Friday, March 16, 2007

Bad Depression Treatments

In a recent edition of the West Australian's Mind&Body supplement Dr Dingle discusses "New Ways Out of Depression".

How we treat depression is of great concern. The drugs we give to our kids don't solve the problem, at best they manage the symptoms. As a result, the underlying problem remains. In addition, these drugs can have many adverse side-effects. Drugs can be effective when used with other treatments that identify the cause but the first action should always be treating the illness through modifications in diet, environment, attitude and lifestyle.

Dr Dingle then goes on about cognitive behavioural therapy, diet (mainly tryptophan rich foods and omega 3 fats), exercise, "relaxation and breathing techniques" and meditation. He concludes:

Medication can be a part of this but only in conjunction with other, safer treatments, along with common sense.

While EoR doesn't disagree that many of those things may help people with depression, the subtle message here is "Drugs bad". Just because medication for depression treats the "symptoms" and not the "cause", why is that a bad thing? Many medications for depression have side effects (including weight gain and lethargy). As an alternative to not taking drugs and suffering suicidal ideation and its potentially fatal consequences, the side effects may be preferable. This seems doubly dangerous advice since Dr Dingle appears to be targeting his message to children (or their parents at least).

Dr Dingle also makes much of SAMe:

More than 100 double-blind studies have shown that supplementing with SAMe (S-adenosyl methionine), a chemical natural to our body, is equal or superior to using antidepressants. SAMe doesn't appear to have side effects and has many potential benefits. SAMe has been shown to increase the levels of serotonin and dopamine in depressed patients.

Dr Dingle has no qualifications to provide medical advice that EoR is aware of, nor to suggest treatment for mental disorders. Real psychiatrists are a lot more cautious:

A 58-year-old man’s condition was stable on a selective serotonin reuptake inhibitor (SSRI) after 3 major depressive episodes in the previous 10 years. He disliked the idea of taking a drug for a long time and at one point took himself off the SSRI and started taking St. John’s wort. However, the reappearance of symptoms of depression soon persuaded him to go back on the SSRI. [...] [SAMe side effects] were few in the published studies, but all the studies were
short term. There is no systematic evidence about long-term side effects or toxicity. The oral doses used in published studies are most often in the range of 400-1600 mg per day, but there is no evidence about the best dose. SAMe is usually sold over the counter in tablets with a stated SAMe content of 200 mg or 400 mg. A major problem is that SAMe is very unstable at room temperature when exposed to air. It is not possible to know how much SAMe might remain in tablets bought over the counter. [...] Although SAMe and 5-HTP may have antidepressant effects when given in an appropriate way, there
is no evidence that either compound would be effective or safe in the long term using the preparations sold over the counter in the United States and via the Internet. Neither can be recommended.

Indeed, the concern that people with depression may be using SAMe in Australia without regard to advice from a doctor or psychiatrist has led to the Therapeutic Goods Administration issuing a regulatory notice for inclusion on the product:

"Individuals who are using prescription anti-depressants or suffer from bipolar depression should not use this product unless under the supervision of a health practitioner"

Dr Dingle does a disservice, at the very least, not to emphasise this point. It is also concerning that his articles promoting the dangers of various toxins, poor diet and learning problems could not be said to be untainted, since he also promotes "The Dingle Deal" as a commercial enterprise.

This program takes an integrated approach through Diet, Environment, Attitude and Lifestyle (the DEAL) to
provide the participant with immediate steps to reduce stress and the impact it has on health and productivity.

Dr Dingle claims he's been researching these topics for a good long time. Since he was two years old, in fact:

GEORGE NEGUS: [...] Why should we listen to Dr Peter Dingle?

DR PETER DINGLE: One - I've been researching it ever since I can remember, about two years of age.

GEORGE NEGUS: How would you describe yourself academically? Um, a behavioural scientist or what?

DR PETER DINGLE: No, I now describe myself... Are you ready for this one? It's a nutritional and environmental toxicologist.

GEORGE NEGUS: Oh, simple, yeah. But you do actually have qualifications that allows you to sound off and be a soothsayer on this whole issue.

DR PETER DINGLE: Correct, correct. We've got research happening in the behavioural sciences. We've got research happening in the nutritional area. We've got research happening in the environmental area, and the lifestyle too.

Notice Dr Dingle doesn't actually answer the question about his qualifications. He is an Associate Professor in the School of Science and Engineering, Environmental Science, at Murdoch University. EoR was unable to locate any mention of research being undertaken in that school that appeared to match Dr Dingle's claims above, though there is a list on his details page. A search for any publications returned zero results (obviously, Murdoch University does not index the populist press).

Of course, Dr Dingle knows his target audience. He regularly publishes columns in the alternative health section of the West Australian newspaper, has a regular column in the newage Nova magazine, and is clearly happy to associate himself with the "curers" of autism and ADD such as Defeat Autism Now!, chiropracters, craniosacralists, homeopaths and Mr Sichel.

Dr Dingle's aim is to live to 140 (that would make 138 years of research!). He himself describes his presentations as:

personal and memorable stories interlaced with a bit of magic.


  1. Obviously, the good doctor is yet another self-proclaimed health practicioner. As an individual who has suffered two major depressive episodes (the first, in my teens, requiring a period of hospitlization), I am intimately acquainted with what works, and what works. I can safely say that an SSRI gave me my life back.

    This individual promoting SAM-E, as you note, is targeting a credulous audience, where he can slip by the average individual that anything you put in your body for the purpose of creating a biochemical alteration so as to treat sickness or alter one's psychological state IS A DRUG. Including SAM-E.

    Secondly, this whole idea of "treating the symptoms but not treating the underlying cause" is also nonsense. In many cases of clinical depression, no "cause," in terms of social, genetic, dietary or exercise factors can be determined. Ergo, the individual who seems to have every reason in the world to be "happy" suffers nonetheless.

    The simple fact of the matter is that depression is a complex phenomenon, and many different factors are involved, and that they are not necessarily the same from individual to individual. To advance a certain regime of exercise and diet and, of course, SAM-E, is to suggest that these address universal causitive factors. Which is simply not true.

    As for the suggestion that SSRIs, being a "drug," treat only the symptoms, and not the underlying causes,any psychiatrist worth his salt will tell you something like: "while the mechanism behid clinical depression is not well-understood, it is believed to be related to the role of neurotransmitters at the level of the synapses - particularly serotonin, but norepinephrine and dompamine also seem to play a role in some individuals. The aim of the SSRIs, and other drugs which also address norepinephrine and/or dopamine balance, is to correct the reuptake problem in the synapses, and thereby alleviate depression (and a range of other disorders, including OCD, PTSD, and panic attacks).

    The point here is that no one knows exactly what is going on in the synapses of the depressed individual, at the molecular level, that produces symptoms of depression in the affected individual. For all we know, it could be subtle difference in the brain architecture of the depressed individual, compared to the brains of other individuals. This is certainly not without precedent in mental illness: the brains of schizophrenics are physically different from well individuals, the ongoing englargement of the ventricles of the brain being one factor involved. Likewise, apparently degenerative changes in brain structure may lead to the onset of Alzheimers.

    Bottom line: the cause of clinical depression is not known. The SSRIs have helped literally millions of people (the risk of suicidal ideation in some individuals in the early phase of SSRI therapy has been blown all out of proportion in the media, and can be managed by a sensible physician and a cooperative patient, and through the education of friends and family of the afflicted individual).

    I wonder if the good doctor would suggest that diabetics stop taking insulin, and try some "holistic" treatment instead.

    Clinical depression is a serious physical illness. Because the brain is an ORGAN, just like the pancreas. This "doctors" ideas in regard to "treating the source" hearken back to an older time in pyschiatry where the end-all-be-all of treatment was the pyschiatrist's couch, taking vitamins, and taking up a hobby.

  2. Yes, you are right. He's just another "Self-proclaimed health practicioner". The so called good doctor is a graduate of environmental science, not a medical doctor. He dabbles in indoor air quality and the like. He is keen to teach and do the circuits of schools, local radio etc. But that's no assurance of the content. Murdoch University embraces him - there's competition for students and he raises its public profile. I think his announcements on depression are recklessly egotistical. All care and no responsibility.

  3. Fast forward to June 2010 and Dr Dingle's in the news for a whole different set of reasons.


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