Prozac Nation No More?

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 A major study that appeared recently in the New England Journal of Medicine, which reviewed both unpublished and published studies submitted to the FDA, found that, when the unpublished trials were included, antidepressants were not nearly as effective as they've been thought to be.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