No longer depressed, or on meds

Star Tribune (Minneapolis) (MCT) - Henry Quant was just 5 years old and bedridden with chronic fevers when he began taking pills for anxiety and depression.

His mother knew that the drugs helped, but they made her nervous.

"The really scary part," Elizabeth Quant said, "is we don't know what these do long term."

This summer, under the watchful eye of his physician, Henry, now 7, replaced his antidepressants with vitamins and learned some stress-relief exercises to calm himself.

"Now he's doing better and better," said his mother, who lives with her husband, Shawn, and three children in south Minneapolis. If Henry, a second-grader, starts to relapse, his mother says she won't hesitate to change course. But after two months, she's thrilled. "He's happy and he's healthy, that's Henry."

At one time, psychiatrists might have cringed at the thought of using alternative medicine instead of "real" treatments for mental health care. But a growing number of doctors are adding herbs, nutritional supplements and meditation to their arsenal of psychiatric drugs, as evidence mounts that natural therapies can help. Even stalwarts of the medical establishment, from the University of Minnesota to Allina Hospitals & Clinics, are exploring ways to use mind-body therapies to treat depression and anxiety.

In part, it's an effort to recapture the human touch in mental health care, which some say has been lost since antidepressants became the most widely prescribed drugs in the land.

"I think it is a backlash to the whole push for antidepressants, and I think maybe a reasonable one," said Dr. Gary Oftedahl, who helped design a depression treatment program for the Institute for Clinical Systems Improvement, a Bloomington, Minn., health policy group. "We've tried to medicalize depression almost to the point of not looking at the simpler things that can be done."

Few dispute that antidepressants can be lifesavers, and that many people are alive today because of them. Yet Sue Abderholden, who heads the National Alliance on Mental Illness, Minnesota chapter, said she is delighted to see more attention to mind-body therapies. "We've never said a pill's going to cure it. It just takes more than that."

FROM PASSIVE TO ACTIVE

At Children's Hospitals and Clinics of Minnesota, kids are being taught how to manage depression and anxiety with everything from scented oils to deep-breathing, exercise, prayer and "quiet reflection."

"I think people are fed up with having their kids medicated as the only option," said Dr. Timothy Culbert, head of integrative medicine at Children's, and Henry's doctor.

Last year, Culbert co-wrote a series of self-care books for children ("Be the Boss of Your Body" by Free Spirit Publishing) on ways to cope with pain, stress and sleep problems _ all linked to depression.

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Several patients have been able to get off medication, while others have cut their dosage, Culbert said. His goal is to teach kids to help themselves, not just passively receive therapy.

Henry Quant started showing signs of depression at age 2. He had a rare condition, called periodic fever syndrome, that caused chronic high fevers and left him sad and listless. By the time he was 5, his mother recalled, one bout of fever lasted months. "He was so sick, and he didn't understand. He was sobbing a lot."

Eventually, doctors found a treatment _ removing his tonsils and adenoids _ for the fevers. With antidepressants, the youngster's spirits began to lift, his mother said.

This summer, Elizabeth Quant took Henry to Culbert's integrative medicine program. Culbert recommended vitamins, massages and other calming therapies, as Henry's medication was tapered off.

The boy also was taught self-help techniques. "One of them is to sit quietly for about two minutes and just think of something happy," his mother said. With those techniques, and a strict diet-and-exercise routine, she says, "I believe we have it under control now."

Dr. James Gordon, a Harvard-trained psychiatrist, insists that many people struggling with depression could do without mood-changing drugs. But he says doctors have been cowed by insurers and drug companies into writing prescriptions at the first sign of depression.

"Many feel trapped in a system that tells them their patients have to be on drugs (or) they're not doing their job," said Gordon, who heads the Center for Mind-Body Medicine in Washington.

Gordon travels the world preaching that depression isn't really a disease, but a life out of balance. He makes that case in his latest book, "Unstuck." In July, he brought his message to a workshop in Minneapolis, hosted by Allina.

"The dominant issue in depression in stress," he said. "Why not teach people how to deal with stress?" Gordon's solution: A mix of meditation, dance therapy, deep breathing, exercise, herbs, nutritional supplements and self-help strategies, which he has packaged into an eight-week course.

"I do not say never take antidepressants. What I say is, antidepressants are a last resort, not a first choice," said Gordon. "It may turn out that it's far less expensive, economically as well as humanly, to help people help themselves." Most people have to pay for alternative mental-health treatments out of pocket, because insurers generally don't.

Snake oil or happy medium

Dr. Paul Goering, who heads Allina's mental health program, calls himself a skeptic. To some fellow psychiatrists, he admits, a treatment is no better than snake-oil if it's not "exhaustively tested."

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Yet he invited Gordon to Minnesota to share his views as part of an Allina project exploring alternative treatments in mental health.

Goering notes that there's growing evidence that practices such as yoga and exercise can promote mental health. More studies are underway, in Minnesota and around the country. "I think we will be very cautious about introducing it," he said. "But I think there's something there."

He's not alone.

The Mayo Clinic has been weaving mind-body therapies into all fields of medicine, including psychiatry, for several years. Even the University of Minnesota psychiatry department, which has long focused on the biology of brain diseases, is taking a fresh look at alternative medicine, said its chairman, Dr. Charles Schultz.

"If it leads to a better outcome, then I think it's our obligation to look at it," he said.

His main concern, he said, is that patients who really need medication won't get it. Untreated depression, he notes, is a leading cause of suicide. "I will not say that every single person needs to start on an antidepressant medication as soon as they describe feeling sad or hopeless," he said. "On the other hand, we can't ignore how severe depression is."

Dr. Jeffrey Sawyer, a self-described holistic psychiatrist in St. Louis Park, says the problem lies at the extremes _ insisting drugs aren't necessary, or that they're the only thing that works.

"I think," he said, "there's a happy medium in the middle that blends both worlds."

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© 2008, Star Tribune (Minneapolis)