark Hyman, MD, a highly skilled, integrated Family physician who is a Center for Mind-Body Medicine Board Member, and a core faculty person in our Food As Medicine training. In The UltraMind Solution, Mark suggests that the most effective and, indeed, scientific way to address the epidemic of psychiatric disorders (affecting 1.1 billion people worldwide) is not with psychotropic drugs that treat postulated alterations in neurotransmitters, but with nutritional therapies that address the underlying biological imbalances that ultimately may disturb neurotransmitter functioning.

The UltraMind Solution is based on the principles of “functional medicine,” a systems approach to chronic disease and to the physical and emotional problems that beset our population. It is a road map for both patients and practitioners, a clear, thoughtful, guide to the ways the body can become imbalanced, and to the simple, natural methods-largely food and supplements-that can be used to restore the imbalances in the entire body, and most particularly, the brain. It’s a book that significantly deepened my own understanding of biological factors in depression. I believe, as well, it will enhance the information on biology that I present in my book Unstuck: Your Guide to the Seven Stage Journey Out of Depression.

In a series of clear, well documented chapters, Mark discusses the “7 keys” to his program, and the ways that readers can use them. These keys include optimal nutrition, hormone balancing, decreasing inflammation, improving digestion, enhancing detoxification, increasing energy metabolism, and calming the mind. In The UltraMind Solution, Mark includes more than 400 well-chosen scientific references and dozens of case studies, together with diagnostic questionnaires. He offers as well clear steps that readers can take to use this information to help and heal themselves. You can learn more about The UltraMind Solution by going to the following website: http://www.ultramindhealth.com/cmbm.

Mark is also presenting a six part webinar series for clinicians on applications of functional medicine to brain and mood disorders. In particular, he will discuss diagnostic and therapeutic approaches to ADD/ADHD, autism, dementia, and depression. Access to these webinars is complimentary for practitioners who obtain a copy of The UltraMind Solution by going to the website below.

http://www.ultramindhealth.com/cmbm

PTSD on Wall Street and Main Street

“You don’t have to go to Gaza to treat posttraumatic stress disorder,” my friend said. “Just come to New York.”

It’s not that the mental and emotional state of the US population is indistinguishable from that of Gaza’s Palestinians — many of whom have lived with eight years of war and civil strife — thousands of lives lost and homes destroyed, and unemployment reaching 40-50 — some say 70-80– percent. Indeed, even those of us hit hardest three weeks into the worst of this unraveling financial crisis, are still technically experiencing only an “acute stress disorder.” But there are signs that each day, this growing financial crisis is traumatizing us more and more. Add to that our costly, life-claiming Middle East war, and we — like the Palenstinians in Gaza — may also be on our way to significant levels of population-wide traumatic stress.

Posttraumatic stress disorder, which by definition lasts longer than several weeks, is characterized by three sets of symptoms: “Hyperarousal,” an agitated state in which the heart may race, concentration and sleep are disturbed, startle responses are exaggerated and anger easily triggered; “Re-experiencing” the original trauma — in nightmares, intense and disturbing memories, and flashbacks; and “Avoidance” of trauma-related thoughts and feelings, coupled often with a sense of detachment and estrangement, emotional numbness and an apprehension about a bleak future.

All these are in abundant supply in those closest to the crisis — the ones who have lost jobs and pensions, older people who see their retirement savings melting away, and people of all ages who cannot keep up payment on their homes. Many who are, or were, working on Wall Street are sleeping fitfully, jiggling their knees uncontrollably in meetings, drinking and eating too much, losing their appetites, and popping antacids and tranquilizers. One broker friend is awake far into the night, worrying about her elderly clients’ inability to live on their diminished incomes and whether or not she will be able to pay her own child’s tuition. Others, like one 30-year Lehman Brothers veteran who is married to a colleague, have receded into states of frozen denial; acting as if somehow everything were still as it was. He dresses as meticulously as he always did and sits for hours at a computer which no longer registers his trades.

And the symptoms are also present with more or less intensity in many of the rest of us who feel the financial foundations crumbling under our feet. I have been hearing from retirees who are waking up in the middle of the night, panicked, to pore over diminished budgets, then fall asleep worrying that their fixed incomes will no longer permit them to live in the houses they saved a lifetime to buy. A colleague out West tells me her psychiatric inpatient service is overflowing with people whose loss of homes and jobs has undermined their precarious emotional, as well as economic, security. Meanwhile, anxious and depressed people, unable to afford gas for the long trip to the outpatient clinic, call in for more prescriptions for tranquilizers, antidepressants, and sleeping pills. And children may be just as deeply affected as their parents; according to The Washington Post, a recent national survey of 500 teenagers found that already, “70% fear ‘an immediate negative impact’ on the security of their families.”

Former senator Phil Gramm’s infamously dismissive comment declaring the US in the midst of a “mental recession” is likely to turn out to be true in a way he never intended. Financial irresponsibility and lack of oversight are indeed creating the conditions for “mental” disturbance. The associated loss of confidence and hope further threatens the trust upon which credit and the financial markets depend.

Even when trauma is reliably over, the feelings of being overwhelmed and stuck persist. Five years after the war in Kosovo, we found that 44% of all high school seniors in the Suhareka region still had symptoms of PTSD. And when stress is ongoing, its symptoms and the accompanying depression are continually reinforced. Some Americans will never recover financially or emotionally from the loss of jobs and homes and savings. Others will be long unemployed, and their misfortune and lack of income — and the emotional distress both bring — will affect businesses in their communities as well as in their own families and friends. Meanwhile, vast numbers, perhaps our entire population, will likely feel the uncertainty and vulnerability that the ongoing and deepening financial crisis is provoking — feelings that still bedevil so many who lived through the Great Depression. One recent landmark study on the influence of genetics and “life stress” showed that of all possible causes, financial setbacks were most likely to contribute to depression.
In Gaza and Israel — where the consequences and threats of terrorist bombings are ever-present — and in Kosovo and New Orleans, my colleagues and I have helped tens of thousands of fearful and vulnerable people in the midst of chaos. We teach them meditation, deep breathing and movement techniques, mental images, and exercise. Learning these techniques, they find places of calm and control within themselves, discover solutions to problems that had seemed unsolvable, and raise their depleted physical and emotional energy. Acting to help themselves, they find antidotes to the helplessness and hopelessness that are the hallmarks of depression and traumatic stress. Learning together they discover mutual support and a renewed sense of community.

In Gaza, in the most vulnerable parts of Israel, and in New Orleans, there is another factor that makes people’s stress and depression — and, yes, their anger as well — so much worse. This is the sense of being dismissed and neglected by the larger world on which they had once depended.
These feelings of neglect, deception, and disrespect are only increasing as the financial crisis deepens here and expands overseas. They must be addressed. The various bailouts are initial investments in confidence as well as credit, the first signs of a public assumption of responsibility. But they are only a down payment on the far more comprehensive measures that must follow, and should only be the first step in the government’s effort to regain the trust that is necessary to real recovery.

As a country, we must honestly admit to and address the causes of our crisis — greed, arrogance, and indifference. Then we must begin to pay honest, ongoing attention to the concerns of a population that feels betrayed, vulnerable, and abandoned. These steps will promote stress reduction as well as provide fiscal reassurance. Meanwhile, we have to learn, quite literally, to breathe deeply, to relax in the midst of fear and uncertainty, to trust that we, like the Israelis and Palestinians and New Orleanians, can grow and change through adversity. We cannot avoid the fear and the stress in the world in these troubled times. We can however, learn to live more peacefully with them.

Republished with permission from The Huffington Post

First published October 23, 2008, 10:52 AM EST at

http://www.huffingtonpost.com/james-s-gordon/ptsd-on-wall-street-and-m_b_137160.html

Teleclass: "An Introduction to Mind-Body Health"

Title: Teleclass: “An Introduction to Mind-Body Health”
Location: http://www.mblwellness.com/about-Best-of-Stress-Management/teleclass.htm
Description: This introductory teleclass is perfect for beginners who want to learn about mind-body health and how simple relaxation exercises can improve their health. Participants will receive a free “Mind-Body Mini Kit,” which includes a downloadable audio meditation, a video on stress, and written materials. Participants can also listen to the class on the internet.
Start Time: 08:30:00pm EST
Date: 2008-11-12

Free Webinar Lesson 4: Other Useful Techniques and Advice for Participants

Title: Free Webinar Lesson 4: Other Useful Techniques and Advice for Participants
Location: http://www.mblwellness.com/unstuck
Description: The last free webinar in a four-part series, “A Natural Approach to Treating Depression,” Dr. Gordon offers more resources and guidelines to help you on your journey.

Lesson 4: Other Useful Techniques and Advice for Participants

Key lessons: Dr. Gordon discusses a variety of other techniques that are effective in treating depression; he provides some final advice and words of encouragement for participants.

Download pack still available at www.mblwellness.com!
Start Time: 8:30pm EST
Date: November 24, 2008

Free Webinar Lesson 3: Exercise and Movement

Title: Free Webinar Lesson 3: Exercise and Movement
Location: http://www.mblwellness.com/unstuck
Description: The third free webinar in a 4-part series; tune in to hear Dr. James Gordon discuss the mental and physical benefits of exercise, and offer some easy guidelines for getting started.

Lesson 3: Exercise and Movement

Key Lessons: Physical exercise can significantly improve mood; Dr. Gordon provides advice on how to start an exercise program; Dr. Gordon shows a movement technique he has taught around the world.

The free download pack available at www.mblwellness.com includes MP3 relaxation exercises and guides to meditation!!

Start Time: 06:30:00 pm EST (note time change)
Date: November 22, 2008

Free Webinar Lesson 2: Relaxation/Stress Management

Title: Free Webinar Lesson 2–Relaxation/Stress Management
Location: http://www.mblwellness.com/unstuck
Description: The second free webinar in a 4-part series, Dr. Gordon discusses relaxation and stress reduction techniques and exercises in handy video form.

Lesson 2: Relaxation/Stress Management

Key lessons: Stress and depression are connected; simple relaxation exercises can help with the symptoms of depression; Dr. Gordon teaches a relaxation exercise. (The Unstuck pack contains useful tools for this lesson.)

Don’t forget to download the free Unstuck resource pack at www.mblwellness.com!
Start Time: 8:30pm EST
Date: November 20, 2008

Free Webinar, Lesson 1: "A Natural Approach for Treating Depression" series

Title: Webinar: “A Natural Approach for Treating Depression” series: Lesson 1:
Location: www.mblwellness.com/unstuck
Description: A 4-part free webinar by Dr. James S. Gordon on the approaches he describes in “Unstuck: Your Guide to the Seven-Stage Journey Out of Depression.”

Lesson 1 – An Overview of Depression and How You Can Treat it Yourself with the Help of a Guide.

Key Lessons: Prescription drugs aren’t the only answer; people can use simple techniques to treat their condition; people should work with their doctor and find a guide to help them through the process; depression is not a disease, but a condition in which peoples’ lives are out of balance, or “stuck.” (Participants should read the excerpt from the Introduction of Unstuck in the Unstuck Pack, available at www.mblwellness.com.)

Start Time: 08:30:00 pm EST
Date: November 18, 2008

NEWS RELEASE: "Landmark CMBM Randomized Controlled Trial Treating PTSD in Children Published in Journal of Clinical Psychiatry"

The Washington, DC based Center for Mind-Body Medicine (CMBM) announced today the publication of a landmark study on the use of its comprehensive, non-drug model to treat posttraumatic stress disorder (PTSD) in war traumatized children. The study, “Treatment of Posttraumatic Stress Disorder in Post-War Kosovar Adolescents Using Mind-Body Skills Groups: A Randomized Controlled Trial,” which was published today online in the Journal of Clinical Psychiatry is the first randomized controlled trial (RCT) ever of any intervention with war traumatized children. It is also the first RCT of a successful, comprehensive mind-body approach with any traumatized population.

The study demonstrates that the Center’s groundbreaking model can be used to produce highly significant and lasting changes in levels of stress, flashbacks, nightmares, and symptoms of withdrawal and numbing in highly traumatized children – those who lived in an area of Kosovo where in 1999 90% of the homes were burned and bombed and 20% of the children lost one or both parents.

The CMBM approach includes self-expression in words, drawings, and movement and mind-body techniques (including meditation, guided imagery, biofeedback and yoga) was offered to these children over 12 sessions in an educational, supportive small group setting. This intervention produced an approximate 80% reduction in PTSD in the treatment groups, much of which was maintained at 3 month follow-up. This is the same model that CMBM’s founder and director, James S. Gordon, MD, describes in detail in his new book, Unstuck: Your Guide to the Seven Stage Journey Out of Depression.

“This RCT,” Dr. Gordon, the lead author, says, “is important because it provides scientific evidence for the efficacy of a model that has been taught to almost 3,000 health and mental health professionals and educators worldwide. We’ve used this small group model to give tens of thousands of children and adults practical tools that help them to feel better quickly, and we’ve taught them to use their intuition and imagination to solve problems that had seemed overwhelming. We help traumatized people around the world to draw on strengths they may have forgotten they have and we offer them a ‘safe place’ in which they can share their pain with others who have suffered as they have.”

“This model is educational, non-stigmatizing, and powerfully effective. It can be easily taught and can be used by people of all ages on their own,” Dr. Gordon explains. “It’s highly acceptable to populations which do not want to be given medication, those without access to a doctor or therapist, and those who are in psychotherapy.”

This model, which Dr. Gordon presents in a step-by-step self-help format in Unstuck, is currently being used by CMBM with war traumatized populations in Israel and Gaza as well as in post-Katrina southern Louisiana. It is widely used with anxious and depressed people and those with chronic illness in the US, and has already been incorporated as a stress reduction program for students in a dozen US medical schools.

The CMBM model is also of increasing interest to the US Department of Defense and the Veterans Administration. “The military,” Dr. Gordon says, “understands the breadth and depth of the psychological crisis (as many as 300,000 returning veterans are expected to have posttraumatic stress disorder or major depressive disorder, and another 320,000 will have been made vulnerable to these conditions by traumatic brain injury). The military’s leadership is committed to finding evidence-based approaches, like the one taught by The Center for Mind-Body Medicine, that can make a difference for the individual veteran and his/her family, an approach that can be taught to the large numbers of professionals and peer counselors who serve them.” More than 100 health and mental health professionals who work with the military are expected at the next CMBM training in mind-body medicine on October 25-29 in Minneapolis, and many more are expressing interest in learning and using the CMBM model.

Good News, Bad News, Better News

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

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