Transcript Slide 1

UNSTUCK:
An Integrative Approach
to Depression
James S. Gordon, MD
Founder and Director, The Center for Mind-Body Medicine
Clinical Professor, Departments of Psychiatry and Family
Medicine, Georgetown Medical School
Chair, White House Commission on Complementary and
What is Depression?
• A human experience, not a disease
• It is often precipitated by loss of a person, a role, a
status, and can be a catalyst for a journey toward
greater health and wholeness.
• A sign of imbalance – physical, emotional, mental,
social, spiritual – in one’s life.
• The beginning of a journey. A wake up call to the
need for change, not the end of a disease process.
Soft Belly
Begin with Relaxation – antidote to the fight or
flight response and to stress which is so intimately
connected to depression.
• Lee, AL, WO Ogle, RM Sapolsky. Stress and depression: possible links to neuron death in the hippocampus. Bipolar
Disord 2002:4(2):117-28
• Sapolsky, RM. Why stress is bad for your brain. Science 1996:273(5276):749-50.
The Seven Stages
of the Journey Out of Depression
1. The Call
The awareness that we are depressed, and that some kind of
change, of journey, is necessary
2. Meeting Guides on the Path
Meeting and choosing the men and women who can help,
and developing our own inner guidance and wisdom
3. Surrender to Change
Allowing and encouraging ourselves to let go of what
constrains and freezes us, and to move into the current of
life
The Seven Stages
4. Dealing with Demons
Meeting the challenges—self-doubt, loneliness,
procrastination, pride, resentment, apprehension,
perfectionism, fear with all its faces, guilt, shame, self-pity,
and all the others—and finding in them the unique daimon,
the genius, of our own meaning, purpose and direction
5. The Dark Night of the Soul
Allowing, and inviting, as we move through the despair that
may come to any of us, the deepest, life-giving freedom to
emerge
The Seven Stages
6. Spirituality: The Blessing
Experiencing the unity and peace, the love and generosity,
the connection to something or someone greater than
ourselves, that can transform our lives
7. The Return
Learning to live every day joyously, deeply, consciously, with
ourselves and others, in the light of what we have
experienced and are always learning
Awareness of…
1) The limitations of the disease theory of
depression
• Valenstein E. Blaming the brain: the truth about drugs and mental health. New York: Free Press. 1998.
• Sadock BJ, VA Sadock, HI Kaplan. Kaplan & Sadock’s comprehensive textbook of psychiatry. 8th ed. Philadelphia: Lippincott
Williams & Wilkins. 2005. Lacasse JR, J Leo. Serotonin and depression: a disconnect between the advertisements and the
scientific literature. PLoS Med 2005;2(12):e392.
• Roggenbach J, B Muller-Oerlinghausen, L Franke. Suicidality, impulsivity, and aggression – is there a link to 5HIAA
concentration in the cerebrospinal fluid? Psychiatry Res 2002;113(1-2):193-206.
Awareness of…
2) The dangers of antidepressants
• Montejo-Gonzalez AL, et al. SSRI-induced sexual dysfunction: fluoxetine, paroxetine, srtraline, and fluvoxamine in a
prospective, multicenter, and descriptive clinical study of 344 patients. J Sex Marital Ther 1997;23(3):176-94.
• Hansen L. Fluoxetine dose-increment related akathisia in depression: implications for clinical care, recognition, and
management of selective serotonin reuptake inhibitor-induced akathisia. J Psychopharmacol 2003;17(4):451-52.
• Black K, et al. Selective serotonin reuptake inhibitor discontinuation syndrome: proposed diagnostic criteria. J Psychiatry
Neurosci 2000;25(3):255-61.
Awareness of…
3) The limited effectiveness of drugs
• Moncrieff, J. and I. Kirsch, Efficacy of antidepressants in adults. BMJ, 2005. 331(7509): p. 155-7.
• Kirsch I, JT Moore, A Scoboria, SS Nicholls. The emperor’s new drugs: an analysis of antidepressant medication data
submitted to the US Food and Drug Administration. Prevention and Treatment 5 (Article 23). 2002;
http://www.journals.apa.org/prevention/volume5/pre0050023a.html.
• Khan, A., H.A. Warner, and W.A. Brown, Symptom reduction and suicide risk in patients treated with placebo in
antidepressant clinical trials: an analysis of the Food and Drug Administration database. Arch Gen Psychiatry, 2000. 57(4): p.
311-7.
• Turner EH, et al. Selective publication of antidepressant trials and its influence on apparent efficacy. N Engl J Med
2008;358(3):252-60
Hope
Hope for the possibility of change is central to
the Unstuck approach.
• Beecher, HK. The powerful placebo. JAMA 1955:159(17):375-91.
• Roberts, A, et al. The power of nonspecific effects in healing: implications for psychosocial and biological treatments.
Clin Psychol Rev 1993:13:375-91.
• Walsh, BT, et al. Placebo response in studies of major depression: variable, substantial, and growing. JAMA
2002:287(14):1840-47.
Hope
Placebo Response
Placebo – “I shall please” in Latin, a medical way
of describing hope as well as faith. Placebo
is powerful medicine. We need always to
use it.
It can be 35-70% as effective as an active, proven
intervention.
• Beecher, HK. The powerful placebo. JAMA 1955:159(17):375-91.
• Roberts, A, et al. The power of nonspecific effects in healing: implications for psychosocial and biological treatments.
Clin Psychol Rev 1993:13:375-91.
• Walsh, BT, et al. Placebo response in studies of major depression: variable, substantial, and growing. JAMA
2002:287(14):1840-47.
Neuroplasticity
Our brains, contrary to long term teaching, have
the capacity to grow and change anatomically as
well as physiologically.
• Eriksson, PS, et al. Neurogenesis in the adult human hippocampus. Nat Med 1998:4(11):1313-17.
• Kandel, E. A new intellectual framework for psychiatry. Am J Psychiatry 1998:155:457-69.
Neuroplasticity
Natural, non-pharmacological techniques
including psychotherapy, meditation, and
exercise can produce these positive changes.
• Martin, SD, et al. Brain blood flow changes in depressed patients treated with interpersonal psychotherapy or
venlafaxine hydrochloride: preliminary findings. Arch Gen Psychiatry 2001:54(7):641-48.
• Goldapple, K, et al. Modulation of cortical-limbic pathways in major depression: treatment –specific effects of cognitive
behavior therapy. Arch Gen Psychiatry 2004:61(1):34-41. Rhodes, J.S., et al., Exercise increases hippocampal
neurogenesis to high levels but does not improve spatial learning in mice bred for increased voluntary wheel running.
Behav Neurosci, 2003. 117(5): p. 1006-16.
• van Praag, H., G. Kempermann, and F.H. Gage, Running increases cell proliferation and neurogenesis in the adult
mouse dentate gyrus. Nat Neurosci, 1999. 2(3): p. 266-70.
• van Praag, H., et al., Exercise enhances learning and hippocampal neurogenesis in aged mice. J Neurosci, 2005.
25(38): p. 8680-5.
• Lazar, S.W., et al., Meditation experience is associated with increased cortical thickness. Neuroreport, 2005. 16(17):
p. 1893-7.
The Call
The First Note
Becoming aware of your depression and of the need
for change.
Following is the CES-D scale. Use it as an aid to becoming more aware of what
you’re thinking and feeling. It’s a mirror, and it clarifies the first note of the Call.
If you’re unsure of an answer, don’t linger too long. Just circle what seems most
correct and move on. The scoring scale follows the test, but don’t look at it until
you’re finished.
If you score in the range of “clinical concern,” pay attention. Even if you don’t
score in that range, notice your answers. What areas and issues do they suggest
that you need to work on? Remember, this is just a diagnostic tool. It’s for your
use. It provides useful hints and a starting place. It is not an endpoint.
• Radloff, L. The CES-D scale: a self-report depression scale for research in the general population. Appl Psych Meas
1997:1(3):385-401.
The First Note
CES- Depression Scale
Begin, using the scale below, by circling the number before each
statement which best describes how you felt or behaved
DURING THE PAST WEEK
0 = Rarely or none (less than 1 day)
1 = Some or a little (1-2 days)
0123
0123
0123
0123
0123
0123
2 = Occasionally or moderate (3-4 days)
3 = Most or all of the time (5-7 days)
I was bothered by things that usually don't bother me.
I did nor feel like eating; my appetite was poor.
I felt that I could not shake off the blues even with help
from my family/friends.
I felt that I was just as good as other people (Reverse Score).
I had trouble keeping my mind on what I was doing.
I felt depressed.
The First Note
CES- Depression Scale
0 = Rarely or none (less than 1 day)
1 = Some or a little (1-2 days)
0123
0123
0123
0123
0123
0123
I felt that everything I did
was an effort.
I felt hopeful about the future
(Reverse Score).
I thought my life bad been a
failure.
I felt fearful.
My sleep was restless.
I was happy (Reverse Score).
2 = Occasionally or moderate (3-4 days)
3 = Most or all of the time (5-7 days)
0123
0123
0123
0123
0123
0123
0123
0123
I talked less than usual.
I felt lonely.
People were unfriendly.
I enjoyed life (Reverse Score).
I had crying spells.
I felt sad.
I felt that people dislike me.
I could not get "going."
The First Note
CES- Depression Scale
Scoring:
Add up all the circled numbers (Questions 4, 8, 12 and 16 are reverse scored,
meaning that a response of 3 is scored as a 0 and a response of 0 as 3; similarly, a
1 response is scored as a 2 and a 2 response as 1).
The interpretation of your scoring varies depending on your age and culture. In
general, however, if your score is between 10-15 you may be mildly depressed. A
score of 16-25 suggests moderate depression and scores over 25 indicate that, at
least right now, you may be significantly depressed. Remember, however, that
these questions and scores are simply a way for you to take stock of how you’re
feeling right now. They are not set in concrete, and they definitely don’t mean
you have a disease.
You may want to use the CES-D every few months, to see how your worldview
and the way you’re feeling changes. Keep the results if you’d like. They can help
you see how you’ve changed and show you some of the challenges you still have
to meet.
The Call
The Second Note
It’s time to act. Taking the steps to prepare for change.
Answer the following questions:
1) What’s going on right now?
2) Where do I want to be headed? What changes
are necessary?
3) What are my first steps for getting where I’m
going?
A Journal for Your Journey
Self-expression decreases stress.
Your journal is your friend and companion.
Write every day.
• Pennebaker JW, JK Kiecolt-Glaser, R Glaser. Disclosure of traumas and immune function: health implications for
psychotherapy. J Consult Clin Psychol, 1988;56(2):239-45.
• Hemenover SH. The good, the bad, and the healthy: impacts of emotional disclosure of trauma on resilient selfconcept and psychological distress. Pers Soc Psychol Bull 2003;29(10):1236-44.
• Smyth JM, et al. Effects of writing about stressful experiences on symptom reduction in patients with asthma or
rheumatoid arthritis: a randomized trial. JAMA 1999;281(14):1304-9.
Physical Causes of Depression
Depression is not a disease, but disease, and
drugs, can cause or contribute to depression.
Rule out obvious physical illnesses and drug
effects (side effects), and then address more
subtle biological imbalances.
Physical Causes of Depression
Prescription Drugs
Prescription Drugs that May Cause or Contribute to Depression
Antianxiety medicines
Antidepressants
Antihistamines (these can, of course, be purchased over the counter in
drugstores as well as be prescribed_
Antihypertensives (a variety of drugs that lower blood pressure
Anti-inflammatory agents (used for an injury, arthritis, etc.)
Antiseizure medicines (used to protect against epilepsy)
Birth control pills
Chemotherapeutic agents (used to treat a variety of cancers)
Corticosteroids (synthetic versions of the adrenal stress hormones used for a
wide variety of conditions from arthritis to asthma and eczema)
Sleeping pills of all kinds
Physical Causes of Depression
Medical Conditions
May Give Rise To, and/or Be Accompanied By, Depression
Acquired Immune Deficiency Syndrome (AIDS)
Adrenal gland overactivity, with hypersecretion of stress hormones (Cushing’s Disease), and
underactivity (Addison’s Disease)
Autoimmune Illnesses, where the body’s immune cells attack its own tissue in a variety of locations;
examples include lupus erythematosus and rheumatoid arthritis
Cancer, especially cancer of the brain (where pressure on the brain may contribute to the
symptoms) and cancer of the pancreas
Cerebrovascular disease, in particular, strokes, or “cerebrovascular accidents,” in which the blood
supply to the brain, and therefore its adequate functioning, is compromised
Chronic Fatigue Immune Deficiency Syndrome (CFIDS): A multisystem condition, perhaps
precipitated by Epstein Barr or another viral illness, characterized by extreme fatigue, and
sometimes muscle and joint pain, as well as depression
Chronic pain
Diabetes, a disease in which major problems in sugar metabolism and in circulation are caused by
the body’s inability to produce, or adequately use, insulin
Physical Causes of Depression
Medical Conditions
May Give Rise To, and/or Be Accompanied By, Depression
Heart disease, including heart failure and heart-valve malfunction; these are often accompanied by
shortness of breath
Infections, both bacterial and viral, including Lyme disease
Lung disease, particularly chronic obstructive pulmonary disease, which may be present in longtime
smokers, coal miners, asbestos workers, etc.
Multiple sclerosis, a disorder with a variety of symptoms, including visual problems and weakness of
limbs, produced by inflammation in the “white matter” that surrounds the nerve cells in the brain
Parkinson’s disease, a disease characterized by dopamine deficiency in the substancia nigra of the
brain, with symptoms including trembling, especially of the hands; muscular rigidity; and difficulty
moving
Thyroid disease, including both overactivity (hyperthyroidism) and underactivity (hypothyroidism)
Trauma to the head
Wilson’s disease, an inherited illness in which abnormal copper metabolism may damage the
nervous system and liver
Physical Causes of Depression
More Subtle, Often Missed
• Subclinical Hypothyroidism
Sometimes with normal thyroid levels and only slightly elevated
or normal TSH.
Rx: Thyroid supplementation.
• Cooper, DS. Clinical practice. Subclinical hypothyroidism. N Engl J Med. 2001:345(4):260-65.
• Haggerty, JJ Jr, RA Stern, GA Mason, J Beckwith, et al. Subclinical hypothyroidism: a modifiable risk factor for
depression? Am J Psychiatry 1993:150(3):508-10.
• Monzani, F, P DelGuerra, N Caraccio, CA Pruneti, E Pucci, et al. Subclinical hypothyroidism: neurobehavioral features
and beneficial effect of L-thyroxine treatment. Clin Investig 1993:71(5):367-71.
More Subtle, Often Missed
• Heavy Metal Toxicity
A subject of maximum controversy.
Look for it if any possibility of exposure (dental assistance)
and/or if all else in the Unstuck approach is not working.
Rx: Detoxification, Chelation
• Cordeiro, Q., Jr., M. de Araujo Medrado Faria, and R. Fraguas, Jr., Depression, insomnia, and memory loss in a
patient with chronic intoxication by inorganic mercury. J Neuropsychiatry Clin Neurosci, 2003. 15(4): p. 457-8.
• Powell, T.J., Chronic neurobehavioural effects of mercury poisoning on a group of Zulu chemical workers. Brain Inj,
2000. 14(9): p. 797-814.
• Otto D, Y Xia, Y Li, K Wu, L He, J Telech, et al. Neurosensory effects of chronic human exposure to arsenic
associated with body burden and environmental measures. Hum Exp Toxicol 207;26(3):169-77.
• Schlegel-Zawadzka M, A Zieba, D Dudek, J Zak-Knapik, G Nowak. Is serum copper a “trait marker” of unipolar
depression? A preliminary clinical study. Pol J Pharmacol 1999;51(6):535-38.
More Subtle, Often Missed
• SIBO – Small Intestinal Bowel Overgrowth
High toxic bacteria - Low lactobacillus, bifidobacterium
Often accompanies stress.
Rx: Replace lactobacillus and bifidobacterium
(2-3 billion/capsule; 1 per day).
• Holdeman, LV, IJ Good, WE Moore. Human fecal flora: variation in bacterial composition within individuals and a possible
effect of emotional stress. Appl Environ Microbol 1976:31(3):359-75.
• Lizko, NN. Stress and intestinal microflora. Nahrung 1987:31(5-6):443-47.
• Moore, WE, EP Cato, LV Holdeman. Some current concepts in intestinal bacteriology. Am J Clin Nutr 1978:31 suppl.:S3342.
• Gruenwald, J, HJ Graubaum, A Harde. Effect of a probiotic multivitamin compound on stress and exhaustion. Adv Ther
2002:19(3):141-50.
• Pimentel ME, J Chow, HC Lin. Eradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel
syndrome. Am J Gastroenterol 2000:95(12):3503-506.
More Subtle, Often Missed
• SAD – Seasonal Affective Disorder
Fairly common
Rx: May be remedied by using full spectrum light
(10,000 lux; 30 minutes in the morning)
• Magnusson, A, H Kristbjarnarson. Treatment of seasonal affective disorder with high-intensity light: a phototherapy
study with an Icelandic group of patients. J Affect Disord 1991:21(2):141-47.
• Terman, JS, et al. Efficacy of brief, intense light exposure for treatment of winter depression. Psychopharmacol Bull
1990:26(1):3-11.
• Terman, M, JS Terman, DC Ross. A controlled trial of timed bright light and negative air ionization for treatment of
winter depression. Arch Gen Psychiatry 1998:55(10):875-82.
More Subtle, Often Missed
• Non-Seasonal Light-Related Depression
Consider this possibility
No harm in treatment, possible significant benefit
• Prasko, J, et al. Bright light therapy and/or imipramine for inpatients with recurrent non-seasonal depression. Neuro
Endocrinol Lett 2002:23(2):109-13.
• Martiny, K, et al. Adjunctive bright light in non-seasonal major depression: results from patient-reported symptom and
well-being scales. Acta Psychiatr Scand 2005:111(6):453-59.
• Yamada, N, et al. Clinical and chronobiological effects of light therapy on nonseasonal affective disorders. Biol
Psychiatry 1995:37(12):866-73.
Healthier Body, Happier Mind
Guide to Mood Healthy Eating
• Eat whole foods, organic if possible, raw often
• Westover, A.N. and L.B. Marangell, A cross-national relationship between sugar consumption and major depression?
Depress Anxiety, 2002. 16(3): p. 118-20.
• Lien, L., et al., Consumption of soft drinks and hyperactivity, mental distress, and conduct problems among
adolescents in Oslo, Norway. Am J Public Health, 2006. 96(10): p. 1815-20.
Guide to Mood Healthy Eating
Carbohydrates
• Decrease sugar and high glycemic index
carbohydrates and focus on the complex
carbohydrates – vegetables, whole grains
• Westover, A.N. and L.B. Marangell, A cross-national relationship between sugar consumption and major depression?
Depress Anxiety, 2002. 16(3): p. 118-20.
• Lien, L., et al., Consumption of soft drinks and hyperactivity, mental distress, and conduct problems among
adolescents in Oslo, Norway. Am J Public Health, 2006. 96(10): p. 1815-20.
Guide to Mood Healthy Eating
Fats
• No trans fats
• Less animal fat, more from plant oils from such
sources as extra virgin olive oil
• PGE 1 and PGE3 may improve mood, PGE2 in
red meat may lower it
• Norden M. Beyond Prozac: Brain-Toxic Lifestyles, Natural Antidotes & New Generation Antidepressants. 1995.
Harper Collins. 258p.
• Lieb J, R Karmali, D Horrobin. Elevated levels of prostaglandin E2 and thromboxane B2 in depression. Prostaglandins
Leukot Med 1983;10(4):361-67.
• Nishino S, R Ueno, K Ohishi, T Sakai, O Hayaishi. Salivary prostaglandin concentrations: possible state indicators for
major depression. Am J Psychiatry. 1989;146(3):365-68.
• Ohishi K, R Ueno, S Nishino, T Sakai, O Hayaishi. Increased level of salivary prostaglandins in patients with major
depression. Biol Psychiatry 1988;23(4):326-34.
Guide to Mood Healthy Eating
Protein
• Protein should come mostly from plants, but
also from deep water fish (salmon, halibut,
mackerel)
Guide to Mood Healthy Eating
Fiber
• Constipation is a symptom of depression.
• Eat enough fiber. Increase from 15gm a day
that is our average to the 100gm a day our
ancestors consumed.
• We need both soluble and insoluble fiber.
Guide to Mood Healthy Eating
Soluble Fiber
• Soluble fiber (pectin) is present in oatmeal as
oatbran, nuts, seeds, beans, and fruit.
• Soluble fiber slows sugar metabolism,
increases growth of beneficial bacteria.
Guide to Mood Healthy Eating
Insoluble Fiber
• Insoluble fiber (cellulose) is present in whole
grains and bran, as well as in lentils and beans
and many vegetables (carrots, zucchini,
cucumbers, etc).
• Insoluble fiber promotes bowel regularity;
removes cholesterol, hormones, and toxins
from gut.
Guide to Mood Healthy Eating
Water
• Drink more (filtered or spring).
Approximately 3 quarts per day including 2
12 ounce glasses first thing in the morning to
stimulate the gastrocolic reflex, improve
bowel movement.
Food Sensitivity
Non IgE mediated, probably by IgG
Reactions of tissues in the body to proteins that cross the
intestinal wall to enter the blood stream.
Many symptoms including depression.
• Isolauri, E, S Rautava, M Kalliomaki. Food allergy in irritable bowel syndrome: new facts and old fallacies. Gut
2004:53(10)1391-93.
• Sampson, HA. Food allergy. J Allergy Clin Immunol 2003:111(2):540-47.
• Atkinson, W, TA Sheldon, N Shaath, PJ Whorwell. Food elimination based on IgG antibodies in irritable bowel
syndrome: a randomised controlled trial. Gut 2004:53(10):1459-64.
Elimination Diet
Creating Your Own Elimination Diet
For three weeks, eliminate foods that are the main part of many modern
American diets and that clinicians have found to be the most obvious and
consistent causes of food sensitivity: milk, wheat, sugar, corn, soy, and
citrus. Eat a diet of whole foods, preferably organic, and preferably
without red meat. And drink plenty of water.
During the first few days, as you “withdraw” from the food(s) to which
you are sensitive, you may feel worse – and even more depressed. This is
unpleasant, but it may actually be a good sign, a confirmation of a food
sensitivity. In a few more days, these symptoms should subside, and
you’ll likely feel much better.
Creating Your Own Elimination Diet
Keep a diary and each day record the answers to the following questions:
How do you feel? What do you crave? What’s the relationship between
the time you ate, what you ate, and how you feel? Are you less, or more,
depressed on this elimination diet, more energetic or better able to
concentrate? What about other symptoms? Does any of this change
over time?
Then, after three weeks, reintroduce the foods that you’ve eliminated, one
at a time. See, for example, how you feel after a meal of conventional
wheat pasta (with olive oil rather than cheese or butter). What is it like
the next day? Is your mood unchanged or worse? Are you more
fatigued? Is your digestion affected? You may want to record the
answers in your journal.
Creating Your Own Elimination Diet
Then, a week or two later, experiment with another of the eliminated
foods, perhaps milk (or cheese) and so on. If you are truly sensitive to a
food, eliminating it should, after several weeks, improve your symptoms,
and reintroducing it should reproduce some of the original symptoms.
Supplementation
Most Americans are deficient in one or more
essential nutrients. Many nutrient deficiencies
may cause or contribute to depression including:
• http://www.health.gov/dietaryguidelines/dga2005/report/.
• http://www.who.int/nutrition/databases/micronutrients/en/index.html
Supplementation
• Thiamine
• Brozek, J. Psychological effects of thiamine restriction and deprivation in normal young men. Am. J. Clin. Nutr
1957: 5:109–18.
•Folic Acid
• Gilbody, S, T Lightfoot, and T Sheldon. Is low folate a risk factor for depression? A meta-analysis and
exploration of heterogeneity. J Epidemiol Community Health 2007:61(7):631-7.
• Young SN. Folate and depression—a neglected problem. J Psychiatry Neurosci 2007;32:80-2.
• Tiemeier, H, et al., Vitamin B12, folate, and homocysteine in depression: the Rotterdam Study. Am J Psychiatry
2002: 159(12): 2099-101.
• Dimopoulos N, Piperi C, Salonicioti A, et al. Correlation of folate, vitamin B12 and homocysteine plasma levels
with depression in an elderly Greek population. Clin Biochem 2007;46:604-8.
•Pyridoxine (B6)
• Hvas, AM, et al., Vitamin B6 level is associated with symptoms of depression. Psychother Psychosom
2004:73(6):340-3.
Supplementation
• B12
• Tiemeier, H, et al., Vitamin B12, folate, and homocysteine in depression: the Rotterdam Study. Am J
Psychiatry 2002: 159(12): 2099-101.
• Dimopoulos N, Piperi C, Salonicioti A, et al. Correlation of folate, vitamin B12 and homocysteine plasma
levels with depression in an elderly Greek population. Clin Biochem 2007;46:604-8.
• Vitamin C
• Kinsman, RA, J Hood. Some behavioral effects of ascorbic acid deficiency. Am J Clin Nutr, 1971:24(4):45564.
• Magnesium
• Rasmussen, HH, PB Mortensen, IW Jensen. Depression and magnesium deficiency. Int J Psychiatry Med
1989:19(1):57-63.
• Eby, GA, KL Eby. Rapid recovery from major depression using magnesium treatment. Med Hypotheses
2006:67(2):362-70.
Supplementation
• Zinc
• Maes, M, et al., Lower serum zinc in major depression in relation to changes in serum acute phase proteins. J
Affect Disord 1999:56(2-3):189-94.
• Maes, M, et al., Hypozincemia in depression. J Affect Disord 1994:31(2):135-40.
• Selenium
• Benton, D. Selenium intake, mood and other aspects of psychological functioning. Nutr Neurosci
2002:5(6):363-74.
• Benton, D, R Cook. The impact of selenium supplementation on mood. Biol Psychiatry 1991:29(11):1092-8.
• Chromium
• McLeod, MN, RN Golden. Chromium treatment of depression. Int J Neuropsychopharmacol
2000:3(4):311-314.
• Davidson, JR, et al., Effectiveness of chromium in atypical depression: a placebo-controlled trial. Biol
Psychiatry 2003:53(3):261-4.
• http://www.health.gov/dietaryguidelines/dga2005/report/.
• http://www.who.int/nutrition/databases/micronutrients/en/index.html
Supplementation
Omega-3 Fatty Acids deficiencies are correlated
with depression in epidemiological studies.
• Sanchez-Villegas, A., et al., Long chain omega-3 fatty acids intake, fish consumption and mental disorders in the SUN
cohort study. Eur J Nutr, 2007. 46(6): p. 337-46.
• Tanskanan A, JR Hibbeln, J Tuomilehto, A Uutela, A Haukkala, et al. Fish consumption and depressive symptoms in
the general population in Finland. Pschiatr Serv 2001;52(4):529-31.
Supplementation
Supplementation with Omega-3s improves mood
in both major depression and bipolar disorder.
• Stoll, A.L., et al., Omega 3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled trial. Arch Gen
Psychiatry, 1999. 56(5): p. 407-12.
• Lin, P.Y. and K.P. Su, A meta-analytic review of double-blind, placebo-controlled trials of antidepressant efficacy of
omega-3 fatty acids. J Clin Psychiatry, 2007. 68(7): p. 1056-61.
• Logan, A.C., Omega-3 fatty acids and major depression: a primer for the mental health professional. Lipids Health
Dis, 2004. 3: p. 25.
Supplementation
Mood Healthy Daily Doses
Vitamins
Vitamin A (retinol)
Vitamin A (from beta-carotene)
Vitamin D
Vitamin E (d-alpha tocopherol)
Vitamin K (phytonadione)
Vitamin C (ascorbic acid)
Vitamin B1 (thiamine)
Vitamin B2 (riboflavin)
Niacin
5,000 IU
5,000-10,000 IU
100-300 IU
200-400 IU
60-90 mg
500-2,000 mg
15-50 mg
10-50 mg
20-60 mg
Supplementation
Mood Healthy Daily Doses
Vitamins
Niacinamide
10-30 mg
Vitamin B6 (pyridoxine) 50-100 mg
Biotin
100-300 mcg
Pantothenic acid
200-500 mg
Folic acid
400-1200 mcg
Vitamin B12
200-800 mcg
Choline
150-500 mg
Inositol
150-500 mg
Supplementation
Mood Healthy Daily Doses
Minerals
Boron
Calcium
Chromium
Copper
Iodine
1-2 mg
500-1,500 mg
200-400 mcg
1-3 mg
50-150 mcg
Magnesium
Manganese
Molybdenum
Potassium
Selenium
Zinc
250-750 mg
5-10 mg
10-25 mcg
200-500 mg
100-200 mcg
15-30 mg
Omega-3 Fatty Acids (at least one half as EPA and DHA)
3000 mg
Guides on the Journey
The power of human help
“Unconditional Positive Regard”
Finding a Guide
Discovering our own Inner Guide
“Stuckness”
“Stuck”: This is how people so often say they feel
That’s why I call this approach and my book about it,
“Unstuck”
• Depression is an impasse to be navigated, as well as an imbalance to be
corrected.
• People feel stuck in a prolonged fight or flight response or frozen in
immobility.
• They feel stuck in helplessness and hopelessness.
• They feel stuck in their lives, dissatisfied with where they are now, and
unable to change.
• This is the end result of underlying physical, emotional, mental and
spiritual blocks and imbalances that produce depression, inhibit our
normal functioning and blight our relationships.
Surrender into the Current of
Our Lives
Some people can simply do this.
Most of us need to act to breakup up the fixed
psychological, emotional, mental, and spiritual
stuckness, before we can surrender.
Our Goal Is To Become Unstuck
Shaking and Dancing
A practical way to shake things up,
to surrender to life
Exercise and Depression
By itself, exercise is as effective as any known
treatment for depression.
Exercise should always be a significant part of
any integrative approach.
• Nabkasorn C, N Miyai, A Sootmongkol, S Junprasert, H Yamamoto, M Arita, K Miyashita. Effects of physical exercise
on depression, neuroendocrine stress hormones, and physiological fitness in adolescent females with depressive
symptoms. Euro J Pub Health 2006;16(2):179-84.
• Blumenthal, JA, et al. Effects of exercise training on older patients with major depression. Arch Intern Med
1999;159(19):2349-56.
• Babyak M, et al. Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months.
Psychosom Med 2000;62(5):633-38.
Exercise and Depression
Exercise alters brain chemistry, increasing
serotonin, norepinephrine, and endorphin
levels.
• Soares, J., M.G. Naffah-Mazzacoratti, and E.A. Cavalheiro, Increased serotonin levels in physically trained men. Braz
J Med Biol Res, 1994. 27(7): p. 1635-8.
• Carr, D.B., et al., Physical conditioning facilitates the exercise-induced secretion of beta-endorphin and beta-lipotropin
in women. N Engl J Med, 1981. 305(10): p. 560-3
Exercise and Depression
Exercise may promote neurogenesis.
• Rhodes, J.S., et al., Exercise increases hippocampal neurogenesis to high levels but does not improve spatial
learning in mice bred for increased voluntary wheel running. Behav Neurosci, 2003. 117(5): p. 1006-16.
• van Praag, H., G. Kempermann, and F.H. Gage, Running increases cell proliferation and neurogenesis in the adult
mouse dentate gyrus. Nat Neurosci, 1999. 2(3): p. 266-70.
• van Praag, H., et al., Exercise enhances learning and hippocampal neurogenesis in aged mice. J Neurosci, 2005.
25(38): p. 8680-5.
Dealing with Depression’s Demons
Demon and Daimon
The Demon – what disturbs and desolates us and
keeps us stuck – conceals our daimon.
Our Daimon is the guiding principle and fulfiller
of our life’s purpose
Dealing with Depression’s Demons
Meditation As Your Basic Method
Relax with your demons using mindfulness to
help you gain distance from and perceptive on
them.
Use specific exercises to come to know and learn
from your demons.
Dialogue with an SPI.
Dark Night of the Soul
• Suicide is more common than we imagine, and
suicidal thoughts and feelings are present in
many of us.
• These times are excruciating and they can be
our deepest teachers.
• We need to be able to share these thoughts and
feelings.
• Most often need a Guide.
Dark Night of the Soul
Dark nights and suicidal thoughts and actions
are particularly common among adolescents.
• 3rd leading cause of death in the US population age
15-44, 2nd for college students.
• 1/5 of high school students have “considered” suicide.
• 1/10 have attempted it.
• Youth Risk Behavior Surveillance: National College Health Risk Behavior Survey – United States, 1997,” Morbidity
and Mortality Weekly Report, 47 (1997): No SS-3
• http://www.cdc.gov/ncipc/factsheets/children.htm
Spirituality: The Blessing
• Spirituality connects us to what is beyond us
and what is deepest within us – informs and
encourages our daimon
• Spirituality is fundamental to our
understanding and experience of the journey.
• Spiritual experience and understanding
change the nature of the journey.
Spirituality
Spirituality and Breath
Connected in many languages:
• Sanskrit
• Hebrew
• Chinese
• Greek
• Prana
• Rvach
• Chi
• Pneuma
Spirituality
Breath
Life begins and ends with breath.
Breath connects us to that which is beyond us.
Breath allows us to experience spirituality
through its calming and energizing qualities.
Spirituality
• Religion and Spirituality
• Prayer
• Love
The Return
• Living Each Moment
• Being Aware
• With every Person
• In every Situation
• Celebrating each moment, Letting it go
Available at:
www.cmbm.org/u
nstuck