Drugs don’t work (and other mental health myths)

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TThere is no doubt that public attitudes towards mental health have already taken a turn. Just consider the plethora of public figures, from Robbie Williams and Lady Gaga to Baroness Davidson, who have opened up about their struggles.

According to an analysis of English newspapers, the number of articles stigmatizing mental illness roughly halved between 2008 and 2016, while those challenging that stigma roughly doubled in the same period. And that seems to have a positive impact on everyday experiences of prejudice: People with mental illness now report much less discrimination from family, friends and colleagues compared to just a few years ago.

Despite this progress, some myths about mental illness are still widely shared, including false claims about the effectiveness of treatments. Here are six of the most prevalent beliefs and the truth behind them.

Mental illnesses are overdiagnosed

Let’s start with the idea that people confuse everyday distress with a clinical disorder. The claim is a favorite of television personalities and newspaper columnists, who regularly claim that the increased focus on mental health is reducing people’s self-sufficiency, so they turn to medical interventions, rather than to deal with the problems in their lives.

In reality, there is very little hard evidence that overdiagnosis is the serious problem that some claim. Surveys of depression in Western countries, for example, have failed to reveal a large increase in diagnoses as people jump on the “mental health bandwagon.” “The evidence points to stability,” says Professor Johan “Hans” Ormel of the University of Groningen in the Netherlands. He suggests that doctors are just as likely to miss actual cases as they are to misdiagnose someone who is simply experiencing transient distress.

time is a healer

Related to the claim that doctors are medicalizing everyday distress, there is the suggestion that many people who think they have depression should show more resilience and simply wait for time to heal their problems. If they are simply suffering from a transient blues, after all, then the problem should surely go away on its own.

To find out if this was really the case, researchers in Australia examined data from 16 clinical trials, in which a control group of patients had been placed on a “waiting list” before receiving treatment. They found that only one in eight of these patients went into remission while waiting for therapy, while the rest continued to show symptoms during the three-month period.

Antidepressants don’t work

It is not just the diagnostic process that has inspired medical myths; treatments used to help patients are often misinformed.

A common belief is that a common class of antidepressant medications, called SSRIs (selective serotonin reuptake inhibitors), are ineffective and work no better than a placebo. The idea recently attracted wide attention following the publication of an article that raises serious questions about the proposed mechanism of these pills.

SSRIs, which include Prozac, were thought to address a “chemical imbalance” in the brain, by correcting levels of the neurotransmitter serotonin, which is thought to be involved in mood regulation, among other functions. However, the recent article reviewed the evidence to date and concluded that there was no clear link between serotonin levels and depression.

But there are plenty of other ways they can help relieve symptoms, for example by reducing inflammation, which is another possible contributor to depression. Importantly, a recent meta-analysis in the Lancet, considering multiple clinical trials, confirmed that SSRIs are effective in relieving depression. While they don’t work for everyone, they are 50% more likely to produce a response than placebo pills. In the words of Professor Cathryn Lewis of King’s College London and Professor Andrew M McIntosh of the University of Edinburgh, the clinical benefits are now “beyond reasonable doubt”.

‘Happy pills’ simply numb people’s feelings

Other myths concern side effects. You will see many articles, for example, that claim that antidepressant pills “dull” people’s emotions. There seems to be a good basis for this idea: Many patients report concerns that their medications have muted the ups and downs of life, resulting in feelings of numbness.

However, until recently, few studies had questioned the causes of emotional blunting, and it now appears that feelings of numbness may be a residual symptom of depression. It makes sense: depression is often accompanied by apathy and an inability to feel pleasure. SSRIs have eliminated the most prominent feelings of hopelessness, but they don’t necessarily increase positive emotions and motivation, says Professor Guy Goodwin of the University of Oxford, who conducted the recent study: “The feeling of emotional numbing is real, but it’s not It’s caused by drugs.”

Mental illness makes people more creative

Perhaps the most persistent myth has been the idea that mental suffering is a source of artistic genius, from Virginia Woolf to Kanye West. But any evidence supporting the link between creativity and mental illness is extremely tenuous, says Professor James C Kaufman of the University of Connecticut.

Historiometric analyses, for example, have probed the biographies of notable artists. While these studies seem to suggest that mental illness is more prevalent in creative personalities, any post hoc diagnosis based solely on text should be treated with great caution. “They’re not super objective,” says Kaufman. “Very few creativity researchers believe there is a strong connection.” And the idea that mental anguish can inspire great art certainly shouldn’t be a reason to avoid treatment for a serious illness, he says.

Schizophrenia is untreatable

Despite changing attitudes towards other mental illnesses, schizophrenia is still subject to a great deal of stigma, says Marjorie Wallace, founder and chief executive of mental health charity SANE. “Schizophrenia remains a ‘neglected disease’ because it has been removed from all these anti-stigma campaigns, which have emphasized stress, depression and anxiety.” This means that most people have only a vague understanding of the condition, even though the lifetime prevalence is around 1.5% in the UK.

A big misconception is that schizophrenia is simply “untreatable.” However, with the right medications and talk therapies, 45% of people with schizophrenia go into remission after one or more psychotic episodes, while 35% show mixed patterns of remission and relapse. The belief that there is no chance of recovery can be a source of great despair for people who have been diagnosed with the disease and their families. (Activist and filmmaker Jonny Benjamin described the diagnosis as a life sentence.)

In general, earlier interventions are more effective. But a chronic lack of resources in the health service means that many people with schizophrenia don’t get help in the early stages of a crisis, Wallace says, reducing their chances of recovery. They may be turned away at hospitals or psychiatric facilities, and often it will be the police who end up dealing with the patient. The escalation of their condition in these cases only adds to the perception that it is untreatable, yet the person would have done much better had they had access to treatment sooner.

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