Defecting From Prozac Nation

What you can and can't do when psychotherapy and psychopharmaceuticals no longer- or never did- work.


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Banishing the Dark Cloud of

 

Depression

 

Nearly one in ten adults suffers from chronic depression. While therapy and new anti-depressant drugs provide relief to most patients, increasing numbers of sufferers are choosing alternative therapies to regain their mental health

 

By Jennifer Frey

Illustration by Gordon Wiebe

 

One evening after work in the summer of 2002, as  then 27-year-old Irvington resident Stacie* entered a Manhattan subway on her way home, a man came up from behind her and dragged her into a deserted tunnel, where he raped her. Over the next year, the dark-haired Irvington resident sank helplessly into depression, closing herself off from the world. She quit the gym, where she had enjoyed working out six times a week, and repeatedly turned down offers to go out with friends.

 

As the months wore on, Stacie stopped dating and even shunned contact with her mother, with whom she had been used to chatting with daily. “I couldn’t find joy in anything,” she says, not even her three beloved dogs. “Life shut down.”

 

As her downward spiral continued, Stacie lost her appetite, shedding 25 pounds from her slender five-foot, five-inch frame, until she tipped the scales at barely 100 pounds.

 

Seven months after the assault, she lost her job constructing Web sites, after her boss complained her work had been slipping badly. “I’d go to meetings and say all of two words: hello and goodbye. I couldn’t apply myself to anything. I really wasn’t functioning at work.”

 

Stacie kept thinking she’d finally touched bottom, only to find herself sinking further. She began having recurring nightmares and experiencing flashbacks of the rape, and resorted to sleeping with a light on. When she caught herself writing instructions to her friends for the care of her dogs should she commit suicide, she knew she needed help, fast.

 

But Stacie didn’t turn to a psychiatrist or conventional psychologist for fear she’d end up on medication. “I saw people who were on it, and I didn’t want to be anymore catatonic than I already felt,” she says. So in May 2003, nearly a year after the attack, Stacie responded to an advertisement in an alternative health magazine and sought out a hypnotist who specialized in trauma.

 

Stacie is not alone in either her depression—or the route she eventually chose to fight it. Nearly one in 10 adult Americans suffers from depression, according to the National Institute of Mental Health. That translates statistically into some 43,350 cases in Westchester alone. And we’re not talking about a case of the Monday morning blues, but debilitating, persistent depression that interferes with a person’s ability to function on a daily basis.

 

Unfortunately, there’s no simple blood test or medical procedure that can determine if someone is clinically depressed or just having a bad day. Instead, a person is diagnosed with major depression if he or she has five or more of nine “warning” signs, which can include reduced interest in all or most activities, significant weight gain or loss, fatigue, feelings of guilt, worthlessness, or fantasies of suicide.

 

Fortunately, modern medicine can help dispel the dismal cloud of depression for most sufferers. At most, 80 percent of patients respond to either psychotherapy or antidepressant medications (which work by raising the level of the neurotrasmitters serotonin or norepinephrine in the brain) or a combination of the two.

 

What about the remaining 20 percent, the men and women for whom therapy and Zoloft or Paxil don’t work? A significant number seek non-traditional therapies such as meditation, yoga, acupuncture, ancient Indian Ayurvedic medicine, and mind/body therapies, to alleviate their depression. Some individuals shun conventional therapy altogether, wishing to avoid the adverse side effects of psychiatric medication (e.g., potential sexual impairment, significant weight gain or loss, and agitation). For some chronic patients the beneficial effects of antidepressants wear off over time, leaving them lower than ever. According to Dr. George S. Alexopoulos, professor of psychiatry and director of the Weill-Cornell Institute of Geriatric Psychiatry, 25 percent of patients who respond to medication are still not brought to “full remission.”

 

But…yoga? “There’s evidence that alternative treatments work,” says Dr. Michael Finkelstein, who stepped down as the medical director of the Northern Westchester Hospital to launch a holistic affiliate, The Center for Health and Healing, in Mount Kisco. Alternative medicine, by definition any treatment outside of the conventional accepted therapies, is often light on scientific research. Yet medical researchers have begun giving serious attention to the efficacy of non-traditional therapies. “People are frustrated with the limited answers that physicians are giving them about alternatives to procedures and drugs—and they’re questioning whether there’s a more natural, less expensive way,” says Dr. Finkelstein.

 

Hospitals have also become more accepting of alternative therapies, especially since more patients are demanding them. In 2000, more than 60 percent of Americans’ out-of-pocket healthcare dollars were spent on alternative medicine, according to Dr. Robert Stine, a psychiatrist who trained at New York Medical College with a Master’s degree in Traditional Oriental Medicine from the Pacific College of Oriental Medicine in Manhattan. “People are saying, ‘Whoa, we’d better

follow the money.”

 

The Center For Health and Healing, which offers acupuncture, hypnosis, physician-guided holistic medical consultations, Reiki therapies, and herbal remedies, opened in February 2003 after a hospital survey showed that 70 percent of its patients were interested in an integrated approach.

 

Sitting anxiously in alternative psychologist and hypnotherapist Judith Acosta’s waiting room in Tarrytown for the first time, Stacie relaxed after hearing the comforting sounds of Acosta’s dogs scampering about the house. Acosta, who was trained at the New York Society of Ericksonian Psychotherapy and Hypnosis in Manhattan, diagnosed Stacie with major depression and post-traumatic stress disorder. She started Stacie on a treatment of psychotherapy combined with hypnotherapy, putting Stacie into a state of focused attention or altered consciousness. Acosta also relied upon a technique known as Eye Movement Desensitization Reprocessing (EMDR), which integrates talk and behavioral therapy with sensory stimulation including eye movements, tapping, and tones. During therapy sessions, Acosta would coax Stacie to clear her mind, speaking softly until Stacie sunk into a meditative state. Then she would tell Stacie to focus on a particular idea or thing bothering her; Acosta would then ask her to lightly tap herself somewhere on her head, temple or neck; at the same time, Stacie would try to visualize what she wanted to change. 

 

Coming out of the hypnotic state, she recalls, “I’d feel fresh and alive, like I’d just drunk a tall glass of ice cold water when I was parched,” Stacie says. “There was no specific a-ha! moment. But I can remember bouncing out of her office, walking home and feeling like nothing could touch me.”

 

While current theories of hypnosis are provisional, a recent overview of complementary therapies for depression in the Journal of the American Medical Association reports that while hypnotherapy can’t cure depression, it may promote the process of cognitive therapy aimed at changing negative thoughts and behavior. “I wouldn’t have believed it, but it worked,” says Stacie.

 

In her quest for a cure to her depression, Stacie also visited a homeopathic doctor, who prescribed a one-time treatment of sepia, a white pellet derived from the ink exuded by the cuttlefish when it is threatened. After taking the sepia, Stacie says she fell asleep for three hours with little effect. But three days later, “I felt like a 200-pound body bar was lifted off my shoulders,” she recalls.

 

While the medical literature regarding homeopathy (a discipline based on the idea that what ails you can cure you if given in minute amounts) consists mainly of unsubstantiated cases, at least one clinical trial conducted in France in the 1980s, which compared homeopathic treatment with valium for patients suffering from anxiety and depression, favored homeopathy in the end.

 

Many physicians, however, are skeptical. Dr. Richard Brown, an MD and psychopharmacologist, who practices holistic medicine and is also an associate professor of clinical psychiatry at Columbia University, says: “There’s never been a well done, controlled study of homeopathy showing it’s better than a placebo.” But he adds: “Placebos are helpful for a lot of people. They’re great when they work and have far fewer side effects.”

 

In any case, after two years of psychotherapy, hypnotherapy, meditation, and yoga, Stacie can sleep again, has gained back her weight, is in a relationship, has gone back to work, and is studying alternative medicine. “Without a doubt, I’m cured,” she proclaims.

 

Doctors now believe most depression is a disease, like diabetes or epilepsy, with an organic basis. Most cases are the result of a combination of chemical, genetic, and environmental factors, says Dr. Steven Shainmark, a psychiatrist and chief of outpatient services at St. Vincent’s Westchester in Harrison. Research now indicates that in many cases of depression, the brain’s neural circuits responsible for regulating moods, thought, sleep, appetite, and other behaviors malfunction because of low levels of chemical neurotransmitters, such as serotonin and norepinephrine, that the brain requires to function properly. Duke University researchers recently discovered that some people possess a genetic mutation that reduces their production of serotonin by 80 percent, making them more susceptible to major depressions.

 

Yet the knowledge that depression has an actual physical basis doesn’t erase the stigma its sufferers feel. “When you have cancer, it’s on a lab sheet. Depression is not like that,” says Nancy, a 56-year old resident of Bethel, CT. “You feel so responsible, you think maybe you’re lazy or doing something wrong. It’s such a silent, excruciating pain.”

 

For the past 25 years, Nancy has woven in and out of traditional and alternative methods to treat her recurring depression. She has sought spiritual advisors, tried special diets and vitamin regimens, and took Paxil, a popular and powerful antidepressant, which, in her case, eventually lost its effectiveness.

 

So, feeling as if she had few other avenues left, in the fall of 2003, Nancy sought out Regina Walsh, a Bedford-based acupuncturist, who had studied at the Traditional Acupuncture Institute in Laurel, MD (now called the Tai Sophia Institute). Acupuncture, an ancient Chinese medical treatment based on the Taoist philosophy of correcting an imbalance in the natural flow of the body’s energy, or qi (pronounced chee), thus allowing the body to heal itself, is usually used to treat pain. Practitioners insert hair-thin needles into specific points that supposedly correspond to specific bodily organs.

 

Walsh inserted the acupuncture needles into Nancy’s hands, wrist, feet, and lower legs. Meanwhile, her doctor also took Nancy off Paxil and started her on Wellbutrin, another antidepressant. After about a month, Nancy’s disrupted sleep returned to normal and she felt more even keeled. “It works on a level within my body that other things may not touch,” says Nancy, who believes that the combination of antidepressants and a monthly acupuncture “tune up” is giving her long-term relief.

 

Some Western physicians believe that acupuncture works by somehow stimulating the body’s release of endorphins. In 1997, a National Institutes of Health panel of scientists, researchers, and practitioners determined that acupuncture was effective in treating a variety of physical illnesses, including nausea caused by chemotherapy, addiction, headaches, and lower back pain. Acupuncture isn’t an accepted practice for treating depression. “It’s helpful at treating somatic symptoms but not effective at treating clinical depression,” says White Plains psychiatrist Dr. Arthur Badikian. Yet it has made inroads: researchers at Stanford University recently ran a clinical trial on 61 pregnant women who were severely depressed. “We had positive results,” reports Rosa N. Schnyer, one of the researchers. But she cautions that the scientific data is only preliminary.

 

Sharon*, a 40-year old Pleasantville mom who started seeing an acupuncturist last fall as a last-ditch attempt to get off of antidepressants and out of psychotherapy, is a believer. “To come in every week for psychotherapy and have the same conversation is mind-numbing,” she says. By contrast, Sharon finds acupuncture so relaxing that she often falls asleep with the needles between her eyes, in her ears, hands, and feet. “There were times when just the act of having the needles in and lying down for 45 minutes helped me change gears a little bit,” says Sharon, who admits she isn’t cured yet, but feels she’s doing better.

 

Another popular natural treatment for depression is a common herb, hypericum perforatum, better known as St. John’s Wort. Widely prescribed in Europe, it is extracted from a wild plant with a strong turpentine-like odor. Small studies in Europe have suggested that it is effective in treating mild to moderate depression, but a larger clinical trial funded in part by NIMH concluded in 2002 that the herb was no more effective than a placebo. Still, the latest clinical study, published in February in the British Medical Journal, reports that St. John’s Wort performed as well as Paxil in treating moderate and severe depression, and was better tolerated. “Currently, there is evidence that St. John’s Wort may actually work,” says Dr. Andrew Nierenberg, a psychiatrist at Massachusetts General Hospital in Boston, which is conducting an ongoing study of its effectiveness.

 

Scientists speculate that St. John’s Wort elevates biochemicals in the brain, namely dopamine and seratonin, that affect mood, and reduces adrenal activity, which is increased by depression. Says Dr. Alexopoulos: “St. John's wort is a selective serotonin reuptake inhibitor (SSRI)”—a type of antidepressant that includes Prozac, Paxil, and Zoloft—“and has similar side effects to the rest of SSRIs.”

 

Sometimes depression strikes people out of the blue, for no apparent reason. That’s what happened to Maria*, a 46-year-old married professional living in Hastings-on-Hudson. She was exercising and meditating regularly in 2001 when her mental health unexpectedly entered a downward spiral. “It was an effort just to get out of bed in the morning,” she recalls “I was feeling no joy. I was in a dark, lonely place, having dark thoughts about my life.”

 

One night, shaken from having had to fire an underling, she called her office supervisor and just sobbed on the phone. The next day, she was admitted to the psychiatric ward at South Memorial Hospital in Tarrytown and given the antidepressant Effexor.

 

The antidepressant permitted her to function for about a year. Then she suffered another breakdown. “The police found me sitting in my car, shaking, crying, and agitating,” she recalls—and she was admitted to New York Presbyterian in White Plains. Because she was no longer responding to medication, she consented to undergo a series of seven electroconvulsive therapy (ECT) sessions. (ECT is not an alternative therapy like hypnosis or acupuncture, but a tested conventional medical procedure.) “After the second one, I started to recognize my surroundings and could follow the routine of eating and bathing,” she says. “By the seventh ECT, I could carry on a conversation, and it made sense.”

 

In 1938, Italian psychiatrist Ugo Cerletti pioneered the use of ECT to treat people suffering from mental illnesses such as depression. In the early days of electro therapy, patients remained awake and weren’t given muscle relaxants. As a result, about 40 percent of patients would break bones because they jerked so violently when the electrical stimulation was set off. “That was frightening and uncomfortable,” says Dr. Robert Young, who runs the ECT unit at NewYork Presbyterian Hospital/Westchester Division in White Plains.

 

ECT has come a long way since then. Today, the entire ECT procedure takes 20 minutes, most of which is setting it up, says Dr. Young. “It’s like having a dental extraction,” he says. “When it’s done correctly, there’s not much to see.”

 

Patients are given anesthesia and muscle relaxants. Electrodes are placed on each temple, through which a current about as powerful as a 100-watt light bulb (less than a third of what you get from a cardiac paddle) is administered, putting the patient into a grand mal seizure for between 15 to 30 seconds. Typically, patients wake up groggy and experience some memory loss. “For severe depression and other illnesses that do not respond to medication, it’s the most effective intervention  you can use,” says Dr. Young.

 

Doctors still aren’t sure how ECT works upon the brain. One theory is that the electricity works like antidepressants, affecting neurotransmitters in the brain, which results in increased levels of dopamine and norepinephrine. Others believe that the electrical current affects the hypothalmus gland, which controls hormones that affect mood. And a third theory says that the brain’s effort to resist seizures dampens abnormally active brain activity and stabilizes mood.

 

An estimated 60,000 people will have the treatment this year; a series of eight to 10 treatments is recommended for acute depression. Symptoms will improve for nearly 80 percent of the patients, who almost always require treatment with medication following a course of ECT to prevent a relapse. It can, however, permanently damage a patient’s memory.

 

Maria, for example, still has gaps in her memory as a result of her ECT treatments and finds herself back on antidepressants today. Even so, she claims, her treatment was the proper course for her. “I was in a really bad state. I don’t know how long antidepressants would have taken to kick in,” she says. She’s exercising again, cooking once more, and has even joined a book group. “I can face the day now—I even look forward to facing the day.”

 

Freelance writer Jennifer Frey, who lives in Larchmont, wrote about the legal troubles of dogs gone wild in the February issue.

 

 

 

 

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