The myth of the chemical cure

One on the most stunning pieces on psychoactive pharmaceutical drugs I have read. What is more Dr Moncrieff is a psychiatrist and has an impressive CV in the area of mental health and research.

The following article, just a small taste of her book, is reprinted from the BBC


'The myth of the chemical cure'


Dr Joanna Moncrieff
Mental health expert

Taking a pill to treat depression is widely believed to work by reversing a chemical imbalance.

But in this week's Scrubbing Up health column, Dr Joanna Moncrieff, of the department of mental health sciences at University College London, says they actually put people into "drug-induced states".

If you've seen a doctor about emotional problems some time over the past 20 years, you may have been told that you had a chemical imbalance, and that you needed tablets to correct it.

It's not just doctors that think this way, either.

Magazines, newspapers, patients' organisations and internet sites have all publicised the idea that conditions like depression, anxiety, schizophrenia and bipolar disorder can be treated by drugs that help to rectify an underlying brain problem.

People with schizophrenia and other conditions are frequently told that they need to take psychiatric medication for the rest of their lives to stabilise their brain chemicals, just like a diabetic needs to take insulin.

The trouble is there is little justification for this view of psychiatric drugs.

Altered states

First, although ideas like the serotonin theory of depression have been widely publicised, scientific research has not detected any reliable abnormalities of the serotonin system in people who are depressed.

Second, it is often said the fact that drug treatment "works" proves there's an underlying biological deficiency.

“ Psychoactive drugs make people feel different ”
But there is another explanation for how psychiatric drugs affect people with emotional problems.

It is frequently overlooked that drugs used in psychiatry are psychoactive drugs, like alcohol and cannabis.

Psychoactive drugs make people feel different; they put people into an altered mental and physical state.

They affect everyone, regardless of whether they have a mental disorder or not.

Therefore, an alternative way of understanding how psychiatric drugs affect people is to look at the psychoactive effects they produce.

Drugs referred to as antipsychotics, for example, dampen down thoughts and emotions, which may be helpful in someone with psychosis.

Drugs like Valium produce a state of relaxation and a pleasant drowsiness, which may reduce anxiety and agitation.

Drugs labelled as "anti-depressants" come from many different chemical classes and produce a variety of effects.

Prior to the 1950s, the drugs that were used for mental health problems were thought of as psychoactive drugs, which produced mainly sedative effects.

'Informed choice'

Views about psychiatric drugs changed over the course of the 1950s and 1960s.

They gradually came to be seen as being specific treatments for specific diseases, or "magic bullets", and their psychoactive effects were forgotten.

However, this transformation was not based on any compelling evidence.

In my view it remains more plausible that they "work" by producing drug-induced states which suppress or mask emotional problems.

“ If we gave people a clearer picture drug treatment might not always be so appealing ”
This doesn't mean psychiatric drugs can't be useful, sometimes.

But, people need to be aware of what they do and the sorts of effects they produce.

At the moment people are being encouraged to believe that taking a pill will make them feel better by reversing some defective brain process.

That sounds good. If your brain is not functioning properly, and a drug can make it work better, then it makes sense to take the pill.

If, on the other hand, we gave people a clearer picture, drug treatment might not always be so appealing.

If you told people that we have no idea what is going on in their brain, but that they could take a drug that would make them feel different and might help to suppress their thoughts and feelings, then many people might choose to avoid taking drugs if they could.

On the other hand, people who are severely disturbed or distressed might welcome these effects, at least for a time.

People need to make up their own minds about whether taking psychoactive drugs is a useful way to manage emotional problems.

To do this responsibly, however, doctors and patients need much more information about the nature of psychiatric drugs and the effects they produce.
Have we been misled about these medications? Are people now too reliant on them?

Provocative thoughts from experts in the worlds of health and medicine
Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/8138893.stm

Published: 2009/07/15 04:30:46 GMT

Positive thinking

I heard on the radio that depression is the number one reason why Britains go to see their GP. Whether the current financial meltdown is the reason, or that deep sadness is the face of England, I am not sure.

But maybe it has something to do with this ethos:



While this is not an article on living with depression (check out these posts if you are), it is about the economic dark cloud we are constantly being told we are living under. Despite the GFC (and the variety of acronyms describing the butterfly effect of the USA’s banking crisis coupled with spending up big invading foreign countries) in Australia the hip pocket of the average person is better than 18 months ago. While rents have continued to rise and now hopefully peak as property prices slide, mortgage repayments and petrol prices are significantly cheaper. The government has been throwing money at families and pensioners and now almost anyone who has put in a tax return in the past year will get close to a thousand dollars in their hot hands in coming weeks.

But we continue to think negatively. With every branch of the media telling us things are only going to get worse, many good things that are being overlooked.

Maybe thinking before we spend is not a bad habit to get into. Just how much cheap plastic junk do we need to fill our homes with? Do we need to throw a packet of sugary biscuits into the supermarket trolley? A glass of water from the tap or filter is considerably cheaper than soft drinks. The maxim of quality over quantity is a useful one. Make a small investment in what you need rather than go for a retail fix every time you feel down.

As a small business owner the first thing every other self-employed person I meet asks me is, “How is business?” (It’s fine, thanks for asking). But the reality is that while a recession threatens some ventures, the good ones grow stronger.

Kate Bezar, founder and genius behind “Dumbo Feather” (one of the most read magazines in my waiting room) mused recently:

(see) tough times as opportunities to re-think, re-evaluate and refresh. Perhaps now is the time to quietly nut out a business plan for your dream, to try something new; write that book, take off traveling for a year, pare life back to its essentials and discover how truly liberating that can be.

Which lead her to unearth a lovely new strategy, to knock the stiff upper lip out of place.




Find out more about this.

So without being too Pollyanna about all things financial, yes it is likely that belts will get tighter but this is the time to make strategies to make it work to your advantage. As the rather tongue-in-cheek poster urgers, get inventive, make things, think outside the box.

As all the best (or perhaps worst) new age books will tell you, money=energy. You can store it away for a rainy day but it will likely atrophy without use. You can spend it all with no thought for tomorrow and worry about the hangover later. Or you can sort the good stuff from the dross and prioritise what makes you happy and healthy.

My personal list includes: organic food, massages, being more discriminatory about eating out (support local business, invest in quality, always eat in when there are those organic veggies in the fridge) and have a holiday.

My entertainment budget provides some laughter at the comedy festival and live music, balanced by free books and dvds from my wonderful local library, more gatherings of friends around the kitchen table and probably too much free entertainment courtesy of the internet.

So are you going to be a victim of fear, or turn this negative into a positive?

Recovering from the bushfires

The tragic events of the 7th February 2009 have left most of us in Victoria, if not all of Australia, reeling. The “Black Saturday” fires have surpassed all that have gone before in their ferocity, magnitude and human devastation. While those directly affected by the fires are still in shock and dealing with the immediate issues of survival, the rest of us are also experiencing a wide range of emotions in response to this event.

There is the thinnest of degrees of separation between most Melbournians and the places or people in the path of these fires. But even when we don’t know anyone directly involved there has been a huge ripple of grief through our community.

While we are trying to make some kind of intellectual sense of the horror weekend, our emotions may have taken on a life of their own. Some common reactions have been a sense of guilt (why am I feeling like this when I have lost nothing?), embarrassment, discomfort and great sadness or depression.

Survivor Guilt

“Survivor guilt” is term often applied to people who have lived through traumatic events such as these bushfires, coming through it while those around them have lost loved ones or a home. News stories of the past week keep showing examples of this – a person returning to a home left standing who says they should feel happy about it but can’t or another that has lost their house but talks in code of “those worse off” or “deserve help more than me”. But even out of the bushfire zone, we too can have a sense of survivor guilt by feeling embarrassed, helpless and inadequate in response to this.

There is no magic remedy for “survivor guilt” but recognising it and naming it, is a good place to start. Trying to talk to others about what you are feeling is helpful. There has been some great outpouring on blogs, where readers keep commenting they feel the same way and find comfort in knowing they are not the only one to respond like this. The main thing to remember is that your response is normal and has its own emotional logic. There is no right or wrong way to react to something like this.

Read this short article recently in the Sydney Morning Herald by the director of Lifeline for more information.

Grief, Depression and Post Traumatic Stress Disorder

Another common reaction to the fires has been grief and it’s many stages. A commonly used model explaining most people’s reaction to grief is the one attributed to Psychiatrist Elizabeth Kübler-Ross. This outlines five stages in how we react to any kind of grief or loss. While the bush fires are an obvious example, as are any experience of death, it equally relates to relationships ending, being faced with a major illness (your own or someone close to you), loosing a job and many other common situations.

1. Denial. “I’m fine”. Often characterized by shock and disbelief at what has happened, we tend to claim we are all right and coping fine.

2. Anger. “It’s not fair”. We need to find someone to blame. Sometimes it is our self but it can be the ‘victim’, the authorities or someone or thing totally unrelated to the incident.

3. Bargaining. “I’ll do anything…” While some strike a deal with their god, others play out scenarios in their heads. A child whose parents are breaking up might think if they did their homework or ate their vegetables every night then it wouldn’t happen.

4. Depression. “There’s no point to life”. When life feels incredibly bleak with no glimmer of hope and we feel like it will never improve.

5. Acceptance. “I can go on”. Acceptance doesn’t necessarily mean life is the same as before but it is about finding a new normal.

We can’t force our way through the stages or say “well, I got angry yesterday so I can tick that off”, often people come and go backwards and forwards through the stages but ultimately depression comes before acceptance and is for most people is an unavoidable part of recovery.

If you have a history of depression or have suffered loss or trauma previously in your life, just watching the recent events unfold may trigger these feelings of grief, sadness, hopelessness and depression. Often when you have experienced a major loss in your life you have an increased empathy for the suffering of others. Even if you don’t know anyone in the path of the fires you may become overwhelmed with sadness and find yourself breaking down in tears. This is a normal reaction. However if your usual self-care fails to help and these feelings persist it is important to see a psychologist, trained counsellor or similar professional to help you deal with the underlying issues.

Post Traumatic Stress Disorder (PTSD) is a complex anxiety based reaction to a stressful event. It is often characterised by reliving the situation over and over in your head, feeling anxious, hypervigilance, insomnia, phobias and avoidance of similar stimuli. While soldiers, survivors of torture and those who have been in previous fires are obvious candidates, so to is a person who has experienced a car crash or invasive medical treatment. While PTSD is an obvious outcome for most who have been at the front line of this fire, those who are not been directly affected by it but have a history of PTSD may be experiencing a triggering of their anxiety and stress, no matter how long ago their initial exposure was. PTSD needs specialised help from a psychologist or psychiatrist.

Natural Therapies

While talking and getting psychological help is the first step to recovery, the following remedies may also help this process.

Herbs for the nervous system – good quality, organic teas such as chamomile, skullcap, lavender and passionflower. One heaped teaspoon per cup, four-five cups a day.

St Johns Wort tablets or tincture, if you are not on prescribed medications (including the pill).

Kava root tablets (best prescribed by an experienced herbalist with good product knowledge for quality and safety) are excellent for anxiety and trauma.

Try to stop watching television and have a descent break from the media. Go for walks, get a massage, talk to friends, play soothing music, have a hug, play with your pets. Try to stick to some kind of routine, including regular meals and a set time to go to bed.

Flower essences for trauma

Flower essences are in the realm of complementary therapies known as “vibrational medicine”. The ‘essence’ of a flower is distilled involving a method of infusion and dilution, in a similar way to homoeopathy. While it is a challenge to modern science to validate any form of healing involving subtle energies, I have experienced hundreds of situations where I have witnessed the positive effects of these remedies. There are many different branches of the flower essences family. Three of the most widely used in this country are the original Bach Flowers, Flower Essence Services (previously known as the Californian Flower Essences) and Australian Bush Flower Essences

Arnica: Number 1 remedy for shock, helps the body and psyche recover from trauma. (Also useful as a homoeopathic remedy, taken as drops or pilules).

Bleeding heart: invaluable for grief and loss. Intense grieving, especially for those that have died or a relationship that has ended. A deep heart connection that has been severed.

See a beautiful photo of bleeding heart (Dicentra formosa) by Paige Woodward.

“Rescue Remedy”: a combination of 5 Bach flowers (Star of Bethlehem, Rock Rose, Clematis, Cherry Plum and Impatiens) that deals with different aspects of stress and emergencies. I think of it as for those “Beam me up Scotty” type of moments when feeling overwhelmed by a situation.

How to help someone who is grieving

When someone you love has lost a home, family members, a treasured pet in the bushfires, or through some other form of loss - what can you do to help them? Most of us feel overwhelmed and inadequate when facing someone else’s grief. The following may be useful:

If they are a close friend, then contact them, let them know you love them and are thinking of them. Ask if they want a hug. If you leave a message don’t demand to hear back from them - while talking to people can be healing, at other times it can be overwhelming. Call them again a few days, or a week later letting you know you are there for them when they are ready for it.

Try to leave your own agenda behind, whether it is that you feel the need to be useful or have past grief of your own that is overflowing – your friend doesn’t need that burden. Be patient.

Don’t push them to talk but don’t pretend nothing has happened.

They will need different things at different times. Don’t expect them to be consistent. One day they might want distraction, another time to cry or be angry. Everyone’s journey of grief follows their unique pattern.

Don’t forget them. When the buzz dies down about the fires, or the funeral is long over – people can often feel abandoned or isolated. Further down the track bring the flowers, food, wine and other comforts that you know they like. Often the full impact of loss takes weeks or months to fully hit. This event will take years to heal. It’s never too late to be there for them.

Further help

Lifeline – 24 hour telephone counselling service 13 11 14.

How to get a Medicare rebate when seeing a psychologist. (Making psychological care in Australia affordable).

Bushfire help contact numbers.

Health Trip shows on Anxiety, lifting our spirits and insomnia.


Listen to the podcast, available now online.

holiday blues

Christmas tends to polarize peoples feelings. While some love the rituals that lead up to the 25th of December, for those at the other end of the spectrum it can find this a painful and depressing time of year.

The numbers of people for who do not even believe in Christmas is growing. According to the 2006 census, 32% of Australian did not define their beliefs as Christian, so about one third of us find this festival irrelevant.

But for the two thirds of the population for who actively participate in the season, it can be an alienating experience to feel indifference or despair at the time of such a culturally significant festival.

There are lots of reasons why this can be a difficult time. Being away from family, or experiencing it shrink through members dying, can transform the day from childhood fun to adult misery. For people prone to depression, just the commercial bonhomie of the season can be overwhelming and have a paradoxical effect.

Others may on the surface like Christmas but feel overcome by the trappings or feel they have too many social events to juggle. The commercialisation of the season can be irritating, so too the pressure to spend more money than is comfortable on presents and create a feast for others to enjoy while you slave in a sweltering kitchen.

Lifeline has an article online Staying Balanced over the Festive Season:

First and foremost, it is important to be aware of your own limits and to recognize the signs of stress, anxiety or depression - these can include symptoms such as irritability, tiredness, loss of appetite etc. About 1 in 5 people will experience a mental health problem that requires professional treatment at some time in their life. Many more will experience times of crisis, stress, depression or anxiety.

Lifeline’s tips to deal with the season include:

Take time out for yourself; do something that makes you feel good

Look after yourself physically, make sure you get a good night’s sleep, eat well and get some exercise. If you look after your body you will feel better too

Limit alcohol and other drugs. There can be a temptation to drink too much at Christmas, but alcohol can fuel arguments and cause unwanted behaviours.

If you are feeling down or stressed, tell someone how you are feeling, e.g friends, family or colleagues.

Understand that it is common for people to feel stressed at this time of year. This could include your family and friends too.

Know your limits and have a plan for dealing with stressful situations. If you need to calm down, perhaps a walk, some time out on your own will help.

Try not to expect too much – aiming for the “perfect” Christmas or assuming that everyone one will be on their best behaviour may not be realistic.

Finding meaning/strategies to cope with Christmas.

All of the above – be kind to yourself, get help, talk about it, have realistic expectations.

I’d add the following thoughts:

Learn the power of “no” – trying to think things through before automatically agreeing to other peoples wishes can be challenging. If saying “no” outright is too difficult start with “I’II get back to you on that”, or “I’ll give it some thought” or even, “I always over commit myself at this time of the year and want to try to do it differently this time”.

Accept what you can’t change. News alert, most families aren’t entirely “functional”! You are not alone if you find their quirks or habits irritating. Unfortunately the holiday season tends to bring out the worst in people; those with addictions or mood problems may start with good intentions but deteriorate on the day. By understanding you are not responsible for this and you cannot change their behaviour means that you do not have to react automatically to their dysfunctions. If someone is looking for an argument, try agreeing with them rather than pointing out the flaws in their views – this is can be quite disarming and even amusing.

Get off the couch. Move your body, not just on the day but also in the weeks leading up to Christmas. A half hour walk can lift the spirits and change your mood.

Keep your blood sugar stable – whether its binging on chocolate or having a drink or two too many, whatever your poison these behaviours tend to make our blood sugar levels roller coaster with a rebound drop in our moods and energy. Try to have three square meals a day – with some fruit or vegetables plus a serve of protein (eggs, meat, fish) or slow release carbs (beans, seeds, nuts, wholegrains). Back off from the sugar and alcohol a notch and drink an extra couple of glasses of water a day to stay hydrated.

Start some new traditions: I adored Christmas as a child but also learned to love my alternative festivities when I moved to another part of the world. I have to admit, spending the 25th with other people’s families makes me more homesick for my own than having an “orphans Christmas”, a special day of fun with a partner or even a non-Christmas on my own eating what I like and sitting in the sun reading with no need to go anywhere or do anything (the last option might sound odd but if you ever crave a day of total freedom its worth embracing at least once in your life).

If someone in your family dies, it might help to change the ritual in some way – change the menu, time of day you eat the big feast, try a different location such as a picnic in the park, make a small shrine for them in the house with their photo, candle and a token gift.

Some years after my brother died I realised I missed the ritual of buying a present for him. What worked for me was finding a charity to donate the amount I’d spend on him for Christmas.

If all else fails, it is only one day of the year. Make a soft landing for yourself on the 26th or the next day you have control over to plan. Whether it is a trip to the beach or art gallery, a day in bed with a stack of good books, a catch up with a friend or connecting yourself to your stereo or MP3 player to listen to the music you love to flush out the saccharine diet of carols….


Naturopathic help

St John’s Wort: if you are not on prescribed medications such as the hormones, antidepressants, anti (organ) rejection drugs, this is a clinically proven and easy to obtain remedy to ease the blues.

If you can’t take St John’s wort – add chamomile tea to your daily fluid intake, or burn essential oils of chamomile, lavender or rose,

Take a good multivitamin with at least 50 mg of B6, every day. If caffeine is part of your diet, wait two hours after drinking to take your vitamins.

Add fish oil as a supplement. There is strong evidence that a lack of omega 3 fatty acids (abundant and easily absorbed from fish oil) contributes to depression.

Understanding depression at Christmastime

I came across this good insider’s view of the season. If you know someone prone to depression this may help you understand how this time of year is potentially worse for them. If this is how you feel, then you know you are not alone.

Decorate the house? You don't even know if you'll get laundry done so you'll have clean underwear tomorrow. Send out Christmas cards to 50 of your closest relatives and friends? What would you say in them - "Doing awful. My new pastime is staring at the ceiling. I hate myself. My clothes are falling off me because I don't eat anymore. I can't wait till the holidays are over. Don't bother to call. By the way, Happy Holidays!".

It's miserable to be depressed during the holidays. One reason is that you know that you really should be enjoying all the wonderful things that come along with them. As down as I sound on the season, I really do enjoy a lot of Christmas-sy things - decorating the tree and the house, giving and receiving presents, watching Rudolph and the Grinch and even sending out Christmas cards. But when I'm depressed, the fact that I can't enjoy these things makes me twice as miserable, and I berate myself for not partaking fully in the joys of the season.

From the ”Wings of Madness – Depression and the Holidays Survival Guide” (click the link to read the whole article).



Further links, thoughts and resources

Give a little: while some choose to volunteer to help serve Christmas lunch to the homeless or needy, most of the charities involved comment that they have too many volunteers for that one day and not enough help throughout the year.

My charity of choice is the Smith Family. It is one of the few non-religious charities (for that one third of the population who want to encourage change without dogma) in Australia and does effective, evidenced based, grass roots work at breaking the poverty cycle. One of its simplest programs, Learning For Life involve supporting children and young adults through their school years through hands on support, to money for school uniforms, shoes and books.

Support for charities such as this can be practical rather than financial through volunteering time for one off projects like the Christmas Appeal, to supervising learning clubs to help kids with their homework.

Lifeline – 24 hours, free telephone counselling service phone 13 11 44 (Australia wide).

Spend ten minutes listening to British author and journalist Sally Brampton talk about her depression, in this insightful BBC “Women’s Hour” interview.

The Australian Psychological Society can help you find a psychologist.

From past Health Trip shows

Healthy eating at Christmas

Healthy tips for surviving the Party Season

Need inexpensive present ideas at Christmas, check out Health Trip Stress Less Present Guide

Some ways to lift our spirits.

Further tips on coping with anxiety

Don't beat yourself up over feeling empty instead of full of the joy of the season. You're feeling empty because that's a part of the illness. It's not your fault, and you're not a bad person or a loser because of it. Even people who are not depressed are often having trouble getting in touch with the real meaning of the season.

”Wings of Madness – Depression and the Holidays Survival Guide”

Evidence based medicine update

My relationship with evidence based medicine (EBM) has always been ambivalent. It is a limited system of enquiry but I love it when it confirms my own holistic world view and get exasperated when it does not!

But jokes aside, EBM is an overused tool. While it is easy to be seduced by the world of medical science, when we create the mother of all scientific analysis it tends to replicate rather than eradicate the flaws of the system in the first place.

There are a number of issues with the “gold standard”, placebo controlled, double blinded trials when applying them to an individual system of treatment such as naturopathy. How much of the client’s improved wellbeing is being catalysed by the diet changes, herbs, other natural medicine or the type of consultation itself? Longer than the average GP style visits, that most natural therapists choose, have been accused of creating a placebo effect. Others suggest that it is talk therapy and the process of ‘witnessing’ or acknowledging the clients journey that is a potent healing tool in itself.

We say that as naturopaths we “treat the individual, not the disease”, so while there may be commonalities in prescribing, for a common condition as basic as constipation, there may be dozens of frequently prescribed herbs who’s mode of action varies beyond being a straight laxative. This is because the underlying condition itself may be viewed as having many different causes and not all originating in the bowel itself.

Herbs are a complex mixture of chemicals that vary when sourced in different growing conditions and locations. The herbs can be used in a variety of ways. For internal treatment alone there are alcohol or glycerine extracts, tablets, capsules, powders, teas and combinations within all the above form. These combinations of herbs themselves can potentially have a synergistic reaction, meaning the herb itself may work slightly or even massively differently to when it is used on its own. So with EBM there are many issues that arise from the style and substance of treatment.


Whenever any system of enquiry limits itself in such a way, it is potentially problematic. The Cochrane Collaboration for example, leads the field with systematic reviews of medical literature. Basically it takes all the published research on a certain medical treatment and includes for analysis only studies that meet its rigorous criteria. Then they crunch the numbers and conclude the validity or otherwise of a particular drug, herb, surgery or other method of treatment. If Cochrane doesn’t give the tick to the treatment, it is often deemed unsuitable, ineffective and at worst dangerous by those who take the service at face value. Most reviews of complementary medicines are stamped with Cochrane's “no evidence to inform current practice”. All this means was they couldn’t find enough medical trials to analyze the effectiveness of the treatment.


Unfortunately if there is a lack of literature on the subject, usually due to the vast majority of this kind of research being funded by pharmaceutical companies, Cochrane is unable to recommend the treatment.

A recent example can be found regarding programs for people with dementia that focuses on physical activity rather than drugs. This is a brilliantly low cost treatment in terms of the public health coffers but without obvious profit it is hard to fund pilot programs, then bigger trials and finally reproduce the trial another time to show the first one wasn’t a fluke.

There is insufficient evidence to determine the effectiveness of physical activity programs in managing or improving cognition, function, behaviour, depression, and mortality in people with dementia

Summary: Few trials examined these important outcomes. In addition, family caregiver outcomes and use of health care services were not reported in any of the included studies. There is some evidence that physical activity delays the onset of dementia in healthy older adults and slows down cognitive decline to prevent the onset of cognitive disability. Studies using animal models suggest that physical activity has the potential to attenuate the pathophysiology of dementia. Four trials met the inclusion criteria. However, only two trials were included in the analyses because the required data from the other two trials were not made available. Further well-designed research is required.

The Cochrane Collaboration


But while some members of the medical community are quick to use lack of evidence as a way to discredit complementary health treatment, it can be deafeningly silent on putting it’s love of EBM where its mouth is when it comes to short comings of its own medicines and treatments.

What if the studies used for meta-analysis were fundamentally flawed in the first place? This has been recently discovered to be the case in much of the breast cancer research conducted in vitro, for many years. Due to an initial identification error, cell line 435, used in at least 650 studies of metastatic breast cancer for over quarter of a century was the wrong cancer. In 2000 it was discovered that cell line 435 had the characteristics of melanoma, a skin cancer. It was not breast cancer after all.

The consequences of this mistake must have ramifications on all current breast cancer treatment. But more of a concern is the 8 years it has taken from the first researcher raising the alarm, to the claim being widely accepted in the research community.

In the past month there have been a number of EBM reviews of treatments that have swung against current medical practice. Perhaps the most damning is a Cochrane review of prenatal care. How many women going to their GP to have their pregnancy confirmed are being told that current best practice would recommend that they leave the practitioner's office as fast as possible and consult a midwife, not a doctor or obstetrician for the health of their unborn child and the best chance of a low intervention birth?

The Cochrane Review analysed 11 published trials, involving 12,276 women comparing midwife care to medical doctors. The evidence overwhelmingly supported Midwife care: it was associated with lower rates of both miscarriage and medical intervention as well as a greater likelihood of a vaginal delivery.

Midwife-led care was associated with several benefits for mothers and babies, and had no identified adverse effects. The main benefits were a reduced risk of losing a baby before 24 weeks. Also during labour, there was a reduced use of regional analgesia, with fewer episiotomies or instrumental births. Midwife-led care also increased the woman's chance of being cared for in labour by a midwife she had got to know. It also increased the chance of a spontaneous vaginal birth and initiation of breastfeeding. In addition, midwife-led care led to more women feeling they were in control during labour. There was no difference in risk of a mother losing her baby after 24 weeks. The review concluded that all women should be offered midwife-led models of care.

The current caesarian rate in Australia is 31%, close to a 1:3 of live births. It would be logical to conclude if every GP followed EBM best practice and recommended their client chose midwife based care, not only would more babies survive to 24 weeks but the cost of health care would be much lower.

A second clanger to be dropped by Cochrane this month is in regards to the effectiveness of St John’s Wort in the treatment of major depression. Herbalists have always known that good quality (and quality is the key for all herbal prescribing) St John’s Wort takes the edge of depression. Previously researchers grudgingly accepted it had some validity but only for mild depression. But the effectiveness of St John’s wort for treating mild to severe depression has finally shone through. Cochrane concluded that the herb is at least as good as antidepressant medication but without the nasty side effects.

Depression is characterized by depressed mood and/or loss of interest or pleasure in nearly all activities and a variety of other symptoms for periods longer than two weeks. Extracts of St. John's wort (botanical name Hypericum perforatum L.) are prescribed widely for the treatment of depression.

We have reviewed 29 studies in 5489 patients with depression that compared treatment with extracts of St. John's wort for 4 to 12 weeks with placebo treatment or standard antidepressants. The studies came from a variety of countries, tested several different St. John's wort extracts, and mostly included patients suffering from mild to moderately severe symptoms. Overall, the St. John's wort extracts tested in the trials were superior to placebo, similarly effective as standard antidepressants, and had fewer side effects than standard antidepressants. However, findings were more favourable to St. John's wort extracts in studies form German-speaking countries where these products have a long tradition and are often prescribed by physicians, while in studies from other countries St. John's wort extracts seemed less effective. This differences could be due to the inclusion of patients with slightly different types of depression, but it cannot be ruled out that some smaller studies from German-speaking countries were flawed and reported overoptimistic results.

Patients suffering from depressive symptoms who wish to use a St. John's wort product should consult a health professional. Using a St. John's wort extract might be justified, but important issues should be taken into account: St. John's wort products available on the market vary to a great extent. The results of this review apply only to the preparations tested in the studies included, and possibly to extracts with similar characteristics. Side effects of St. John's wort extracts are usually minor and uncommon. However, the effects of other drugs might be significantly compromised.

Cochrane Review: “St John's wort for major depression”, Linde K, Berner MM, Kriston L.

Beyond the scope of the Review were some of the actual issues with the commonly prescribed antidepressants.

As covered in a previous post, current evidence finds that common antidepressant drugs aren't very effective. In fact, the study reported in the link concludes, “Meta-analyses of antidepressant medications have reported only modest benefits over placebo treatment, and when unpublished trial data are included, the benefit falls below accepted criteria for clinical significance.“

A small study examining the effect of Paroxetine (a common SSRI) on sperm has just been published. Following earlier anecdotal evidence of men experiencing decreased fertility while taking SSRIs this study looked at sperm samples from healthy men before taking the drug and after four weeks of treatment. DNA abnormalities in the sperm rose from 13% before taking the medication to over 30% one month into the trial. This evidence suggests that this class of antidepressant has a significant negative effect on male fertility.

The use of SSRIs in adolescents has become increasingly controversial due to an apparent increase in suicides in young people taking these drugs. According the TGA: ” “None of the SSRIs, and indeed no antidepressant, is currently approved in Australia for the treatment of MDD (major depressive disorder) in children and adolescents (persons aged less than 18 years).”

Yet despite a long list of common side effects, let alone a worsening of symptoms or infertility, the vast majority of GPs and psychiatrists prescribe these drugs over an equally effective and less adversely reacting herb.

As a herbalist, I strongly suggest that you see both a qualified herbalist and registered psychologist for the treatment of depression. You may also be eligible for a Medicare rebate when seeing a psychologist in Australia.

EBM is an interesting tool. If your medical professionals subscribe to it, then you have a right to question their treatment in terms of current evidence.

How effective are SSRIs? Not as good as you think!

A new study looking at the effectiveness of common antidepressant drugs has found them lacking. Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration was coauthored internationally, analyzing study data submitted to the FDA including previously unpublished data obtained under Freedom of Information rules. This makes it the first meta-analysis of an unbiased range of research on the efficacy of 3 common SSRI (selective serotonin re-uptake inhibitor) drugs: Prozac, Efexor and Aropax .

The findings of the new study do not paint the same optimistic picture as the companies producing these drugs would like us to believe and through statistical analysis concluded that those people who were severely depressed did not respond as well to the medication as previously reported. In fact the study concluded:

“Meta-analyses of antidepressant medications have reported only modest benefits over placebo treatment, and when unpublished trial data are included, the benefit falls below accepted criteria for clinical significance.“

This study also highlights an ongoing issue with predominantly pharmaceutical industry funded research – the non-inclusion of all trials when the drug is submitted for approval (eg: to the FDA in the USA) and in cases such as this where there is post-market research, reassessment of efficacy once the drug has been approved. This is a problem that has dogged medical research for years.

The meta-analysis looked only at drug efficacy, not adverse reactions or other issues that many patients have with taking SSRIs.

Herbal alternatives to SSRI’s: St Johns wort – suitable if not on other medications including ‘the pill’ and other hormonal drugs. Most studies have found it works as well as SSRI’s and with fewer side effects. Lavender and hops are also popular alternatives.

A lifestyle and spiritual approach to wellbeing is covered in the show on raising our spirits.

While you are here, don’t forget to offer a comment on the happiness thread.


Update: The Independent featured a particularly good response.

Life, death and cartography

A great candid interview with author Stella Duffy on the BBC Radio 4 is worth clicking on if you have a spare 7 minutes. She discusses her novel “State of Happiness” (a very moving story of love, death and cartography) and her own journey with breast cancer.

As Stella says, “I don’t think we talk about death enough, we don’t talk about disease enough, it’s a really normal life thing. People die, we are all going to die, it’s how it is – and unless we embrace it easier, better, more willingly I think we are going to keep on giving ourselves a really hard time.”

It is a refreshing discussion about life, death, language and much more (and surprisingly uplifting too.)


While you are there, you might like to listen* to writer Sally Brampton talk about depression and her memoir “Shoot the Damn Dog”. She also discusses tools for contentment and ways of helping a child deal with a depressed parent.

*Note: interview with Sally begins 10 minutes into the podcast.

Mental Health - getting the care you need

The Federal Government has announced a $3.2 million initiative to ‘educate’ GPs in referral options concerning mental health. The subtext is that 8 months down the track since the Medicare subsidised consultations with psychologists were introduced, the service is proving to be too popular and costly. The popularity of the rebate is interesting considering there has been little publicity, or even encouragement, for this GP referral service since it’s introduction at the beginning of the year.

Although the re-education scheme, in the hope that cheaper mental health services such as consulting a social worker or occupational therapist will be offered in preference, was only announced yesterday - I have for some time had a significant number of clients complain about the difficulty they have had in convincing their GP that they would benefit from seeing a psychologist. One woman was told by her regular doctor that she would need to come back for a long consultation for assessment before she would decide whether seeing a psychologist was justifiable. While this extra consulting may be considered a hidden drain on Medicare, the issue is that the patients often find it confronting to ask for help over mental health issues and this just makes it less likely they will get the help they need. Some doctors however, have given the referral without hesitation.

But equally of concern is the ongoing habit of the majority of GPs to prescribe popular antidepressant drugs at the first sign of depression in a client, without offering a referral of any kind for emotional help. Anecdotally, as reported to me by my clients – this is the most common course of action occurring in Melbourne General Practices.

Although drug therapy may be the cheapest option to the government, in common mental health issues such as exogenous depression it is not often the most effective course of action. In the notoriously underfunded health sector of mental health - $3.2 million could go a long way in appropriately, therapeutically assisting a vast number of patients.

Sometimes finding a psychologist can take a little time to get one who you feel comfortable with – this is no different from finding a good match with a doctor, naturopath or any other health practitioner. But you do have a right to demand the referral, in order to make this service affordable. If you are unhappy with the way you have been treated in this area, consider contacting the Health Services Commissioner in your State.

Links

Victorian Government Mental Health Services index

Health Services Commissioner

The Australian Psychological Society

The Victorian Psychologists Association

Victorian Psychologists Registration Board: find a qualified psychologist in your area
PADA: Panic, Anxiety, Depression Assistance

The good oil on depression

Sydney’s Black Dog Institute has released a review of studies into Omega-3 fatty acids and mood disorders. The conclusion is there is significant evidence that a lack of eicosapentanenoic acid (EPA) and eicosapentanenoic acid (DHA) can contribute to depression and bipolar disorders.

Read the full report or a summary at the institute’s website.

Comment

The body can’t easily manufacture Omega-3 fatty acids so it is important to make sure the following foods are eaten regularly. If your diet is low in these or you have depression, heart disease, dysfunctional sperm production, PMS or skin problems (to name but a few) a supplement would be worth taking.

Fish is one of the richest sources of EPA and DHA, including good old fashioned cod liver oil.

Some really important information about vegetarian sources of Omega-3 fatty acid
Plant foods like flaxseeds and walnuts contain alpha-linolenic acid (ALA) - which was not the focus of the study. An important fact often gets missed in any discussions about plant oils. The body needs to convert ALA to EPA and DHA to get the benefits and this does not always occur. In fact if it doesn’t, there is a risk of the body using the ALA to form chemicals that create inflammation (the opposite of what you want to happen).

Some co-factors that help the positive conversion process include VitaminsB3, B6, C as well as magnesium and zinc. I’d strongly recommend you take a supplement of these eg: a good multivitamin that includes 50mg of B6, plus about 500mg of vitamin C .

* never eat an oil that smells rancid (bitter tasting or off smelling).