Supplements for Mental Health - The Evidence

As you may know, I very recently updated the content on mcmanweb, including my articles on supplements. My position is generally sympathetic, but I also urge skepticism. This extract from a longer article explains why ...

Before we examine the brain, let's look at an adjacent organ - the eye. There are convincing studies, published in reputable journals such as JAMA, showing that various nutrients - in particular lutein (found in dark green leafy vegetables) significantly reduce the risk, or slow the progress, of age-related macular degeneration (AMD).

These studies are not necessarily conclusive, but why they are so convincing is that:

1. They address a condition that everyone clearly understands (loss of vision in the center field).
2. We know this condition's causes and effects (build-up of blood vessels supplying the retina in one form of the illness).
3. We can identify a specific region of the anatomy (the macula in the retina).
4. We know this region's function (high resolution vision).
5. We can identify specific biochemical processes (such as cone cells processing light).
6. We have linked a specific agent (lutein) to the macula.
7. We see a clear link all the way down the chain from treatment (lutein) to structure (intact macula) to function (operating macula) to outcome (good vision, lower risk of AMD). 

Now, let's switch from the eye to the brain, from AMD to depression. Yes, we have studies, but here's what we're up against:

1. They attempt to address a condition that no one understands (feeling sad? loss of energy? irrational thinking?).
2. We don't know this condition's causes and effects (environment? biology?).
3. We can't identify a specific region of the anatomy (hippocampus? amygdala? anterior cingulate? cortices?).
4. Even if we could identify a specific region (in all likelihood we are talking many regions), we are a long way from connecting function to the condition we are trying to fix).
5. Our understanding of the specific biochemical processes is primitive (such as "chemical imbalance" involving serotonin or dopamine).
6. We have not linked any specific agent to any region or any process.
7. We cannot show any clear link all the way down the chain from treatment (with any agent) to structure (such as changes to specific brain regions) to function (such as an optimum anterior cingulate) to outcome (feeling good? more energy? rational thinking?).

Just to be clear, I have used these same arguments elsewhere to demonstrate that we have clear lack of evidence for using antidepressants to treat depression.

Here's where I'm going with this: Pharma has invested billions in clinical trials that have been rigged in every conceivable way to make antidepressants look good, and they have failed miserably. In hindsight, it's easy to see why:

They were testing for the wrong condition ("depression," as opposed to something more specific such as loss of energy or lack of motivation) on a wide population (anyone who was "depressed") with no understanding of the underlying biology or the environmental conditions that bring on "depression".

Thus, if you are skeptical of meds for psychiatric conditions, be equally skeptical of supplements for psychiatric conditions. No matter what you may hear - from any source - we have no credible evidence remotely approaching what lutein does for macular degeneration, nor are we likely to for decades to come.

Rerun - My Favorite Mental Health Blogs

I originally ran this in August. The end of the year is a suitable time for a rerun. Note: Two of my favorite bloggers on this lists have books just about to come out: Therese Borchard (Beyond Blue) and Gretchen Rubin (The Happiness Project), both which I very highly recommend. (Click the links for my reasons.)


Enjoy ...

If your main interest is staying ignorant and resentful and unwell forever, there are plenty of bloggers out there eager to help you stay the way you are. If you are actually interested in gaining insight into what makes you tick and in figuring out what treatments and recovery techniques work best for you, the list is much shorter.

Following are my blogging heroes, highly-intelligent and principled individuals whose mission is to enlighten and inform:

Beyond Blue. No one does it better than Therese Borchard. Her combination of wit and intelligence and practical advice, with a deeply personal dimension, is without equal. I recently had the privilege of reading an advance copy of her book of the same name, and this is part of the endorsement I sent to her publisher:

"Let me count the contradictions: perfectionist-screw-up, brilliant-confused, depressed-hilarious ... Therese is a saint in pursuit of a masterpiece, and BEYOND BLUE is Exhibit A. This is The Book of Job as Art Buchwald might have written it, had he been as talented as Therese. Wise, compassionate, and funny beyond measure, Therese ultimately offers up healing."

About.com - Bipolar. Kimberly Read and Marcia Purse are the equivalent of those NFL quarterbacks who neither rack up statistics nor personal glory - all they do is win football games. Kimberly and Marcia were blogging way back before the neologism, blog, was coined. Unlike virtually every blogger out there, this veteran tag team neither draws attention to themselves nor dazzles readers with seductive prose - and that is their strength.

Instead, for more than a decade, in their own quietly reliable fashion, Kimberly and Marcia have served up reports of new research, new insights, and new developments - information that facilitates us in making intelligent choices without the distortions of overweening egos.

Postpartum Progress. It is highly unusual to cite a blog as the best resource for any given subject. For instance, there may be some great cancer bloggers out there, but to find out what you need to know about cancer you would probably go the American Cancer Society website. Not so for postpartum mental illness. The place to go is Katherine Stone's Postpartum Progress.

Katherine achieves the rare trifecta in passionate advocacy, personal experience, and state-of-the-art information, with each component in service to the others and thus creating a sum much greater than its parts. If you are a woman, or know someone who is, this blog is essential reading.

ADHD Roller Coaster. Gina Pera puts a song in my heart every time she butts heads with antipsychiatry nutjobs and the idiots who legitimize them. Sample this attack on Bill Maher and a panel of dunces:

"They’re entitled to their own opinions, as they say, but not to their own facts. And when their deluded opinions target my friends with ADHD — on the airwaves, in print, or on the Internet — it leaves me at once angry and heartsick at their cold-hearted, mingy-minded meanness, never mind ignorance. ..."

Gina's focus is ADHD, and her blog is by far the best on the topic, but it is as a passionate advocate of reason that she truly shines. The opposite of antipsychiatry is not pro-psychiatry. It is pro-consumer, pro-patient, pro-family member. Pro-wisdom, pro-empathy, pro-science, pro-intelligence. No question about it - Gina is our leading spokesperson.

The Happiness Project. We're all experts in misery. But if we want to get unstuck and get to well, we need to acquaint ourselves with the concept of happy. Gretchen Rubin is a highly-regarded author who, in pursuit of a book, has spent a year "test-driving every principle, tip, theory, and scientific study I could find, whether from Aristotle or St. Therese or Martin Seligman or Oprah."

From her latest offering: "The biggest challenge of a happiness project isn’t figuring out what resolutions I should make, but actually sticking to my resolutions. Somewhat to my surprise, I've found that I have quite a lot of trouble keeping my resolutions related to play ... "

Holy cow! I can really relate to that. My guess is all the rest of you are thinking the same thing.

Prozac Monologues. So far, I have singled out established authors, all of them very well-known in their respective fields. Willa Goodfellow's Prozac Monologues, which got started up in April, is my tribute to a new kid on the block. Don't be put off by her latest offering, which is highly complimentary of my work - that was how we met. Then I read her other pieces, and was floored by the homework she turned in.

Let's put it this way: Until I encountered Prozac Monologues, I thought I was the only one who had ever mentioned, anterior cingulate, in a blog. It can be very lonely blogging on topics ignored by everyone else, and suddenly I'm not alone. (The anterior cingulate modulates emotions in the brain.)

Promising bloggers have an unfortunate tendency to burn out, so I urge all of you to drop a comment on her blog site offering encouragement. To Willa: It's very easy for bloggers to get discouraged, particularly when dealing with depression. But clearly we need you. Stick with it ...

***

No doubt, I am leaving out dozens of worthy bloggers. If you have a favorite, please put your recommendation in the form of a comment below. Trust me, I will follow up.

Considering Ethnic Perspectives

On Friday, I attended a one-day conference on ethnic diversity in the older mental health community, put on by the Senior Mental Health Partnership, which is a program of NAMI San Diego. The emphasis was on the special needs of the many and diverse ethnic groups that call San Diego county their home. These needs include cultural and language barriers that pose a challenge to treatment, as well as the psychic horrors from atrocities that many must contend with, particularly older generations.

My friend Sally Shepherd MN of UCSD , who organized the conference and set the scene in an opening presentation, provided this salient example:

According to one study, 70 percent of southeast Asian refugees receiving mental health care met diagnostic criteria for PTSD. In a study of Cambodian adolescents who survived Pol Pot’s concentration camps, nearly half experienced PTSD and 41 percent suffered from depression ten years after leaving Cambodia.

Meanwhile, demographics are dramatically shifting. Ms Shepherd noted that in a matter of years, latinos in California will outnumber whites. By 2020, whites will comprise 37 percent of the population while hispanics will make up 41 percent, almost an exact reversal on current figures. By 2050, this “minority” will be in a “majority” at more than 50 percent of the population, with whites at one in four.

As one commentator remarked: “Few of their children in the country learn English ... the signs in our streets have inscriptions in both languages ... unless the stream of their importation could be turned ... they will soon so outnumber us, that all the advantages we have will not in my opinion be able to preserve our language, and even our government will become precarious.”

Ben Franklin said that, back in 1753, not Lou Dobbs. Franklin was expressing his alarm over Germans settling in Pennsylvania. Some things, Ms Shepherd pointed out, apparently never change.

Concepcion Barrio PhD of the USC School of Social Work talked about mobilizing “culturally salient protective factors” in working with latinos. These include strong family attachments, supportive community networks, and deep spiritual/religious convictions. For instance, according to a 1998 study, of those with severe mental illness, 75 percent of latinos and 60 percent of African-Americans lived with their families, as opposed to just 30 percent of whites.

A 2006 meta-analysis of 56 studies found that interventions targeted to specific cultural groups were four times more effective than non-targeted interventions and that those conducted in a client’s native language were twice as effective as those conducted in English.

Simply having providers employ ethnically-matched staff, along with other surface strategies, is only part of the picture, Dr Barrio argued. Deeper approaches incorporate the traditions of the ethnic group. She cited the well-known “Mexican Paradox,” which has to do with first-generation Mexican-Americans faring a lot better mentally than assimilated later generations.

In addition, Dr Barrio pointed out, families from third-world nations tend to manifest lower “expressed emotions,” such as hostilities. Acceptance and warmth in Mexican-American families, for instance, predict better outcomes from schizophrenia.

The catch, of course, is that mental health providers need to be making the effort. In this context, we hear terms such as “cultural competency,” which involves, among other things, not making false assumptions about others’ ways based on one’s own limited personal experience.

Not good in healthcare, Ms Shepherd concluded.

More later ...

My Favorite Mental Health Blogs

If your main interest is staying ignorant and resentful and unwell forever, there are plenty of bloggers out there eager to help you stay the way you are. If you are actually interested in gaining insight into what makes you tick and in figuring out what treatments and recovery techniques work best for you, the list is much shorter.

Following are my blogging heroes, highly-intelligent and principled individuals whose mission is to enlighten and inform:

Beyond Blue. No one does it better than Therese Borchard. Her combination of wit and intelligence and practical advice, with a deeply personal dimension, is without equal. I recently had the privilege of reading an advance copy of her book of the same name, and this is part of the endorsement I sent to her publisher:

"Let me count the contradictions: perfectionist-screw-up, brilliant-confused, depressed-hilarious ... Therese is a saint in pursuit of a masterpiece, and BEYOND BLUE is Exhibit A. This is The Book of Job as Art Buchwald might have written it, had he been as talented as Therese. Wise, compassionate, and funny beyond measure, Therese ultimately offers up healing."

About.com - Bipolar. Kimberly Read and Marcia Purse are the equivalent of those NFL quarterbacks who neither rack up statistics nor personal glory - all they do is win football games. Kimberly and Marcia were blogging way back before the neologism, blog, was coined. Unlike virtually every blogger out there, this veteran tag team neither draws attention to themselves nor dazzles readers with seductive prose - and that is their strength.

Instead, for more than a decade, in their own quietly reliable fashion, Kimberly and Marcia have served up reports of new research, new insights, and new developments - information that facilitates us in making intelligent choices without the distortions of overweening egos.

Postpartum Progress. It is highly unusual to cite a blog as the best resource for any given subject. For instance, there may be some great cancer bloggers out there, but to find out what you need to know about cancer you would probably go the American Cancer Society website. Not so for postpartum mental illness. The place to go is Katherine Stone's Postpartum Progress.

Katherine achieves the rare trifecta in passionate advocacy, personal experience, and state-of-the-art information, with each component in service to the others and thus creating a sum much greater than its parts. If you are a woman, or know someone who is, this blog is essential reading.

ADHD Roller Coaster. Gina Pera puts a song in my heart every time she butts heads with antipsychiatry nutjobs and the idiots who legitimize them. Sample this attack on Bill Maher and a panel of dunces:

"They’re entitled to their own opinions, as they say, but not to their own facts. And when their deluded opinions target my friends with ADHD — on the airwaves, in print, or on the Internet — it leaves me at once angry and heartsick at their cold-hearted, mingy-minded meanness, never mind ignorance. ..."

Gina's focus is ADHD, and her blog is by far the best on the topic, but it is as a passionate advocate of reason that she truly shines. The opposite of antipsychiatry is not pro-psychiatry. It is pro-consumer, pro-patient, pro-family member. Pro-wisdom, pro-empathy, pro-science, pro-intelligence. No question about it - Gina is our leading spokesperson.

The Happiness Project. We're all experts in misery. But if we want to get unstuck and get to well, we need to acquaint ourselves with the concept of happy. Gretchen Rubin is a highly-regarded author who, in pursuit of a book, has spent a year "test-driving every principle, tip, theory, and scientific study I could find, whether from Aristotle or St. Therese or Martin Seligman or Oprah."

From her latest offering: "The biggest challenge of a happiness project isn’t figuring out what resolutions I should make, but actually sticking to my resolutions. Somewhat to my surprise, I've found that I have quite a lot of trouble keeping my resolutions related to play ... "

Holy cow! I can really relate to that. My guess is all the rest of you are thinking the same thing.

Prozac Monologues. So far, I have singled out established authors, all of them very well-known in their respective fields. Willa Goodfellow's Prozac Monologues, which got started up in April, is my tribute to a new kid on the block. Don't be put off by her latest offering, which is highly complimentary of my work - that was how we met. Then I read her other pieces, and was floored by the homework she turned in.

Let's put it this way: Until I encountered Prozac Monologues, I thought I was the only one who had ever mentioned, anterior cingulate, in a blog. It can be very lonely blogging on topics ignored by everyone else, and suddenly I'm not alone. (The anterior cingulate modulates emotions in the brain.)

Promising bloggers have an unfortunate tendency to burn out, so I urge all of you to drop a comment on her blog site offering encouragement. To Willa: It's very easy for bloggers to get discouraged, particularly when dealing with depression. But clearly we need you. Stick with it ...

***

No doubt, I am leaving out dozens of worthy bloggers. If you have a favorite, please put your recommendation in the form of a comment below. Trust me, I will follow up.