I have been thinking over the last few weeks about restarting my blog with serious vigour, exploring issues to art, magic, and whatever may take my fancy in a way that I feel I can be sufficiently informative on. However, a blog post by a friend caught my attention recently and I felt the need to respond. Geraint Clarke’s blog can be found here. My post won’t be as flashy and broken up as his, unfortunately science doesn’t befriend good looking blog posts. It is far more complicated, murky, and needs long explanation.
As Geraint states in his article, he is not a doctor, and nor am I. I do, on the other hand, have a British Psychological Society (BPS) recognised degree in Psychology and am going on to study my master’s degree in Psychology within the next year. This does not give me the ability to diagnose, disprove, or comment on anyone’s mental health or its treatment, but it has provided me with a strong understanding of the field. I will try to respond to Geraint’s writing in a way that responds to each of his points as he wrote them, however I will diverge considerably at times and raise new points.
Firstly, Geraint mentions Parker (2007) as evidence of how depression is overdiagnosed with the claims that 79% of people met the standard for depression. However, this claim misses out a lot of the relevant information in regards to Parker’s claims including how the entire article was written as part of a debate between two researchers with both taking opposing views on whether depression is overdiagnosed. Hickie (2007), the counter argument to Parker’s claims, states that an audit of GP diagnostics from the UK, Australia, and New Zealand suggests that depression is not overdiagnosed. Instead it is more likely to be recognised in those with more severe cases, are likely to harm themselves or others, and those that ask for help. It is massively a case of cherry picking your data to only mention Parker’s claims without mentioning Hickie as doing so only bolsters your opinion without offering counter-evidence. This is poor form in academia, however I can’t say as much for Geraint as he is writing a blog that is based, rightly, on his opinion.
I will state that Parker’s research falls flat in the fact that the participants in the research (242 Teachers) were not diagnosed with depression, but rather showed some criteria to be diagnosed with a level of depression. This does not mean they would be diagnosed under a clinical setting as a full diagnosis takes considerably longer, with much more information needed. I could go into further methodological flaws about double-blind tests, researcher bias, and sampling, however this is not an academic piece and would be considerably boring.
However, it is important to note that if Parker (2007) is accurate in his conclusions that does not mean you do not have depression. It is undoubtedly the case that some of the people within that group do suffer with said condition. Telling them they are overdiagnosed is absurd and down right dangerous.
Next Geraint goes on to mention the American Psychology Association’s (APA) symptoms of depression, claiming they overlap. For those unaware, the APA publish The Diagnostic and Statistical Manual of Mental Disorders (DSM), which is currently in its fifth form, hence the usual abbreviation DSM-5. Focusing on the DSM-5 it states in regards to depression that five of the following symptoms must be elicited by a patient for a minimum of two weeks before depression can be diagnosed.
- Depressed mood most of the day, nearly every day.
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
- Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
- A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
- Diminished ability to think or concentrate, or indecisiveness, nearly every day.
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. (APA, 2013)
Whilst it can be claimed that at least one of these applies to everyone, it certainly isn’t the series of Barnum Statement’s that Geraint claims as at least five of these must be recognised and are not simply self-reported. On top of this any contradictions are down to individual experience. Depression has a spectrum and comes in multiple forms (most famously unipolar and bipolar), not everyone struggles the same. This is similar to any medical condition, whilst one person may show one symptom worse than another, the opposite may be true for another patient.
Tolentino and Scmidt (2018) conducted research into the reliability of the DSM-5 model in its reliability in separating patients without depression (ND), moderate depression (MD), and severe depression (SD). They concluded that the model was reliable at finding the differences between all three categories by comparing results against the Hamilton Depression Rating Scale (HAMD). It is certainly not the cover all that Geraint describes, but rather a reliable diagnostic tool.
Next Geraint describes his personal experience of the medical diagnosis of depression. The reason these are not used as evidence within academia is that one person’s experience is not reliable. What applies to one person may not apply to another. This is why reliable evidence is based on as large a sample size as possible so that we can ween out as much individual variation as we can and get results that fall close to a mean value. For example, if we took a 2000 people and asked them to flip a coin 10 times, statistically speaking at least one of them would have it come up heads 10 times. This does not mean that individual’s experience is relatable to everyone, but that they are the outlier. This applies here similarly, Geraint’s experience, if 100% accurately recalled, does not apply to everyone.
I do have questions over Geraint’s doctor, however. This is not how depression should be diagnosed, it is far more complicated than that. If they immediately prescribed fluoxetine they did something incredibly dangerous and a complaint should be put into the Parliamentary and Health Service Ombudsmen. Geraint saw a bad doctor for a psychological health issue in my opinion, and not all doctors are like this.
Ironically after dismissing Geraint’s experience with mental health on the National Health Service (NHS) as not relatable, I am going to talk about my own. Two years ago, I was diagnosed with anxiety and depression, two things I do struggle with and work on every day. However, after my diagnosis I stated I did not wish to be medicated (for personal reasons), instead I have received excellent therapy from the NHS that has helped me reframe my thinking and progress going forward. You can discuss treatment options with your doctor, and they will listen. The truth is anti-depressants would be a hindrance for me personally, but that may not be the case if you are struggling with depression. Do not stop taking medication because a blogger told you, talk to a medical professional and they will help. They want to help you get better, because if they didn’t make people better they would be out of a job.
Moving forward Geraint makes a questionable claim about doctors being “trained to treat symptoms, not causes” (Clarke, 2019). A simple example discredits this; a doctor will reset you bone, not just give you painkillers and send you on your way. They are treating the cause of the pain and the symptom, the same applies with mental health concerns. Often when prescribed medication for depression patients are also offered counselling as a dual prong attack. Typically, in the UK this takes the form of Cognitive Behavioural Therapy (CBT). However, I will agree with the claim there are considerable issues with the pharmaceutical industry, especially in the USA. All you need do is look at the recent issues with the opioid epidemic. This does not however mean you would not benefit from anti-depressants if you struggle from depression. Sandler (2003) demonstrated that fluoxetine did have a significantly higher rate of improvement in patients with major depressive disorder (MDD) when compared to placebo, demonstrating that said treatment is efficacious. Rather than straight up refusing help because you think your doctor might be working for Big Pharma, discuss treatment options with them. Also remember that not all anti-depressants work for everyone, it can take time to find the best one, and if it makes you feel worse immediately go to a doctor.
Geraint follows on to list issues that may make you feel like you are depressed, suggesting resolutions because “you probably don’t have depression”. I do not disagree with the fact that any of these can help (though more supplements in a bit), what I do disagree with is the implied conclusion that if these work you don’t have depression. The reality is diet, exercise, supplements (to be revisited), and sleep are great ways to help treat depression. North et al. (1990) concluded via a meta-analysis that exercise was an effective in treating depression. Dash et al. (2015) concluded the gut micro-biome does influence depression. Geraint here is describing known ways to treat depression, so why not go see a doctor and do these?
I do, however, find some issue with the claim behind 5-HTP. Not that it doesn’t work, because it does (Hinz et al., 2012), however there is an issue here. Geraint is correct in stating that 5-HTP is a precursor to serotonin (chemically shortened to 5-HT), although serotonin is not a hormone but a neuro-chemical. For the uninitiated; neurons do not fire electrical pulses between each other but rather along their bodies. Instead at the tips they fire neuro-chemicals that the next neuron picks up. It is suggested that a reduction in serotonin, alongside dopamine and noradrenaline, are the cause of depression. This is where Selective Serotonin Reuptake Inhibitors (SSRIs) come in. They are the most popular type of anti-depressant and work by helping there be more serotonin between the neurons (a bit more complicated and boring than that). Fluoxetine is an SSRI. Essentially Geraint’s suggestion is; don’t take professionally prescribed medicine from your doctor, instead take this pill you can buy from Holland & Barret that doesn’t work as well.
In conclusion, this blog post was dangerous and unfortunately ill informed. That’s not to say I don’t like Geraint’s other work, I have found great benefit from some of his writing and he has helped me personally. But don’t read a blog post from a magician and marketer to get your medical advice, go see your doctor. And if you don’t like their conclusion, go see another for a second opinion. And be careful in believing everything I said here too, I’m only slightly more qualified in this field than Geraint (and less qualified in blogging evidently).
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Clarke, G. (2019, April 28). You Probably DON’T Have Depression. Retrieved April 30, 2019, from https://medium.com/@geraint_clarke/you-probably-dont-have-depression-ac673cafdda7?sk=58a91495a8ab87d341fba6faf68f2268&fbclid=IwAR3qGjAfQLSt0-uF-r_4rm2XmolIvS0pcCEeW2M3SbnrhFmXvWzgU-hnk4k
CNN Library. (2019, April 11). Opioid Crisis Fast Facts. Retrieved April 30, 2019, from https://edition.cnn.com/2017/09/18/health/opioid-crisis-fast-facts/index.html
Dash, S., Clarke, G., Berk, M., & Jacka, F. N. (2015). The gut microbiome and diet in psychiatry. Current Opinion in Psychiatry,28(1), 1-6. doi:10.1097/yco.0000000000000117
Hickie, I. (2007). Is depression overdiagnosed? No. British Medical Journal, 335, 329.
Hinz, M., Stein, A., & Hinz, M. (2012). 5-HTP efficacy and contraindications. Neuropsychiatric Disease and Treatment,323. doi:10.2147/ndt.s33259
North, T.C., McCullagh, P., & Tran, Z.V. (1990). The Effect of Exercise on Depression. Exercise and Sports Sciences Review, 18(1), 379-416
Parker, G. (2007). Is depression overdiagnosed? Yes. British Medical Journal, 335, 328.
Sandler, A. D. (2003). Fluoxetine for acute depression in children and adolescents: A placebo-controlled, randomized clinical trial. Journal of Developmental & Behavioral Pediatrics,24(1), 82-83. doi:10.1097/00004703-200302000-00031
Tolentino, J.C. & Schmidt, S.L. (2018). DSM-5 Criteria and Depression Severity: Implications for Clinical Practice. Front Psychology, 9, 450. doi: 10.3389/fpsyt.2018.00450