UltraWellness or Ultra-Hype? Antidepressant as Demagogue
Mark Hyman, MD, is a “practicing physician and pioneer in functional medicine,” according to his bio on the Huffington Post where he recently penned the nonsensical, “Why Antidepressants Don’t Work for Treating Depression.” I say “nonsensical” because this article is based upon a study that came out 3 years ago, so writing this article to educate the public seems not to be its primary purpose.
Exhibiting sound reasoning and logic also doesn’t seem apparent in this article, since generally a scientist or doctor would not dismiss an entire class of medications — antidepressants — based upon a single study. Or when there are many different types of antidepressants and sub-classes — SSRIs, tricyclics, MAOIs, SRNIs, etc. The study questioned by Dr. Hyman only looked at the more modern and commonly prescribed antidepressants, but it had nothing to say about the older, cheaper antidepressants still prescribed widely in other parts of the world.
The New England Journal of Medicine study in question only looked at studies submitted to the U.S. Food and Drug Administration (FDA) for initial approval of the drug. These studies are important, but hardly provide the final or definitive answer when it comes to proving effectiveness of a particular drug. In fact, after a drug has undergone and received FDA approval, it tends to undergo dozens — and sometimes hundreds — of additional research studies as researchers compare the drug to other treatments, include it in depression research, or conduct large government-sponsored trials such as STAR*D. STAR*D demonstrated that antidepressants are effective, but that it may not be the first antidepressant you try that will work for you.
So why is Mark Hyman, MD writing about antidepressants and a study conducted 3 years ago today?
Well, I think we can gain a clue here:
What can we do? Unfortunately, there is no easy answer. But I do think functional medicine, on which my approach of UltraWellness is based, provides a more intelligent way of understanding the research. Rather than using drugs to suppress symptoms, Functional Medicine helps us find the true causes of problems, including depression.
Ah, UltraWellness. That scientific medical approach to fixing the causes of sickness. Depression being just another medical sickness, apparently.
Wait… You haven’t heard of UltraWellness from the medical research? Well, that’s no surprise, because I couldn’t find a single entry in PubMed referring to “UltraWellness.” And when I perused Dr. Hyman’s website, I also found a not-unsurprising lack of research references to his approach to curing sickness.
But Dr. Hyman does have anecdotes! And he peppers the rest of the article with examples from his actual clinical practice as a family physician showing how he quickly and readily “cured depression” by finding the root cause of it in every case — food allergies, removing high levels of mercury, and vitamin deficiencies.
You see, Dr. Hyman was trained as a medical doctor. So apparently he doesn’t really see mental health problems as mental disorders that more often than not have biopsychosocial causes. It is, in my opinion, an extremely simplistic, naive, un-nuanced view of mental disorders — they are just another medical illness that can be cured with vitamins, omega-3 fish oils, and exercise. Indeed, those things have been shown to work to help some people some of the time — but usually those with mild depression. Research evidence varies for each item, but it’s unlikely that even a combination of all of these things is going to help those with no pre-existing vitamin deficiencies or other medical problems.
Which is an important consideration, because virtually every diagnosis in the DSM-IV (the reference book used to diagnose mental disorders such as depression) has this important criteria — “The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).” So to suggest that depression can be caused by a general medical condition, like hyperthroidism, is to miss one of the exclusionary criteria in the diagnosis of most mental disorders. According to the DSM, if you have the medical condition, you don’t have the mental disorder.
For moderate to severe depression, a more nuanced and complex approach is usually needed to treat it effectively and in a timely manner. So yes, get checked for mercury and hyperthyroidism, and take your vitamins. But let’s not discount the benefits of antidepressants and psychotherapy treatments that also have been proven — both by time and research — to help people with depression.
Read the full article: Mark Hyman, MD: Why Antidepressants Don’t Work for Treating Depression.
Grohol, J. (2010). UltraWellness or Ultra-Hype? Antidepressant as Demagogue. Psych Central. Retrieved on May 4, 2015, from http://psychcentral.com/blog/archives/2010/04/25/ultrawellness-or-ultra-hype-antidepressant-as-demagogue/