One of my life-long battles is to ensure that people get the most objective, useful information they can about mental illness and its treatment. It’s painful to me when I come across a popular website that misrepresents these illnesses or their treatment.
So you can imagine my surprise when I reviewed the National Institute of Mental Health’s (NIMH) page on depression recently. This is a super-important page to get right, because it often appears as the number one or two search result in Google.
It starts off well enough, but then devolves when it gets to a section entitled “Treatment and Therapies.”
Biases can be in your face, such as when a psychiatrist suggests, “Take antidepressants for depression — it’s the only thing that works!” Or biases can be more subtle, even unintended.
Treatment of Depression
I’ve written enough words to fill a (small) book about effective treatments for depression. I’ve talked about newer therapies that show promise, including ketamine and rTMS devices.
The main takeaway from anything I’ve written is that a combination approach using both psychotherapy and antidepressant medication is usually best for most people. Even if you don’t “believe” in therapy or don’t think there’s anything “wrong” with you, time and time again the research is super clear about the effectiveness of this combined approach. If you want to start feeling better as soon as possible, this is the method to use.
So in a 904 word section on treatment of depression, why does the NIMH devote a measly 61 words — about 7 percent of the section– to psychotherapy?
This is a perfect example of a subtle bias. It’s not in your face, but it’s clearly there.
Of course, the section with the most words — and therefore the greatest focus — is medications. An astounding 414 words — over 45 percent — of the depression treatment section is devoted to talking about antidepressant medications. The NIMH also wants to be very clear it is only talking about FDA-approved (e.g., government-sanctioned) medications, because it devotes 118 words — more than the entire psychotherapy section! — warning you against taking herbal supplements for depression treatment. Despite there being a fairly robust consensus in the international community that things like St. John’s wort are generally okay to try for most people, and can have about the same clinical effectiveness as an FDA-approved antidepressant medication.
The NIMH also writes far more about electroconvulsive therapy (ECT, aka shock therapy) than psychotherapy. In this section, 231 words are devoted to ECT — more than 25 percent of the treatment section! ECT is rarely prescribed as a treatment for depression in the vast majority of people who suffer from it. It’s estimated that less than 5 percent of people diagnosed with severe clinical depression will ever try ECT. And it comes with some potentially significant, serious side effects.
Why This is a Problem
We take the issue of treatment bias seriously here at Psych Central and always have. If the research shows a combined treatment approach that includes both psychotherapy and medications is best, then an article describing depression treatment needs to reflect that finding. Psychotherapy needs to be given the same amount of editorial focus in an article as medications. And it needs to be given far more focus than extreme, rarely-used treatments such as ECT.
The NIMH article also fails to note that most people try to treat their depression on their own, using self-help methods and strategies first. This is, by far, the most common treatment strategy employed. For some people, it actually works and can be effective in treatment of mild depression.
To be fair, the NIMH is not a clinical treatment center, nor focused on education about the treatment of mental disorders. It is primarily a research arm of the federal government. The fact that Google believes this is one of the best pages on the Internet for accurate, unbiased depression information (despite lacking author information or references) is not the NIMH’s fault.
But they know — or should know — it is often the #1 result in for a search on depression. Knowing that, they should work with a team of science editors and writers to ensure it reflects an accurate portrayal of treatment strategies generally employed in clinical practice today.
Because right now, the page reflects some alternative treatment universe divorced from the clinical reality on the ground. One where medications and ECT are routinely used to treat depression, and psychotherapy is just a footnote.