Life Extension Magazine December 2008
James S. Gordon, MD
“Depression is the defining disorder of our time.” So says James S. Gordon, MD, noted psychiatrist, practitioner of integrative medicine, founder and director of The Center for Mind-Body Medicine in Washington, DC, and author of the recently published Unstuck: Your Guide to the Seven-Stage Journey Out of Depression (The Penguin Press, 2008).
“However, depression is not a disease,” he adds, “and the vast majority of people who are taking antidepressants or who have been told they should take antidepressants do not need to.”
Gordon’s groundbreaking book, which presents an innovative, multidisciplinary approach to dealing with depression, grew out of his more than forty years of treating this disorder, studying its many causes, and discovering over time what does and does not work. He is now convinced that except for a very small number of people, antidepressant medication is not only ineffective, it can also be dangerous. In an exclusive interview with Life Extension magazine, Gordon recently discussed his new book and his work, explaining his singular views.
Depression In America
Gordon notes that approximately 20 million Americans are diagnosed with depression each year, while tens of millions more suffer from such associated symptoms such as lack of energy and feelings of unhappiness or dissatisfaction with their lives. Many of these people never seek medical help. The cost for treating depression and related illnesses has been estimated at $80 billion dollars a year and rising, and it is the number one cause of disability in the workplace.
In his book, Gordon notes that prescriptions for antidepressant drugs, written by psychiatrists, general practitioners, family practitioners, and internal medicine specialists, are as high as 200 million a year, and there are good reasons to believe this number will continue to escalate. It is just one more example of the American preference for a “quick fix,” although in this case, the fix may be completely unwarranted and even hazardous.
Antidepressants have many acknowledged side effects, among them a long rumored and recently acknowledged increase in suicidal thinking, particularly among children, adolescents, and young adults, which forced the FDA to require a black box warning on all antidepressant medications. In addition, these drugs can cause insomnia, anxiety, nausea, decreased sex drive, tremors, sleepiness, weight loss or gain, fatigue, diarrhea, constipation, headaches, sweating, and dizziness.
But that’s not all. Withdrawal from antidepressants can also cause serious side effects, including depression, mood swings, anxiety, insomnia, dizziness, tremors, and more. It might all be worth it if antidepressants were a proven cure for depression, but unfortunately, the opposite is more likely true: there are studies showing that they are about as effective as placebos. This “cure,” which is widely prescribed by so many of our health care professionals, not only fails to work most of the time, it also can threaten our mental and physical health.
In addition to being prescribed these pharmaceuticals, people with depression may also be referred to some form of talk therapy, which, though helpful, is only a partial approach. These are the two main methods for treating depression today.
It is Gordon’s belief, as outlined in Unstuck, that even with talk therapy, antidepressants are likely to be less effective for helping those with depression than an integrative approach that combines a number of proven, nontoxic therapies. Dr. Gordon believes that this complementary approach is the best and most successful way to help those who suffer from depression.
Gordon’s Transformative View of Depression
Traditional psychiatry defines depression as “a chemical imbalance in the brain.” This explanation, often employed in advertisements for antidepressants, is used to justify the claim that medication can easily correct the imbalance. Specifically, we are told that depression is caused by low levels of serotonin and that antidepressant drugs will bring these levels back to normal. What the ads fail to tell us is that serotonin levels in the brain cannot be measured, no one knows what levels are “normal,” and this entire theory has yet to be scientifically proven.
“Antidepressants don’t work so well because they’re addressing what is sometimes a symptom of depression, rather than addressing the causes,” says Gordon. In regard to the theory that antidepressant drugs increase neurotransmitter levels in the brain, Gordon says, “In fact, we don‘t know if those neurotransmitters are actually decreased in depression; and it’s not even clear that the drugs act primarily by increasing neurotransmitters. The major effect of those drugs is to protect the brain against the effects of stress. But in any case, they’re dealing with a symptom rather than the cause.” And there are many causes.
“Depression is a sign that our lives are out of balance, that we’re stuck,” Gordon continues. “It’s a wake-up call and the start of a journey that can help us become whole and happy, a journey that can change and transform our lives.”
Gordon reveals that his own journey began more than forty years ago when he personally experienced several months of clinical depression after breaking up with his girlfriend, and while struggling to find meaning in medical school. Turning this crisis into a positive path of lifetime learning about a wide range of therapies, Gordon began to study traditional healing practices from India, Tibet, China, Africa, and the Americas, much of which he has incorporated into his work. Joseph Campbell’s The Hero With A Thousand Faces has also been a significant influence, helping Gordon formulate the seven stages of the self-healing experience presented in his book.
“If you look at depression as the beginning of a journey to help yourself and to find the meaning and purpose that has been lost,” Gordon explains, “it becomes a very different kind of experience, one in which you can find the joy that you’re no longer feeling or perhaps have never felt.”
As for why he is convinced that depression is not a disease, Gordon says, “The evidence is simply not there. There are no reliable biochemical and physiological changes that you see with a disease process, there are not the abnormalities in structure, and, more importantly, the drugs that are supposed to be the answer to this ‘disease’ just don’t work very well.” Gordon believes that once people stop seeing depression as a disease, they will begin to explore what is causing their symptoms, putting themselves on the road to permanent freedom from their symptoms and ultimately transforming their lives and restoring their health.
The “Unstuck” Approach
Depression, to Gordon, is not confined to the brain, but is a condition that affects the whole body. Therefore, it is the whole body that must be treated. Gordon’s approach, as outlined in Unstuck, includes diet and nutritional supplements; exercise, movement, yoga and dance; meditation; guided imagery; spiritual practice and prayer; traditional Chinese medicine, including herbs and acupuncture; and psychotherapy.
The book goes into considerable detail about all these areas, enabling readers to formulate their own individualized program of recovery in conjunction with their health care professionals. Each chapter ends with a summation of important points and a few pages entitled “Your Prescription for Self-Care,” which give readers an opportunity to examine themselves, and to try out suggestions and then record their thoughts and experiences. In addition, Gordon has scattered running case histories throughout the book, most of which are positive and inspiring stories illustrating how the use of his methods has helped various patients deal with depression.
Finally, the book includes an extensive and user-friendly resources section, providing a wealth of information for those who want to explore in depth one or more of the topics covered in the book.
Food For Optimal Mental and Physical Health
Discussing dietary needs, Gordon covers macronutrients, including carbohydrates, protein, and fats. He advises avoiding simple sugars; eating a diet with 30% protein, especially fish, turkey and chicken, and avoiding red meat; increasing fiber, which he notes is often deficient in the American diet—he recommends 4 to 6 tablespoons of unprocessed oat bran a day; and 8 to 12 glasses of water.
Gordon also notes that sensitivities to such common foods as citrus fruit and sugar are more common than most people realize and can often contribute to depression. He recommends trying an elimination diet to test for sensitivity to these and other frequent allergens including milk, wheat, corn, and soy.
“There’s a very simple rule of my diet,” Gordon says. “You put back the good things and take out the things that may be causing damage. This diet is much more in harmony with the way our ancestors used to eat. It’s essentially a whole foods diet wherever possible, a diet that eliminates all or almost all processed food, extra sugar, extra salt, food additives, and coloring—all the things that give us trouble.”
Gordon adds that, according to the United States Department of Agriculture, at least 80% of Americans are deficient in one or more nutrients. “This is stunning,” he states. “We need to eat a diet that is not nutrient-deficient. So I stay primarily with vegetables, whole grains, fruit, and fish.”
Supplements That Fight Depression
“We are each biochemically unique,” Gordon cautions in his book. “What is best for you may well be different from what is right for someone else with similar symptoms,” he says, adding that “one person may need ten or one hundred times as much of one nutrient as another.” This concept, so familiar to Life Extension members, is an integral part of Gordon’s program.
When it comes to nutritional supplements and their importance in fighting depression, Gordon is a strong believer. He emphasizes the regular use of omega-3 fish oils, and cites supporting clinical studies, saying, “The omega-3s seem to be especially important. Epidemiological evidence shows a correlation between intake of fish high in omega-3s and decreased incidence of depression.” Gordon recommends 3,000 mg a day, divided into two doses.
Other supplements he recommends include B vitamins, vitamin C, magnesium, zinc, selenium, chromium, and calcium. [See Table of Content bellow for more Information]
How does Gordon determine each patient’s nutritional needs? “There’s a general nutritional supplement I give to everyone who is depressed,” he says, “and there’s also a list of vitamins and minerals that I use. But there may be some people who have very significant deficiencies and need something more precise to alleviate their depression, so I refer these people to a nutritional physician or nutritionist for testing.”
Gordon mentions that he also uses SAMe, St. John’s wort, and tryptophan from time to time to help his depressed patients, particularly when other methods and supplements don’t seem to be working.
Using Guided Imagery For Positive Results
Gordon has used guided imagery for the past thirty years. Originally taught to him by Protestant minister and sister of President Jimmy Carter, Ruth Carter Stapleton, and used by traditional healers, this technique helps people create their own personal mental images that can be important tools in healing. The book provides detailed, step-by-step directions, teaching readers how to create safe places and find inner guides to assist the resolution of problems that have been troubling them.
Pointing out that imagery practices directly affect the brain, Gordon says, “imagery can affect the autonomic nervous system and your physical functioning.” He cites studies showing that imagery can reduce nausea and vomiting associated with cancer chemotherapy, lower blood pressure and heart rate, and decrease stress, pain and anxiety—factors closely linked to depression.
“Imagery can also affect the immune system,” he adds, noting that the centers we use for imagery are connected with the hypothalamus, “the central switching center for the immune system.” Through the book’s Resources section (or on Gordon’s website, www.cmbm.org), you can also order The Best of Stress Management, a kit that provides instructions for guided imagery, meditation, and many of the other mind-body approaches he describes in Unstuck.
Mood-Enhancing Effects of Physical Movement
In a chapter titled “Surrender to Change,” Gordon emphasizes the need to let go of control as part of overcoming depression. “The journey through and beyond depression,” he says, “requires a balance of action and acceptance.”
Explaining that depression includes a resistance to change and a clinging to established habits, Gordon urges people to get “unstuck” and to cultivate an openness that will allow them to move forward.
He recommends several ways of doing this, including reaching out and connecting with other people and engaging with life and then surrendering to it. Mind-body skills groups around the country, led by professional people trained at Gordon’s Center for Mind-Body Medicine, provide opportunities for people to express themselves freely and learn relaxation techniques, including meditation and biofeedback.
“Everything we think or feel is recorded in our bodies as well as in our minds,” he observes. “Persistent anger, and particularly the grinding suppressed fury of hostility, have been implicated in heart disease and seem to be a factor in chronic pain. Fear, stress, and anxiety lower our immunity and make us more vulnerable to all physical illnesses—and the affectionate support of others helps us to heal when we are ill, and to stay well.”
Gordon defines depression as “a kind of stuckness, in body as well as mind,” and recommends physical activity, which he says alters brain chemistry and mood. He suggests walking, yoga, and a technique he calls “shaking and dancing,” that he teaches in Unstuck, in which people shake off chronic tension and then let their bodies move freely.
“The most important thing is to begin to move your body,” advises Gordon, “to break up the fixed patterns, the inertia, that characterizes depression, to move once again into, to surrender to, the flow of your life and of life itself.”
Meditation and Related Techniques For Relaxation and Healing
Unstuck discusses several different types of meditation, prayers and spiritual practices that Dr. Gordon has found helpful for people working to overcome depression. These practices deal with our deepest feelings and are designed to help us uncover hidden and long-held negative emotions and ultimately free us from them.
“All the approaches in this book,” says Gordon, “...can be viewed as meditative...all are designed to make it possible for us to live in a relaxed, moment-to-moment awareness.”
He includes a forgiveness meditation, noting that it is not easy for people to admit and deal with resentment and anger, and he cites studies showing that forgiveness is an important ‘antidote’ to the guilt and self-blame that so often accompany depression.
Gordon also advocates the power of prayer and love, pointing out that “Love, in fact, is the primal force of connection.”
Working With Traditional Chinese Medicine
“I first learned about acupuncture around 1970,” says Gordon. “I thought at first it might be a placebo, but then I read a study about using it with oxen who had laminitis, inflammation of the hooves, and when I read it was successful, I realized it was unlikely to be a placebo!” Maintaining an interest in the ancient technique, Gordon eventually found an expert and learned it himself; he now is able to use acupuncture in his practice to release patients’ blockages and allow their energy to flow freely.
Gordon uses Traditional Chinese Medicine (TCM) with almost all his patients and advocates Chinese herbs. He explains that herbalists “talk with you first, getting your history. There are some very specific questions a Chinese herbalist will ask,” he continues. “They will look at your tongue, feel your belly, take pulses at the radial artery and finally, create a prescription of many different kinds of herbs.”
The Gordon Approach to Depression
Although Gordon’s book is written specifically for those who are suffering from depression, most of what he advocates can also be beneficial for those who are healthy. His diet, supplements, exercise, and other programs can serve all of us and are worth studying and applying to our lives. In essence, he has combined the best of state-of-the-art science with traditional healing and wisdom to formulate a balanced, holistic, whole-body system for complete health.
But when it comes to depression and the way it is treated in America today, with the often automatic use of powerful drugs that may well do more harm than good and never seem to cure the condition, Gordon’s program is particularly important.
“This is what science is about,” he says, “exploring what we don‘t know, and I’m afraid that too much of the science in pharmacology is going over the same ground again and again.” Gordon’s methods, quite different from standard approaches, appear to be ahead of their time, and he sees his book, Unstuck, as a first step in a concerted endeavor to change the way the medical system views and treats depression.
“This book is really the springboard for my talking publicly about all these issues regarding depression,” Gordon explains. “Why not use methods that don’t have all the side effects and that might be even more helpful?”
Gordon ends our discussion by noting, “I don’t know if my approach can help everybody. I’m not saying that. But I would say that 80 to 90% of people with depression will do significantly better if they adopt this approach.
“We need to look at our troubles and difficulties as an opportunity and not simply as a disaster. It doesn’t mean that anxiety and confusion aren’t painful—of course they are—but if we see that they are also the beginning of meaningful change, it makes them less painful.”
Training Programs For the Unstuck Approach
Dr. Gordon’s Center for Mind-Body Medicine provides regular training programs for health professionals who want to learn how to use his techniques. The Center also has a Global Trauma Relief program that provides training for assisting those with traumatic psychological problems in areas around the world that have been devastated by war or natural disasters. The Program is currently active in Kosovo, Gaza, Israel, and areas in the United States such as New Orleans, where natural disasters have affected large numbers of people. Details can be found at www.cmbm.org or by calling the Washington, DC Center at 202-966-7338. Unstuck can be purchased online either at The Center for Mind-Body Medicine website, www.cmbm.org/unstuck, or at www.amazon.com.
1. Personal interview with James Gordon. MD, July 14, 2008.
2. Gordon J. Unstuck: Your Guide to the Seven-Stage Journey Out of Depression. New York, NY: The Penguin Press; 2008.
3. Information on Unstuck from The Penguin Press publicist Sarah Hutson.
4. Available at:www.cmbm.org. Accessed August 25, 2008.
5. Available at:www.ahrq.gov. Accessed August 25, 2008.
6. Available at: www.fda.gov/CDER/Drug/antidepressants. Accessed August 25, 2008.
7. Available at: www.nimh.nih.gov/health/publications/depression/complete-publication.shtml. Accessed August 25, 2008.
8. Available at: www.helpguide.org/mental/medications_depression.htm. Accessed August 25, 2008.