Mental Suggestion

By Jim McVeagh 21/01/2010

If ever there was a good example of why health journalists should seek to gain a proper understanding of the material they are writing about it is this:

Study finds vitamins boost mental health

People with mental illness made “remarkable” improvements by taking a daily dose of nutritional supplements rather than conventional medicines, a trial has found.

The work by a Canterbury University clinical psychologist has shown the potential that consumption of the right micronutrients, such as vitamins, minerals and amino acids, could have for helping a range of mental health problems.

Cue hordes of depressed people rushing off to the vitamin store to cure their depression…

There is only one problem with the above opening lines. It gives entirely the wrong impression. Of course the journalist who wrote this can claim that this impression is erroneous. After all, he carefully used weasel words such as “potential”, “could have” and “range”. But there is no doubt that the opening line supports the heading. And the heading is simply claptrap.

Firstly, this is a tiny trial of 14 people, so it is hardly a definitive study. Compare that to the literally tens of thousands of people involved in trails of medications such as Prozac.

Secondly, the mental illnesses studied here were ADHD and Severe Mood Dysregulation (similar to but less severe than bipolar disorder). Both of these are usually paediatric diagnoses although this trial was with adults. Presumably, they all therefore had long-standing diagnoses. Both of these problems are unusual in that have been shown in other studies to be strongly related to diet. It is therefore dangerous to drawn any conclusions from this study about other mental illnesses. I was particularly concerned to read this:

“Most of the individuals were in a moderate to severe depressed state at the start of the trial,” Dr Rucklidge said..

“At the end of the eight weeks, the mean score on the depression measure fell in the normal non-depressed range, which is a fairly remarkable change in such a short time, especially as many had not experienced such improvements with other conventional treatments.

This is exactly the sort of statement that should be avoided. It gives the impression that vitamin therapy is an effective form of treatment for depression and yet there is no evidence for this beyond Dr. Rucklidge’s tiny study. It is well within the bounds of possibility that both the placebo effect and the simple act of engaging in continuing assessment of these people lead to their improvement. Yet a mental health patient will read this and take themselves off their medication to “try vitamins”. They will not ask their GP first (trust me on this), they will simply do it.

Guess who will be cleaning up the resultant mess. Not Dr. Rucklidge.

When will doctors stop promoting inconclusive, often unpublished studies and journalists learn to ignore self-serving clinicians?


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0 Responses to “Mental Suggestion”

  • Hi, I’m Julia Rucklidge, Associate Professor of Psychology, the researcher behind the micronutrient study you blogged about.
    You write my study is “unpublished”. Actually, it is published in the Journal of Attention Disorders. We have also published on this topic in CNS Spectrums, Science, Expert Review in Neurotherapeutics, and Journal of Anxiety Disorders. I am happy to provide you with all these references.
    Of course other researchers have been publishing on this topic for decades. There are RCTs that show benefit of micronutrients in the treatment of symptoms associated with Alzheimer’s (Remington et al., 2008), behavioural problems in children (Schoenthaler and Bier, 2000) and offending behaviour in incarcerated populations (Gesch et al., 2002). Multivitamin/mineral supplementation has also been shown to improve nonverbal IQ in normal children by up to 8.3IQ compared with placebo (Benton and Cook, 1991).
    You write there is” no evidence” that vitamin therapy is an effective form of treatment for depression beyond my tiny study. Actually, vitamin and mineral therapy has been undertaken for more than 100 years, as documented in this review of the literature: Kaplan, B. J., Crawford, S. G., Field, C. J., & Simpson, J. S. (2007). Vitamins, minerals, and mood. Psychological Bulletin, 133 (5), 747-760.
    You also should know that if a “tiny” study finds an effect, then we know that the effect is large. It is far more worrisome when researchers have to sample thousands, in order to detect the effect.
    When will medical bloggers read the peer-reviewed scientific literature before writing blogs?