The numbers inform us — we are indeed a “Prozac Nation.” In 2007 alone, doctors wrote a staggering 232.7 million prescriptions for antidepressants, such as Prozac, more even than medications for high blood pressure. Without question, the drugs can be of benefit. But, many who take them complain about the side effects (weight gain, dry mouth, nausea, decreased libido and others) and for some people, the meds aren’t even helpful. Choosing to step away from medication can be a very good decision for many who don’t want to be on these drugs, but it is not as simple as deciding not to take an aspirin for your headache today.
James S. Gordon, MD, a Harvard-educated psychiatrist and founder and director of The Center for Mind-Body Medicine in Washington, DC, and former chairman of the White House Commission on Complementary and Alternative Medicine Policy, experienced his own severe bout of depression some 40 years ago when he was a medical student. In time and with considerable effort and the guidance and support of a skilled therapist, he recovered from the depression. In the years since then, he has treated thousands of others who’ve suffered from depression and anxiety, helping the vast majority of them not only to recover, but also to feel better than they ever have, without the use of antidepressant drugs.
Now, in his new book, Unstuck: Your Guide to the Seven-Stage Journey Out of Depression, Dr. Gordon clearly outlines the step-by-step system that he has developed to help his patients move through and finally overcome depression.
When we spoke, Dr. Gordon’s first words of advice were: never go off the drugs cold turkey. Withdrawal from these medications is a process and it takes time, several weeks at the very least and often more. Stopping suddenly can cause extremely uncomfortable symptoms — agitation, anxiety, diarrhea, nausea, dizziness, headaches, fatigue — and sometimes, more severe depression. Even gradual withdrawal is usually accompanied by uncomfortable physical sensations and not infrequently a period in which depressive feelings may be heightened.
To avoid problems and increase the likelihood of success, advance planning is critical. First, Dr. Gordon advises identifying a person to be your “Guide,” with whom you can work throughout the entire process of overcoming depression and withdrawing from drugs. This should be a professional with the ability to understand what you are experiencing, someone who provides encouragement, understanding and support. In his book, Dr. Gordon describes in detail the characteristics you should look for in such a Guide — among them are a willingness to see depression, confusion and anxiety as the beginning of a journey toward wholeness rather than the endpoint of a disease process… an appreciation of your strengths and your capacity to help yourself… a sensitivity to your vulnerability… and the knowledge and skill to give you the kinds of tools you need to move through and beyond depression. A variety of professionals, including physicians, psychologists and social workers, can act as your Guide, but Dr. Gordon also emphasizes the importance of finding additional sources of support from family and friends who will be regularly available to you. Support groups and, in moments of crisis, hotlines can be helpful as well.
Lay a firm physical and emotional foundation for the journey through depression by righting imbalances in mind and body. Dr. Gordon recommends numerous ways to do this. Meditation, he explains, creates biological changes in the brain and body that will help you diminish your level of stress and gain perspective on your fears. Cognitive approaches will help you to identify and move beyond negative beliefs. Expressive activities, including writing in a journal, drawing and dance can bring relief from distressing emotions and help you find solutions to problems that have stymied you.
Foods and supplements can help improve and maintain mood. Among them are a number of vitamins and minerals (for example, B vitamins, magnesium, chromium and selenium) that may be deficient when you’re depressed or anxious. Omega-3 fatty acids, Dr. Gordon tells us, have been repeatedly shown to improve mood in depressed people. He gives more information in his book about how to use these to stabilize your mood. Many people find sustenance and inspiration for dealing with depression’s challenges by studying spiritual wisdom and practices from a variety of religions around the world.
Dr. Gordon says that he finds that people who follow his program generally feel significantly better and stronger and ready to reduce their medications within one to three months of taking the above steps. However, he says, others, typically those he describes as being “profoundly depressed,” may need considerably more time to get to this point, even with adequate therapy and emotional support. Respect and follow a timeline that feels right to you and your Guide.
Before you begin decreasing your dosage, be sure you feel improved enough that you and the medical professional with whom you’ve chosen to work (who could be your Guide) agree that you are ready. You need medical supervision — possibly from the doctor who prescribed the meds for you initially or another who is familiar with the withdrawal process and who supports the approach you’d like to take. Choose someone who is an MD or an osteopathic physician who describes him or herself as “integrative” or “holistic” or a naturopathic physician, says Dr. Gordon.
As you go through the challenge of actually withdrawing from the drugs, Dr. Gordon stresses the importance of following the suggested regimen of healthy eating, frequent exercise, meditation, self-expression and the like. Many people also find that having acupuncture treatments is very helpful, he says. It enhances relaxation, improves mood and also decreases the physical stress that may accompany withdrawal.
If you still find yourself feeling shaky, blue and/or unbalanced, there are natural substances known to help ease depression. The supplement Dr. Gordon prefers to use is SAMe (S-adenosylmethionine), because it is efficacious for many people and also one of the most thoroughly researched of the natural products. SAMe works by releasing a substance that is essential to the production of neurotransmitters that antidepressant medications also target — serotonin, norepinephrine and dopamine. While certain pharmaceutical drugs block reuptake of these brain chemicals, SAMe encourages production of them. Dr. Gordon says SAMe’s possible side effects, which might include headaches, gastrointestinal hyperactivity and emotional numbing, are far fewer and less troubling than those of the drugs and withdrawal symptoms are also less intense. Again, it is important to work with your doctor as you decrease your antidepressant and begin to take SAMe. This is important because SAMe and antidepressant drugs work on the same neurotransmitters. When you buy SAMe in the health food store, you should look for brands that indicate they have been produced with “good manufacturing practices” (GMPs).
Other substances Dr. Gordon reports as helpful include tryptophan and 5-HTP, precursors to serotonin that increase neurotransmitter production, and St. John’s wort (Hypericum), a popular herb for treating depression. Even though these are easy to buy at drug stores or health food stores, they are powerful substances and should be taken only under ongoing supervision of a physician, nutritionist or herbalist experienced in their use.
While it would be great to believe that all depression can be overcome, there are people for whom intractable clinical depression is a lifelong challenge, who may need medication to live successfully with it. However, even so, Dr. Gordon generally suggests that if you and your Guide don’t feel after several months that you are able to withdraw from your drugs, you still may be able to do so in the future. Remember, he advises, that change and healing are always happening and that you can follow the suggestions in his book even while you continue to take medication.
That said, Dr. Gordon shares his perspective on depression: Bleak times and feelings, including even the darkest depression, are not separate from the rest of life. They are a part of it. Understanding that sometimes pain needs to be felt and worked through, rather than medicated, can help you avoid getting on the pharmaceutical merry-go-round in the first place. “With the right tools people can deal with the hard times and also learn to celebrate the good times,” he says.” Even the most disturbing periods in life can be positive and life affirming and full of intense and powerful growth.”
