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UNSTUCK: An Integrative Approach to Depression

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Title: UNSTUCK: An Integrative Approach to Depression


1
UNSTUCK An Integrative Approachto 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 Alternative Medicine Policy

2
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 ones life.
  • The beginning of a journey. A wake up call to
    the need for change, not the end of a disease
    process.

3

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 20024(2)117-28
  • Sapolsky, RM. Why stress is bad for your brain.
    Science 1996273(5276)749-50.

4
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

5
The Seven Stages
  • 4. Dealing with Demons
  • Meeting the challengesself-doubt, loneliness,
    procrastination, pride, resentment, apprehension,
    perfectionism, fear with all its faces, guilt,
    shame, self-pity, and all the othersand 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

6
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

7

Awareness of
  • 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
    Sadocks 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 20052(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
    2002113(1-2)193-206.

8

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 199723(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 200317(4)451-52.
  • Black K, et al. Selective serotonin reuptake
    inhibitor discontinuation syndrome proposed
    diagnostic criteria. J Psychiatry Neurosci
    200025(3)255-61.

9

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
    emperors 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/pre
    0050023a.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 2008358(3)252-60

10

Hope
  • Hope for the possibility of change is central to
    the Unstuck approach.
  • Beecher, HK. The powerful placebo. JAMA
    1955159(17)375-91.
  • Roberts, A, et al. The power of nonspecific
    effects in healing implications for psychosocial
    and biological treatments. Clin Psychol Rev
    199313375-91.
  • Walsh, BT, et al. Placebo response in studies of
    major depression variable, substantial, and
    growing. JAMA 2002287(14)1840-47.

11

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
    1955159(17)375-91.
  • Roberts, A, et al. The power of nonspecific
    effects in healing implications for psychosocial
    and biological treatments. Clin Psychol Rev
    199313375-91.
  • Walsh, BT, et al. Placebo response in studies of
    major depression variable, substantial, and
    growing. JAMA 2002287(14)1840-47.

12

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 19984(11)1313-17.
  • Kandel, E. A new intellectual framework for
    psychiatry. Am J Psychiatry 1998155457-69.

13

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
    200154(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 200461(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.

14

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 youre thinking
    and feeling. Its a mirror, and it clarifies the
    first note of the Call.
  • If youre unsure of an answer, dont linger too
    long. Just circle what seems most correct and
    move on. The scoring scale follows the test, but
    dont look at it until youre finished.
  • If you score in the range of clinical concern,
    pay attention. Even if you dont 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. Its
    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 19971(3)385-401.

15

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) 2
    Occasionally or moderate (3-4 days)
  • 1 Some or a little (1-2 days) 3 Most or all
    of the time (5-7 days)

0 1 2 3 I was bothered by things that usually
don't bother me. 0 1 2 3 I did nor feel like
eating my appetite was poor. 0 1 2 3 I felt
that I could not shake off the blues even with
help from my family/friends. 0 1 2 3 I felt
that I was just as good as other people (Reverse
Score). 0 1 2 3 I had trouble keeping my mind on
what I was doing. 0 1 2 3 I felt depressed.
16

The First Note
CES- Depression Scale
  • 0 Rarely or none (less than 1 day) 2
    Occasionally or moderate (3-4 days)
  • 1 Some or a little (1-2 days) 3 Most or all
    of the time (5-7 days)

0 1 2 3 I felt that everything I did was an
effort. 0 1 2 3 I felt hopeful about the future
(Reverse Score). 0 1 2 3 I thought my life bad
been a failure. 0 1 2 3 I felt fearful. 0 1 2
3 My sleep was restless. 0 1 2 3 I was happy
(Reverse Score).
0 1 2 3 I talked less than usual. 0 1 2 3 I
felt lonely. 0 1 2 3 People were unfriendly. 0 1
2 3 I enjoyed life (Reverse Score). 0 1 2 3 I
had crying spells. 0 1 2 3 I felt sad. 0 1 2 3
I felt that people dislike me. 0 1 2 3 I could
not get "going."
17

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 youre feeling right
    now. They are not set in concrete, and they
    definitely dont mean you have a disease.
  • You may want to use the CES-D every few months,
    to see how your worldview and the way youre
    feeling changes. Keep the results if youd like.
    They can help you see how youve changed and show
    you some of the challenges you still have to
    meet.

18
The Call
The Second Note
Its time to act. Taking the steps to prepare for
change.
  • Answer the following questions
  • Whats going on right now?
  • Where do I want to be headed? What changes are
    necessary?
  • What are my first steps for getting where Im
    going?

19

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, 198856(2)239-45.
  • Hemenover SH. The good, the bad, and the healthy
    impacts of emotional disclosure of trauma on
    resilient self-concept and psychological
    distress. Pers Soc Psychol Bull
    200329(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 1999281(14)1304-9.

20

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.

21

Physical Causes of Depression
Prescription Drugs
  • Prescription Drugs that May Cause or Contribute
    to Depression

22

Physical Causes of Depression
Medical Conditions
  • May Give Rise To, and/or Be Accompanied By,
    Depression

23

Physical Causes of Depression
Medical Conditions
  • May Give Rise To, and/or Be Accompanied By,
    Depression

24

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. 2001345(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
    1993150(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
    199371(5)367-71.

25
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
    20726(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
    199951(6)535-38.

26

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 197631(3)359-75.
  • Lizko, NN. Stress and intestinal microflora.
    Nahrung 198731(5-6)443-47.
  • Moore, WE, EP Cato, LV Holdeman. Some current
    concepts in intestinal bacteriology. Am J Clin
    Nutr 197831 suppl.S33-42.
  • Gruenwald, J, HJ Graubaum, A Harde. Effect of a
    probiotic multivitamin compound on stress and
    exhaustion. Adv Ther 200219(3)141-50.
  • Pimentel ME, J Chow, HC Lin. Eradication of
    small intestinal bacterial overgrowth reduces
    symptoms of irritable bowel syndrome. Am J
    Gastroenterol 200095(12)3503-506.

27

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
    199121(2)141-47.
  • Terman, JS, et al. Efficacy of brief, intense
    light exposure for treatment of winter
    depression. Psychopharmacol Bull 199026(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 199855(10)875-82.

28
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
    200223(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 2005111(6)453-59.
  • Yamada, N, et al. Clinical and chronobiological
    effects of light therapy on nonseasonal affective
    disorders. Biol Psychiatry 199537(12)866-73.

29

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.

30

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.

31

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
    198310(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. 1989146(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
    198823(4)326-34.

32

Guide to Mood Healthy Eating
Protein
  • Protein should come mostly from plants, but also
    from deep water fish (salmon, halibut, mackerel)

33

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.

34

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.

35

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.

36

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.

37

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 200453(10)1391-93.
  • Sampson, HA. Food allergy. J Allergy Clin Immunol
    2003111(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 200453(10)1459-64.

38

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
    youll likely feel much better.

39

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? Whats 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 youve 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.

40

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.

41

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/re
    port/.
  • http//www.who.int/nutrition/databases/micronutrie
    nts/en/index.html

42

Supplementation
  • Thiamine
  • Folic Acid
  • Pyridoxine (B6)
  • Brozek, J. Psychological effects of thiamine
    restriction and deprivation in normal young men.
    Am. J. Clin. Nutr 1957 510918.
  • 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 200761(7)631-7.
  • Young SN. Folate and depressiona neglected
    problem. J Psychiatry Neurosci 20073280-2.
  • 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
    200746604-8.
  • Hvas, AM, et al., Vitamin B6 level is associated
    with symptoms of depression. Psychother Psychosom
    200473(6)340-3.

43

Supplementation
  • B12
  • Vitamin C
  • Magnesium
  • 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
    200746604-8.
  • Kinsman, RA, J Hood. Some behavioral effects of
    ascorbic acid deficiency. Am J Clin Nutr,
    197124(4)455-64.
  • Rasmussen, HH, PB Mortensen, IW Jensen.
    Depression and magnesium deficiency. Int J
    Psychiatry Med 198919(1)57-63.
  • Eby, GA, KL Eby. Rapid recovery from major
    depression using magnesium treatment. Med
    Hypotheses 200667(2)362-70.

44

Supplementation
  • Zinc
  • Selenium
  • Chromium
  • Maes, M, et al., Lower serum zinc in major
    depression in relation to changes in serum acute
    phase proteins. J Affect Disord
    199956(2-3)189-94.
  • Maes, M, et al., Hypozincemia in depression. J
    Affect Disord 199431(2)135-40.
  • Benton, D. Selenium intake, mood and other
    aspects of psychological functioning. Nutr
    Neurosci 20025(6)363-74.
  • Benton, D, R Cook. The impact of selenium
    supplementation on mood. Biol Psychiatry
    199129(11)1092-8.
  • McLeod, MN, RN Golden. Chromium treatment of
    depression. Int J Neuropsychopharmacol
    20003(4)311-314.
  • Davidson, JR, et al., Effectiveness of chromium
    in atypical depression a placebo-controlled
    trial. Biol Psychiatry 200353(3)261-4.
  • http//www.health.gov/dietaryguidelines/dga2005/re
    port/.
  • http//www.who.int/nutrition/databases/micronutrie
    nts/en/index.html

45

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 200152(4)529-31.

46

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.

47

Supplementation
Mood Healthy Daily Doses
  • Vitamins
  • Vitamin A (retinol) 5,000 IU
  • Vitamin A (from beta-carotene) 5,000-10,000 IU
  • Vitamin D 100-300 IU
  • Vitamin E (d-alpha tocopherol) 200-400 IU
  • Vitamin K (phytonadione) 60-90 mg
  • Vitamin C (ascorbic acid) 500-2,000 mg
  • Vitamin B1 (thiamine) 15-50 mg
  • Vitamin B2 (riboflavin) 10-50 mg
  • Niacin 20-60 mg

48

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

49

Supplementation
Mood Healthy Daily Doses
  • Minerals
  • Boron 1-2 mg
  • Calcium 500-1,500 mg
  • Chromium 200-400 mcg
  • Copper 1-3 mg
  • Iodine 50-150 mcg

Magnesium 250-750 mg Manganese 5-10
mg Molybdenum 10-25 mcg Potassium 200-500
mg Selenium 100-200 mcg Zinc 15-30 mg
Omega-3 Fatty Acids (at least one half as EPA and
DHA) 3000 mg
50
Guides on the Journey
The power of human help Unconditional Positive
Regard Finding a Guide Discovering our own Inner
Guide
51
Stuckness
Stuck This is how people so often say they
feel Thats 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.

52
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.

53
Our Goal Is To Become Unstuck
  • Shaking and Dancing
  • A practical way to shake things up,
  • to surrender to life

54
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 200616(2)179-84.
  • Blumenthal, JA, et al. Effects of exercise
    training on older patients with major depression.
    Arch Intern Med 1999159(19)2349-56.
  • Babyak M, et al. Exercise treatment for major
    depression maintenance of therapeutic benefit at
    10 months. Psychosom Med 200062(5)633-38.

55
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

56
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.

57

Dealing with Depressions 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 lifes purpose

58

Dealing with Depressions 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.

59

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.

60

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

61

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.

62

Spirituality
Spirituality and Breath
  • Connected in many languages
  • Sanskrit
  • Hebrew
  • Chinese
  • Greek
  • Prana
  • Rvach
  • Chi
  • Pneuma

63

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.

64
Spirituality
  • Religion and Spirituality
  • Prayer
  • Love

65

The Return
  • Living Each Moment
  • Being Aware
  • With every Person
  • In every Situation
  • Celebrating each moment, Letting it go

66
Available at www.cmbm.org/unstuck
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