research

The vision and projects to fulfil the Foundation's mission in research and education were recently featured in the National Health Association's Winter 2018 edition of Health Science Magazine.

Though current medical and surgical treatments manage coronary artery disease, they do little to prevent or stop it. Nutritional intervention, as shown in our study and others, has halted and even reversed CAD.

Authors: Caldwell B. Esselstyn Jr, MD; Gina Gendy, MD; Jonathan Doyle, MCS; Mladen Golubic, MD, PhD; Michael F. Roizen, MD; The Wellness Institute of the Cleveland Clinic, Lyndhurst, Ohio

This original research article appears in the Journal of Family Practice in July 2014, vol 63, no 7

ABSTRACT
Purpose: Plant-based nutrition achieved coronary artery disease (CAD) arrest and reversal in a small study. However, there was skepticism that this approach could succeed in a larger group of patients. The purpose of our follow-up study was to define the degree of adherence and outcomes of 198 consecutive patient volunteers who received counseling to convert from a usual diet to plant-based nutrition.

Methods: We followed 198 consecutive patients counseled in plant-based nutrition. These patients with established cardiovascular disease (CVD) were interested in transitioning to plant-based nutrition as an adjunct to usual cardiovascular care. We considered participants adherent if they eliminated dairy, fish, and meat, and added oil.

Results: Of the 198 patients with CVD, 177 (89%) were adherent. Major cardiac events judged to be recurrent disease totaled one stroke in the adherent cardiovascular participants—a recurrent event rate of .6%,
significantly less than reported by other studies of plant-based nutrition therapy. Thirteen of 21 (62%) nonadherent participants experienced adverse events.

Conclusion: Most of the volunteer patients with CVD responded to intensive counseling, and those who sustained plant-based nutrition for a mean of 3.7 years experienced a low rate of subsequent cardiac events. This dietary approach to treatment deserves a wider test to see if adherence can be sustained in broader populations. Plant-based nutrition has the potential for a large effect on the CVD epidemic.

To read the article in its entirety (11 pages), please click here or on the attachment below.

Bastyr University & TrueNorth Health

“Fasting and Alternatives to Standard Therapeutics (FAST): Determining the Molecular and
Physiological Mechanisms Responsible for Adult Hypertension and Obesity”

Please Help Us Learn About

Fasting and Vegan Diet

Is medically supervised water-only fasting an effective treatment for High Blood Pressure?

Vegan, Low Salt and Low Fat Diets, are shown to be an effective lifestyle therapy to reduce blood pressure and promote weight loss. Another potentially effective therapy to reduce blood pressure and promote weight loss is Short-Term, Medically Supervised, Water Only Fasting.  Safe and effective alternatives for the treatment of high blood pressure and obesity are increasingly needed.  This study aims to find out whether short-term fasting, combined with dietary modification, is more effective at reducing blood pressure and increasing weight loss than dietary modification alone.

If you have High Blood Pressure and are Obese and between the ages of 21 and 65, you may be eligible to participate in a research study about fasting and diet.

Study participants will be asked to get a baseline screening and get periodic blood work in addition to your normal health care.  Participants with a normal physical exam and blood work who also have greater than 140/90 mmHg and are Obese at the initial screening will be eligible to participate in the study.

If a screening visit and blood work results show you are eligible, you will be able to undergo the vegan diet and the fasting treatment as a part of this research study. At the end of the 6-week study, you will also be asked to attend one more study visit after 6 months to obtain additional blood work and physical measures.

At TrueNorth Health, we see a variety of unique patient cases. Recently, our medical team treated a case of subacute appendicitis with medically supervised water only fasting followed by diet and lifestyle modifications. This patient recovered from the appendicitis, and the results are presented in the attached case study. A Case of Nonpharmacologic Conservative Management of Suspected Uncomplicated Subacute Appendicitis in an A...

Medically Supervised Water-only Fasting in the Treatment of Hypertension

Medically Supervised Water-Only Fasting in the Treatment of Borderline Hypertension

Psychotherapy - It's Not What You Think

What is the epidemic condition that causes more death and disability in industrialized countries than any other?

What is the leading reason for visits to doctors and the single biggest justification for drug prescriptions?

What condition affects the majority of Americans over the age of 65, often has no symptoms, and is referred to as the  "silent killer"?

If you said high blood pressure, also known as hypertension, you would be correct.

Blood Pressure Basics

Blood pressure measurements are recorded as two distinct numbers, the first one over the second. The top number is called the systolic blood pressure and this number represents the pressure of the blood in the vessels during the heart's contraction.  The bottom number, or diastolic blood pressure, represents the pressure of the blood in the vessels when the heart relaxes.

Both measurements are important risk factors that are associated with your risk of morbidity and mortality.  That means your risk of becoming ill or dead.

For every point your systolic blood pressure rises over 90 there is a one percent increased risk of mortality.  Looked at positively, this means that for every point you drop your systolic blood pressure all the way down to 90, there is a one percent reduction in mortality.  Therefore, an individual who successfully reduces his/her systolic blood pressure from 150 to 110 through improved dietary and lifestyle habits would reduce their risk of all cause mortality by a whopping 40 percent.  Said simply, this means that if you reduce your systolic blood pressure by 40 points, you are 40% less likely to die this year.

Blood Pressure Matters

When blood pressure is elevated the increased wear and tear on the blood vessels and the turbulence created in the bloodstream appears to increase the tendency to form fatty sores called plaques.  When these plaques rupture they may lead to a blockage of the blood vessels that feed circulation to the heart or brain resulting in a heart attack or stroke.  These incidents are the leading cause of death in industrialized countries.

Interestingly, the majority of heart attacks and strokes that result from increased blood pressure occur in individuals whose blood pressure is not yet elevated high enough to justify the significant risks of medications.  All blood pressure medications are known to have significant risks and side effects.  These side effects are so dangerous that until blood pressures are significantly elevated (greater than 160 mm/Hg in most patients) the risks of medications outweigh the potential benefit.

Fortunately there are many options other than drugs that work to safely lower blood pressure, thereby reducing the risk of premature death and disability.

*Blood pressure numbers are given here as  "points" without the associated terminology as  "millimeters of mercury," indicated by "mm Hg."  The correct way to technically describe blood pressure of 120/80 is  "120/80 mm/Hg."

What Works

As Figure 1 indicates, numerous approaches have been scientifically proven to be safe and effective at lowering blood pressure.  For example, for every Kg of weight loss (2.2 pounds), systolic blood pressure is reduced an average of 1.6 points.  The adoption of a vegetarian high fiber diet will also reduce systolic blood pressure, by an average of 2.8 points.  Also, and very significantly, the reduction of alcohol and sodium will reduce systolic blood pressure by 4.8 and 16 points respectively.  It is interesting to note that the 16 point reduction from severe sodium restriction is actually a larger effect size than would be expected from any combination of medications.  Exercise has additionally been shown to have a powerful normalizing effect on blood pressure.  For example, a regular walking program of 45 minutes, 4-5 times a week may reduce blood pressure by an average of about 7 points.

Water-Only Fasting and Blood Pressure

In a study conducted at the TrueNorth Health Center in California and published in the June 2001 issue of the Journal of Manipulative and Physiological Therapeutics, the use of water-only fasting followed by a low-fat, low-salt vegan diet demonstrated the largest effect on lowering blood pressure of any study in the scientific literature (See Figure 2).  The average drop in systolic blood pressure in 174 consecutive patients was 37 points.  In those patients with higher levels of blood pressure, starting at what is called Stage 3 hypertension (where the systolic blood pressure exceeds 180 points or 180 mm/Hg), the average reduction was 60 points!

In a second study, also conducted at the TrueNorth Health Center and published in the October 2002 issue of the Journal of Alternative and Complementary Medicine, a group of 68 patients with "borderline" high blood pressure (systolic blood pressure between 120 and 140 mm Hg) underwent a period of water-only fasting for an average of two weeks.  The average reduction in blood pressure exceeded 20 points, resulting in a final average blood pressure of 96/67.  This is a level similar to that level suspected to be optimum blood pressure by Dr. Richard Peto of Oxford and other authorities.

Worth Getting Healthy

In 2001, California's largest labor union, The International Union of Operating Engineers, elected to make the TrueNorth Health residential health education program a fully covered medical benefit offered to all active and retired union members and their families that suffer with high blood pressure or diabetes.  This represents the first time in history that a major medical payer has agreed to provide water-only fasting as a fully covered medical benefit. 

The Operating Engineers Union is self-insured and all information concerning medical expenses is centralized.  This has allowed us to accurately evaluate the effect of the fasting program on the cost of medical treatment and drugs in the year prior to, and the year after, participation in the TrueNorth Health program.  The results have been clinically and economically impressive.  The cost of medical and drug treatment was reduced an average of over $2700 per member in the first year alone.  This cost savings exceeded the cost of the program, demonstrating that fasting can be both clinically and economically effective.  TrueNorth Health Center will continue to track the outcomes of the Union members in the years to come, and we expect the long-term results to be outstanding.

Feeding After the Fast

The effect of fasting on blood pressure can seem like a miracle, as patients who have been told that they need to take medications "for the rest of your life" are able to throw away those medications.  However, in order to sustain the results requires compliance with a health promoting lifestyle, including proper diet, sleep, and exercise habits. With respect to diet, we instruct our patients to avoid all processed foods that contain added salt, including bread, cheese, highly salted salad dressings, soups, sauces, soda, as well as the use of coffee, alcohol and chocolate.  In place of a conventional American diet, we encourage a diet derived exclusively from whole, minimally processed foods including fruits, vegetables, unprocessed whole grains, beans, and raw nuts and seeds.

Breakfast is often fresh fruit and/or oatmeal with some ground flax seeds.  Lunch is often a large raw vegetable salad, with steamed vegetables and minimally processed complex carbohydrates including steamed or baked potatoes, yams, squash, etc.  Dinner may include another large raw vegetable salad, more steamed vegetables and rice, millet, or a dish out of The Health Promoting Cookbook.

By avoiding all meat, fish, fowl, eggs and dairy products as well as all foods with added oil, flour, salt and sugar, our patients eliminate the dietary excess that is a contributing cause of high blood pressure.  When combined with a program of proper sleep and exercise, the results are consistently outstanding.  By utilizing fasting to jump start a new way of living, patients are able to break bad habits and gain control of their health.  High blood pressure is just one of many major health concerns that can be successfully treated with this approach.  And it is one that you can definitely learn to live without!
 

Our genetically-programmed behavior does not always serve us well in our modern environment.

When I began my practice more than 20 years ago, I still had a lot to learn. I had the skills and information to help sick people get well and healthy people stay well.  But I thought that all I had to do was take a careful medical history, perform a thorough physical examination, and prepare detailed diet and lifestyle recommendations. Then, I thought, my patients would follow my advice diligently and get outstanding results.

But it did not always work that way. I found that people did not want to make drastic lifestyle changes, or give up their bad habits. They did not quickly or easily give up cigarettes, coffee, alcohol, and other drugs. The same was true for meat, fish, fowl, eggs, or dairy products, as well as oil, salt, and sugar.

My patients believed in magic. They believed that despite their bad habits, indiscretions, and lack of personal fortitude, the magic of modern medicine somehow would enable them to make a few small changes that required minimal effort and would instantly overcome years of abuse to their health.

Many of these patients had been given poor advice by their doctors. They had been told that changing the color of their meat from red to white, or that being "moderate" in continuing their unhealthful habits was all that was required. Some patients thought that their problems were "all in the head"; some thought that their conditions were the "inevitable result of aging." Many thought that they just might have to "learn to live with it." It was frustrating to see people who were sick and dying, suffering needlessly, hanging on to the very habits that caused their problems.

Over time, I began to observe that the patients who did the best in the long run were those who developed a reality-based philosophy of life. It was not enough to tell these individuals what to do, they wanted to understand how and why it worked. At that point, I realized that my role as a physician would involve more re-education than I originally thought.

During these past 20 years, I have had the pleasure and privilege of helping several thousand individuals learn to get healthy and stay healthy. I would like to share some of the information that can help you do the same. Let's take a look at some of the things that influence our behavior tendencies. To a large extent, our behavior - the choices we make - determines the quantity and the quality of our lives.

Beyond survival

On one level, humans are like other animals: genetically-programmed, biologically-driven organisms whose fundamental purpose in life is survival. (By survival I mean getting enough to eat and not getting eaten.) But humans also operate on an entirely different level. We have developed the most powerful tool that the world has ever seen-language. Language has allowed us to dominate the planet. Unlike other animals, who acquire knowledge only through direct, individual experience, language allows humans to accumulate knowledge and pass it on. Language is the power behind the success of our species.

Knowledge which might take an individual a lifetime to accumulate can be passed on in a matter of moments by listening to someone speak or by reading their words. This enables us to benefit from the cumulative life experiences of those who came before us.

One outgrowth of our unique gift of language has been the development of a mathematically-based system to help us determine what is real-which we call science. The scientific method is not perfect, but it is a tremendously powerful tool that helps us separate fact from fantasy. One of the direct benefits of this system is our ability to monitor and evaluate factors that either enhance or impair health.

Pleasure vs. happiness

Most animals spend virtually all of their time trying to get enough to eat and  not get eaten. But we humans have been able to gain control over our environment to such an extent-at least in the powerful, developed countries-that we have been able to get enough to eat, not get eaten, and still have some time left over. Now that we can look beyond mere survival, we can explore what gives life meaning, or put another way, what makes us happy.

Many people confuse pleasure with happiness. This can be a big problem and can lead to some very unhappy results. It is imperative that we recognize the difference between pleasure and happiness.

Pleasure is a stereotypical response of your nervous system to specific stimulation. Food, sexual activity, even drugs can stimulate your nervous system in such a way that you can experience pleasure. Happiness is an emotional state that occurs spontaneously when you perceive the overall balance of your life experience as highly positive.

Many people, when unhappy, mistakenly assume that they are lacking pleasure in their lives. They assume that they have a pleasure deficiency and go about trying to stimulate the pleasure-sensing mechanisms of their nervous system. Drug addiction is an extreme example of pleasure-seeking behavior. Drug addicts often will destroy their lives just to induce a temporarily-pleasurable response. Crack cocaine addicts reportedly have sold their infant children for a few rocks of cocaine. But no matter how much cocaine or other drugs an addict uses, no matter how much the drug stimulates the pleasure-sensing mechanisms in the brain, he or she never will achieve happiness through drug use.

The need for planning

To achieve happiness, we need to develop a happiness strategy. That strategy is to learn to delay gratification and not to be driven solely by short-term, pleasure-seeking behavior.

Imagine a person who has lumber and nails, and decides he wants to build a house. Suppose he begins to randomly nail boards together, hoping a wonderful house will result. Without a plan, what are the chances that these random actions will result in a nice house? But with careful planning, a good set of blueprints, and lots of hard work and patience, the likelihood of success increases dramatically. We need to approach our health and happiness this way. Without a plan, we are unlikely to create happiness for ourselves.

Craving concentrated foods

There is a reason why we find some things pleasurable and others painful. There was a time when our very survival depended upon knowing the distinction between what benefited us and what harmed us. Many of the behaviors that served us well in a natural environment-when our focus was getting enough to eat and not getting eaten-may not serve us well today.

Consider our desire to eat concentrated foods-foods high in calories. The earliest humans lived in a natural setting where food was scarce. They needed to eat as much concentrated food as they could get, just to survive. Those who were successful at getting enough food to survive passed that trait on to succeeding generations. We all still have this basic instinct in our genetic makeup to eat concentrated food when it is available. But now we live in an entirely different world.

Most readers of Health Science magazine live in an environment characterized by food excess, not by food scarcity. In a natural setting there are no chocolate chip cookie trees, no hamburger bushes, and no refined or processed foods. But in our increasingly artificial world, there are fast "foods" available on virtually every corner. These processed foods are designed to appeal to our genetically-driven instincts, and they fool our natural senses. Our natural desire to eat concentrated food whenever it is available no longer serves our needs, since we are living at a time when concentrated foods are everywhere.

Unhealthy illusions

It is not easy to be healthy and happy in an environment that seems designed to make us sick and miserable.

How many people do you know who drive two hours each day, in heavy traffic, to jobs they hate, to work with people they dislike, to make a product they detest, for a company they despise, to make money to buy products they do not need, under the illusion that if they just could cram a little more short-term, pleasure-seeking, self-indulgent behavior into their lives, they might be happy.

Why is it that so many of us continue to participate in behavior that is known to cause pain, disease, and premature death? Why do we continue to use harmful drugs like tobacco, alcohol, and coffee? Why do we continue to eat animal products and junk food, despite the known dangers?

We do these things because we like them. They give us pleasure. While it is true that there is nothing inherently wrong with pleasure-seeking behavior, it can be destructive, especially if it becomes the primary focus of life.

Sadly, the primary motivation of many people is pleasure-seeking behavior. They believe that if they are not happy, they must have a pleasure deficiency. They live under the illusion that if they can just squeeze more pleasure into their lives, they will be happy.

This life of illusion begins when we are young. We teach our children to be drug addicts. We teach them that the way you deal with problems is through drugs. When we have a headache, we take a pill. When we have a fever, we take another pill. When we have a cough, we drink a syrup. When dad has a hard day and needs to relax, he drinks alcohol. When we are so sleep-deprived that we can hardly get out of bed in the morning, we drink a highly destructive nervous-system stimulant called caffeine, hidden in our tea or coffee. We give this same addictive drug to children in the form of chocolate and cola drinks.

Social roadblocks to health

There are many barriers to making diet and lifestyle changes that I call the social roadblocks to health. The human nervous system is wired to recognize social conformity. When an individual challenges the social norm by being "different," it can create psychological pain in people around them. This pain is called cognitive dissonance. People do not like how cognitive dissonance makes them feel, so they work very hard to eliminate it and, if necessary, you.

People evaluate by comparison. In order to feel better about themselves, people either try to improve their lot in life, or try to bring you down, so that they feel better by comparison. Since most people do not get enough sleep, they are too tired to improve themselves. They may put what little energy they do have into trying to bring you down.

When they see you trying to eat well, they may try to tempt you with a very stimulating, high-fat dessert, or something else that you no longer choose to eat. If you decline, they may comment along the line of, "What's the point in being healthy if there is no joy in life?" or "You are no fun anymore!" or "Don't you think you're carrying this health thing a little too far?"

They also may become instant nutrition experts. When you were eating hot dogs, fried chicken, cupcakes, or candy, no one said a thing. But just start bringing healthy meals to work, and you may start hearing comments like, "You can't live on that!" And, "Where are you going to get your protein?" What they really feel, but are unable to express, is that by improving yourself, you are making them feel uncomfortable about themselves.

Make a plan for success

Successful individuals begin new projects with their goal in mind. They focus on the important things and do not get distracted by the lesser things, no matter how urgent they might seem at the moment. If happiness is your goal, remember that health is an important foundation for happiness, and that health results from healthful living.

Healthful living means taking responsibility for four main areas of your life: diet-eating the right foods, for the right reasons; environment-maintaining a healthy home and workplace; activity-getting enough exercise, rest and sleep; and psychology-engaging in productive activity and developing effective interpersonal skills.

We are all different, but the equalizing factor in all of our lives is time. We all get 168 hours per week. At most, we have about 30,000 days left to live. The challenge for each of us is how to use our time to promote the greatest health and happiness for ourselves and our loved ones.

Important strategies for dealing with modern problems that can trick our natural psychology!

Our moods and emotions are signals to tell us about how our lives are going. When things are going well, we tend to feel good. When something goes poorly, our moods or emotions tend to shift towards an unpleasant internal state. In this way, moods and emotions act as feedback systems to help us act in productive ways to keep going in the same direction if things are going well, and to change direction if things are going poorly.

When much in our lives is going poorly, it is not uncommon to experience depression. Depression acts as a signal, and as a motivating force, to help us look carefully at what is not going well, and to consider alternative courses of action. In order to deal with depression most effectively, it can be useful to understand how we sometimes come to be depressed, and what actions we can take to restore better mood functioning.

Feelings and feedback

Moods and emotions, our psychological feelings, are feedback systems that can indicate the effectiveness of our actions. They work in a similar fashion to physical pains and pleasures. If we sprain an ankle, for example, we feel physical pain because our behavioral error has resulted in physical damage and has potentially compromised our survival. The pain of walking on the injured ankle helps discourage us from doing anything that could cause further injury, and thus aids the healing process.

On the more pleasant side, we often feel physical pleasure when we eat calorie-rich foods when we are hungry, or while we stand in front of a warm fire when we are chilled. These and other physical pain/pleasure mechanisms assist us in our survival by encouraging some behaviors, while discouraging others.

Our psychological feelings include moods and emotions. These two experiences have subtle, but important, differences. Moods are the gentle, long-term states that can last for hours at a time. We can say, often with accuracy, that we were "in a good mood all morning" or even "all day long." In such instances, our internal states are quite positive, though with fluctuations, possibly throughout the whole day.

Emotions, on the other hand, are very intense experiences, usually lasting only a few minutes. Emotions, like moods, are signals of a positive or negative relationship between person and environment, but they reflect the person's perception of something as immediately important. We cannot be intensively emotional for very long, because our neurochemical machinery cannot sustain intense emotional reactions for hours on end, as is possible with mood states. Like an "emergency" signal, for good or for bad, emotions tend to be intense and short-lived. When a football team wins a big game, for example, the players and fans may celebrate intensively for several minutes, but then the celebration tends to run out of steam. The cheering quiets, and the stadium empties. A good mood may come after the celebration, and linger for hours or even days, but the intense positive emotions following victory quickly will fade.

It has long been recognized that physical pains and pleasures are fairly reliable guides with respect to physical dangers (injury and illness) and positive survival values (food, water, and appropriate temperature). Less recognition has been given to the connection between our psychological feeling, our moods and emotions, and their utility at signaling dangers and positive survival values.

Important signals

Throughout much of history, moods and emotions often have been considered independent of reason. of being unpredictable and sometimes nonsensical. Psychologists now understand that this is not the case. Just as physical pains and pleasures are important signals, so, too, are moods and emotions. For example, we may feel anxiety when we are not certain that we can perform a given task.

Anxiety is generally a useful guide, signaling us that our proposed endeavor may require our very best effort to succeed, and, in fact, may require talent beyond our current abilities. Anxiety signals us to consider carefully whether the action is a worthwhile risk. It is unusual to feel anxiety over "nothing." While people sometimes experience anxiety attacks "out of the blue," this is not the most common pattern.

The survival value of anxiety is obvious if you are contemplating a trek across dangerous terrain, you had better be anxious. You had better consider carefully whether this is an intelligent undertaking. And if it is, your anxiety will help to facilitate careful planning, checking and rechecking of supplies, the rehearsing of potentially needed skills, worrying about things that could go wrong, and so forth.

Depression

In this short article, it is not possible to address psychological functioning per se (that would require an entire book). So let's focus on one particularly problematic experience: that of depressed moods. The approach I take begins with recognizing that depressed moods may best be thought of as "psychological pain" and be taken seriously as signals that some life issues may be out of balance.

A sensible approach to pain is to attempt to identify the cause of the pain, remove it if possible, and try to create the conditions most likely to lead to recovery. For example, if a person has pain from a sprained ankle, the prescription of painkillers should not be the first option considered.

While in some circumstances painkillers might be useful, their use carries substantial risks. When pain is masked by painkillers, damaging behavior is more likely to continue. Similarly, while medications for depressed moods may be useful and sometimes necessary, they should not be considered ideal treatment, and they are not risk-free.

Many medical professionals consider depression to be a "disease," an aberration of normal neurochemical functioning that is best treated with powerful antidepressant drugs. The success of these drugs is sometimes remarkable, and it would be both foolish and irresponsible for a mental health professional to ignore their utility. However, the view that depression is always, or even often, simply a function of aberrant brain chemistry is probably incorrect. In my opinion, aberrant brain chemistry should not be considered the "first hypothesis" by mental health professionals, or by their patients.

Instead, depression should be first considered as a signal, a symptom that a person's life is out of balance and may need examination, reorganization, and personal growth. Very often, there are legitimate reasons for a person being depressed, and those reasons cannot and should not be ignored or hidden behind the power of antidepressant drugs.

Many mental health professionals disagree with this view. Their argument goes something like this: "It doesn't matter what causes depression, what matters is that it is unpleasant. Therefore, it doesn't matter how we get rid of it, what counts is that if we can get rid of it, we should get rid of it!"

They also often downplay the "side effects" (the unwanted effects) of medications (antidepressant drugs). Their argument might continue as, "The pain and suffering of a depressed person is awful, and if there is a quick, effective, and low-risk method for eliminating the suffering, that should be the treatment of choice."

Pills not always best
   
While there is understandable logic in the above view, recent scientific evidence gives us reason to dampen the enthusiasm regarding the use of antidepressant drugs. In addition to the substantial issue of potentially dangerous side effects, there is the issue of long-term effectiveness. When the long-term effects of antidepressant medications are compared with cognitive-behavioral therapy, a treatment style that attempts to address underlying psychological issues, the medications perform relatively poorly.

Both antidepressant medications and cognitive-behavior psychotherapy for depression work effectively in 60-70% of cases, within a few weeks. Medications tend to work a bit more quickly. But after the discontinuation of their medication, about 50% of patients can be expected to relapse into a depressive episode within the following year. This is in stark contrast to patients who receive cognitive-behavior psychotherapy, with periodic maintenance therapy, for depression. Their risk of relapse is perhaps 10-15%.

This remarkable distinction in relapse rates suggests the possibility that patients who receive effective psychotherapy may be getting "to the root" of the causes of their depression, putting them in more control of their psychological lives. The suggestion is that cognitive-behavior therapy results in the self-examination, reorganization, and personal growth needed to meet challenges that previously were overwhelming.

Dealing with depression

Many people experience periods of time during which they have recurrent depressed moods. When depressed moods begin to dominate a person's day-to-day life for several consecutive weeks or longer, professional assistance may be indicated. Persistent depression can be a sign that 1) the person needs assistance in developing more effective happiness strategies, or 2) a serious biochemical disturbance exists that may benefit from antidepressant medication. It is a myth that mental health professionals can easily tell the difference between these two alternatives. Future research efforts may help us learn to better clarify what the most appropriate treatment alternative should be for a given patient.
 

Mental health professionals, such as psychiatrists and psychologists, often have very different views about the most appropriate initial intervention strategy for a given situation. My own bias is to focus on the possibility that persistent depressed moods are at least partly, if not largely, due to the person needing assistance in developing more effective happiness strategies. If these strategies appear to be ineffective, medical management may then be indicated.

Good basic strategies

Many people have found the following three mood-supporting strategies to be helpful. They are not complicated and require no professional assistance.

1. Make a list of pleasant activities and then schedule them into your calendar. Too often, we get caught in the routine of familiar patterns and habits that do not challenge or motivate us. Our negative moods may be a signal that our actions are not being sufficiently directed towards activities that we most value.

2. Take on new challenges that lead to personal growth. Sometimes depression comes about because we are stymied in personal growth. Taking on new challenges can rekindle the excitement of youth, when everything was new, much was exciting, and things were often worth doing to the best of our abilities.

Take steps to eliminate your unhealthful lifestyle habits. Unhealthful lifestyle habits sometimes can contribute to depression. If you are having recurrent depressed moods, one place to start taking control is by addressing the following three basic issues, eating properly, exercising regularly, and getting enough sleep. In some cases, therapeutic fasting may help, since a properly conducted fast provides the opportunity for a period of profound physiological and psychological rest.

When you need help

There are times when these basic strategies are not enough. Sometimes our depressed moods may be signaling the need to examine major life issues carefully, make difficult choices, and find creative ways to expand our self-confidence. Sometimes such processes are done better with the assistance of a skilled professional. The psychotherapy medium that I recommend (and practice) is called cognitive-behavior therapy (or sometimes just "cognitive therapy"). This style of therapy is recommended because it represents the best-researched, most apparently effective style of psychotherapy currently available. While other styles may have merit, none at present can claim the solid foundation of scientifically-demonstrated success of this approach. This is the approach we use at the TrueNorth Health Center.

Clearly, there are times when antidepressant medications are indicated, and the assistance of a psychiatrist can be important (psychiatrists are medical doctors who work with mind-altering medications). I don't want to give the impression that such interventions should be viewed only as a "last resort." Rather, I am uncomfortable with the view that medications should be "first resort," which too often is the case. If depression persists in the face of cognitive and behavioral therapeutic strategies, it can be comforting to know that medications exist that may make a difference.

Reasons for good cheer

There are many reasons why we no longer need to feel overwhelmed or intimidated by a period of depressed moods. Earlier this century, a depressed patient seen by a Freudian analyst was thought to be, in effect, psychologically healthy! Freud considered misery to be reflective of rationality; that life was inherently miserable and that only those who were somewhat oblivious to the facts of their lives could be reasonably happy. Little wonder that treatment approaches of those times were notoriously unsuccessful!

Today, we no longer view depression as a sign of psychological health or clarity of insight. Depression is perhaps best viewed as a symptom, a signal that there are life challenges that may need to be examined and addressed. Sometimes our thinking can be so unclear as to require the services of a skilled professional, and the results are often very positive. There are excellent books that can help people treat themselves, such as Feeling Good: The New Mood Theory, by the cognitive therapist/psychiatrist Dr. David Burns. And should medical intervention be indicated, we now have access to antidepressant medications that are safer and more effective than ever before.

Depressed moods are no fun. And if they persist, your life can sink into a depressive episode that can last for months, and sometimes longer. The good news is that depressive processes are understood better than ever. If you cannot solve it yourself, get help! Take action. This is one problem that you can definitely learn to live without.