Non-science and “blatantly false explanations” about depression are causing harmful misinformation that may mean people fail to get the care they need, a leading expert has said.
Global mental health authority Professor Ian Hickie says evidence about Australia’s most common psychiatric disorder is widely distorted, and dangerous myths risk putting people with clinical depression off potentially successful treatments.
Ian Hickie is busting myths about depression.Credit: Jessica Hromas
“Really disreputable options are presented as miracle cures, being sold very actively to an unsuspecting or naive general public... some very intriguing new options are dismissed,” he says.
Hickie, co-director of health and policy at the University of Sydney’s Brain and Mind Centre, said the myth that antidepressants don’t work was the most damaging.
An English documentary recently shown on Four Corners, which promoted stories of serious side effects was “appalling” and “resurfaced 20-year-old ideas as they are something new”.
“We continue to see the misrepresentation of the science around mental health,” said Hickie, a former chief executive of the national mental health body, Beyond Blue.
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In his book, The Devil You Knew, out on Tuesday, Hickie takes on disinformation, alternative facts and fake news he says is being spread online and in other forums about depression, a disorder which one in five Australians will be diagnosed during their lifetime.
The suggestion anti-depressants do not work is the most concerning, said Hickie, who has examined their efficacy as part of the Australian Genetics in Depression Study, which has more than 20,000 participants.
“This is a constant, that there’s some question about their efficacy: it’s nonsense. It’s been demonstrably nonsense for 20 years; they do [work]. The question is what will work for you,” he said.
“The evidence from clinical trials and from the real-world is that they work. The second-biggest myth is that they cause more problems, including suicide and side effects, than they solve.
“The great majority of people who do live with some degree of side effects find the benefits overwhelmingly outweigh the negatives. The great majority of patients’ lives are much better off.”
Australian Institute of Health and Welfare data shows 18 per cent of Australians filled a mental health-related prescription in 2021-22.
Another harmful but popular myth is that all depression is connected to childhood trauma, and that “everyone who’s depressed must have had a traumatic episode”.
The idea childhood trauma is the root cause of mental health issues leads people to place heavy emphasis on the cause of the depression, rather than the path out of it.
Lack of pleasure in life, not depressed mood, is what clinical depression is all about.
Professor Ian Hickie, author of ‘The Devil You Knew’
“In many situations, it’s the complicated nature of your genetics, background things that are not knowable.
“The question isn’t, ‘how did you get into the hole’, it’s ‘how do you get out’ ... that is about understanding your own vulnerability; what it is that might put them back at risk again, so they can take actions to prevent recurrence of the problem.”
The cases of high-profile Australians who discussed depression openly, including actor Garry McDonald, former West Australian premier Geoff Gallop and former prime minister Malcolm Turnbull, illustrated why “a generic throw-away line” about depression being caused by childhood trauma is less helpful than understanding your individual vulnerability.
Former prime minister Malcolm Turnbull discussed suicidal ideation and depression in his memoir.Credit: Dominic Lorrimer
“For Garry McDonald and Geoff Gallop, managing their anxiety is critical. Turnbull makes a very interesting comment about managing his everyday life ... he realises that in the wrong situation and wrong set of circumstances, it could happen again,” Hickie said.
“These are really successful people who accept they’ve got a vulnerability. They may not be able to fully understand why it happens, but they accept that it happens, so they successfully lead their lives in ways that work for them.“
Other theories that needed to be debunked were that people with depression always needed time off work to get well – “we say we don’t get well to go to work, we go to work to get well” – and that depression is simply sadness and also is “all in the mind”.
“Clinical depression is as much physical [as it is mental], you are physically sick across your whole body, and that includes your brain,” he said. “If you’re not physically sick, you’re not depressed.”
“Lack of pleasure in life, not depressed mood, is what clinical depression is all about.”
As more young people are being diagnosed with more complex mental health issues in recent years, Hickie wants the idea that young people with depression are simply “lazy teenagers” put aside. This also applies to the idea depression can be eradicated “if we simply build more resilient children”.
He said it was important to know there is a link between childhood anxiety, teenage depression and adult alcohol abuse, and to dispel the idea that those with depression could treat themselves by exercising more and changing their diet.
The suggestions that ageing necessarily produces depression is wrong, and older people’s mental health had improved substantially, he said, especially those who age in good physical health.
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While it is possible for people to get adequate treatment for depression in the Australian health system, it is important never to try to navigate it alone – as doing so while depressed is extremely difficult – and to keep pushing for answers.
“Don’t settle for just a bit better: our health system will spit you out the moment you’re just a bit better,” Hickie said. “The goal is to leave the devil behind, stick with it. The first answer you get may not be the best answer. Like all well-educated consumers, you might need to shop around.”
If you or anyone you know needs support call Lifeline 131 114 or Beyond Blue 1300 224 636.
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