Drugs Don’t Work (and Other Mental Health Myths)

TThere is no doubt here that public attitudes towards mental health have already turned a corner. Just consider the sheer number 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 over the same period. And this appears to have a positive impact on daily experiences of prejudice: people with mental illness now report significantly less discrimination from family, friends and peers 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 common beliefs and the truth behind them.

Mental illnesses are overdiagnosed

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

In reality, there is very little hard evidence that overdiagnosis is the serious problem some claim it to be. Depression surveys 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. It suggests that doctors are just as likely to miss real 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 is the suggestion that many people who think they have depression should show more resilience and simply bide their time to heal their problems. If they are simply suffering from transient sadness, after all, surely the problem should go away on its own?

To find out if this was really the case, researchers in Australia looked at 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 over the three-month period.

Antidepressants don’t work

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

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 gained widespread attention after the publication of an article that raises some serious questions about the proposed mechanism of these pills.

SSRIs, which include Prozac, were thought to address a “chemical imbalance” in the brain, correcting levels of the neurotransmitter serotonin, which is thought to be involved in mood regulation, among other functions. The recent paper, however, looked at the evidence so far and concluded that there was no clear link between serotonin levels and depression.

But there are many other ways they can help relieve symptoms, by reducing inflammation, which is another potential contributor to depression, for example. It is important to note that a recent meta-analysis al Lancet, considering multiple clinical trials, confirmed that SSRIs are effective in alleviating depression. Although 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 are about side effects. You’ll see a lot of articles, for example, claiming that antidepressant pills “dull” people’s emotions. There is a seemingly good basis for this idea: Many patients report that their medications have dulled the highs and lows of life, resulting in numb feelings.

Until recently, however, few studies had interrogated the causes of emotional numbing, 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 removed the most prominent feelings of hopelessness, but they do not necessarily increase positive emotions and motivation, says Professor Guy Goodwin of the University of Oxford, who conducted the recent study: “The feeling of emotional dullness is real, but it’s not 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 a link between creativity and mental illness is extremely tenuous, says University of Connecticut professor James C Kaufman.

“Historiometric” analyses, for example, have probed the biographies of notable artists. Although these studies seem to suggest that mental illness is more common in creative personalities, any post-hoc diagnosis based solely on a text should be treated with great caution. “They’re not super goals,” Kaufman says. “Very few creativity researchers believe there is a strong connection.” And the idea that mental anguish can inspire great art certainly shouldn’t be reason to avoid treatment for serious conditions, 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 is still a ‘forgotten illness’ because it has been squeezed out of all these anti-stigma campaigns, which have emphasized stress, depression and anxiety.” This means that most people only have a vague understanding of the condition, despite the lifetime prevalence being around 1.5% in the UK.

A big misconception is that schizophrenia is simply “curable”. With appropriate medication and talking therapies, however, 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 cause 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 the chronic lack of health service resources means that many people with schizophrenia do not get help in the early stages of a crisis, says Wallace, which reduces their chances of recovery. They may be taken away from hospitals or psychiatric facilities, and it will often be police officers who end up dealing with the patient. Escalating their condition in such cases only adds to the perception that it is impossible to treat, but the person may have fared much better if they had had access to treatment sooner.

  • The Expectancy Effect: How Your Mindset Can Transform Your Life by David Robson is published by Canongate (£18.99). To support the guardian i Observer order your copy at guardianbookshop.com. Shipping charges may apply

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